Anticholinergics [corrected] in patients with overactive bladder: Assessment of ambulatory urodynamics and patient perception

AIMS

The aim of this study was to evaluate whether ambulatory urodynamic monitoring (AUM) may reflect patient perception of bladder condition and treatment benefit in patients with overactive bladder (OAB).

METHODS

A total of 33 women and 7 men 23 to 72 years old who were undergoing AUM were included in this study. At baseline, patients were asked to complete the following information in the micturition chart for 3 consecutive days. Patients were given anticholinergics once daily for the 2 weeks. Two weeks after the treatment, all patients received an identical repeat study.

RESULTS

Most parameters of AUM, micturition chart and patient perception were improved 2 weeks after treatment. However, when Spearman correlation coefficients were performed, all AUM parameters did not correlate with patient perception of bladder condition after treatment although some AUM parameters regarding incontinence were associated with patient perception of bladder condition at baseline. In addition, when patients were divided as the 'no or some benefit' group (n = 25) and the 'much benefit' group (n = 15), all AUM parameters except total voided volume (P = 0.004) were not significantly different in the two groups.

CONCLUSIONS

Because patients with pelvic floor dysfunction have widely varying expectations from treatment, the patient's goal for treatment is highly subjective. Our findings suggest that AUM does not take into account the patient perception of disease severity, and correlations between the patient view of treatment outcome and objective measures are poor. Therefore, strategies for assessing OAB should incorporate self-perceived disease condition.

Predicting factor analysis of postoperative complications after robot-assisted radical cystectomy: Multicenter KORARC database study

OBJECTIVES

To evaluate postoperative complications following robot-assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications.

METHODS

Prospectively collected medical records of 730 robot-assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non-complication). We assessed recurrence-free survival, cancer-specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications.

RESULTS

Any total and high-grade complication (Clavien-Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer-specific survival (log-rank P = 0.038, median cancer-specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high-grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications.

CONCLUSIONS

Patients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer-specific survival rate.

The clinical impact of strict criteria for active surveillance of prostate cancer in Korean population: Results from a prospective cohort

PURPOSE

To evaluate the clinical impact of strict selection criteria for active surveillance (AS) of prostate cancer in a Korean population.

MATERIALS AND METHODS

A single-center, prospectively collected AS cohort from December 2016 to February 2019 was used. Following pre-determined criteria, patients were categorized into "strict AS" and "non-strict AS" groups. Clinicopathological progression-free survival (PFS) and treatment-free survival (TFS) of the two groups were compared using the Kaplan-Meier curve and log-rank test. Age-adjusted hazard ratios for clinicopathological progression was calculated using Cox proportional regression analysis.

RESULTS

Of 54 eligible patients, 25 and 29 were assigned to "strict AS" and "non-strict AS," respectively. Clinicopathological progression and definitive treatment rates were 24.0% (6 of 25 patients) vs. 51.7% (15 of 29 patients) and 32.0% (8 of 25 patients) vs. 62.1% (18 of 29 patients) in "strict AS" and "non-strict AS" groups. Progress to high-risk cancer (pathologic T3 or surgical Gleason Grade 2 over) in radical prostatectomy was higher in "non-strict AS" than "strict AS". PFS (mean 34.6±2.9 mo vs. 22.6±2.7 mo; p=0.025) and TFS (mean 31.8±3.2 mo vs. 19.6±2.4 mo; p=0.018) favor the "strict AS" group than "non-strict AS" group. Age-adjusted hazard ratio for clinicopathological progression of strict criteria was 0.36 (95% confidence interval, 0.14-0.94; p=0.04).

CONCLUSIONS

PFS and TFS were better in the "strict AS" group than in the "non-strict AS" group. This finding should be informed to relevant patients during decision making and considered in Korean guidelines.

Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea

PURPOSE

The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions.

MATERIALS AND METHODS

This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral periodwith consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method.

RESULTS

The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recen-tly.

CONCLUSION

We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.

Orthotopic ileal neobladder reconstruction in a woman who developed squamous cell carcinoma of the urinary bladder after kidney transplantation

The case of a 62-year-old woman who developed squamous cell carcinoma of the bladder 16 years after a kidney transplant is reported here. After the transplant, immunosuppressive therapy was maintained with cyclosporin A (200 mg/day) and the patient's serum creatinine level was 0.9 mg/dL. She was diagnosed with squamous cell carcinoma of the bladder 16 years later and underwent radical cystectomy with an orthotopic ileal neobladder. The Studer technique was used and the afferent ileal loop was anastomosed to the graft ureter. The postoperative course was uneventful. At the 6-month follow-up visit, the patient showed no evidence of recurrence. Her serum creatinine level was 1.0 mg/dL. The patient was continent during the day and the night. This case shows that the construction of an orthotopic ileal neobladder after cystectomy is safe and feasible in kidney transplant recipients.

Disease-specific survival in patients with renal cell carcinoma: an audit of a large series from Korea

BACKGROUND

To evaluate the question of whether or not young age is an independent prognostic factor for disease-specific survival in Korean patients with renal cell carcinoma.

METHODS

A total of 785 patients with an age range of 22-84 years (median, 56) were included in the study. Patients were categorized according to age; 40 years or less (n = 93), 41-60 years (n = 416) and older than 60 years (n = 276).

RESULTS

Patients 40 years or less at diagnosis differed significantly from older patients for the following parameters: smaller tumour diameter (P = 0.001), less advanced stage (P = 0.002), lower Fuhrman nuclear grade (P = 0.017) and fewer clear cell carcinomas (P < 0.001). Five-year disease-specific survival rate in patients 40 years or younger was also higher than that of older patients (92.7% versus 86.0% versus 69.2%; P < 0.001). When subgroup analysis was performed, only in patients with tumour diameter 4.1-7.0 cm (P = 0.018), pT1-pT2,N0,M0 (P = 0.001) or clear cell type carcinoma (P < 0.001), disease-specific survival probability for patients 40 years or younger was higher than that of older patients. When the Cox proportional hazards model was applied, age at diagnosis was not an independent prognostic predictor of disease-specific survival.

CONCLUSIONS

Tumours found in young adults show more favourable histological features than those found in older adults. However, according to results from multivariate analysis, young patients do not have higher disease-specific survival rate after adjusting for clinical and pathological variables.

Role of multiparametric magnetic resonance imaging to predict postoperative Gleason score upgrading in prostate cancer with Gleason score 3 + 4

BACKGROUND

To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) in Gleason score (GS) 3 + 4 prostate cancer (PCa) and evaluate independent factors in mpMRI that can predict GS upgrading, we compared the outcomes of GS upgrading group and GS non-upgrading group.

PATIENTS AND METHODS

We analyzed the data of 539 patients undergoing radical prostatectomy (RP) for biopsy GS 3 + 4 PCa from two tertiary referral centers. Univariate and multivariate analyses were performed to determine significant predictors of GS upgrading. GS upgrading, the study outcome, was defined as GS ≥ 4 + 3 at definitive pathology at RP specimen.

RESULTS

GS upgrading rate was 35.3% and biochemical recurrence (BCR) rate was 8.0%. GS upgrading group was significantly older (p = 0.015), had significantly higher prebiopsy serum prostate-specific antigen (PSA) level (p = 0.001) and PSA density (p = 0.003), had a higher number of prostate biopsy (p = 0.026). There were 413 lesions (76.6%) of PI-RADS lesion ≥ 4, 236 (57.1%) for PI-RADS 4 and 177 (42.9%) for PI-RADS 5 lesion. Multivariate logistic regression analysis revealed that age (p = 0.045), initial prebiopsy PSA level (p = 0.002) and presence of PI-RADS lesion ≥ 4 (p = 0.044) are independent predictors of GS upgrading.

CONCLUSION

MpMRI can predict postoperative Gleason score upgrading in prostate cancer with Gleason score 3 + 4. Especially, presence of clinically significant PI-RADS lesion ≥ 4, the significant predictor of GS upgrading, in preoperative mpMRI needs to be paid attention and can be helpful for patient counseling on prostate cancer treatment.

Robot-assisted laparoscopic management of urachal cysts in adults

We report two cases where a urachal cyst was managed by robot-assisted laparoscopic surgery. A 47-year-old man and a 43-year-old woman presented with gross hematuria and lower abdominal pain, respectively. Diagnosis of urachal cyst was established by computed tomography imaging. Robot-assisted laparoscopic surgery was performed transperitoneally via four ports. Both patients were diagnosed as having a urachal cyst with inflammation. Our experience suggests that robot-assisted laparoscopic excisions of urachal cysts can be performed easily and safely in adults.

Sleep-related nocturnal erections and erections during midazolam-induced sedation in healthy young men

This study was performed to evaluate the characteristics of penile erection during midazolam-induced sedation after nocturnal sleep deprivation (NSD) and to determine the effect of NSD on erectile episodes in healthy, sexually functional young men. This procedure might possibly prove to be a brief office-based method of assessing whether erectile dysfunction is psychogenic or biogenic. Nineteen volunteers between the ages of 20 and 29 years participated in this study. We measured the morning penile erection after midazolam (3-5 mg) administration intravenously and all subjects completed 42 tests. Of 42 test, 28 tests revealed erectile episodes, whereas no erectile episodes were observed in 14 tests. Nocturnal sleep deprivation rate was significantly higher in tests with erectile episodes than in tests without erectile episode (P=0.030). Test order or duration of test was not different between two test results. Number of erectile episodes (r=0.374, P=0.015), tip radial rigidity (r=0.412, P=0.007), base radial rigidity (r=0.366, P=0.017) and tip tumescence (r=0.447, P=0.003) correlated with the degree of NSD. When we determined whether NSD was discriminative with regard to erectile episodes, the area under the receiver operating characteristic curve was calculated at 0.705 (95% confidence interval, 0.527-0.883; P=0.032) for the possibility of erectile episodes. Nocturnal sleep deprivation might recover the inhibited rapid eye movement sleep during midazolam-induced sedation. Our findings suggest that erection monitoring during midazolam-induced sedation after NSD may be convenient. However, validation of midazolam-induced morning penile tumescence monitoring with a large population is mandatory.

Digital rectal examination as a prostate cancer-screening method in a country with a low incidence of prostate cancer

The objective of this study was to evaluate the value of using digital rectal examination (DRE) for prostate cancer diagnosis in an Asian population. Patients with serum prostate-specific antigen (PSA) levels ranging from 2.5 to 19.9 ng/ml underwent transrectal ultrasonography-guided prostate biopsies. Patients were divided into two groups: the normal DRE group (n=721) and the abnormal DRE group (n=192). The cancer detection rate was higher in the abnormal DRE group (47.4%) than in the normal DRE group (23.0%) (P<0.001). However, the detection rates in these two groups were not significantly different in men 45-59 years old as well as in men with low PSA levels (2.5-3.9 ng/ml). In all subjects, the areas under the receiver operating characteristic curves for positive biopsies were 60.0% (95% confidence interval (CI), 55.7-64.3%, P<0.001). However, in the subgroup analysis, the predictive power of the DRE was not significant in men 45-59 years old. In addition, DREs of patients with low PSA levels had no discriminative ability. The pathological features of the prostate biopsies were not significantly different between the two groups in subjects 45-59 years old and in subjects with PSA levels from 2.5 to 3.9 ng/ml. Our data indicate that DREs increase the probability of cancer detection. However, our findings also raise the question, 'Are DREs really useful for cancer detection in younger men and men with low PSA levels in the Asian population?'

Efficacy of neoadjuvant atezolizumab treatment in patients with advanced urothelial bladder cancer according to the BASQ classification: a study protocol for an open-label, two-cohort, phase II trial

INTRODUCTION

Atezolizumab is a programmed death ligand-1 inhibitor for urothelial bladder cancer treatment. Atezolizumab has become the standard therapy for patients with urothelial bladder cancer who are not responding to cisplatin-based chemotherapy and is also used as a first-line treatment in cisplatin-ineligible patients. However, the efficacy of atezolizumab as a neoadjuvant chemotherapy for radical cystectomy has not yet been published and is still under study. This trial investigates the effectiveness of basal/squamous-like (BASQ) classification in the selection of an effective target group of patients with muscle-invasive bladder cancer (MIBC) for neoadjuvant atezolizumab treatment.

METHODS AND ANALYSIS

This study is an open-label, two-cohort, phase II trial. It was designed to evaluate the efficacy of neoadjuvant atezolizumab treatment in patients with MIBC (T2-4N0M0) pathological responses after neoadjuvant chemotherapy and radical cystectomy. According to the molecular subtype characteristics of previous transurethral resection of the bladder specimens, patients are divided into two groups: luminal type (KRT5/6-KRT14-FOXA1+GATA3+) and basal type (KRT5/6+KRT14+FOXA1-GATA3-). Every 3 weeks, atezolizumab is administered at a dose of 1200 mg for three cycles prior to radical cystectomy in patients with MIBC. The primary end point is objective pathological responses in the intention-to-treat patients. The secondary end point is a 1-year progression-free survival difference according to the BASQ classification in patients who underwent neoadjuvant atezolizumab treatment.

ETHICS AND DISSEMINATION

The study protocol was approved by the Institutional Review Board of Seoul National University Hospital, Seoul, Republic of Korea (H 1806-051-950). The trial is registered at ClinicalTrials.gov. The trial results will be published in peer-reviewed journals and at conferences.

TRIAL REGISTRATION NUMBER

NCT03577132.

Accuracy of actual stage prediction using Vesical Imaging Reporting and Data System (VI-RADS) before radical cystectomy for urothelial carcinoma in SUPER-UC-Cx

BACKGROUND

Previous studies using the Vesical Imaging Reporting and Data System (VI-RADS) to predict muscle-invasive bladder cancer (MIBC) had some limitations. Most studies were performed with transurethral resection of bladder tumor (TUR-BT) specimens with few samples. This study was conducted to address these shortcomings and confirm the accuracy of VI-RADS for bladder cancer.

METHODS

This study used data from the Seoul National University Prospectively Enrolled Registry for Urothelial Cancer-Radical Cystectomy (SUPER-UC-Cx). Patients who underwent multiparametric magnetic resonance imaging (mp-MRI) before radical cystectomy (RC) were included in this study between March 2020 and March 2022. All images were reported by radiologists and reviewed by two urologists. The patient characteristics and clinical information were blinded during the review. The performance of qualitative and quantitative variables in predicting muscle layer invasion or perivesical fat infiltration was verified by receiver operating characteristic (ROC) curve analysis.

RESULTS

Of 208 patients, 182 (87.5%) underwent mp-MRI before RC. Twenty-three patients with non-urothelial carcinoma, inappropriate MRI scans, and bladder filling were excluded. Cut-off for muscle invasion, VI-RADS score of 4 had the highest area under the curve (AUC) (sensitivity 0.84; specificity 0.93; accuracy 0.90; positive predictive value (PPV) 0.84; negative predictive value (NPV) 0.93, and AUC 0.88). Cut-off for perivesical fat invasion and VI-RADS score of 5 had the highest AUC (sensitivity, 0.78; specificity, 0.99; accuracy, 0.95; PPV, 0.96; NPV, 0.95; and AUC, 0.89).

CONCLUSIONS

VI-RADS is a good predictor of bladder cancer staging before RC and is especially helpful in predicting muscle invasion and perivesical fat infiltration.

Multifactorial, site-specific recurrence models after radical cystectomy for urothelial carcinoma: external validation in a cohort of Korean patients

PURPOSE

The aim of this study was to evaluate the accuracy of site-specific recurrence models after radical cystectomy in the Korean population.

MATERIALS AND METHODS

We conducted a review of an electronic medical record of 572 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. Primary end point was the site-specific recurrence after radical cystectomy.

RESULTS

The median follow-up in the validation cohort was 42.3 months (interquartile range: 23.0-89.3 months). During the follow-up period, there were 165 patients (28.8%), 85 (14.9%), 31 (5.4%), and 78 (13.6%) who recurred in abdomen/pelvis, thoracic region, upper urinary tract, and bone, respectively. The c-indices of abdomen/pelvis, thoracic region, upper urinary tract, and bone models 3 years after radical cystectomy were 0.69 (95% confidence interval [CI], 0.65-0.73), 0.69 (95% CI, 0.64-0.75), 0.61 (95% CI, 0.52-0.69), and 0.65 (95% CI, 0.59-0.71), respectively. Kaplan-Meier curves demonstrated that models discriminated well and log-rank test were all highly significant (all p<0.001), except upper urinary tract model (p = 0.366). Decision curve analysis revealed that the use of prediction models for abdomen/pelvis, thoracic region, and bone recurrence was associated with net benefit gains relative to the treat-all strategy, but not the model for upper urinary tract recurrence.

CONCLUSIONS

Abdomen/pelvis, thoracic region, and bone models demonstrate moderate discrimination, adequate calibration, and meaningful net benefit gains, whereas upper urinary tract model does not seem applicable to patients from Asia because it has suboptimal accuracy.

Comprehensive molecular characterization of TFE3-rearranged renal cell carcinoma

TFE3-rearranged renal cell cancer (tRCC) is a rare form of RCC that involves chromosomal translocation of the Xp11.2 TFE3 gene. Despite its early onset and poor prognosis, the molecular mechanisms of the pathogenesis of tRCC remain elusive. This study aimed to identify novel therapeutic targets for patients with primary and recurrent tRCC. We collected 19 TFE3-positive RCC tissues that were diagnosed by immunohistochemistry and subjected them to genetic characterization to examine their genomic and transcriptomic features. Tumor-specific signatures were extracted using whole exome sequencing (WES) and RNA sequencing (RNA-seq) data, and the functional consequences were analyzed in a cell line with TFE3 translocation. Both a low burden of somatic single nucleotide variants (SNVs) and a positive correlation between the number of somatic variants and age of onset were observed. Transcriptome analysis revealed that four samples (21.1%) lacked the expected fusion event and clustered with the genomic profiles of clear cell RCC (ccRCC) tissues. The fusion event also demonstrated an enrichment of upregulated genes associated with mitochondrial respiration compared with ccRCC expression profiles. Comparison of the RNA expression profile with the TFE3 ChIP-seq pattern data indicated that PPARGC1A is a metabolic regulator of the oncogenic process. Cell proliferation was reduced when PPARGC1A and its related metabolic pathways were repressed by its inhibitor SR-18292. In conclusion, we demonstrate that PPARGC1A-mediated mitochondrial respiration can be considered a potential therapeutic target in tRCC. This study identifies an uncharacterized genetic profile of an RCC subtype with unique clinical features and provides therapeutic options specific to tRCC.

Efficacy of the Treatment of Intraperitoneal Bladder Perforation during Transurethral Resection of Bladder Tumor with the Urethral Catheter Alone: Retrospective Analysis of over 15 Years Using the Clinical Data Warehouse System

INTRODUCTION

We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT).

PATIENTS AND METHODS

We retrospectively evaluated the medical records of 4,543 patients who underwent TURBT from January 2000 to December 2017 using the Clinical Data Warehouse system. The clinicopathologic characteristics, recurrence-free survival, and progression-free survival were compared between the patient groups with intraperitoneal perforation treated with the Foley catheter alone, extraperitoneal perforation, and matched control TURBT.

RESULTS

Intraperitoneal perforation and extraperitoneal perforation were observed in 16 (35.6%) and 29 (64.4%) patients, respectively. In the intraperitoneal perforation group, 11 (68.8%), 2 (12.5%), and 3 (18.8%) patients were treated with the Foley catheter alone, additional percutaneous drainage, and delayed open surgery, respectively. The use of the Foley catheter alone in patients with intraperitoneal perforation of smaller size than the cystoscope or no pelvic radiotherapy history showed improved efficacy without sequelae or therapeutic delay. One of the 2 patients with the size of the intraperitoneal perforation larger than the cystoscope was successfully treated with the Foley catheter alone, whereas the other patient underwent delayed surgical repair. There was no difference in recurrence-free survival and progression-free survival of the intraperitoneal perforation treated with the Foley catheter alone compared to those of the matched control TURBT (p = 0.909, p = 0.518) and the extraperitoneal perforation (p = 0.458, p = 0.699).

CONCLUSIONS

Intraperitoneal perforation rarely occurred during TURBT. In the case of intraperitoneal perforation of size smaller than cystoscopy or without pelvic radiotherapy history, treatment with the Foley alone showed successful improvement and safe oncological results. Therefore, treatment with the urethral catheter alone can be carefully considered when an intraperitoneal perforation smaller than the cystoscope size or without pelvic radiotherapy history occurs.

Prostate biopsy in subjects with abnormal transrectal ultrasonography but normal digital examination findings and prostate-specific antigen levels

AIM

The aim of the present study was to evaluate the value of transrectal ultrasonography (TRUS) for prostate cancer diagnosis in men with no other indication for biopsy, such as an abnormal digital rectal examination or abnormally high prostate-specific antigen (PSA) levels.

MATERIALS AND METHODS

The study cohort contained a total of 104 men aged 41-78 years (median 62.5 years) who had suspicious findings on TRUS. The median prostate volume of the patients was 33.0 ml (range 15.0-90.9) and the serum PSA ranged from 0.2 to 4.0 ng/ml (median 2.5 ng/ml).

RESULTS

Of 104 men, 12 (11.5%) were diagnosed with prostate cancer on initial biopsy. The positive predictive value (PPV) was 3.7% for PSA 0.1-1.0 ng/ml, 4.8% for PSA 1.1-2.0 ng/ml, 16.7% for PSA 2.1-3.0 ng/ml and 18.4% for PSA 3.1-4.0 ng/ml. The PPV for cancer with Gleason score 7 or higher was 0.0%, 0.0%, 16.7% and 7.9%, respectively. No statistically significant differences in patient characteristics and biopsy results were found between patients who received only systemic biopsy and those who received systemic plus lesion-directed biopsies.

CONCLUSION

The results of this study do not provide a rationale to recommend the additional use of lesion-directed biopsy in patients with suspicious lesions at TRUS but with no other indication for biopsy. Furthermore, our data raise the question of whether serum PSA levels lower than 4.0 ng/ml should be considered normal in Asian men.

Patterns in the diagnosis and management of benign prostatic hyperplasia in a country that does not have country-specific clinical practice guidelines

PURPOSE

We have evaluated the patterns of diagnostic and treatment practices for benign prostatic hyperplasia (BPH) in a country that does not have country-specific clinical practice guidelines.

MATERIALS AND METHODS

Probability samples were taken from the Korean Urological Association Registry of Physicians, and randomly sampled Korean urologists were asked to complete a questionnaire. The survey explored practice characteristics and attitudes, as well as diagnostic and treatment strategies, for the management of BPH.

RESULTS

Of the 850 questionnaires sent, 302 were returned, and 277 of those were included in the final analysis (response rate 32.6%). For the initial evaluation, most urologists routinely used digital rectal examinations (DRE) and urinalysis. Uroflowmetry was used 34.7% of the time. Pressure-flow studies were rarely done. Symptom assessment was used in only 46.9% of cases. In addition, a significant number (58.8%) reported that treatment decisions were not based on the symptom questionnaire. Before surgery, almost all urologists routinely used DRE, urinalysis, and prostate-specific antigen tests. Of the respondents, 55.6% and 41.9% had prescribed alpha- blockers and alpha-blockers with 5-alpha reductase inhibitors, respectively. 81.2% of urologists perceived that selective alpha-blockers are different in terms of efficacy, and 82.7% felt that they differed in safety. Most respondents prescribed 5-alpha reductase inhibitors based on the prostate size.

CONCLUSION

These data provide a picture of current practices regarding the management of BPH in Korea. The diagnostic and treatment practices for BPH do not follow published guidelines. Our findings ask the question "How influential are international guidelines, and do they really affect patient management in countries that do not have country-specific guidelines?"

Catheter-associated urinary tract infections in patients who have undergone radical cystectomy for bladder cancer: A prospective randomized clinical study of two silicone catheters (clinical benefit of antibiotic silicone material)

PURPOSE

The prevalence of catheter-associated urinary tract infections (CAUTIs) varies from 5% to 8.2%, and the risk of infection increases by 5% to 7% per day of primary indwelling. We investigated whether a novel biofilm inhibitory mechanism using an inhibitory silicone urethral catheter (a coated Foley catheter) can reduce CAUTIs compared to conventional non-coated Foley catheters.

MATERIALS AND METHODS

This study prospectively analyzed the difference in the incidence of CAUTIs in patients who underwent radical cystectomy with an orthotopic neobladder for bladder cancer and received a coated or conventional non-coated catheter. Additionally, differences in bacterial colonization between the groups were analyzed using a catheter-tip bacterial culture test.

RESULTS

Eighty-five patients were randomized into the "coated Foley catheter" group (abbreviated as "case" group; 41 patients) and a control group (44 patients). The two groups were identical except for their surgical history. The incidence of CAUTIs 2 weeks after radical cystectomy was 21.95% (case) and 27.27% (control), with no significant difference between the two groups. However, when the catheter was removed 2 weeks after surgery, the catheter tip culture test revealed significant bacterial colonies in 25 (60.98%) and 38 (86.36%) patients in the case and control group, respectively. No catheter-related postoperative side effects were observed in either group.

CONCLUSIONS

The incidence of CAUTIs in the two groups did not differ according to the catheter material. However, the catheter bacterial culture test showed that bacterial colonization was significantly suppressed on the Bi-Fi Free technology catheter, which comparatively inhibited biofilm formation.

Korean version of the convalescence and recovery evaluation: translation and linguistic validation

BACKGROUND

To develop a Korean version of the original English version of the convalescence and recovery evaluation (CARE) questionnaire. The linguistic validation of the CARE questionnaire was tested on Korean patients who underwent abdominal and pelvic surgery.

METHODS

The CARE questionnaire was translated and validated linguistically in the following steps. Permission to translate the Korean version of the original version, forward translation into the Korean, reconciliation, backward translation into English, cognitive debriefing through patient interviews, and finally proofreading.

RESULTS

The forward translation was carried out by two independent bilingual translators with non-medical backgrounds. In the translation step to Korean, the terms "bloated and gassy" and "trouble concentrating" were adjusted to make them easier to understand. Backward translation was performed by another translator who was not included in the forward translation. At the backward-translation stage, the Korean version was accepted without any objection, almost matching the original version except for a few words. Cognitive debriefing by means of patient interviews was performed with 10 patients admitted to the department of urology for renal, bladder, and prostate cancer for cancer treatment. There was no difficulty in understanding the content of the questionnaire. Because most of the terms were clear and understandable, no further changes were made in the panel discussion.

CONCLUSIONS

The Korean version of the CARE questionnaire has been verified and is ready for use. Additional testing steps are required for the psychometric performance of the Korean version of CARE.