• 대한비뇨기종양학회지
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• 제16권3호
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• pp.89-96
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• 2018

Upper tract urothelial carcinoma (UTUC) has a relatively low prevalence rate of about 1.8 per 100,000 people. According to the recent literature, the development of diagnostic techniques has gradually increased the prevalence and diagnosis rate. In the past, when UTUC was diagnosed, more than 60% of the patients were diagnosed as locally advanced or metastatic cancer. However, since 2010, approximately 70% of the patients have been diagnosed as operable stage. Although radical nephroureterectomy is known as the basis of treatment for UTUC, overall survival is poor in patients with lymph node invasion. Especially, the finding that a localized UTUC is associated with a high risk of cancer metastasis in approximately 50% of patients suggests that these patients may not have sufficient treatment through surgery alone. The European Association of Urology and the National Comprehensive Cancer Network guideline 2017 suggested that postoperative adjuvant chemotherapy may be considered in patients with advanced UTUC beyond pT2. Also, recent meta-analyses have reported that cisplatin-based adjuvant chemotherapy can be expected to have a synergistic effect of overall survival and disease-free survival. However, many patients with UTUC undergo postoperative renal failure, which may result in failure to perform cisplatin-based adjuvant chemotherapy with adequate dose. For this reason, several researchers have suggested that it is beneficial to apply neoadjuvant chemotherapy when the preoperative renal function is maintained to a certain extent. But, neoadjuvant chemotherapy has not been used by many clinicians because of the lack of studies and the rarity of the disease. We are currently discussing the outcomes and prospects of perioperative chemotherapy.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.383-391
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• 2018

Purpose: We aimed to analyze the incidence and prevalence of urolithiasis in Korea over the last decade using the National Health Insurance (NHI) sample cohort data. Materials and Methods: From January 2002 to December 2013, we enrolled sample cohort data from the NHI. Patients diagnosed with international classification of diseases code N20 or N13.2 were included. The incidence and prevalence rate was counted from the same period and patients previously diagnosed with urolithiasis were excluded. We compared the incidence and prevalence of urolithiasis by region, age, and sex, and identified the changes. Results: Total 1,111,828 subjects were included. Of these subjects, 36,857 had urolithiasis. The male-to-female ratio was 1.57:1, and total incidence rate was 3.27 per 1,000 person-years (1,000p-yrs). The annual incidence was lowest in 2013 (3,138 patients) and highest in 2005 (3,751 patients). Incidence rate by diagnostic code was highest in ureter stone only (2.49 per 1,000p-yrs) and was lowest in kidney and ureter stone both (0.17 per 1,000p-yrs). Prevalence gradually increased from 3,172 in 2002 and 5,758 in 2013. Jeollanam-do had the highest incidence rate of 3.70 persons per 1,000p-yrs, and Jeju had the lowest rate of 2.84 persons per 1,000p-yrs. In gender analysis, Daegu had the highest incidence (4.56) in males, Jeollanam-do had the highest incidence (3.20) in females. Conclusions: Annual incidence remained stable, whereas prevalence gradually increased. The incidence in male was 1.57 times higher than female, and the peak incidence age was 45-49 years, with the highest incidence occurring in Jeollanam-do and the lowest in Jeju.

• Urogenital Tract Infection
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• 제13권3호
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• pp.66-71
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• 2018

Purpose: To determine the appropriate regimen of antibiotic prophylaxis for the prevention of bacterial infections in patients receiving percutaneous nephrolithotomy (PCNL). Materials and Methods: Forty patients, who planned to undergo PCNL from October 2015 to August 2017, were assigned randomly into two groups. Patients in the single-dose group (n=20) were administered an intravenous single dose of 2 g ceftriaxone 30 minutes before PCNL, whereas those in the three-days regimen group (n=20) were administered a preoperative intravenous single dose of 2 g ceftriaxone and an additional postoperative oral cefpodoxime proxetil (100 mg twice a day) for three days. The incidences of infectious complications in the two groups, such as pyrexia, systemic inflammatory response syndrome (SIRS), and sepsis, were compared. Results: Fever (axillary temperature >$38.0^{\circ}C$) did not develop in any of the patients in the single-dose group but developed in one patient (5.0%) in the three-day regimen group due to pneumonia (p=0.3). SIRS developed in a total of eight patients (20.0%), four patients from each group. None of the patients in either group developed sepsis after PCNL. Conclusions: The three-day prophylactic antibiotic regimen did not demonstrate better efficacy for the prevention of bacterial infections in patients with PCNL compared to the single-dose prophylactic antibiotic regimen.

• Urogenital Tract Infection
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• 제13권3호
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• pp.51-57
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• 2018

Purpose: The effects of Lactobacillus fermentation extract (LFE) on cystitis induced by Escherichia coli lipopolysaccharide (LPS) in the mouse bladder were investigated by pathological analyses and measurement of the levels of tumor necrosis factor-alpha ($TNF-{\alpha}$) and interleukin-18 (IL-18). Materials and Methods: LFE was administered orally ($5{\mu}g/L$) to mice for 10 days after which the study group (n=12) received transurethral injection of $5{\mu}g/L$ LPS. The bladder tissue was then harvested after 24 hours and subjected to hematoxylin and eosin staining. A semi-quantitative score was used to evaluate inflammation (bladder inflammation index, BII). $TNF-{\alpha}$ immunohistochemical staining and multiplex cytokine assays were also performed. $TNF-{\alpha}$ and IL-18 levels were determined. The results were compared with those of the control group (n=12). Results: The BII in the control and study groups was $2.7{\pm}0.5$ and $1.1{\pm}0.7$, respectively, with the control group scores differing significantly from the study group scores (p<0.001). $TNF-{\alpha}$ immunohistochemical staining results were similar. The $TNF-{\alpha}$ levels determined by the multiplex cytokine assay were $2.82{\pm}1.35pg/mg$ and $1.55{\pm}0.56pg/mg$ for the control and study groups, respectively, and the difference between these groups was statistically significant (p=0.007). Conclusions: Oral administration of LFE appears to have a preventive effect against the inflammatory responses and $TNF-{\alpha}$ expression induced by transurethral instillation of LPS in the mouse bladder. Further studies are required to determine the clinical application of this finding.

• Urogenital Tract Infection
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• 제13권3호
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• pp.79-83
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• 2018

Purpose: The 5 alpha reductase inhibitor (5ARI) reduces the size of the prostate and alleviates lower urinary tract symptoms. After stopping 5ARI, the prostate quickly recovers to its pre-medication size. The purpose of this study was to investigate the factors affecting the restoration of prostate size after 5ARI discontinuation. Materials and Methods: Between March 2009 and May 2017, patients who visited an outpatient clinic and were diagnosed with benign prostatic hyperplasia were selected and start 5ARI medication. After 6 months of medication, the patients stopped medication for 1 year. Meanwhile, we measured the prostate volumes of patients 3 times (before and after medication, after discontinuation) and divide the patients into 3 groups (maintained, intermediate, and restored) with recovered prostate volume ratio. After classification, we investigated the relationship between the variable factors (age, serum prostate-specific antigen, initial volume, reduced volume after medication) between groups. Results: Among the 147 selected patients, the mean age and plasma PSA level were $61.6{\pm}7.9$ and $0.8{\pm}0.6$, respectively. The mean initial prostate volume was $32.3{\pm}4.2ml$, which reduced to $23.2{\pm}3.2ml$ after medication. After one year of discontinuation, the mean volume was $31.4{\pm}6.4ml$, with restoration to 101.5% of the reduced size. We noticed a tendency that patients with faster prostate volume recovery were generally older than those with slower recovery; however, this was not statistically significant. Other factors showed no relationship with prostate recovery. Conclusions: When using 5ARI in elderly patients, continuous treatment seems better than intermittent treatment. If discontinuation is needed, short term follow-up is recommended.

• Urogenital Tract Infection
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• 제13권3호
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• pp.58-65
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• 2018

Purpose: This study aimed to investigate the relationship between uropathogens of infants with febrile urinary tract infection (UTI) and vesicoureteral reflux (VUR). Materials and Methods: We analyzed 308 infants hospitalized for febrile UTI between January 2010 and December 2015, and assessed the voiding cystourethrography (VCUG). The medical records, including clinical symptoms, laboratory findings, urinalysis, urine culture tests, ultrasound (US), dimercaptosuccinic acid scan, and VCUG, were retrospectively obtained. The incidences of VUR and high-grade VURs (III, IV, and V) were analyzed in 4 groups categorized by uropathogens and renal US findings. Results: The mean age of 308 infants was $3.29{\pm}2.18months$. The male-to-female ratio was 3.46:1. In urine culture tests, 267 infants (86.69%) showed single bacterial uropathogen; Escherichia coli in 241 infants (78.25%) and non-E. coli uropathogens in 26 infants (8.44%). Multiple distinctive microorganisms were identified as causative uropathogens in 41 infants (13.31%). Abnormal findings of US and VCUG were identified in 216 and 64 patients, respectively. In 308 infants, the incidences of VUR and high-grade VUR were not different among the 4 groups. In 239 male infants, the incidences of high-grade VUR were higher in patients with non-E. coli single or multiple uropathogen and with abnormal US findings (p=0.042). Conclusions: In male infants with non-E. coli uropathogen or multiple uropathogens and with abnormal US findings at febrile UTI, there was an increased chance of finding high-grade VURs on subsequent VCUG tests.

• Journal of Medicine and Life Science
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• 제17권3호
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• pp.94-97
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• 2020

Ultrasonography is used to examine gross or microscopic hematuria without side effects. It is one of the methods of diagnosing bladder lesions, but in some cases, the lesions are not found. We attempted to identify the problems during the ultrasonic examination by analyzing the symptoms, location of lesion, and medical history of urothelial cancer for cases of undetected bladder lesions. Thirty-three patients who underwent transurethral resection of a bladder tumor from January 1 to May 4, 2018 in one hospital were enrolled in this study. Patients who underwent preoperative ultrasonography and cystoscopy were treated. Ultrasonography did not detect bladder lesions in five patients. The size of the lesion was 0.5~2.5 cm in various locations, such as the side, front, and so on. Ultrasonic examination requires more attention if there is gross hematuria or a history of urothelial cancer, and it is necessary to detect recurrence by conducting cystoscopy at the same time, especially when there are lesions on the anterior wall of the bladder.

• Clinical and Experimental Reproductive Medicine
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• 제51권1호
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• pp.48-56
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• 2024

Objective: This study investigated the relationship of anthropometric and metabolic risk factors with seminal and sex steroidal hormone parameters in a screened population of healthy males. Methods: The participants were healthy young men without chronic or congenital diseases. The body composition parameters that we investigated were measured weight, height, and waist circumference (WC), as well as bioelectrical impedance analysis. Semen samples were analyzed for semen volume, sperm concentration, sperm motility and morphology, seminal pH, and liquefaction time. Biochemistry analysis, including glucose and lipid metabolism parameters, was conducted on fasting blood samples. Testicular volume was calculated separately for each testis using ultrasonography. Results: Body mass index exhibited an inverse association with total sperm count. WC showed negative correlations with numerous seminal parameters, including sperm concentration, total sperm count, sperm morphology, and follicle-stimulating hormone levels. The basal metabolic rate was associated with seminal pH, liquefaction time, and sperm motility. WC, fat mass percentage, and triglyceride levels exhibited negative correlations with sex hormone binding globulin. The measures of glucose metabolism were associated with a greater number of seminal parameters than the measures of cholesterol metabolism. C-reactive protein levels were inversely associated with sperm concentration and total sperm count. Conclusion: Anthropometric and metabolic risk factors were found to predict semen quality and alterations in sex steroidal hormone levels.

• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.48-52
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• 2024

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6273-6276
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• 2012

Background/Aim: Six prostate cancer (PCa) susceptibility loci were identified in a genome-wide association study (GWAS) in populations of European decent. However, the associations of these 6 single-nucleotide polymorphisms (SNPs) with PCa has remained tobe clarified in men in Northern China. This study aimed to explore the loci associated with PCa risk in a Northern Chinese population. Methods: Blood samples and clinical information of 289 PCa patients and 288 controls from Beijing and Tianjin were collected. All risk SNPs were genotyped using polymerase chain reaction (PCR)-high resolution melting curve technology and gene sequencing. Associations between PCa and clinical covariates (age at diagnosis, prostate-specific antigen [PSA], Gleason score, tumor stage, and level of aggressiveness) and frequencies of alleles and genotypes of these SNPs were analyzed using genetic statistics. Results: Among the candidate SNPs, 11p15 (rs7127900, A) was associated with PCa risk (P = 0.02, odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.09-2.46). Genotypes showed differences between cases and controls on 11p15 (rs7127900, A), 11q13 (rs7931342, T), and HNF1B (rs4430796, A) (P = 0.03, P = 0.01, and P = 0.04, respectively). The genotype TG on 11q13 (rs7931342, T) was positively associated with an increased Gleason score (P = 0.04, OR = 2.15, 95% CI = 1.02-4.55). Patients carrying TG on 17q24 (rs1859962, G) were negatively associated with an increased body mass index (BMI) (P = 0.03, OR = 0.44, 95% CI = 0.21-0.92) while those with AG on HNF1B (rs4430796, A) were more likely to have PSA increase (P = 0.002). Conclusion: Our study suggests that 11p15 (rs7127900, A) could be a susceptibility locus associated with PCa in Northern Chinese. Genotype TG on 11q13 (rs7931342, T) could be related to an increased Gleason score, AG on HNF1B (rs4430796, A) could be associated with PSA increase, and TG on 17q24 (rs1859962, G) could be negatively associated with an increased BMI in Chinese men with PCa.