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1.  Adolescent Varicocele: Are Somatometric Parameters a Cause? 
Korean Journal of Urology  2014;55(8):533-535.
It has been reported that varicocele is found less frequently in obese men. Accordingly, we evaluated varicocele patients and statistically analyzed the correlation between varicocele and somatometric parameters.
Materials and Methods
A total of 211 patients underwent surgery for varicoceles. All patients underwent history taking, physical examination, and scrotal ultrasound to determine the presence and severity of varicocele. An age-matched control group consisted of 102 patients who were found not to have varicocele according to physical examinations and scrotal ultrasound. The age, weight, height, and body mass index (BMI) of the two groups were compared. The statistical analyses were performed by use of PASW Statistics ver. 18.0. A p-value of less than 0.05 was used for statistical significance.
In the varicocele group, the mean age, height, weight, and BMI were 29.42±14.01 years, 168.53±9.97 cm, 62.14±13.17 kg, and 21.66±3.21 kg/m2, respectively. The distribution of varicocele grade was as follows: 103 (48.8%) grade III, 72 (34.1%) grade II, and 36 (17.1%) grade I. In the control group, the mean age, height, weight, and BMI were 30.83±17.31 years, 161.93±19.83 cm, 64.69±17.86 kg, and 24.04±3.64 kg/m2, respectively. Analyzing these data specifically in adolescents, they showed significant differences in age, height, and BMI (p=0.000, p=0.000, and p=0.004, respectively) between two groups. There were no significant differences in somatometric parameters between patients with different grades of varicocele.
Our results showed that patients with varicoceles were significantly taller and had a lower BMI than did patients without varicoceles, especially among adolescents. Carefully designed future studies may be needed.
PMCID: PMC4131082  PMID: 25132948
Body height; Body mass index; Varicocele
2.  Is a secondary procedure necessary in every case of failed endoscopic treatment for vesicoureteral reflux? 
Korean Journal of Urology  2015;56(5):398-404.
Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR.
Materials and Methods
We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure.
Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction.
Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.
PMCID: PMC4426513  PMID: 25964842
Child; Endoscopy; Urodynamics; Vesico-ureteral reflux
3.  Renal Function Following Curative Surgery for Renal Cell Carcinoma: Who Is at Risk for Renal Insufficiency? 
Korean Journal of Urology  2013;54(12):830-833.
To investigate the incidence and predictive factors associated with the development of chronic kidney disease (CKD) in patients undergoing curative surgery for renal cell carcinoma.
Materials and Methods
From 2003 to 2010, we retrospectively investigated 108 patients undergoing partial nephrectomy or radical nephrectomy (RN) for renal tumors with a preoperative glomerular filtration rate (GFR)≥60. The GFR was calculated by use of the four-variable modification of diet in renal disease (MDRD) formula. CKD was defined as an estimated GFR (eGFR) less than 60 mL/min per 1.73 m2. Demographic and clinicopathologic parameters were evaluated by using the chi-square and Student t-tests and multivariate regression analysis to determine the variables independently associated with the development of postoperative CKD.
Of the 108 patients without preoperative CKD, CKD developed in 43 patients (39.8%). In the analysis of clinical factors between patients with and those without CKD development, gender, body mass index, diabetes mellitus, hypertension, and tumor size were not significant clinical factors. Statistical significance for CKD development was found for age of 60 years or greater (p=0.013), decreased preoperative eGFR (p<0.001), and RN group (p<0.001). In the multivariate analysis, decreased preoperative eGFR (p=0.001) and RN group (p=0.002) were significant independent predictors.
The results of our study show that decreased preoperative renal function and RN were significant independent predictors of postoperative CKD. In patients who had a relatively decreased preoperative eGFR, especially when estimated by use of the MDRD formula, nephron-sparing surgery should be considered for the treatment of small renal tumors.
PMCID: PMC3866285  PMID: 24363863
Chronic kidney disease; Glomerular filtration rate; Renal cell carcinoma
4.  Bone Cement-Augmented Short Segment Fixation with Percutaneous Screws for Thoracolumbar Burst Fractures Accompanied by Severe Osteoporosis 
The purpose of this study was to determine the efficacy of bone cement-augmented short segment fixation using percutaneous screws for thoracolumbar burst fractures in a background of severe osteoporosis.
Sixteen patients with a single-level thoracolumbar burst fracture (T11-L2) accompanying severe osteoporosis treated from January 2008 to November 2009 were prospectively analyzed. Surgical procedures included postural reduction for 3 days and bone cement augmented percutaneous screw fixation at the fracture level and at adjacent levels without bone fusion. Due to the possibility of implant failure, patients underwent implant removal 12 months after screw fixation. Imaging and clinical findings, including involved vertebral levels, local kyphosis, canal encroachment, and complications were analyzed.
Prior to surgery, mean pain score (visual analogue scale) was 8.2 and this decreased to a mean of 2.2 at 12 months after screw fixation. None of the patients complained of pain worsening during the 6 months following implant removal. The percentage of canal compromise at the fractured level improved from a mean of 41.0% to 18.4% at 12 months after surgery. Mean kyphotic angle was improved significantly from 19.8° before surgery to 7.8 at 12 months after screw fixation. Canal compromise and kyphotic angle improvements were maintained at 6 months after implant removal. No significant neurological deterioration or complications occurred after screw removal in any patient.
Bone cement augmented short segment fixation using a percutaneous system can be an alternative to the traditional open technique for the management of selected thoracolumbar burst fractures accompanied by severe osteoporosis.
PMCID: PMC3488644  PMID: 23133724
Burst fracture; Fusion; Percutaneous
5.  Is Increased Prostatic Urethral Angle Related to Lower Urinary Tract Symptoms in Males with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms? 
Korean Journal of Urology  2012;53(6):410-413.
The prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) was recently reported. We investigated the statistical significance of an increased PUA on the International Prostate Symptom Score (IPSS) in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptom (LUTS).
Materials and Methods
A retrospective analysis was done of 270 men with BPH/LUTS from July 2009 to June 2011. Prostate volume, PUA, and intravesical prostatic protrusion (IPP) were measured by transrectal ultrasonography (TRUS). The IPSS was analyzed separately as storage and voiding symptom score. In order to minimize the effect of prostate size on voiding, patients with prostate size over 40 ml were excluded.
The mean age was 62.0±9.3 years. The mean prostate volume was 29.0±5.5 ml (range, 20 to 40 ml), and median PUA and IPP were 34° (range, 12 to 52°) and 1.7 mm (range, 0 to 5.3 mm), respectively. The mean IPSS, mean IPSS-ss, and mean IPSS-vs were 19.0±8.2, 7.3±4.0, and 11.6±5.5, respectively. The prostate volume had no statistically significant correlation with IPSS, IPSS-ss, or IPSS-vs. IPP had a statistically significant correlation with IPSS (p<0.001), IPSS-ss (p<0.001), and IPSS-vs (p<0.001). PUA had no statistically significant correlation with IPSS or IPSS-ss. However, PUA had a significant correlation with IPSS-vs (p=0.047). Comparing a higher PUA (≥34°) with a lower PUA (<34°), patients with a higher PUA had a higher IPSS (p=0.001) and a higher IPSS-vs (p=0.001). There was no significant difference in IPSS-ss, prostate volume, or PSA between the two groups.
IPP showed significantly correlated with the IPSS and voiding symptom score was affected by the PUA but not by the prostate volume. As the PUA increased, the patients' voiding symptoms worsened. Further study may be needed.
PMCID: PMC3382691  PMID: 22741050
BPH; LUTS; Prostate; Urethra
6.  Function of the Cold Receptor (TRPM8) Associated with Voiding Dysfunction in Bladder Outlet Obstruction in Rats 
Bladder outlet obstruction (BOO) causes storage and voiding dysfunction in the lower urinary tract. We investigated the expression of transient receptor potential cation channel subfamily M member 8 (TRPM8) to evaluate the relationship between TRPM8 expression and overactive bladder (OAB) in a rat model of BOO.
Fifty female Sprague-Dawley rats were divided into 4 groups; normal (n=10), normal-menthol (n=10), BOO (n=15), BOO-menthol (n=15). After 3 weeks, cystometry was performed by infusing physiological saline and menthol (3 mM) into the bladder at a slow infusion rate. The histological changes and expression of TRPM8 in the bladder were investigated by Masson's trichrome staining, immunofluorescence and reverse transcription-polymerase chain reaction.
Cystometry showed that the intercontraction interval (ICI; 428.2±23.4 vs. 880.4±51.2, P<0.001), micturition pressure (MP; 25.7±1.01 vs. 71.80±3.01, P<0.001), and threshold pressure (2.9±0.25 vs. 9.2±1.58, P<0.01) were significantly increased in BOO rats. The bladder wall was significantly dilated compared with the control. Detrusor muscle hypertrophy and a thick mucosa layer were observed in BOO bladder. After menthol treatment, ICIs were decreased and MPs were increased in the menthol treatment groups. TRPM8-positive cells and mRNA were predominantly increased in the bladder and dorsal root ganglia of all groups compared with the normal group.
Increased bladder wall thickness and proportion of collagen probably affect voiding dysfunction. Furthermore, an increase of TRPM8 expression in BOO may induce entry of Ca2+ from the extracellular space or stores. The increase of Ca2+ probably causes contraction of smooth muscle in BOO. However, OAB symptoms were not observed after menthol treatment although the expression of TRPM8 was abundant in the bladder epithelium after menthol treatment. Although OAB in BOO models may be caused by complex pathways, regulation of TRPM8 presents possibilities for OAB treatment.
PMCID: PMC3395802  PMID: 22816047
TRPM8; Menthol; Cold receptor; Bladder outlet obstruction
7.  Renal Abscesses Measuring 5 cm or Less: Outcome of Medical Treatment without Therapeutic Drainage 
Yonsei Medical Journal  2010;51(4):569-573.
Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment.
Materials and Methods
Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone.
Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM.
Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.
PMCID: PMC2880271  PMID: 20499424
Abscess; kidney; antibiotics; infection

Results 1-7 (7)