Is there a role of radial rigidity in the evaluation of erectile dysfunction?

RigiScan has been the most widely utilized device for measuring erectile rigidity. However, the use of the RigiScan in the evaluation of erectile dysfunction has questionable because the RigiScan device does not directly determine axial rigidity. The aim of this study is to clarify that radial rigidity measured by RigiScan reflects the intracorporeal pressure and erectile capability efficiently. From January 1998 to May 1999, a total of 23 patients with erectile dysfunction were involved in the study. They were evaluated by RigiScan and duplex ultrasonography after intracorporeal injection of prostaglandin E1. We investigated the relationship between radial rigidity and the resistance index. The results of radial rigidity were also compared with that of the degree of erection. For the entire group, significant correlations were found between radial rigidity and the resistance index (r=0.680, P<0.001 for tip rigidity; r=0.703, P<0.001 for base rigidity). In addition, for 12 patients whose tip rigidity exceeded 60% and for 10 whose base rigidity exceeded 60%, the correlations between radial rigidity and the resistance index remained (r=0.659, P=0.020 for tip rigidity; r=0.759, P=0.011 for base rigidity). Based on the response determined by patients, radial rigidity represented the degree of erection efficiently. Our findings suggest that RigiScan is a useful diagnostic tool. Radial rigidity represents the intracorporeal pressure efficiently and has an acceptable role in the evaluation of erectile dysfunction.

Urinary ascites and anuria caused by bilateral fungal balls in a premature infant

A case is reported of anuria and urinary ascites secondary to bilateral ureteropelvic obstruction by fungal balls. Management consisted of bilateral nephrostomy drainage with local irrigation with amphotericin B, and systemic antifungal treatment without surgery. Aspiration by paracentesis was performed for the urinary ascites and continuous drainage through an 8 Fr pig tail catheter for the urinoma. The literature on renal fungus balls in neonates and infants is reviewed.

Metachronous metastatic potential of small renal cell carcinoma: dependence on tumor size

OBJECTIVES

To evaluate the association between tumor diameter and clinicopathologic characteristics and metastatic potential in small (< or = 4 cm) renal cell carcinoma (RCC).

METHODS

A total of 350 patients with an age range of 24-84 years (median, 54) were included in the study. Patients were categorized according to tumor diameter into 3 groups: < or = 2, 2.1-3.0, and 3.1-4.0 cm.

RESULTS

There were no significant differences in age, sex, histologic type, pathologic stage, and Fuhrman's grade according to tumor diameter. Tumor size did not predict synchronous metastatic disease. Distant metastases at diagnosis were documented in 2.1%, 1.6%, and 0.0% in patients with RCC of diameter < or = 2, 2.1-3, and 3.1-4 cm, respectively. During follow-up, recurrence or metastasis developed in 11 patients (3.5%) with a median time to metastasis of 43 months (range 7-104) in 345 patients with localized (N0M0) RCC. Metastases were diagnosed in 2 patients (0.9%) with RCC < or = 3 cm and in 9 patients (7.0%) with RCC 3.1-4.0 cm. Significant difference was noted in metastasis-free survival among groups (P = .023). Multivariate Cox proportional hazards model analysis showed that only tumor diameter was an independent predictor of metastasis-free survival (Hazard ratio, 5.344; 95% confidence interval, 1.137-25.127; P = .034).

CONCLUSIONS

Our findings suggest that risk of metachronous metastasis, but not synchronous metastasis, increases in RCC of diameter > 3.0 cm.

Circumcision practice patterns in South Korea: community based survey

OBJECTIVES

To assess the prevalence of circumcision in South Korean young men dwelling in the community, investigate attitudes and perspectives about circumcision, and how they perceive physician involvement in the decision process.

METHODS

Between May and November 2001, this cross sectional survey was performed. Of 27 202 men aged 20 years dwelling in the community of Choong-chung South Province, 2700 were randomly selected at a 10.0% sampling fraction after a sampling process by census district and a total of 1742 (64.5%) agreed to participate in the study. These subjects completed self administered questionnaires and we included 1674 men (a response rate 62.0%) in the study.

RESULTS

The overall proportion of circumcised was 1306 (78.0%) and an additional 192 (11.5%) wished to be circumcised later. Circumcision was carried out mostly during their elementary and middle school years. Of men circumcised, the decision whether to circumcise was most often made by their parents. Of the subjects, 75.0% believed that circumcision is necessary, while 2.9% believed it to be unnecessary. Among those who believed circumcision to be necessary, the most common reason was to improve penile hygiene (89.1%).

CONCLUSIONS

Our results indicate a positive attitude toward circumcision in South Korean men, linking it with hygienic practices. Circumcision in South Korea depends on the perpetuation of cultural beliefs that support it.

Residual fraction as a parameter to predict bladder outlet obstruction in men with lower urinary tract symptoms

OBJECTIVES

To determine whether noninvasive tests including the residual fraction are reliable for the diagnosis of bladder outlet obstruction (BOO).

METHODS

A total of 212 men (median age 68, range 44-89 years) were included in the present study. The median serum prostate-specific antigen level and prostate volume were 1.3 ng/mL (range 0.2 to 9.4) and 37.9 mL (range 11.3 to 148.0), respectively.

RESULTS

Among the variables analyzed in the multivariate model, the likelihood of BOO varied by the total prostate volume, with a 3.6-fold higher odds for >or=40 mL than for <40 mL (odds ratio [OR], 3.616; 95% confidence interval [CI], 1.217-10.749; P = 0.021). In the same model, a low maximal flow rate (Qmax) (OR, 2.840; 95% CI, 1.260-6.401; P = 0.012) and high residual fraction (OR, 7.103; 95% CI, 1.924-26.225; P = 0.003) were associated with an increased likelihood of BOO. The sensitivity and specificity for predicting BOO using a total prostate volume of 40 mL or greater were 73.7% and 65.2%, respectively. Using a Qmax cut-off of 12 mL/s or less for predicting BOO, the sensitivity and specificity were 77.2% and 54.2%, respectively. Prediction of the BOO by the residual fraction only had a sensitivity and specificity, for a residual fraction of less than 20%, of 75.4% and 67.7%, respectively.

CONCLUSIONS

The presence or absence of BOO might be predicted using non-invasive methods. The residual fraction may help with patient management by better predicting the likely patient classification from pressure-flow studies.

Impact of varicocele on testicular volume in young men: significance of compensatory hypertrophy of contralateral testis

PURPOSE

We examined the impact on ipsilateral testicular volume in young men with varicocele and determined whether compensatory hypertrophy exists.

MATERIALS AND METHODS

Between April and November 2001, 2,700 men who were 20 years old and dwelling in the community were randomly selected at a 10% sampling fraction after a sampling process according to census district. A total of 2,080 men (77% response rate) agreed to participate in the study. All volunteers underwent standard evaluation, including medical history and physical examination.

RESULTS

Testicular volume on the affected side in men with varicocele was significantly smaller than that of the contralateral side, while testicular volume on the contralateral side was significantly larger than that of the left side in normal men. In those with unilateral varicocele testicular volume on the affected side did not depend on varicocele grade but contralateral testicular volume in men with grade I varicocele was significantly smaller than in men with higher grades of the entity. The rate of testicular atrophy increased depending on varicocele grade.

CONCLUSIONS

Varicocele negatively impacts testicular volume on the affected side in young men. Our findings suggest that men with higher grades of varicocele have a hypertrophied testis on the contralateral side.

Serum prostate-specific antigen value adjusted for non-cancerous prostate tissue volume in patients undergoing radical prostatectomy: a new predictor of biochemical recurrence in localized or locally advanced prostate cancer

The aim of this study was to investigate the significance of serum prostate-specific antigen (PSA) value adjusted for total tumor volume (PSA/tumor volume) and serum PSA value adjusted for non-cancerous prostate tissue volume (NCPV) (PSA/NCPV) as a predictor of pathological findings and clinical outcome after radical prostatectomy. Clinical and pathological data of 407 patients (median age: 66.5 years; range: 41.8-85.7 years) were reviewed retrospectively. The median follow-up period was 18.1 months (range: 1.0-107.8 months). Biochemical recurrence was defined as detectable PSA levels (greater than 0.2 ng ml(-1)) and the time of biochemical recurrence was taken to be the first time PSA became detectable. In the multivariate model, PSA/NCPV was an independent predictor of extracapsular extension and positive surgical margin (P<0.05), but PSA/tumor volume was not. Kaplan-Meier curves revealed that PSA/NCPV correlated with biochemical recurrence-free survival (P<0.001; log-rank test) but PSA/tumor volume did not (P=0.275; log-rank test). PSA/NCPV was also a significant independent prognostic factor for biochemical recurrence-free survival on multivariate Cox proportional hazard analysis (P=0.004, relative risk=2.42). Our findings suggest that PSA/NCPV is associated independently with extracapsular extension and surgical margin status and may be an independent prognostic variable of PSA recurrence after radical prostatectomy.

Biochemical recurrence after radical prostatectomy with or without pelvic lymphadenectomy in Korean men with high-risk prostate cancer

OBJECTIVE

To identify predictors of biochemical recurrence (BCR) after radical prostatectomy with or without standard pelvic lymphadenectomy in Korean men with high-risk prostate cancer.

METHODS

The clinical and pathologic data of 199 patients with high-risk features were reviewed retrospectively. High-risk features were prostate-specific antigen level >20 ng/ml, biopsy Gleason score ≥8 or clinical tumor category ≥2c. All patients were followed up by measuring their prostate-specific antigen levels every 3 months. The median follow-up period was 37.0 months (range: 1.0-143.0).

RESULTS

During the follow-up period, biochemical recurrence was observed in 68 patients (34.2%). The 1-, 3- and 5-year biochemical recurrence-free survival rates were 79.6, 61.9 and 49.2%, respectively. Surgical Gleason score ≥8, positive surgical margin, extracapsular extension, and seminal vesicle invasion correlated significantly with biochemical recurrence-free survival (all P < 0.05), but pelvic lymphadenectomy did not. Multivariate Cox's proportional hazard analysis revealed that the only significant independent prognostic factor of biochemical recurrence-free survival was seminal vesicle invasion (P = 0.035, relative risk = 1.81).

CONCLUSIONS

Men with seminal vesicle invasion appear to have a significantly higher biochemical recurrence risk in patients with high-risk prostate cancer. However, since the natural history of prostate cancer is variable and accurate means of identifying those who will progress are currently available, it will be necessary to conduct further studies to find prognostic parameters that will allow the early identification of high-risk patients who could benefit from early salvage or adjuvant therapy.

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20-83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics ( P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60-9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80-11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.

Factors influencing practices for chronic prostatitis: a nationwide survey of urologists in South Korea

BACKGROUND

We investigated the influence of physicians' attitudes on the treatment of chronic prostatitis, and attempted to correlate demographic and professional characteristics with patterns of therapy regarding chronic prostatitis.

METHODS

Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire which explored practice characteristics, attitudes, and diagnostic and treatment strategies for the management of chronic prostatitis. The returned questionnaires were statistically analysed.

RESULTS

Of the 850 questionnaires sent, 302 were returned, and 275 of those were included in the final analysis (response rate 32.4%). Multivariate logistic regression analysis indicated that the type of hospital (P < 0.001) and belief that culture tests helped diagnose chronic prostatitis (P = 0.001) were the most determinant factors with respect to the routine performance or non-performance of culture tests. Most Korean urologists (96.4%) prescribed antibiotics for the primary treatment of chronic prostatitis. Even when primary antibiotic treatment was unsuccessful, urologists frequently prescribed a second course of antibiotics (57.8%). In the multivariate model used, the likelihood of prescribing antibiotics as a secondary treatment varied by the type of hospital, with 0.4-fold odds (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21-0.87; P = 0.019) of the practice occurring in university hospitals, as opposed to primary clinics. According to the same model, the belief that culture tests help to diagnose chronic prostatitis was also an independent influencing factor (OR, 2.29; 95% CI, 1.39-3.77; P = 0.001), whereas the actual performance of culture tests had no statistical significance.

CONCLUSION

Our findings suggest that the personal beliefs and professional characteristics of physicians may influence the diagnosis and treatment of chronic prostatitis in Korea.

Nerve-sparing procedure in radical prostatectomy: a risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures

OBJECTIVE

To identify risk factors for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic radical prostatectomy.

MATERIAL AND METHODS

The medical records of 632 patients who had undergone radical prostatectomy (open retropubic n = 430, pure laparoscopic n = 49, and robot-assisted laparoscopic n = 202) were reviewed retrospectively. Patients with postprostatectomy inguinal hernia were defined as those who had undergone subsequent hernia repair. The mean period of follow-up was 19.5 months (median 19, range 1 to 42).

RESULTS

Hernia repairs were performed in 27 of the 632 patients (4.3%). The site of the repair was right in 15 patients (55.6%), left in 9 patients (33.3%), and bilateral in 3 patients (11.1%). The timing of the hernia repair ranged from 4 to 35 months (mean 13.1) following radical prostatectomy. No difference in hernia-repair-free rates was observed between the extraperitoneal open and transperitoneal pure or robot-assisted laparoscopic radical prostatectomy procedures (p = 0.225, log-rank test). The log-rank test revealed that the nerve sparing procedure (p = 0.019) and the absence of diabetes (p = 0.017) were significant risk factors for postprostatectomy hernia repair. In the multivariate Cox proportional hazards model, neurovascular bundle saving was the only significant risk factor for postprostatectomy inguinal hernia repair (Hazard ratio, 2.64, 95% confidence interval 1.09 to 6.41, p = 0.032).

CONCLUSIONS

These findings suggest that the nerve sparing procedure may increase the risk of hernia repair. Prospective studies are warranted to investigate the possible adverse effects of the nerve sparing technique.

Comparison of voiding parameters in men and women with lower urinary tract symptoms

AIM

The aim of this study was to compare voiding parameters by using urodynamic investigations in men and women with lower urinary tract symptoms (LUTS).

METHODS

A total of 164 individuals (76 men and 88 women) completed the International Prostate Symptom Score (IPSS) and underwent a detailed urodynamic investigation. Patients were stratified by voiding function, which included bladder voiding efficiency (BVE) of < 80% and of >or= 80%.

RESULTS

IPSSs were similar in the men and women except for voiding symptoms for those with a BVE of >or= 80% (12 for men vs. 9 for women, P=0.016). When voiding parameters were compared according to BVE in men and women, respectively, maximum flow rate (Q(max)) (P=0.002), average flow rate (Q(ave)) (P=0.003), voided volume (P=0.037), post-void residual (PVR) (P<0.001), and bladder outlet obstruction index (P=0.016) were different for men with a BVE of < 80% and men with a BVE of >or= 80%. However, for women with a BVE of < 80% or >or= 80%, PVR (P<0.001), detrusor pressure at maximum flow rate (P=0.022), and opening detrusor pressure (P=0.024) were different.

CONCLUSIONS

The voiding parameters of women differ from those of men according to voiding function. The present results show that a pressure-flow study may represent a difference according to BVE in women as well as in men. Our findings suggest that opening detrusor pressure in women reflects the urethral and detrusor during voiding phase accurately as detrusor pressure at maximum flow rate does.

Impact of urinary symptoms on bothersomeness and quality of life in young men

OBJECTIVES

To examine the impact of urinary symptoms on bothersomeness and quality of life among young men in a community.

METHODS

The National Institutes of Health-Chronic Prostatitis Symptom Index was used to identify men with urinary symptoms. The questionnaire also queried about sociodemographic characteristics. A total of 15,264 men without pain or discomfort suggestive of prostatitis were included in this study.

RESULTS

Of the 15,264 subjects, 43.6% reported that they experienced urinary symptoms. With regard to symptom severity, 3.4% did not believe their bladder emptied fully after urinating more than one time in five, and 9.7% had to urinate again within 2 hours more than one time in five. Men in major towns had more severe symptoms, including incomplete emptying and frequency, than those in other areas. Men with a high educational level were less likely to report that they experienced severe frequency. Multivariate logistic regression analyses indicated that urinary symptoms significantly affected bothersomeness and quality of life of young men.

CONCLUSIONS

In a community-based population of healthy 20-year-old Korean men, the prevalence of urinary symptoms was 43.6%. The results of the study indicated that demographic variables might influence the prevalence of urinary symptoms in young men. In addition, our findings suggest that young men with urinary symptoms experience a negative impact on their quality of life.

Hand-assisted laparoscopic and open living donor nephrectomy in Korea

BACKGROUND

We compared the results of hand-assisted laparoscopic living donor nephrectomy (LLDN) and conventional open living donor nephrectomy (OLDN).

METHODS

The clinical data on 49 hand-assisted LLDN and 21 OLDN on the left side performed at two institutions in Korea from January 2001 to February 2003 were reviewed. Demographic data of donors and recipients were similar in the two groups.

RESULTS

There was one conversion to an open procedure due to bleeding in the LLDN group. The median operation times (180 min in LLDN versus 170 min in OLDN) and warm ischemic times (2.5 min in LLDN versus 2.0 min in OLDN) in the two groups were similar. The estimated mean blood loss, duration of hospital stay and complication rate was also similar in the two groups. The LLDN group reported less pain (visual analog scale) postoperatively (4.1 versus 5.3), but this was not significant (P=0.058). The time to oral intake in the LLDN group was significantly longer by an average of 1 day (P=0.001). Return to work was sooner in the LLDN group (4.0 weeks versus 6.0 weeks; P=0.026). The recipient graft function was equivalent between the two groups. Hand-assisted LLDN appears to be a safe and effective alternative to OLDN.

CONCLUSION

Our findings suggest that this technique may give the ability provide grafts of similar quality to OLDN, while extending to the donors the advantages of a traditional LLDN procedure.

Significance of predicted tumor volume as a predictor of pathologic stage in patients undergoing radical prostatectomy

PURPOSE

The purpose of this study was to evaluate whether predicted tumor volume could predict pathologic stage in patients undergoing radical prostatectomy.

MATERIALS AND METHODS

The clinical and pathologic data of 236 patients who underwent a 12-core needle biopsy followed by radical prostatectomy were obtained from our database and reviewed retrospectively.

RESULTS

Observed tumor volume correlated best with serum prostate-specific antigen (PSA) level (r=0.677, p<0.001) and the number of positive biopsy cores (r=0.489, p<0.001). Stepwise multiple linear regression analysis was used to develop a model for predicting tumor volume before radical prostatectomy. All explanatory variables except PSA and the number of positive biopsy cores were eliminated, yielding the equation ([predicted tumor volume]=0.381x[PSA]+0.921x[No. of positive biopsy cores]-0.992). Tumor volume predicted by this equation correlated strongly with observed tumor volume (r=0.722, p<0.001). This was also true when a different cohort of 159 patients was analyzed (r=0.638, p<0.001). The areas under the receiver operating characteristic curves of predicted tumor volume were 68.5% for extracapsular extension, 75.7% for seminal vesicle invasion, and 70.4% for positive surgical margin. Kaplan-Meier curves revealed that predicted tumor volume correlated significantly with biochemical recurrence-free survival (p<0.001; log-rank test).

CONCLUSIONS

Our findings suggest that tumor volume predicted on the basis of PSA levels and number of positive biopsy cores may predict pathologic stage with reasonable accuracy.

Nodal staging score: a tool for survival prediction of node-negative bladder cancer

PURPOSE

A recently developed nodal staging score (NSS) might give an estimation of the likelihood of lymph node (LN) metastasis more accurately than simple cutoff of the number of LNs removed. The study aimed to evaluate whether patients with higher NSS will have a better outcome, since the NSS may provide an accurate staging across tumor stages.

MATERIALS AND METHODS

The clinical and histopathologic data from 242 patients with LN-negative urothelial bladder cancer (pN0) were analyzed. Probability of missing positive LN of <10% (clinical NSS 90%) was set by examining 6 nodes for clinical Ta-Tis tumors, 9 nodes for cT1 tumors, and 25 nodes for cT2 tumors. Multivariate analysis by Cox's proportional hazards model was used to determine the contribution of NSS to cancer-specific survival rates of patients. Discrimination, calibration, and clinical net benefit of the Cox regression model were evaluated using a time-dependent receiver operating characteristics curve, plotting Kaplan-Meyer curve and decision curve analysis.

RESULTS

Margin status and NSS exhibited independent contributions in the Cox regression model. The predictive accuracy of the Cox regression model was 0.756. The Cox regression model successfully stratified the outcome into three different groups based on score. At 2, 5, and 8 years, the Cox regression model performed well across a wide range of threshold probabilities using decision curve analysis.

CONCLUSIONS

Our findings support the prognostic relevance of the NSS 90% cutoff in patients with LN-negative bladder cancer. The present results should be validated by prospective studies with defined LN dissection area.

Two cases of perineal ectopic testis

PURPOSE

Perineal ectopic testis is seen very rarely and here we report on two patients with perineal ectopic testis.

METHODS/RESULTS

We experienced two cases of perineal ectopic testis on which orchiopexies to the corresponding hemiscrotums were performed.

CONCLUSIONS

On surgical exploration, the gubernaculum testes were found to lie fixed to the perineum.

Prognostication in Patients Treated with Radical Cystectomy for Urothelial Bladder Carcinoma: A New Simplified Model Incorporating Histological Variants

PURPOSE

The aim of this study was to evaluate the clinical significance of histological variants (HV) and to develop a new and simple prediction model incorporating variant forms in patients who underwent radical cystectomy for urothelial carcinoma (UC).

MATERIALS AND METHODS

We analyzed the data of 365 patients. We evaluated whether HV were independent predictors of survival. A new scoring model was developed using the regression coefficients from the multivariate Cox proportional hazard model. The patients were divided into three groups on the basis of the score: low-, intermediate- and high-risk. To evaluate the performance of the model, we assessed models in terms of discrimination and calibration.

RESULTS

Patients(median age; 68.5 years) with pure form and squamous differentiation did not differ significantly but statistical analysis of the survival curves of patients with pure form and other variants revealed a statistically significant difference in terms of cancer-specific survival (CSS) (p = 0.005) and overall survival (OS) (p = 0.010). According to the new scoring model HV, the 5-yr CSS rate in each group was 93.3%, 82.9% and 50.5%, respectively. The 5-yr OS rate in each group was 90.0%, 66.3% and 33.2%, respectively. Model discrimination was good for all year models. Calibration was also adequate for the model in all year models.

CONCLUSIONS

HV were found to be important independent prognostic factors in urothelial bladder cancer. This paper presents a new prognostic model incorporating variant forms for predicting CSS and OS in these patients.

Treatment satisfaction after 1 year high-power potassium-titanyl-phosphate photoselective vaporization of the prostate

To investigate the factors that influence treatment satisfaction after high-power potassium-titanyl-phosphate (KTP) laser vaporization of the prostate, we compared the characteristics between patients who were satisfied and those who were not satisfied. In all, 97 patients aged between 53-82 years (median age 67 years) underwent high-power KTP laser vaporization of the prostate for lower urinary tract symptoms due to benign prostatic hyperplasia. At 12 months postoperatively, 60 patients were satisfied with the treatment, whereas 37 were dissatisfied. Although there were no differences in International Prostate Symptom Score (IPSS) values at baseline, the satisfied group scored better in total IPSS at 1, 3, 6, and 12 months postoperatively (P < 0.05). At baseline, the maximum flow rate (Qmax) was lower in the dissatisfied group and remained low throughout the follow-up period, with the exception of 1 month postoperatively (P < 0.05), compared with the satisfied group. There were no differences in other objective data between the two groups, including post-void residual and the number of voids based on the frequency-volume charts. In a multivariate model, a higher bladder contractility index was associated with a greater likelihood of treatment satisfaction 12 months after high-power KTP laser vaporization (odds ratio 1.024, 95% confidence interval 1.001-1.048, P < 0.05). Patients who were not satisfied following the surgery had a smaller improvement in subjective symptoms and Q(max). In addition, our findings suggest that the relative risk of treatment dissatisfaction following high-power KTP laser vaporization was increased in patients with weak detrusor contractility.

Solitary squamous cell carcinoma in the kidney after metachronous development of esophageal and lung cancer

Solitary metastatic renal tumors are rarely encountered clinically. We report the case of a 65-year-old man who developed a solitary renal metastasis after undergoing an esophagectomy for esophageal cancer and subsequent lobectomy for lung cancer. The present case serves to demonstrate that careful follow-up is needed for esophageal cancer patients with cancer of another organ.

Impact of prostate volume on the efficacy of high-power potassium-titanyl-phosphate photoselective vaporization of the prostate: a retrospective, short-term follow-up study on evaluating feasibility and safety

PURPOSE

We determined the impact of prostate volume on the efficacy of the high-power (80 W) potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS).

MATERIALS AND METHODS

Patients were stratified into 3 groups according to prostate volume: '< 40 g' (n = 49) and '40-59 g' (n = 49) and '≥ 60 g' (n = 22). Median follow-up was 9 months (range 6 to 21).

RESULTS

No differences in age and follow-up duration were observed in the three groups. At baseline, no significant differences were noted in the three groups in terms of the International Prostate Symptom Score (IPSS) (21.4, 19.4 and 19.1; p = 0.412) as well as the maximum flow rate (Qmax) (10.2, 9.2, and 8.6 mL/s; p = 0.291) and post-void residual (PVR) (66.2, 80.4, and 71.5 mL; p = 0.856). The mean operative times were 30.9, 46.9, and 58.6 minutes (p< 0.001) and total median energy deliveries for each group were 62.3, 97.6, and 135.9 kJ, respectively (p< 0.001). No severe intraoperative complication was observed. At the last follow-up, these parameters improved significantly regardless of prostate volume, and the IPSS (11.1, 9.4, and 12.3; p = 0.286) as well as Qmax (15.9, 15.9, and 14.2 mL/s; p = 0.690) and PVR (33.7, 28.4, and 14.2 mL; p = 0.395) were not significantly different among the groups.

CONCLUSION

Although a larger prostate requires more time and energy delivery, photoselective laser vaporization of the prostate is safe and efficacious for patients with LUTS regardless of prostate volume.

In vivo hepatocyte growth factor gene transfer to bladder smooth muscle after bladder outlet obstruction in the rat: a morphometric analysis

PURPOSE

We determined whether hepatocyte growth factor gene transfer after partial bladder outlet obstruction would prove effective for decreasing transforming growth factor-beta expression and consequently decreasing collagen deposition in partially obstructed rat bladders.

MATERIALS AND METHODS

Ten-week-old male Sprague-Dawley rats were divided into 3 groups of 10 each, including group 1--sham operation, group 2--bladder outlet obstruction for 4 weeks and group 3--hepatocyte growth factor gene transfer after bladder outlet obstruction. Two weeks after the onset of bladder outlet obstruction in group 3 hepatocyte growth factor-liposome complex (50 microg human hepatocyte growth factor cDNA) was injected into the smooth muscle of the rats.

RESULTS

We noted no difference between groups 2 and 3 with regard to the ratio of bladder weight to body weight. The ratio in groups 2 and 3 was significantly higher than in group 1 (p = 0.043). The mean percent of collagen area +/- SE was 36.32% +/- 1.83%, 27.90% +/- 2.66% and 8.97% +/- 3.35% in groups 1 to 3, respectively (p <0.05). Relative hepatocyte growth factor and c-met mRNA and protein expression were higher in group 3 than in groups 1 and 2. However, the expression of transforming growth factor-beta1 mRNA and protein was higher in group 2 than in groups 1 and 3.

CONCLUSIONS

These findings may imply a possible novel therapeutic strategy against bladder dysfunction arising in patients with bladder outlet obstruction.

Clinical and urodynamic features according to subjective symptom severity in female urinary incontinence

AIMS

The aim of this study was to determine the relationship between subjective symptom severity and clinical or urodynamic parameters and to compare these parameters according to subjective symptom severity.

METHODS

A total of 268 female patients with grade II (n = 94) and grade III (n = 174) according to the Ingelman-Sundberg scale were included in the study. Mean patient age was 55.9 years (range 28-80). Of 268 patients, 196 women (73.1%) complained of stress urinary incontinence (SUI) and 72 (26.9%) reported additional symptoms of urge urinary incontinence (UUI). Fifty-four (20.1%) women previously had hysterectomies and 12 (4.5%) underwent surgery for UI.

RESULTS

Patients with severe incontinence (grade III) are older, have longer duration of symptoms, concomitant urgency or UUI, and low maximal urethral closure pressure and low Valsalva leak point pressure (VLPP). No difference in other characteristics including pad test loss and urethral mobility was observed in the two groups. In the multivariate logistic regression analysis, a longer duration of symptoms was associated with an increased likelihood of severe symptoms (P = 0.025). Patients with mixed incontinence were at five-fold increased risk of severe symptoms compared with those with SUI only (P = 0.011). In the same model, increasing VLPP was associated with a decreased likelihood of severe symptoms (P = 0.037).

CONCLUSIONS

Longer symptom duration, mixed incontinence and low VLPP have independent effects on the severity of incontinence. Our findings suggest that incontinent patients with sphincteric impairment or urge component may have and increased probability of severe symptoms.