The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia / 대한마취과학회지

BACKGROUND: Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia. METHODS: Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 microg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated. RESULTS: VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups. CONCLUSIONS: The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.

Expression of Claudin-1 and -7 in Clear Cell Renal Cell Carcinoma and Its Clinical Significance

PURPOSE: We investigated the correlations between the expression of claudin-1 and claudin-7 in clear cell renal cell carcinoma (clear cell RCC) and clinical parameters. MATERIALS AND METHODS: The subjects of this study were 119 patients with confirmed clear cell RCC between January 2000 and December 2007. Their RCC tissues were immunohistochemically stained for claudin-1 and claudin-7. The correlations between the expression of claudin and parameters such as sex, age, body mass index (BMI), tumor size, TNM stage, Furhman nuclear grade, postoperative distant metastasis, and cancer-specific survival were analyzed. RESULTS: Among the total 119 subjects, claudin-1 was expressed in 18 (15.1%) and claudin- 7 in 31 (26.1%). Claudin-1 was expressed in patients who were older (p=0.007), who had a greater tumor size (p=0.001), who had a higher pathologic T stage (p=0.009), who had preoperative distant metastasis (p=0.035), and who had a higher Furhman nuclear grade (p=0.004). Claudin-7 was expressed only in patients who had a higher Furhman nuclear grade (p=0.031). The risk of postoperative distant metastasis was associated with the expression of claudin-1 (p0.05). CONCLUSIONS: In clear cell RCC, claudin-1 was expressed in patients who were older and who had a greater tumor size, who had higher T or M stages, and who had a higher Furhman nuclear grade. The expression of claudin-1 was associated with a higher risk of postoperative distant metastasis.

Effectiveness of an Immediate Mitomycin C Instillation in Patients with Superficial Bladder Cancer Receiving Periodic Mitomycin C Instillation

PURPOSE: We analyzed the impact of immediate intravesical mitomycin C instillation after transurethral resection of the bladder (TURB) on tumor recurrence and progression in patients with periodic mitomycin C instillation. MATERIALS AND METHODS: Between June 2000 and June 2006, a retrospective study was performed in a total of 115 patients with primary bladder tumors receiving a 6-week course of mitomycin C instillation after TURB. The patients were assigned to two groups: 53 patients in the immediate mitomycin C (I-MMC) group were treated by immediate instillation of mitomycin C after TURB and periodic instillation (6 times, 1 time per week), and 62 patients in the MMC group received only periodic instillation. Tumor recurrence and progression were compared in the two groups. RESULTS: During the mean follow-up period of 46.5 months in the I-MMC group and 47.2 months in the MMC group, early recurrence (within 1 year) occurred in 6 of 53 patients (11.3%) in the I-MMC group and in 18 of 62 patients (29.0%) in the MMC group (p<0.02). Although a significantly lower early recurrence rate was observed in the I-MMC group, this difference was not significant for recurrence within 2 or 3 years or for total recurrence. Progression was not significantly different between the two groups regarding the early and total period. CONCLUSIONS: Our study confirmed the positive effect of a single, immediate mitomycin C instillation in patients with non-muscle-invasive bladder tumors who received periodic mitomycin C instillation. This benefit was limited to early recurrence and was not maintained with long-term follow-up. This approach can be an alternative to periodic mitomycin C instillation without immediate instillation.

Cyclooxygenase-2 Overexpression in Chronic Inflammation Associated with Benign Prostatic Hyperplasia: Is It Related to Apoptosis and Angiogenesis of Prostate Cancer?

PURPOSE: This study was performed to investigate the relationship between cyclooxygenase-2 (COX-2) expression and apoptosis/angiogenesis in inflammatory and noninflammatory benign prostatic hyperplasia (BPH) and prostate cancer (PC). MATERIALS AND METHODS: This study involved 64 BPH and 57 PC patients. The BPH histopathologies were classified by the presence of chronic inflammation as follows: noninflammatory BPH (NI-BPH; n=23) and inflammatory BPH (I-BPH; n=41). The association between the expression of COX-2, expression of Bcl-2, the apoptotic index (AI), expression of vascular endothelial growth factor (VEGF), and microvascular density (MVD) in the prostate was investigated. RESULTS: An overexpression of COX-2, Bcl-2, and VEGF was observed in cases of PC compared with cases of BPH. In PC, the AI was lower and MVD was higher than in BPH. In NI-BPH, I-BPH, and PC, the overexpression of COX-2, Bcl-2, and VEGF gradually increased. The AI was high in I-BPH, but did not differ significantly between the NI-BPH and I-BPH groups or between the NI-BPH and PC groups. MVD was significantly high in PC, but no significant difference was found between NI-BPH and I-BPH. A significant correlation was shown between the overexpression of COX-2 and Bcl-2, and COX-2 and VEGF. However, the AI was not correlated with the overexpression of COX-2 or Bcl-2. MVD was correlated with the overexpression of COX-2 and VEGF. CONCLUSIONS: COX-2 overexpression in PC is correlated with a decrease in apoptosis and an increase in angiogenesis. Chronic inflammation in BPH causes an overexpression of COX-2, which induces the increased expression of Bcl-2 and VEGF. It is likely that chronic inflammation plays a role in the intermediate step of carcinogenesis in the prostate.

Long-Term Effect of Loxoprofen Sodium on Nocturia in Patients with Benign Prostatic Hyperplasia

PURPOSE: We evaluated the long-term effects of loxoprofen on nocturia in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between January 2006 and December 2008, 40 BPH patients with 2 or more episodes of nocturia received an alpha-blocker, 5-alpha reductase inhibitor, and a single dose of 60 mg of loxoprofen at night before sleep for 12 months (Group I). During the same period, 38 BPH patients selected as the control group received an alpha-blocker and 5-alpha reductase inhibitor (Group II). Patients were reevaluated after 3, 6, and 12 months of treatment by the number of nocturia episodes and side effects. RESULTS: After 3 months of treatment, the number of nocturia episodes decreased significantly compared with baseline in both group I and group II (1.9+/-0.7, 2.1+/-0.7, respectively, p0.05). After 6 and 12 months of treatment in group I, treatment-emergent adverse events, including 5 cases of gastric discomfort (12.5%), 3 cases of leg edema (7.5%), and 1 case of decreased urine volume (2.5%), occurred in 9 of the 40 (22.5%) patients. CONCLUSIONS: Loxoprofen can be an effective treatment for patients with nocturia secondary to BPH in the short term. Long-term use of loxoprofen is not recommended because of the side effects.

Correlation between Chemokine Receptor CXCR4 Expression and Prognostic Factors in Patients with Prostate Cancer

PURPOSE: We evaluated the correlation between the expression of CXCR4 and prognostic factors in patients with prostate cancer. MATERIALS AND METHODS: A total of 57 patients who had undergone surgery for prostate cancer were enrolled. Specimens were obtained before any treatment and were stained with antihuman CXCR4 antibody. The intensity of staining was graded as low or high. The age, pretreatment prostate-specific antigen (PSA) level, Gleason score, T stage, biochemical recurrence, local recurrence, and distant metastasis were compared according to the expression of CXCR4 in patients with prostate cancer. RESULTS: Local recurrence was higher in the group with high expression, in 11 of 36 cases (30.6%), than in the group with low expression, in 1 of 21 cases (4.8%), with statistical significance (p=0.040). Distant metastasis was also associated with expression, occurring in 10 of 36 cases (27.8%) in the group with high expression and in 1 of 21 cases (4.8%) in the group with low expression (p=0.041). In the logistic regression test, CXCR4 expression was the only factor in determining local recurrence (p=0.016) and distant metastasis (0.022). Furthermore, the group with high CXCR4 expression showed significantly longer cancer-specific survival than did the low expression group (p=0.041). CXCR4 showed no association with age (p=0.881), pretreatment PSA level (p=0.584), Gleason score (p=0.640), T stage (p=0.967), or biochemical recurrence (p=0.081). CONCLUSIONS: The high expression of CXCR4 was associated with local recurrence and distant metastasis. CXCR4 expression was shown to be a useful prognostic factor for patients with prostate cancer.

The Efficacy of the EORTC Scoring System and Risk Tables for the Prediction of Recurrence and Progression of Non-Muscle-Invasive Bladder Cancer after Intravesical Bacillus Calmette-Guerin Instillation

PURPOSE: The European Organization for Research and Treatment of Cancer (EORTC) scoring system and risk table were introduced in the 2008 European Association of Urology guidelines on TaT1 bladder cancer. We compared the recurrence and progression rate between EORTC risk tables and author's patients who underwent transurethral resection of bladder cancer (TURB) following intravesical Bacillus Calmette-Guerin (BCG) instillation. MATERIALS AND METHODS: The medical records of 251 patients who underwent TURB and were diagnosed with non-muscle-invasive bladder cancer from l993 to 2007 were analyzed. The patients were divided into 2 groups: the recurrence group and the progression group. According to the EORTC scoring system, the patients in each group were categorized in terms of number of tumors, tumor size, prior recurrence rate, T category, carcinoma in situ, and pathologic grade and the scores were summed. According to the summed scores, the recurrence group and the progression group were divided into 3 subgroups: low, intermediate, and high risk, respectively. The recurrence rate and progression rate of each group were compared with the EORTC risk tables. RESULTS: The recurrence rate and progression rate were almost similar to the EORTC risk tables. However, the recurrence rate was low in the intermediate-risk group. CONCLUSIONS: Clinical utilization of the EORTC scoring system and risk tables is very effective in predicting the recurrence and progression of non-muscle-invasive bladder cancer and in selecting treatment.

Correlation between Claudins Expression and Prognostic Factors in Prostate Cancer

PURPOSE: The purpose of this study was to evaluate the correlation between the expression of claudins and prognostic factors in patients with prostate cancer. MATERIALS AND METHODS: The subjects of this study were 48 patients who had undergone surgery for prostate cancer. The Gleason score (6 or lower, 7 or higher), prostate-specific antigen (PSA) level, T stage, biochemical recurrence, local recurrence, and distant metastasis were compared according to the expression of claudin-1 and claudin-5 in prostate cancer. RESULTS: In the group with a low expression of claudin-1, the Gleason score was 7 points or higher in 18 cases (82%) and 6 points or lower in 4 cases (18%). In the group with a high expression of claudin-1, the Gleason score was 7 points or higher in 13 cases (50%) and 6 points or lower in 13 cases (50%). Thus, the low-expression group had more cases with a Gleason score of 7 or higher (p=0.022). The group with a low expression of claudin-5 also had more cases with a Gleason score of 7 or higher (p=0.011). The mean PSA values in the groups with a low and high expression of claudin-1 were 9.6 ng/ml and 5.6 ng/ml, respectively (p=0.007). A low expression of claudin-5 was also associated with a high PSA value (p=0.002). There was no statistical difference in the expression of claudin-1 and claudin-5 by T stage, biochemical recurrence, local recurrence, or distant metastasis. CONCLUSIONS: The low expression of claudin-1, claudin-5 was associated with a Gleason score of 7 or higher and a high PSA value in prostate cancer.

Efficiency of Embolization for Kidney Injury

PURPOSE: High-grade (III, IV, V) renal injury may need interventional management. We investigated whether the selective embolization of the renal artery is effective for the treatment of major renal injury in comparison with emergency renal exploration. METHODS: We retrospectively reviewed the medical and radiologic records of patients who underwent surgery or embolization for renal injury (Grade III, IV, V) between January 1990 and December 2007. We analyzed the change in treatment method before and after 2000, the blood pressure, the hemoglobin at the time of visit, the hospital days and the complications in patients who received surgery or embolization. Preserved renal functions of the embolized kidneys were identified by using enhanced CT. RESULTS: Cases of surgery and embolization were 37 and 13, respectively: 5 and 4 in renal injury grade III, 17 and 6 in grade IV and 13 and 3 in grade V. Cases of surgery and embolization were 33 and 1 before 2000 and 2 and 12 after 2000, repectively: embolizations increased after 2000. No significant differences in mean diastolic pressure, hemoglobin, hospital days and complications existed between the surgery and the embolization groups (p>0.05). However, the transfusion volume was significantly smaller in the embolization group (p<0.05). One postoperative complication occurred in the surgery group. We identified the preserved renal functions of the embolized kidney by using enhanced CT. CONCLUSION: Embolization could be one treatment method for high-grade renal injury. Thus, we might suggest selective embolization a useful method for preserving the renal function in cases of high-grade renal injury.

The Effect of Intraprostatic Chronic Inflammation on Benign Prostatic Hyperplasia Treatment

PURPOSE: Asymptomatic chronic inflammation of the prostate is a common finding in benign prostatic hyperplasia (BPH). We investigated how the chronic inflammation affects medical treatment for BPH. MATERIALS AND METHODS: One pathologist reviewed the chronic inflammation of 82 BPH patients who underwent transrectal ultrasonography (TRUS)-guided needle biopsy. The extent of chronic inflammation was classified into 4 grades, categorized into two groups: the low-grade group and the high-grade group. We compared total, voiding, and storage International Prostate Symptom Score (IPSS) and quality of life (QoL) between the groups at baseline and 1, 3, 6, and 12 months after medical treatment for BPH. RESULTS: There were no significant differences in total IPSS or QoL between the groups during the follow-up period. The low-grade group showed continuous improvement of storage symptoms until 12 months; however, the high-grade group showed improvement until 3 months. Maximal improvements of QoL were observed at 6 months in the high-grade group and at 3 months in the low-grade group. There was no episode of surgery in the low-grade group, but four patients in the high-grade group (9.1%) underwent surgical treatment due to acute urinary retention or insufficient therapeutic response. CONCLUSIONS: Although there was no statistical significance, improvements in IPSS were higher and lasted longer in the low-grade group. We might suggest medical treatment for intraprostatic chronic inflammation in BPH patients.

Nationwide Questionnaire Survey on Practice Patterns for Pediatric Hydronephrosis of Korean Urologists at Secondary or University Hospitals

PURPOSE: To evaluate practice patterns for pediatric hydronephrosis of Korean urologists practicing at secondary or university hospitals. MATERIALS AND METHODS: The subjects were asked to complete questionnaires sent by postal mail or e-mail that explored practicing diagnostic and therapeutic strategies in the management of pediatric hydronephrosis and ureteropelvic junction obstruction. The questionnaires of those responding were analyzed according to whether the respondent practiced at a secondary or university hospital, how long they had been urologists, and whether they specialized in pediatric urology or other specific field of urology. RESULTS: Of the 354 questionnaires sent, 97 were returned (response rate 27.4%). Voiding cystourethrography was not routinely recommended by 95.7% of respondents, and diuretic renal scanning was considered necessary for postnatal evaluation of prenatal hydronephrosis by 78.5%. In addition, 72.2% of these doctors did not routinely recommend antibiotic prophylaxis. Follow-up ultrasonography was recommended at 3 to 6 months (61.1%), and follow-up diuretic renal scanning was recommended at 3 to 6 months (38.6%) or 6 to 12 months (32.7%). The reported length of time it took to deem an operation as a success was 3 to 6 months (49.5% and 60.7%) and within 3 months (34.1% and 19.1%) by ultrasonography and diuretic renal scanning, respectively. CONCLUSIONS: This survey documented a certain degree of variability among Korean urologists concerning standard practices of the assessment, follow-up, and treatment for pediatric hydronephrosis. Results from this survey might contribute useful data for establishing proper guidelines for the management of pediatric hydronephrosis.

Comprehension and Practice Patterns Toward Cryptorchidism in Korean Urologists

PURPOSE: We evaluated the practice patterns of urologists in Korea regarding the diagnosis and management of cryptorchidism. MATERIALS AND METHODS: Self-completed questionnaires that consisted of 15 items concerning the diagnosis and treatment of cryptorchidism were distributed via letters or e-mail to 167 urologists who practiced in training hospitals in Korea. Responses were collected and analyzed statistically. RESULTS: Responses were received from 89 urologists (response rate was 53.5%). Most of the urologists (96%) recommended that cryptorchidism be treated at the age of 1 year or before. In the case of postpubertal cryptorchidism, 72% of Korean urologists preferred orchiopexy first because of cosmesis (42%) and early detection of testicular cancer (38%). Sixty-five percent of all urologists preferred surgical correction of a retractile testis at the time of diagnosis or when the condition persisted until school age or puberty. Pediatric urologists were more conservative in terms of management of a retractile testis than were general urologists (p=0.009). To detect hidden testes in nonpalpable cryptorchidism, most urologists (92%) performed imaging studies, whereas only 39% of urologists performed laparoscopy. CONCLUSIONS: Korean urologists who practice in the training hospitals have a high level of understanding of the management of cryptorchidism. However, some differences of opinion exist in the diagnosis and treatment of nonpalpable undescended testis and retractile testis. These results can be used as baseline data for establishing future diagnosis and treatment guidelines for cryptorchidism.

Effectiveness of Computed Tomography for Predicting the Nuclear Grade of Renal Cell Carcinoma

PURPOSE: Nuclear grade is one of the independent prognostic factors for renal cell carcinoma (RCC). We investigated the effectiveness of a preoperative CT scan for predicting the nuclear grade of clear cell RCC. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent surgery for renal lesions between January 2002 and December 2007. We analyzed the pathologic and radiologic reports of 65 patients who underwent radical nephrectomy for RCC and were diagnosed with clear cell RCC. The Hounsfield unit (HU) of the area with maximum enhancement (M) and the total area of the RCC (T) were measured during CT. Ratio values by nuclear grade were calculated by using formulas (M HU/aorta HU, T HU/aorta HU) to eliminate differences between individuals. RESULTS: A total of 65 cases of clear cell RCCs were classified according to Fuhrman nuclear grade. Five cases were grade I, 33 were grade II, 15 were grade III, and 12 were grade IV. There was a significant difference in CT enhancement between each nuclear grade, and lower nuclear grades tended to have an increased ratio of maximum enhancement (p=0.020). Fuhrman nuclear grade was divided into two groups: low (Fuhrman grades I, II) and high (Fuhrman grades III, IV). The ratio of enhancement for the M area was significantly higher in the low Fuhrman nuclear grade group than in the high group (p=0.033). CONCLUSIONS: CT enhancement is inversely related to the nuclear grade of clear cell RCC. This study found that measuring the area of maximum enhancement in CT may be a useful method for presuming the pathologic nuclear grade of RCC, especially when the Fuhrman nuclear grade is divided into low and high groups.

Clinical Implications of the Expression of Survivin and p53 in Superficial Transitional Cell Carcinoma of the Bladder / 대한비뇨기과학회지

PURPOSE: The prognostic value of p53 remains controversial in transitional cell carcinomas of the bladder. Survivin, an inhibitor of apoptosis, is expressed in many human cancers. Recent studies have reported increased expression of survivin in superficial transitional cell carcinomas of the bladder. We investigated the expression of survivin and p53 and the clinical implications of this expression in superficial transitional cell carcinomas of the bladder. MATERIALS AND METHODS: Immunohistochemical staining of paraffin sections using a monoclonal antibody for survivin and p53 was performed in 82 cases of superficial transitional cell carcinomas of the bladder. Correlations between the expression of survivin and p53 and clinicopathological features, such as age, multiplicity of tumor, size, recurrence, and progression, were examined. RESULTS: Among 82 cases, positive survivin expression (greater than 20%) was observed in 59 cases. Positive p53 expression (greater than 20%) was observed in 46 cases. There were no significant differences in age, gender, multiplicity, tumor size, tumor grade, pT stage, recurrence, or progression-free survival between p53-positive and p53-negative groups (p>0.05). Also, there were no significant differences in age, gender, multiplicity, tumor size, tumor grade, or pT stage between survivin-positive and survivin-negative groups (p>0.05). However, recurrent-free and progression-free survivals were significantly lower in the survivin-positive group than in the survivin-negative group (p<0.05). CONCLUSIONS: The expression of survivin can be recommended as a useful marker for predicting disease recurrence and progression. Survivin may be superior to p53 as a prognostic factor in superficial transitional cell carcinoma of bladder.

Significance of Intraprostatic Inflammation in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

PURPOSE: Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. MATERIALS AND METHODS: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. RESULTS: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). CONCLUSIONS: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients.

Long-Term Results of Transurethral Resection of the Prostate for Large Benign Prostatic Hyperplasia: A Comparative Study with Open Prostatectomy / 대한비뇨기과학회지

PURPOSE: We compare the effectiveness and safety of transurethral resection of the prostate(TURP) with those of open prostatectomy for large benign prostatic hyperplasia(BPH), that was over 70cc of prostate volume. MATERIALS AND METHODS: Seventy-one patients with a prostate volume of more than 70cc and who received TURP were classified to group A, while 41 patients who received open prostatectomy were classified to group B. The International Prostate Symptom Score(IPSS), maximal flow rate(Qmax) and post-voiding residual urine(PVR) volume were evaluated preoperatively and at 1, 3, 5 and over 5 years postoperatively. RESULTS: The postoperative IPSS, Qmax and PVR were significantly improved after 1 year(p0.05). The PVR was significantly lower in group B at 1 year post-operation(p0.05). There were 7 cases(9.8%) of re-operation and 3 cases(4.2%) of re-medication after 5 years of operation. There were no major complications for each group. CONCLUSIONS: On comparison between TURP and open prostatectomy for the patients with large BPH, there were no significant difference in effectiveness and safety for 5 years. Even for the patients with BPH that showed a high volume, TURP is an effective operation that can replace open prostatectomy.

Embryonal Carcinoma of a Pexed Testis / 대한비뇨기과학회지

A 24-year-old patient who had a history of right-side orchidopexy 16 years ago presented with right testicular pain. A hypoechoic mass was seen on the ultrasonography. Inguinal orchiectomy of the right testis was performed. On microscopic examination, the specimen was identical as an embryonal carcinoma.

Embryonal Carcinoma of a Pexed Testis / 대한비뇨기과학회지

A 24-year-old patient who had a history of right-side orchidopexy 16 years ago presented with right testicular pain. A hypoechoic mass was seen on the ultrasonography. Inguinal orchiectomy of the right testis was performed. On microscopic examination, the specimen was identical as an embryonal carcinoma.

Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Acute or chronic prostatic inflammation exists to varying degrees in surgical specimens of prostates, extirpated for the treatment of benign prostatic hyperplasia(BPH). We investigated the relationship between acute urinary retention(AUR) and intraprostatic inflammation. MATERIALS AND METHODS: Between January 1997 and December 2006, 221 patients underwent transurethral resection of the prostate(TURP) for the treatment of BPH. The patients were divided into 2 groups based on the indication for surgery; an AUR group and a lower urinary tract symptoms (LUTS) group. The area of acute inflammation, the extent, and the aggressiveness of chronic inflammation were classified into four grades. The grades of inflammation, prostate volume, age, serum prostate-specific antigen(PSA), and prior medical treatment were compared between the two groups. All specimens were reviewed by one pathologist. RESULTS: The AUR group consisted of 106(47.9%) patients, and the LUTS group consisted of 115(52.1%) patients. There were no statistical differences between the two groups with respect to the mean values of the age, prostate size, and severity of chronic inflammation. There was a significant relationship between AUR and the areas of acute inflammation, and the extent of chronic inflammation(p=0.014 and p=0.003, respectively). The aggressiveness of chronic inflammation had no relationship with AUR (p=0.062). The serum PSA level was higher in the AUR group than the LUTS group(11.5 vs. 5.3ng/ml, respectively). CONCLUSIONS: The association for AUR with acute and chronic inflammation was stronger than that which existed with prostate size. Thus intraprostatic inflammation is an important risk factor in AUR.

The Clinical Significance and Relationship of Medical Therapy for Prostate Stone with Lower Urinary Tract Symptoms / 대한비뇨기과학회지

PURPOSE: In present study, we evaluated the relationship between prostate stone and lower urinary tract symptoms(LUTS) and the effect of medications. MATERIALS AND METHODS: Between July 2005 and June 2007, 328 male patients who underwent transrectal ultrasonography(TRUS) were included in this study. 237 patients who had prostate stone with or without LUTS were divided into 3 groups by the prostate stone size(3-5mm, 6-10mm and larger than 11mm). These patients were also divided into 3 groups according to the prostate stone location(the periurethral group, the peripheral group and the multiple site group). The change of the maximum flow rate(Qmax) and the International Prostate Symptom Score(IPSS) were measured 6 months after treatment with alpha-blocker and 5-alpha reductase inhibitor(5-ARI). RESULTS: 275 of the 328 patients who underwent TRUS complained of LUTS and 200(72.7%) of these 275 patients had prostate stone; 37(69.8%) of the 53 patients who did not have LUTS had prostrate stone. No statistical significance was found between LUTS and the presence of prostate stone (p=0.664). We found that the patients with LUTS showed a trend to have larger stone, but this was not statistically significant(p=0.792). The location of prostate stone tended to be periurethral for the patients with LUTS (p=0.047). The patient group with resistant to pharmacological manage of their LUTS had stones larger than 11mm, but this had no statistical significance(p=0.615). A lesser therapeutic result was related with periurethral stones(p<0.001). CONCLUSIONS: There is no statistical relation for the presence of prostate stone with LUTS. The patients with prostate stone that was located in the periurethral area had more LUTS and less medical benefit.