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1.  Surgical Outcome of Urethroplasty Using Penile Circular Fasciocutaneous Flap for Anterior Urethral Stricture 
Penile circular fasciocutaneous flap urethroplasty is a useful technique for a long anterior urethral stricture due to the flap's hairless nature and ample length. We investigated the surgical outcomes of urethroplasty for a complex anterior urethral stricture, performed using a penile circular fasciocutaneous flap.
Materials and Methods
Between 2008 and 2013, we performed a retrospective review of 29 patients who underwent urethroplasty using a penile circular fasciocutaneous flap and had at least 6 months of follow-up. A total of 20 cases utilized only a fasciocutaneous flap, while 9 cases combined a fasciocutaneous flap with other surgery. Success was defined as no requirement of additional urethral instrumentation.
The overall success rate was 68.9% (20 out of 29 cases) at a median follow-up of 19 months. Furthermore, fasciocutaneous flap urethroplasty rendered the actual stricture-free rate of 79.3%. The location of recurrence was mostly at the junction of the flap. Among 9 surgical failures, 5 cases were treated successfully by using an additional surgical procedure. Fistula repair was needed in 1 case 4 months later. Further, periodic urethral dilation was performed in the remaining 3 cases. The failure rate was significantly higher in patients with suprapubic cystostomy than in patients without suprapubic cystostomy. The most common complication was post-micturition dribbling.
Penile circular fasciocutaneous flap urethroplasty is a useful method for the reconstruction of a long anterior urethral stricture. A sufficient healthy margin should be acquired for better surgical results due to the fact that most recurrence occurs at the junction of the flap.
PMCID: PMC4166375  PMID: 25237658
Penis; Surgical flaps; Urethral stricture
2.  The Incidence of Fever after Subinguinal Microsurgical Varicocelectomy 
In the present study, we aimed to identify the incidence of fever in patients after subinguinal microsurgical varicocelectomy and to evaluate the clinical factors associated with the occurrence of the fever.
Materials and Methods
We retrospectively reviewed the cases of patients who underwent subinguinal microsurgical varicocelectomy (group A) under spinal anesthesia. In addition, we reviewed the cases of patients who underwent microsurgical vasovasostomy under spinal anesthesia as a control group (group B). The incidence of fever in each group was compared. We investigated the clinical factors influencing the occurrence of fever in the patients of group A.
The incidence of fever in group A was significantly higher than that in group B (32.5% [53/163] vs. 0.4% [1/284]; p<0.001). Clinical factors such as age, varicocele grade, weight, height, operation time, number of ligated veins, usage of immediate postoperative analgesics, presence of postoperative hematoma, and duration of hospital stay were not significantly associated with the occurrence of fever.
We found that one-third of the patients developed transient fever after subinguinal microsurgical varicocelectomy, and therefore, this information should be provided during preoperative counseling.
PMCID: PMC4026235  PMID: 24872953
Fever; Varicocele; Vasovasostomy
3.  Current Management of Urethral Stricture 
Korean Journal of Urology  2013;54(9):561-569.
The surgical treatment of urethral stricture diseases is continually evolving. Although various surgical techniques are available for the treatment of anterior urethral stricture, no one technique has been identified as the method of choice. This article provides a brief updated review of the surgical options for the management of different sites and different types of anterior urethral stricture. This review also covers present controversies in urethral reconstruction. Among the various procedures available for treating urethral stricture, one-stage buccal mucosal graft urethroplasty is currently widely used. The choice of technique for urethroplasty for an individual case largely depends on the expertise of the surgeon. Therefore, urologists working in this field should keep themselves updated on the numerous surgical techniques to deal with any condition of the urethra that might surface at the time of surgery.
PMCID: PMC3773584  PMID: 24044088
Urethra; Urethral stricture; Urethroplasty
4.  Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction 
In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
PMCID: PMC3770856  PMID: 24044105
Erectile dysfunction; Guideline; Phosphodiesterase type 5 inhibitors
5.  Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture 
Korean Journal of Urology  2013;54(7):442-447.
Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome.
Materials and Methods
We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed.
Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology.
Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic.
PMCID: PMC3715707  PMID: 23878686
Surgical anastomosis; Treatment outcome; Urethral stricture
6.  Time-Dependent Changes of Erectile Function in Diabetic Rats: Role of Systemic Endothelial Dysfunction 
The World Journal of Men's Health  2012;30(2):114-122.
To understand the potential contribution of systemic endothelial dysfunction to diabetic erectile dysfunction, and the time course of erectile dysfunction in a streptozotocin (STZ)-induced diabetic rat model.
Materials and Methods
Among 84, 12-week-old Sprague-Dawley rats, 48 rats received intraperitoneal STZ and were classified into six groups of diabetes by the period of observation (n=8). The remaining 36 rats were also grouped, similar to the diabetic groups, and served as normal controls. After 4, 6, 8, 10, 12, and 14 weeks of diabetes (serum glucose >250 mg%), all rats underwent cavernous nerve electrostimulation (3 V, 0.2 ms, 30 sec) with varying frequency (2.5~20 Hz). At the end of the study, 8 ml of blood was taken to measure the plasma markers of endothelial function and glycosylated hemoglobin.
Compared to the control, significant reduction of erectile response was not observed until eight weeks after diabetes induction. The diabetic rats had elevation of all plasma markers except for l-selectin. However, the correlation analysis revealed that no systemic marker of endothelial dysfunction was associated with change in erectile function. Only the level of hemoglobin A1c (HbA1c) showed a modest but significant correlation with the peak intracavernosal pressure, corrected by mean arterial pressure (ρ=-0.183), and the area under the curve of the cavernosometry (ρ=-0.207).
Significant reduction of erectile function was not observed until eight weeks after the induction of diabetes. Except for HbA1c, there was no systemic marker associated with endothelial activation and erectile function in the diabetic rats.
PMCID: PMC3623519  PMID: 23596598
Erectile dysfunction; Diabetes mellitus; Rats; Endothelium
7.  Hydrodynamic Relationship between Color Doppler Ultrasonography Findings and the Number of Internal Spermatic Veins in Varicoceles 
Yonsei Medical Journal  2012;53(2):386-392.
The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy.
Materials and Methods
In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist.
Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated.
Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.
PMCID: PMC3282980  PMID: 22318828
Internal spermatic vein; reflux velocity; varicocele
8.  Does the Mother or Father Determine the Offspring Sex Ratio? Investigating the Relationship between Maternal Digit Ratio and Offspring Sex Ratio 
PLoS ONE  2015;10(11):e0143054.
In mammals, high parental testosterone levels present around the time of conception are thought to skew offspring sex ratio toward sons. The second to fourth digit ratio (digit ratio) is now widely accepted as a negative correlate of prenatal testosterone. Thus, we investigated the association between digit ratio and offspring sex ratio.
A total of 508 Korean patients (257 males and 251 females) less than 60 years old who had one or more offspring were prospectively enrolled. The lengths of the 2nd and 4th digits of the right hand were measured by a single investigator using a digital vernier calliper. Next, the patients’ lifetime offspring birth sex ratios were investigated.
Maternal (rather than paternal) digit ratio was significantly associated with the number of sons (r = -0.153, p = 0.015), number of daughters (r = 0.130, p = 0.039), and offspring sex ratio (r = -0.171, p = 0.007). And, the maternal digit ratio was a significant factor for predicting offspring sex ratio (B = -1.620, p = 0.008) on multiple linear regression analysis. The female patients with a lower digit ratio (< 0.95) were found to have a higher offspring sex ratio (0.609 versus 0.521, p = 0.046) compared to those with a higher digit ratio (≥ 0.95). Furthermore, females in the low digit ratio group have a probability 1.138 greater of having sons than females in the high digit ratio group.
Maternal digit ratio was negatively associated with offspring sex ratio. Females with a lower digit ratio were more likely to have more male offspring compared to those with a higher digit ratio. Thus, our results suggest that the sex of offspring might be more influenced by maternal rather than paternal factors.
PMCID: PMC4648576  PMID: 26575995
9.  AB068. Practical diagnosis and treatment algorithm for azoospermia 
Translational Andrology and Urology  2015;4(Suppl 1):AB068.
A male factor is solely responsible in approximately 20% of cases of infertility and contributory in another 30-40%. Azoospermia is present in 15-20% of infertile males. Although the main goal of the evaluation of the infertile men is to identify the reversible conditions, to identify the irreversible causes that can or cannot be managed by assisted reproductive techniques (ART) is also important. Etiologies for azoospermia can be categorized as pre-testicular, testicular and post-testicular. Azoospermia is defined as the absence of sperm from at least two centrifuged semen samples. The initial evaluation of the azoospermia men includes a thorough history, physical examination, and hormonal tests. Physical examination should focus on testis size and presence of vas deferens and varicocele. Hormonal evaluation should include measurement of serum testosterone and follicle stimulating hormone (FSH) levels. When the vasa are palpable, testis size, semen volume and serum FSH are key factors in determining the etiology of the azoospermia. If the semen volume is reduced and this is not an artifact, the first laboratory test is post-ejaculatory urinalysis to exclude a retrograde ejaculation. After exclusion of retrograde ejaculation, transrectal ultrasonography (TRUS) should be considered to identify ejaculatory duct obstruction (EDO). Dilation of the seminal vesicles serves as a sign of EDO. Seminal vesicle aspiration to identify sperm at the time of TRUS can increase the diagnostic accuracy. In our center, TRUS-guided opacification of the seminal tracts with a mixture of contrast media and dye is performed to facilitate effective transurethral resection (TUR) of ejaculatory duct. Based on our experiences, patients with midline cysts who are treated by TUR are expected to have the best outcome. Testis size and level of serum FSH in azoospermic males with normal semen volume are critical factors in determining diagnostic strategies. Men with elevated FSH and bilateral small testis have non-obstructive azoospermia (NOA). Diagnostic testicular biopsy is not required in cases of NOA. Elevated FSH is indicative of a significant problem with spermatogenesis whereas a normal serum FSH does not guarantee intact spermatogenesis. Therefore, patients with normal testis size and FSH level should undergo a testicular biopsy to provide a definitive diagnosis. If the testicular biopsy is normal, most men have bilateral epididymal obstruction. Epididymal obstruction can be identified only by surgical exploration. Vasography is performed at the time of reconstructive surgery. Once sperm are found from the epididymal tubule, vasoepididymostomy is performed. The best results can be achieved by surgeons with training and on-going experience in microsurgery. There is some evidence that a small percentage of men with NOA may benefit from treatment of a clinical varicocele. Therefore, it is reasonable to offer men with NOA and clinical varicoceles a varicocelectomy. However, the most men will still need to use intracytoplasmic sperm injection (ICSI) to conceive. Testicular sperm extraction (TESE) should be offered to all men with NOA. Microsurgical TESE increases retrieval rates, and should be preferred in severe cases of NOA.
PMCID: PMC4708793
Azoospermia; infertile; testicular sperm extraction
10.  Preoperative CT Voiding Cystourethrography Using 16-Multidetector CT in Female Urethral Diverticulum 
PLoS ONE  2014;9(9):e107448.
To evaluate the clinical usefulness of preoperative CT voiding cystourethrography (CT-VCUG) using 16-multidetector computed tomography for female urethral diverticula.
Materials and Methods
Preoperative CT-VCUG was performed in 15 consecutive patients who underwent urethral diverticulectomy from May 2004 to December 2012. The result of preoperative cystourethroscopy and surgical findings were recorded by a single surgeon and CT-VCUG findings including the location of osita were retrospectively reviewed by another urologist who was blinded to the surgical finding. The location of the ostium detected on CT-VCUG was compared descriptively with the intraoperative surgical and preoperative cystourethroscopic findings.
A total of 14 consecutive patients who underwent preoperative CT-VCUG and urethral diverticulectomy were included in the analysis. Ostia were detected on CT-VCUG in all cases, whereas ostia were identified in 10 patients (71.4%) by cystourethroscopy. Ostia were located between the 4 and 8 o’clock direction. Mean distance from the bladder neck to the ostium was 24.2 mm. Circumferential and horseshoe shaped diverticula were observed in 6 and 4 patients, respectively. The surgical findings correlated well with the CT findings.
Preoperative CT-VCUG can be useful in identifying the ostia of urethral diverticula in patients scheduled for urethral diverticulectomy and can provide structural information, useful to establish surgical strategy.
PMCID: PMC4162593  PMID: 25216189
11.  Efficacy and Safety of the Selective α1A-Adrenoceptor Blocker Silodosin for Severe Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: A Prospective, Single-Open-Label, Multicenter Study in Korea 
Korean Journal of Urology  2014;55(5):335-340.
To evaluate the efficacy and safety of silodosin 8 mg once daily in a 12-week treatment of subjects with severe lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
Materials and Methods
A total of 100 subjects from 10 urology centers in Korea were included in this study. The inclusion criteria were as follows: age ≥50 years, International Prostate Symptom Score (IPSS) ≥20, quality of life (QoL) score ≥3, urine volume ≥120 mL and maximal urinary flow rate (Qmax) <15 mL/s, and postvoid residual volume (PVR) <100 mL. We assessed the improvement of LUTS with change in IPSS, QoL score, Qmax, PVR, and adverse events at baseline and 4 and 12 weeks after treatment with silodosin 8 mg once daily.
The IPSS values were 23.27±3.34, 15.89±6.26, and 13.80±6.31 at baseline, 4, and 12 weeks, respectively, with significant improvements (p<0.0001, p=0.0214, respectively). QoL scores were 4.44±0.85, 3.38±1.20, and 3.04±1.20 at baseline, 4, and 12 weeks, respectively, and the differences were statistically significant (p<0.0001). There was a significant difference in Qmax between baseline and 12 weeks (p<0.0001) but not in PVR (p=0.9404) during the clinical trial. The most frequent adverse event in this study was ejaculation failure with 13 cases. However, no subject dropped out because of ejaculation failure, and in 12 of the 13 cases it was fully resolved without further treatment.
Silodosin 8 mg once daily may be effective and safe in Korean patients with severe LUTS associated with BPH.
PMCID: PMC4026660  PMID: 24868338
α1A-Adrenoceptor antagonis; Benign prostatic hyperplasia; Lower urinary tract symptoms; Selective; Silodosin
12.  Urologist's Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey 
The World Journal of Men's Health  2013;31(3):226-231.
According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE.
Materials and Methods
The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012.
Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN).
A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.
PMCID: PMC3888892  PMID: 24459656
Physician's practice patterns; Premature ejaculation; Urologic surgical procedures
13.  Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study 
Korean Journal of Urology  2012;53(2):104-108.
To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition.
Materials and Methods
Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry.
The mean age and body mass index of the patients was 64.5±6.2 years and 24.2±2.6 kg/m2, respectively. Mean total prostate volume and transitional zone volume were 48.8±18.8 ml and 24.2±16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery.
Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.
PMCID: PMC3285704  PMID: 22379589
Erectile dysfunction; Holmium; Lasers; Prostatic hyperplasia
14.  Second to fourth digit ratio: a predictor of adult penile length 
Asian Journal of Andrology  2011;13(5):710-714.
The second to fourth digit ratio (2D:4D) has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor (AR). Both prenatal testosterone and the AR play a central role in penile growth. In this study, we investigated the relationship between digit ratio and penile length. Korean men who were hospitalized for urological surgery at a single tertiary academic centre were examined in this study, and 144 men aged 20 years or older who gave informed consent were prospectively enrolled. Right-hand second- and fourth-digit lengths were measured by a single investigator prior to measurement of penile length. Under anaesthesia, flaccid and stretched penile lengths were measured by another investigator who did not measure nor have any the information regarding the digit lengths. Univariate and multivariate analysis using linear regression models showed that only height was a significant predictive factor for flaccid penile length (univariate analysis: r=0.185, P=0.026; multivariate analysis: r=0.172, P=0.038) and that only digit ratio was a significant predictive factor for stretched penile length (univariate analysis:r=−0.216, P=0.009; multivariate analysis: r=−0.201, P=0.024; stretched penile length=−9.201×digit ratio + 20.577). Based on this evidence, we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in adult penile length.
PMCID: PMC3739592  PMID: 21725330
digit ratio; flaccid penile length; stretched penile length
15.  A Significant Number of Sessile Serrated Adenomas Might Not Be Accurately Diagnosed in Daily Practice 
Gut and Liver  2010;4(4):498-502.
The diagnosis of hyperplastic polyps (HPs) may involve a conglomeration of subgroups of serrated polyps. The diagnosis of HPs may therefore be revisited if this is sessile serrated adenoma (SSA). The aim of this study was to determine clinically and endoscopically relevant information associated with reclassification to SSA.
After reviewing the data from 1,372 patients who underwent colonoscopic polypectomy, 49 HPs larger than 10 mm were analyzed in this study. Two gastrointestinal pathologists reclassified each of the original 49 HPs as conventional HPs, SSAs, and others.
Among the 49 initially diagnosed HPs, 18.4% were reclassified into SSAs or mixed polyps. Overall architectural features were useful for the diagnosis of SSA, but cytological features were less useful. The patient and polyp characteristics did not differ between HPs with and without reclassification of the initial pathological diagnosis.
A significant number of SSAs might not be accurately diagnosed in daily clinical practice without any predilection for size, shape, and location. Therefore, when large HPs are diagnosed in clinical practice, it is necessary for physicians to have greater awareness of the diagnosis of SSA and to individualize subsequent surveillance.
PMCID: PMC3021605  PMID: 21253298
Colorectal polyp; Hyperplastic polyp; Sessile serrated adenoma
16.  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 
Yonsei Medical Journal  2010;51(6):877-882.
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).
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.
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.
PMCID: PMC2995958  PMID: 20879054
Prostate; benign prostatic hyperplasia; vaporization; KTP; laser surgery
17.  Urodynamic and Histological Changes in a Sterile Rabbit Vesicoureteral Reflux Model 
Journal of Korean Medical Science  2010;25(9):1352-1358.
This study aimed to investigate pressure changes of renal pelvis and histological change of kidneys in a surgically induced sterile rabbit vesicoureteral reflux (VUR) model. Five rabbits served as a control group, 7 as the sham-operated group, and 8 served as the VUR group. Three weeks later, urodynamic studies were performed, and histological examinations evaluated degree of inflammation, fibrosis, and tubular damage in the kidneys. At a low infusion rate, renal pelvic pressure in the VUR group was stable until late filling phase and then increased slightly. At a high infusion rate, the renal pelvic pressures of the sham-operated and control groups were stable until late filling phase and then increased slightly, whereas the renal pelvic pressure in the VUR group steadily increased from mid filling phase. Focal thinning of the tubular epithelium and interstitial widening were observed in certain cortical areas of refluxing kidneys, without inflammatory cell infiltration. Obvious changes in the mean diameters of distal tubules and extracellular matrix volume fractions were observed in two highly refluxing kidneys. High pressure reflux with bladder instability may result in renal cortical changes.
PMCID: PMC2923783  PMID: 20808680
Vesico-Ureteral Reflux; Urodynamics; Histology
18.  Treatment satisfaction after 1 year high-power potassium-titanyl-phosphate photoselective vaporization of the prostate 
Asian Journal of Andrology  2010;12(5):728-734.
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 Qmax. 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.
PMCID: PMC3739308  PMID: 20818402
benign prostatic hyperplasia; potassium-titanyl-phosphate; prostate; satisfaction; vaporization
19.  Changes in Nocturia after Photoselective Vaporization of the Prostate for Patients with Benign Prostatic Hyperplasia 
Korean Journal of Urology  2010;51(8):531-536.
To investigate changes in nocturia and predictive factors for improvement after photoselective vaporization of the prostate (PVP) for patients with benign prostatic hyperplasia (BPH).
Materials and Methods
A total of 103 patients who complained of nocturia of ≥2 times per night on baseline frequency-volume chart (FVC) and who underwent PVP were included in this retrospective study. All patients underwent a preoperative evaluation for BPH including multichannel video urodynamics. The efficacy of the PVP was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score (IPSS) and FVC. Subjective and objective improvement of nocturia were defined as a reduction of ≥50% in nocturnal frequency compared with baseline on the IPSS and FVC, respectively.
As shown by the IPSS and FVC, nocturia was significantly reduced starting from 1 month after PVP. The percentage of patients with improvement in nocturia was 20.0%, 20.7%, 36.2%, and 27.9% on the IPSS, and 30.1%, 48.6%, 52.2%, and 54.5% on the FVC at 1, 3, 6, and 12 months after PVP, respectively. None of the baseline parameters, including the presence or absence of nocturnal polyuria (NPU), reduced nocturnal bladder capacity (NBC), and detrusor overactivity (DO), were associated with improvement of nocturia.
Nocturnal frequency was significantly reduced from the early postoperative period after PVP. Improvement in nocturia after PVP was not affected by baseline nocturnal frequency, the presence or absence of preoperative NPU, or reduced NBC or DO on baseline urodynamics.
PMCID: PMC2924556  PMID: 20733958
Laser therapy; Nocturia; Prostatic hyperplasia
20.  The Effect of the Partial Obstruction Site of the Renal Vein on Testis and Kidney in Rats: Is the Traditional Animal Model Suitable for Varicocele Research? 
Korean Journal of Urology  2010;51(8):565-571.
We investigated the influence of the location of the partial renal vein obstruction on the left kidney, the bilateral testes, and cauda epididymal sperm quality and determined whether this animal model is suitable for varicocele study.
Materials and Methods
A total of 25 adult male Sprague-Dawley rats were assigned to three groups: group 1 (experimental varicocele by partial ligation medial to the internal spermatic vein for 8 weeks, n=8), group 2 (partial ligation lateral to the internal spermatic vein for 8 weeks, n=10), and group 3 (sham operation for 8 weeks, n=7). Rats in groups 1, 2, and 3 underwent a left nephrectomy and bilateral orchiectomy at 8 weeks after the operation. Histological changes and Johnsen score in both testes were analyzed. Fibrotic changes in the left kidney were assessed by quantitative image analysis. Numbers of sperm and proportions of motile sperm in the cauda epididymides were determined.
Significant histological abnormalities and Johnsen score changes were observed in the testes in group 1. Renal fibrosis did not differ significantly among the groups. The proportions of motile sperm were significantly lower bilaterally in group 1 than in groups 2 and 3. However, the mean bilateral epididymal sperm count in group 1 was not significantly lower than in groups 2 and 3.
Our results showed that experimental varicocele in the rat, induced by partial ligation medial to the internal spermatic vein, influences epididymal sperm quality without harmful effects on the left kidney. The present study certifies that this traditional animal model is suitable for varicocele research.
PMCID: PMC2924562  PMID: 20733964
Animal models; Physiopathology; Rats; Varicocele
21.  Long-Term Outcome of the Tension-Free Vaginal Tape Procedure in Female Urinary Incontinence: A 6-Year Follow-Up 
Korean Journal of Urology  2010;51(6):409-415.
We evaluated the long-term outcomes of the tension-free vaginal tape (TVT) procedure for the treatment of female urinary incontinence (UI).
Materials and Methods
We included 141 patients who underwent the TVT procedure for UI and responded to a questionnaire at the 6-year follow-up. The questionnaire included selected questions of the Korean version of the Bristol Female Lower Urinary Tract Symptom (BFLUTS) questionnaire and questions on patients' satisfaction with the procedure. Subjects were characterized as having been cured if they answered 'never' to the questions about any episodes of urine leakage.
The mean follow-up was 85.5 months. The overall long-term cure rate for UI was 83.0% with a satisfaction rate of 80.1%, whereas the 1-year cure rate was 93.4%. The 1-year vs. 6-year cure rates in patients with urodynamic stress UI (SUI group; n=107) and with mixed UI (MUI group; n=34) were 94.1% vs. 84.1% and 89.8% vs. 79.4%, respectively, with no significant difference between the two groups. Also, long-term satisfaction rates in the SUI and MUI groups were 83.2% and 70.6%, without a significant difference between the two. In the MUI group, the 1-year and 6-year cure rates of urgency UI were 81.9% and 58.8%, respectively. There were no serious long-term complications related to the procedure. Most patients (85.9%) would likely recommend the TVT procedure to others.
After 6 years of follow-up, the TVT procedure showed a somewhat decreased cure rate for the treatment of female UI. However, most patients were satisfied with the procedure.
PMCID: PMC2890058  PMID: 20577608
Female; Stress urinary incontinence; Suburethral slings; Urinary incontinence
22.  The Efficacy and Safety of Photoselective Vaporization of the Prostate with a Potassium-titanyl-phosphate Laser for Symptomatic Benign Prostatic Hyperplasia according to Prostate Size: 2-Year Surgical Outcomes 
Korean Journal of Urology  2010;51(5):330-336.
We investigated 2-year follow-up outcomes of patients who underwent potassium-titanyl-phosphate (KTP)-photoselective vaporization of the prostate (PVP) laser therapy for symptomatic benign prostatic hyperplasia (BPH).
Materials and Methods
Of a total of 169 patients who underwent 80 W KTP-PVP by a single surgeon, we retrospectively analyzed the clinical data of 74 patients who completed 2 years of follow-up. The efficacy of the PVP was assessed at 1, 3, 6, 12, and 24 months postoperatively by use of the International Prostate Symptom Score (IPSS) and uroflowmetry with postvoid residual urine volume (PVR). Safety, including complications, was evaluated at each visit.
Mean preoperative total prostate and transitional zone volumes were 42.3 ml (range, 34.0-59.0 ml) and 18.6 ml (range, 10.1-28.6 ml) respectively. According to both IPSS and uroflowmetry, compared with baseline, the improvement in each parameter was sustained significantly at both 1 and 2 years postoperatively (p<0.05). There were no serious intraoperative complications, such as massive hemorrhage requiring transfusion or transurethral resection syndrome. Transient gross hematuria occurred in 16 (21.6%) cases, urgency incontinence in 6 (8.1%) cases, bladder neck contracture (BNC) in 3 (4.1%) cases, and urethral stricture in 1 (2.7%) case. The cases of urethral stricture and BNC developed only in the group with a prostate size of less than 45 ml. No cases required reoperation due to re-growing prostatic tissue.
PVP seems to be a safe and effective procedure for the surgical treatment of symptomatic BPH. After PVP, the subjective and objective improvements in the micturition parameters were sustainable up to 2 years, with minimal complications.
PMCID: PMC2873887  PMID: 20495696
Laser therapy; Potassium titanylphosphate; Prostatic hyperplasia
23.  The One Year Outcome after KTP Laser Vaporization of the Prostate According to the Calculated Vaporized Volume 
Journal of Korean Medical Science  2009;24(6):1187-1191.
The aim of this study was to develop a new simple method for measuring the vaporized volume and to evaluate the outcome of high-power potassium-titanyl-phosphate (KTP) photoselective laser vaporization. A total of 65 patients, with a mean age of 67.7 yr (range 53 to 85), were included in the primary analysis. The vaporized volume was calculated as the pre-operative volume minus the immediate post-operative volume plus the volume of the defect. For all patients, the subjective and objective parameters improved significantly after surgery. Six and 12 months after surgery, the group with a smaller vaporized volume (<15 g) had a lower reduction of the mean International Prostate Symptom Score (P=0.006 and P=0.004) and quality of life index (P=0.006 and P=0.004) when compared to the group with a greater vaporized volume (≥15 g). There were no differences in the change of the maximum flow rate and post-void residual based on the vaporized volume. Our findings suggest that the subjective improvement, after a high-power KTP laser vaporization, may be dependent on the vaporized volume obtained after the procedure.
PMCID: PMC2775872  PMID: 19949680
Prostate; Prostatic Hyperplasia; Vaporization; Laser Therapy
24.  Impacts of the Quinazoline-Based Alpha1-Antagonist, Terazosin, and of the Sulfonamide Derivative, Tamsulosin, on Serum Prostate-Specific Antigen and Prostate Volume 
Journal of Korean Medical Science  2008;23(3):509-513.
The aim of this study was to compare the impacts of terazosin and tamsulosin, on prostate activity, i.e., serum prostate-specific antigen, total prostate volume (TPV), and transition zone volume (TZV). A total of 90 patients who presented with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), ranging in age from 52 to 83 yr (median 65 yr), were included in the study. Patients were given 0.2 mg tamsulosin, 2 mg terazosin, or 4 mg terazosin once daily for an average of 14 months (range, 6-56 months). Subjective (International Prostate Symptom Scores, I-PSS) and objective (maximal flow rate and post-void residual) parameters were assessed both at baseline and at treatment cessation. Serum prostate-specific antigen (PSA) levels were found to be unaffected by treatment (1.2 and 1.3 ng/mL). In total patients, multivariate analysis showed that baseline TPV was the only independent predictor of treatment-related TPV reduction. Moreover, baseline TPV ≥30 g was found to be associated with a higher likelihood of TPV reduction (odds ratio [OR], 3.939; 95% confidence interval [CI], 1.506-10.304; p=0.005), and a baseline TZV of ≥10 g was associated with a 7.1-times greater chance of TZV reduction (OR, 7.100; 95% CI, 2.428-20.763; p<0.001). The same model showed that patients on 2 mg terazosin had a 10.8-fold greater likelihood (OR, 10.770; 95% CI, 1.409-82.323; p=0.022) and that those on 4 mg terazosin had a 9.0-fold greater likelihood (OR, 9.001; 95% CI, 1.724-46.995; p=0.009) of a TZV reduction than those on 0.2 mg tamsulosin. In addition, symptoms improved regardless of prostate activity after taking alpha1-blockers. Our findings suggest that terazosin reduces TZV and demonstrate that the relief of symptoms associated with BPH may not be due to a prostate activity reduction induced by apoptosis in the prostate gland.
PMCID: PMC2526511  PMID: 18583890
Benign Prostatic Hyperplasia; Prostate Volume; Prostate-Specific Antigen; Tamsulosin; Terazosine
25.  Patterns in the Diagnosis and Management of Benign Prostatic Hyperplasia in a Country that does not have Country-Specific Clinical Practice Guidelines 
Yonsei Medical Journal  2007;48(2):281-288.
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.
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.
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?"
PMCID: PMC2628135  PMID: 17461528
Prostate; practice patterns; benign prostatic hyperplasia; prostatic neoplasms

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