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1.  The Dark Side of 5α-Reductase Inhibitors' Therapy: Sexual Dysfunction, High Gleason Grade Prostate Cancer and Depression 
Korean Journal of Urology  2014;55(6):367-379.
With aging, abnormal benign growth of the prostate results in benign prostate hyperplasia (BPH) with concomitant lower urinary tract symptoms (LUTS). Because the prostate is an androgen target tissue, and transforms testosterone into 5α-dihydrotestosterone (5α-DHT), a potent androgen, via 5α-reductase (5α-R) activity, inhibiting this key metabolic reaction was identified as a target for drug development to treat symptoms of BPH. Two drugs, namely finasteride and dutasteride were developed as specific 5α-reductase inhibitors (5α-RIs) and were approved by the U.S. Food and Drug Administration for the treatment of BPH symptoms. These agents have proven useful in the reducing urinary retention and minimizing surgical intervention in patients with BPH symptoms and considerable literature exists describing the benefits of these agents. In this review we highlight the adverse side effects of 5α-RIs on sexual function, high grade prostate cancer incidence, central nervous system function and on depression. 5α-Rs isoforms (types 1-3) are widely distributed in many tissues including the central nervous system and inhibition of these enzymes results in blockade of synthesis of several key hormones and neuro-active steroids leading to a host of adverse effects, including loss of or reduced libido, erectile dysfunction, orgasmic dysfunction, increased high Gleason grade prostate cancer, observed heart failure and cardiovascular events in clinical trials, and depression. Considerable evidence exists from preclinical and clinical studies, which point to significant and serious adverse effects of 5α-RIs, finasteride and dutasteride, on sexual health, vascular health, psychological health and the overall quality of life. Physicians need to be aware of such potential adverse effects and communicate such information to their patients prior to commencing 5α-RIs therapy.
doi:10.4111/kju.2014.55.6.367
PMCID: PMC4064044  PMID: 24955220
5α-Reductase inhibitors; Depression; Physiological sexual dysfunction; Prostate neoplasms
2.  Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy With the Novel Da Vinci Single-Site Platform: Initial Experience 
Korean Journal of Urology  2014;55(6):380-384.
Purpose
To report our initial clinical cases of robotic laparoendoscopic single-site (R-LESS) partial nephrectomy (PN) performed with the use of the novel Da Vinci R-LESS platform.
Materials and Methods
Three patients underwent R-LESS PN from November 2013 through February 2014. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted.
Results
Operative time and estimated blood loss volume ranged between 100 and 110 minutes and between 50 and 500 mL, respectively. None of the patients was transfused. All cases were completed with the off-clamp technique, whereas one case required conversion to the conventional (multiport) approach because of difficulty in creating the appropriate scope for safe tumor resection. No major postoperative complications occurred, and all tumors were resected in safe margins. Length of hospital stay ranged between 3 and 7 days. The lack of EndoWrist movements, the external collisions, and the bed assistant's limited working space were noticed to be the main drawbacks of this surgical method.
Conclusions
Our initial experience with R-LESS PN with the novel Da Vinci platform shows that even though the procedure is feasible, it should be applied in only appropriately selected patients. However, further improvement is needed to overcome the existing limitations.
doi:10.4111/kju.2014.55.6.380
PMCID: PMC4064045  PMID: 24955221
Kidney neoplasms; Robotics
3.  Impact of Histopathological Variant on the Outcome of Patients Treated by Radical Cystectomy 
Korean Journal of Urology  2014;55(6):385-389.
Purpose
It is well established that muscle-invasive urothelial carcinoma (UC) has a marked propensity for divergent differentiation, a fact that has significant diagnostic, prognostic, and therapeutic implications. This work is designed to assess the impact of different histopathologic variants of bladder cancer on morbidity and mortality in patients undergoing radical cystectomy (RC) as compared to the impact in patients with conventional UC.
Materials and Methods
We reviewed records of 201 patients treated with RC and pelvic lymph node dissections. Demographics as well as clinico-pathologic parameters, including histopathological variant, tumor stage, and nodal status, were reviewed. Multivariate analyses were used to evaluate these parameters for overall survival (OS). Kaplan-Meier curves for overall and cancer-specific survival were plotted.
Results
The majority of patients were male (84%), and the mean age was 61±13.1 years (range, 27-87 years). The mean follow-up was 67 months (range, 6-132 months). A histological variant of UC tumor was found in 19 patients (11%). The OS was 55%, and the cancer-specific survival was 35%. The histopathologic variance showed significant impact on morbidity and mortality (p=0.02 and p=0.05, respectively). Patients with divergent histopathology of bladder tumor have poorer survival than do those with UC in a multivariate analysis.
Conclusions
The pathologic stages at RC and lymph node involvement are predictors for OS. Because of its aggressive nature, histopathologic variance is an independent risk factor determining the outcome in terms of both morbidity and mortality.
doi:10.4111/kju.2014.55.6.385
PMCID: PMC4064046  PMID: 24955222
Epithelial neoplasms; Malignant; Urinary bladder neoplasms
4.  A Comparison Between ThinPrep Monolayer and Cytospin Cytology for the Detection of Bladder Cancer 
Korean Journal of Urology  2014;55(6):390-394.
Purpose
The sensitivity of urine cytology is higher for carcinoma in situ and poorly differentiated tumors in bladder cancer, while being fairly low for low-grade or well-differentiated tumors. Development of a sensitive diagnostic test to detect bladder carcinoma would significantly facilitate patient management and allow earlier treatment of this disease. This study compared ThinPrep urine cytology (Cytyc Co.) and conventional Cytospin urine cytology (Shandon Scientific Ltd.) in the diagnosis of bladder cancer.
Materials and Methods
From January 2002 to December 2010, ThinPrep cytology and conventional urine Cytospin cytologic examination of bladder washings were performed in 3,085 subjects suspected of having bladder cancer and in 379 patients with follow-up after transurethral resection of bladder tumor (TUR-BT). The sensitivity and specificity of the urine ThinPrep test was compared with that of conventional Cytospin cytology according to tumor number, size, pathological stage, grade, and recurrence.
Results
Of 3,085 subjects, bladder cancer was confirmed by TUR-BT in 379 subjects. The overall sensitivity of ThinPrep and Cytospin cytology was 60.9% and 59.9% in patients suspected of having bladder cancer, respectively. The overall specificity of ThinPrep and Cytospin cytology was 94.8% and 95.3% in patients suspected of having bladder cancer, respectively. The sensitivity of ThinPrep and Cytospin cytology was increased with increasing number, size, pathological stage, and grade, but there was no significant difference between the two tests.
Conclusions
These results suggest that ThinPrep cytology has no advantage in the diagnosis of bladder cancer of a low grade or low stage.
doi:10.4111/kju.2014.55.6.390
PMCID: PMC4064047  PMID: 24955223
Cytospin cytology; ThinPrep; Urinary bladder neoplasm
5.  Does the Time From Biopsy to Radical Prostatectomy Affect Gleason Score Upgrading in Patients With Clinical T1c Prostate Cancer? 
Korean Journal of Urology  2014;55(6):395-399.
Purpose
It is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU).
Materials and Methods
A total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p<0.05.
Results
GSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU.
Conclusions
We suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.
doi:10.4111/kju.2014.55.6.395
PMCID: PMC4064048  PMID: 24955224
Biopsy; Gleason score; Prostate neoplasms; Prostatectomy
6.  The Changes of Voiding Pattern After Midurethral Sling Between Pure Stress Urinary Incontinence and Stress Urinary Incontinence With Overactive Bladder Group 
Korean Journal of Urology  2014;55(6):400-404.
Purpose
The purpose of this study is to compare changes in voiding pattern after midurethral sling surgery (MUS) between the stress urinary incontinence (SUI) group and the overactive bladder (OAB)+SUI group.
Materials and Methods
From January 2008 to February 2011, a retrospective survey was conducted of 225 female patients who had been diagnosed with SUI and undergone MUS. The subjects were divided into the SUI group and the OAB+SUI group. Changes in the overactive bladder symptom score (OABSS) and American Urological Association-Symptom Index (AUA-SI) before and three months after the MUS were compared.
Results
Of the 225 patients, 165 patients (73.3%) were classified as SUI group, and 60 patients (26.7%) were classified as OAB+SUI group. The mean age of the subjects was 54.7 years (range, 31-80 years), and the mean age of patients was 53.9 years (range, 34-80 years), and 56.8 years (range, 31-78 years) in the SUI group and OAB+SUI group. In SUI group, voiding symptom and storage symptom among the AUA-SI were significantly increased (p<0.05). OABSS were slight increased, but was statistically insignificant (p=0.847). In OAB+SUI group, voiding symptom score and OABSS showed a significant increase (p<0.05), but storage symptom score showed an insignificant increase (p=0.790).
Conclusions
OAB may occur in approximately 18% of SUI patients who undergo MUS surgery, and voiding dysfunctions with deteriorated voiding symptom and storage symptom may also occur. The deteriorated OAB was shown in 45% of SUI patients with OAB after the surgery.
doi:10.4111/kju.2014.55.6.400
PMCID: PMC4064049  PMID: 24955225
Midurethral sling; Overactive bladder; Stress urinary incontinence; Urge incontinence
7.  A Population-Based Study of Factors Associated With Nocturia in Reproductive-Aged Turkish Women 
Korean Journal of Urology  2014;55(6):405-410.
Purpose
This study aimed to investigate the prevalence of nocturia according to the International Continence Society (ICS) definition in Turkish women and to determine the associated risk factors and the correlation of other voiding symptoms with nocturia.
Materials and Methods
A prospective epidemiological study was carried out by use of self-reported questionnaires in 4,250 reproductive-aged women from January 2013 to May 2013. The International Consultation on Incontinence Questionnaire-Short Form and a questionnaire developed by the researchers according to the ICS were administered to define nocturia and other lower urinary tract symptoms. Other physical, reproductive, and health characteristics were also recorded concurrently.
Results
Overall, 1,636 women were included in the final analyses. The women had an average age of 34.4±5.26 years. The overall prevalence of nocturia was 34.7% (567 of 1,636 women). Women with nocturia were older (p<0.001), had a higher body mass index (p=0.026), and had more children (p<0.001). Nocturia occurred more frequently in women with a history of nocturnal enuresis (p<0.001). Three or more pregnancies, 3 or more deliveries, and age >40 years were significant risk factors for nocturia. We also found that other lower urinary tract symptoms correlated significantly (p<0.001) with nocturia.
Conclusions
Although the prevalence of nocturia is higher with increasing age, younger adults are also affected. Nocturia may cause sleep disorders, mood disturbances, reduced quality of life, and distractibility. Thus, even if one void nightly causes a patient to experience bother, nocturia should be queried about and should be treated if necessary according to the cause of the disease.
doi:10.4111/kju.2014.55.6.405
PMCID: PMC4064050  PMID: 24955226
Nocturia; Nocturnal enuresis; Risk factors; Women
8.  Effect of Potassium Magnesium Citrate and Vitamin B-6 Prophylaxis for Recurrent and Multiple Calcium Oxalate and Phosphate Urolithiasis 
Korean Journal of Urology  2014;55(6):411-416.
Purpose
To study the effects of long-term treatment with potassium magnesium citrate and vitamin B-6 prophylaxis (Urikind-KM6; 1,100-mg potassium citrate, 375-mg magnesium citrate, and 20-mg pyridoxine hydrochloride/5 mL) every 8 hours over 3 years.
Materials and Methods
A total of 247 patients with recurrent idiopathic hypocitraturia with or without hyperuricosuria and randomized controls were studied prospectively for 3 years. The total patients were divided into three groups. Control group 1 consisted of 61 patients (24.7%) who had moderate to severe hypocitraturia with or without hyperuricosuria and were recurrent stone formers but discontinued prophylaxis because of drug intolerance within 1 month of therapy. Control group 2 constituted 53 patients (21.5%) who were first-time stone formers and who had mild hypocitraturia with or without hyperuricosuria and were not put on prophylactic therapy and were followed for 3.16±0.08 years. Control group 3 constituted 133 patients (54.8%) who were recurrent stone formers who had moderate to severe hypocitraturia with or without hyperuricosuria and were put on prophylaxis therapy and were followed for 3.16±0.08 years. All patients were followed up at 6-month intervals.
Results
Potassium magnesium citrate prophylaxis produced a sustained increase in 24-hour urinary citrate excretion from initially low values (221.79±13.39 mg/dL) to within normal to high limits (604.04±5.00 mg/dL) at the 6-month follow-up. Urinary pH rose significantly from 5.62±0.2 to 6.87±0.01 and was maintained at 6.87±0.01. The stone recurrence rate declined from 3.23±1.04 per patient per year to 0.35±0.47 per patient per year.
Conclusions
Potassium magnesium citrate prophylaxis was effective in reducing the recurrence of calcium oxalate and phosphate urolithiasis.
doi:10.4111/kju.2014.55.6.411
PMCID: PMC4064051  PMID: 24955227
Calcium oxalate; Potassium-magnesium citrate; Pyridoxine; Urolithiasis
9.  Beta-Defensin 124 Is Required for Efficient Innate Immune Responses in Prostate Epithelial RWPE-1 Cells 
Korean Journal of Urology  2014;55(6):417-425.
Purpose
The present study aimed to determine the role played by β-defensin 124 (DEFB124) in the innate immunity of prostate epithelial RWPE-1 cells during bacterial infection.
Materials and Methods
The expression of DEFB124 was examined by quantitative real-time polymerase chain reaction (PCR), Western blotting, and immunocytochemistry. Enzyme-linked immunosorbent assays and quantitative real-time PCR were performed to determine the production of cytokines and chemokines. Western blotting and chromatin immunoprecipitation studies were performed to assess the interaction between DEFB124 and nuclear factor-kappa B (NF-κB) in peptidoglycan (PGN)-stimulated RWPE-1 cells. By chemotaxis assay, we assessed the effect of DEFB124 on the migration of monocytes.
Results
Exposure to PGN induced DEFB124 upregulation and NF-κB activation through IκBα phosphorylation and IκBα degradation. Bay11-7082, an NF-κB inhibitor, blocked PGN-induced DEFB124 production. Also, NF-κB was shown to be a direct regulator and to directly bind to the -3.14 kb site of the DEFB124 promoter in PGN-treated human prostate epithelial RWPE-1 cells. When DEFB124 was overexpressed in RWPE-1 cells, interestingly, the production of cytokines (interleukin [IL] 6 and IL-12) and chemokines (CCL5, CCL22, and CXCL8) was significantly increased. These DEFB124-upregulated RWPE-1 cells markedly induced chemotactic activity for THP-1 monocytes.
Conclusions
Taken together, these results provide strong evidence for the first time that increased DEFB124 expression via NF-κB activation in PGN-exposed RWPE-1 cells enhances the production of cytokines and chemokines, which may contribute to an efficient innate immune defense.
doi:10.4111/kju.2014.55.6.417
PMCID: PMC4064052  PMID: 24955228
Chemotaxis; Cytokines/chemokines; Defensins; Innate immunity; NF-kappa B
10.  Glued Angiocatheter: A Rare Complication of Intrarenal Pseudoaneurysm Glue Angioembolization 
Korean Journal of Urology  2014;55(6):426-429.
Endovascular management of intraparenchymal renal artery pseudoaneurysms is a reasonable and effective therapeutic technique. Endovascular management preserves the maximum amount of renal tissue and reduces the potential risk of nephrectomy. We present the case of an angiocatheter that became stuck in the renal artery following the injection of cyanoacrylate glue for angioembolization of an intrarenal pseudoaneurysm.
doi:10.4111/kju.2014.55.6.426
PMCID: PMC4064053  PMID: 24955229
Adhesives; False aneurysm; Percutaneous nephrostomy; Therapeutic embolization
11.  Urothelial Tumors of the Urinary Bladder in Two Adolescent Patients: Emphasis on Follow-up Methods 
Korean Journal of Urology  2014;55(6):430-433.
Here we describe two cases of papillary urothelial neoplasm of low malignant potential in adolescent boys. One case was a 16-year-old boy with a polypoid mass beside the right ureteral orifice and the other case was a 13-year-old boy with a papillary mass beside the left ureteral orifice. The initial presentation was hematuria in both cases and the bladder mass was detected by ultrasonography. Complete resection of the bladder tumor was performed by using an 11-Fr pediatric resectoscope. Follow-up has been performed with urine analysis, urine cytology, and bladder ultrasonography or cystoscopy every 3 months with no evidence of recurrence.
doi:10.4111/kju.2014.55.6.430
PMCID: PMC4064054  PMID: 24955230
Adolescent; Urinary bladder neoplasms
13.  Penile Low-Intensity Shock Wave Therapy: A Promising Novel Modality for Erectile Dysfunction 
Korean Journal of Urology  2014;55(5):295-299.
Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood flow and endothelial function. In a series of clinical trials, including randomized double-blind sham-controlled studies, LIST has been shown to have a substantial effect on penile hemodynamics and erectile function in patients with vasculogenic ED. LIST is effective in patients who are responsive to phosphodiesterase 5 inhibitors (PDE5i) and can also convert PDE5i nonresponders to responders. The response to LIST wanes gradually over time, and after 2 years, about half of the patients maintain their function. Extensive research is needed to understand the effect of LIST on erectile tissue, to modify the treatment protocol to maximize its outcomes, and to identify the patients who will benefit the most from this treatment.
doi:10.4111/kju.2014.55.5.295
PMCID: PMC4026654  PMID: 24868332
Erectile dysfunction; Penile; Shockwave treatment; Therapy
14.  Epidemiology of Lower Urinary Tract Symptoms: Emphasis on the Status in Korea 
Korean Journal of Urology  2014;55(5):300-308.
A comprehensive and correct understanding of epidemiologic finding about lower urinary tract symptoms (LUTS) is important for several reasons. First, LUTS are highly prevalent in both genders all around the world and are expected to be a major concern to physicians in the near future because of the rapid rise in the elderly population. Second, it is crucial to observe trends in prevalence when national health care policy is established. By using a Medline search with various terms related to LUTS and prevalence, a review of epidemiologic studies was undertaken with an emphasis on the status in Korea. Despite the suggestions made by the International Continence Society, the lack of uniform definitions and the lack of a unified threshold of symptoms are the biggest obstacles in epidemiologic study with regard to LUTS. Most Korean epidemiologic studies on LUTS have been reported since 2000 and reveal that the prevalences of specific clinical conditions, such as LUTS, benign prostatic hyperplasia, overactive bladder, and detrusor underactivity, are in line with prevalences in Western counties. However, the prevalence of nocturia is somewhat different from that in Western countries. Many epidemiologic studies of LUTS have provided us with valuable information and a better understanding of the clinical conditions. Given that the impact of these clinical conditions on quality of life and health care cost will be emphasized more in the near future, more studies on optimal management approaches to LUTS are needed on the basis of this knowledge.
doi:10.4111/kju.2014.55.5.300
PMCID: PMC4026655  PMID: 24868333
Epidemiology; Korea; Lower urinary tract symptoms; Urinary bladder
15.  Pulmonary Metastases After Low-Dose-Rate Brachytherapy for Localized Prostate Cancer 
Korean Journal of Urology  2014;55(5):309-314.
Purpose
To analyze unusual events and focus discussion on pulmonary metastasis in particular after low-dose-rate brachytherapy (LDR-BT) for prostate cancer (PCa).
Materials and Methods
A total of 616 consecutive patients who had undergone LDR-BT for clinically localized PCa at Jikei University Hospital between October 2003 and April 2010 were enrolled in this study. Follow-up information was summarized, and patterns of biochemical recurrence and clinical outcome were investigated.
Results
Disease risk was stratified as low-risk in 231 patients, intermediate-risk in 365, and high-risk in 20, respectively. Of these patients, 269 (43.7%) had received hormonal therapy (HT) in combination with LDR-BT, and 80 (13.0%) had received external beam radiotherapy (EBRT). Average dosimetric parameter values with and without EBRT were 95.3% and 94.2% for V100, 132.8 Gy and 164.2 Gy for D90, and 180.6 Gy2 and 173.7 Gy2 for the biologically effective dose. Biochemical recurrence was noted in 14 patients (6.1%) in the low-risk group, 25 patients (6.8%) in the intermediate-risk group, and 6 patients (30.0%) in the high-risk group, respectively. In these cases of biochemical recurrence, 9 (64.3%), 13 (52.0%), and 4 patients (66.7%) in each respective risk group showed signs of clinical recurrence. Five patients (19.2%) with clinical recurrence developed pulmonary metastases, of which 4 were isolated lesions. All tumors responded favorably to subsequent HT.
Conclusions
LDR-BT for biologically aggressive PCa may be linked to possible pulmonary metastasis owing to tumor dissemination during seed implantation. This information is important in planning adequate treatment for these patients.
doi:10.4111/kju.2014.55.5.309
PMCID: PMC4026656  PMID: 24868334
Brachytherapy; Neoplasm metastasis; Prostate neoplasms
16.  Efficacy of Bicalutamide 150-mg Monotherapy Compared With Combined Androgen Blockade in Patients With Locally Advanced Prostate Cancer 
Korean Journal of Urology  2014;55(5):315-320.
Purpose
We compared the efficacy, survival rate, and adverse events between bicalutamide 150-mg monotherapy and combined androgen blockade (CAB) in men with locally advanced prostate cancer.
Materials and Methods
From March 2003 to July 2012, we retrospectively included 74 patients who were treated for more than 3 months and were followed up for more than 6 months. 25 men were treated with bicalutamide 150-mg only (group 1) and 49 men received CAB (group 2). Serum prostate-specific antigen (PSA) change, survival rate, and adverse events were compared between the 2 groups.
Results
The PSA levels before and after treatment were 37.0±32.8 ng/mL and 9.5±27.0 ng/mL in group 1 (p<0.001) and 50.2±40.0 ng/mL and 20.0±35.8 ng/mL in group 2 (p<0.001). Mean survival rates were 78.9% in group 1 and 52.3% in group 2 (p=0.055). There were no statistically significant differences in adverse events between the 2 groups (p=0.304). The International Index of Erectile Function 5 (IIEF-5) score before treatment was 19.3±5.9 in group 1 and 18.3±5.8 in group 2 (p=0.487). The IIEF-5 score after treatment was 17.1±6.3 in group 1 and 14.0±6.1 in group 2, which was a statistically significant difference (p=0.036).
Conclusions
The PSA change, mean survival rate, and adverse events in patients with locally advanced prostate cancer treated with bicalutamide 150-mg and CAB did not differ significantly. However, sexual function was better in the bicalutamide 150-mg group. Therefore, bicalutamide 150-mg monotherapy could be considered as a treatment for locally advanced prostate cancer in patients concerned about sexual function.
doi:10.4111/kju.2014.55.5.315
PMCID: PMC4026657  PMID: 24868335
Bicalutamide; Prostatic neoplasms; Therapy
17.  Predictive Value of the Cancer of the Prostate Risk Assessment Score for Recurrence-Free Survival After Radical Prostatectomy in Korea: A Single-Surgeon Series 
Korean Journal of Urology  2014;55(5):321-326.
Purpose
To evaluate the validity of the cancer of the prostate risk assessment (CAPRA) score, a newly developed nomogram for preoperative prediction of recurrence after radical prostatectomy, in a single institution in Korea.
Materials and Methods
We retrospectively studied 115 men who had undergone radical prostatectomy as the first treatment for localized prostate cancer. The validity of the CAPRA score for the prediction of recurrence-free survival (RFS) and pathologic outcome was evaluated by using Kaplan-Meier analysis and a proportional hazards regression model. A seven-group model and a three-group model were used for the results.
Results
None of the variables of the CAPRA score was favorable compared with the previously reported data. The three-group model was significantly related with 3- and 5-year RFS (p<0.05), but the seven-group model was not. The concordance indices of the CAPRA score were 0.74 and 0.77. Of four components excluding the clinical T stage, three independently predicted RFS (age, Gleason sum, and percentage of positive biopsies). The CAPRA score was significantly related to the margin status, extracapsular extension, and seminal vesicle invasion in both the seven- and three-group models. In the three-group model, pathologic outcomes were more strongly related, especially a higher risk of seminal vesicle invasion.
Conclusions
The CAPRA score showed high accuracy for predicting RFS. In particular, the three-group model was more useful for predicting RFS and pathologic outcomes. Therefore, the CAPRA score may be a useful prediction model for risk stratification and may help clinicians to develop localized prostate cancer treatment.
doi:10.4111/kju.2014.55.5.321
PMCID: PMC4026658  PMID: 24868336
Nomograms; Prostatectomy; Prostatic neoplasms; Recurrence
18.  Prognosis of Prostate Cancer With Other Primary Malignancies 
Korean Journal of Urology  2014;55(5):327-334.
Purpose
The objective was to investigate the clinicopathological characteristics and the prognosis of prostate cancer patients affected by other primary malignancies.
Materials and Methods
From 1990 to 2008, we retrospectively reviewed the medical records of 1,317 patients who underwent radical prostatectomy (RP) for prostate cancer. We assessed the effect of other primary malignancies on clinicopathological features, biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS), and overall survival (OS).
Results
Of 1,317 patients, at least one additional other primary malignancy was detected in 187 patients (14.2%). A comparison of patient groups according to the presence or absence of other primary malignancies showed no significant differences in preoperative serum prostate-specific antigen concentrations, pathological Gleason scores, or pathological staging. Prostate cancer patients with other primary malignancies were older than patients without other primary malignancies (p<0.001). No significant differences in 5-year BCR-free survival (80.2% compared with 77.7%; p=0.656) or CSS (98.9% compared with 98.5%; p=0.733) were found between these groups, respectively. Five-year OS was significantly lower in prostate cancer patients with than in those without other primary malignancies (89.3% compared with 95.4%; p<0.001). Multivariate analysis showed that other primary malignancies diagnosed after RP for prostate cancer were independent predictors of OS (hazard ratio, 4.10; p<0.001) but not of BCR-free survival or CSS. Conversely, other primary malignancies diagnosed before RP for prostate cancer did not independently predict BCR-free survival, OS, or CSS.
Conclusions
Prostate cancer prognosis after RP is not dependent on the presence or absence of other primary malignancies. However, other primary malignancies diagnosed after RP for prostate cancer negatively affect OS.
doi:10.4111/kju.2014.55.5.327
PMCID: PMC4026659  PMID: 24868337
Neoplasms; Prognosis; Prostate; Recurrence
19.  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.
Purpose
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.
Results
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.
Conclusions
Silodosin 8 mg once daily may be effective and safe in Korean patients with severe LUTS associated with BPH.
doi:10.4111/kju.2014.55.5.335
PMCID: PMC4026660  PMID: 24868338
α1A-Adrenoceptor antagonis; Benign prostatic hyperplasia; Lower urinary tract symptoms; Selective; Silodosin
20.  Chronic Lower Urinary Tract Symptoms in Young Men Without Symptoms of Chronic Prostatitis: Urodynamic Analyses in 308 Men Aged 50 Years or Younger 
Korean Journal of Urology  2014;55(5):341-348.
Purpose
We investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS.
Materials and Methods
We reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (≥6 months) without symptoms suggestive of chronic prostatitis.
Results
The men's mean age was 40.4 (±10.1) years and their mean duration of symptoms was 38.8 (±49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01).
Conclusions
Because clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.
doi:10.4111/kju.2014.55.5.341
PMCID: PMC4026661  PMID: 24868339
Age groups; Men; Prevalence; Urinary bladder disease; Urodynamics
21.  Unexpected Multidrug Resistance of Methicillin-Resistant Staphylococcus aureus in Urine Samples: A Single-Center Study 
Korean Journal of Urology  2014;55(5):349-353.
Purpose
Infections of methicillin-resistant Staphylococcus aureus (MRSA) are becoming an increasingly concerning clinical problem. The aim of this study was to assess the development of MRSA in urine cultures in a major public university-affiliated hospital and the therapeutical and hygiene-related possibilities for reducing resistance.
Materials and Methods
This study included 243 samples from patients diagnosed with MRSA infection over a period of 6 years. An agar diffusion test measured the effects of antimicrobial agents against bacteria grown in culture. The analyses were based on the guidelines of the Clinical and Laboratory Standards Institute.
Results
A regression analysis was performed, which showed 100% resistance to the following antibiotics throughout the entire testing period: carbapenem, cephalosporin (1st-4th generation), penicillin G, aminopenicillin, β-lactamase, and isoxazolyl penicillin. However, a significant decrease in resistance was found for amikacin, gentamicin, clindamycin, levofloxacin, erythromycin, and mupirocin.
Conclusions
MRSA showed a decreasing trend of antimicrobial resistance, except against carbapenem, cephalosporin (1st-4th generation), penicillin G, aminopenicillin, β-lactamase, and isoxazolyl penicillin, for which complete resistance was observed.
doi:10.4111/kju.2014.55.5.349
PMCID: PMC4026662  PMID: 24868340
Methicillin-resistant Staphylococcus aureus; Multidrug resistance; Urine
22.  Instillation of Hyaluronic Acid via Electromotive Drug Administration Can Improve the Efficacy of Treatment in Patients With Interstitial Cystitis/Painful Bladder Syndrome: A Randomized Prospective Study 
Korean Journal of Urology  2014;55(5):354-359.
Purpose
In the treatment of interstitial cystitis, intravesical hyaluronic acid application may be suggested as a treatment option. In this randomized prospective study, the authors aimed to identify whether instilling the hyaluronic acid with electromotive drug administration (EMDA) would increase the tissue uptake and improve the efficacy.
Materials and Methods
The data of 31 patients who had been diagnosed with bladder pain syndrome/interstitial cystitis (BPS/IC) between 2004 and 2005 were examined. The patients were randomized to two groups: patients in group A received hyaluronic acid directly with a catheter and patients in group B received hyaluronic acid with EMDA. The patients were followed for 24 months and the two groups were compared at certain time intervals. The primary end points of the study were visual analogue scale (VAS) score, global response assessment, and micturition frequency in 24 hours.
Results
There were 6 males and 25 females. The two groups were similar in baseline parameters. The decrease in VAS score and the micturition frequency in 24 hours were significantly lower with EMDA at months 6 and 12. The difference between the two groups was not significant at months 1 and 24. Also, treatment with EMDA, positive KCl test, and pretreatment voiding frequency >17 were associated with higher response rates.
Conclusions
Hyaluronic acid installation is an effective glycosaminoglycan substitution therapy in patients with BPS/IC. Instillation of hyaluronic acid via EMDA can improve the efficacy of the treatment; however, lack of long-term efficacy is the major problem with this glycosaminoglycan substitution therapy.
doi:10.4111/kju.2014.55.5.354
PMCID: PMC4026663  PMID: 24868341
Hyaluronic acid; Interstitial cystitis; Painful bladder syndrome
23.  Misplacement or Migration? Extremely Rare Case of Cardiac Migration of a Ureteral J Stent 
Korean Journal of Urology  2014;55(5):360-362.
A 29-year-old woman with mild back pain when coughing and suprapubic discomfort after voiding was admitted to Pusan National University Hospital. Two weeks earlier, she had undergone a hysterectomy and right-sided ureteroneocystostomy for uterine atony and right ureteral injury with bladder rupture. Computed tomography showed that a ureteral J stent extended from the right ovarian vein to the right cardiac chamber. The stent was retrieved via both femoral veins with a snare loop and pigtail catheter. Computed tomography showed that the urinary and vascular tracts were normal 5 months after the procedure.
doi:10.4111/kju.2014.55.5.360
PMCID: PMC4026664  PMID: 24868342
Foreign-body migration; Heart; Stents
24.  Large Bilateral Adrenal Leiomyomas Presenting as Calcified Adrenal Masses: A Rare Case Report 
Korean Journal of Urology  2014;55(5):363-366.
We report the case of a 55-year-old woman with bilateral, large, calcified adrenal tumors who was treated by laparoscopic adrenalectomy. The patient presented with upper abdominal discomfort for the past 5 years. Her imaging showed bilateral enlarged adrenal glands up to 10-cm size with punctate calcifications. Positron emission tomography scan demonstrated moderate fluorodeoxyglucose avidity in the left adrenal mass. Bilateral laparoscopic adrenalectomy was performed through a transperitoneal approach. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology findings were consistent with adrenal leiomyomatosis.
doi:10.4111/kju.2014.55.5.363
PMCID: PMC4026665  PMID: 24868343
Adrenal gland neoplasm; Adrenalectomy; Laparoscopy; Leiomyoma
25.  Dilemmas Over the Decision to Perform Repeat Prostate Biopsies 
Korean Journal of Urology  2014;55(4):227.
doi:10.4111/kju.2014.55.4.227
PMCID: PMC3988431  PMID: 24741409

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