The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial.

PURPOSE: Fluoroscopy is usually required during retrograde intrarenal surgery (RIRS). Although fluoroscopy is considered necessary for effective and safe RIRS, there is growing awareness regarding radiation exposure risk to patients and surgeons. We conducted a multicenter-based, randomized, controlled trial to compare the safety and effectiveness of radiation-free (RF) RIRS with radiation-usage (RU) RIRS for kidney stone management. MATERIALS AND METHODS: From August 2020 to April 2022, patients with a unilateral kidney stone (≤20 mm) eligible for RIRS were prospectively enrolled in 5 tertiary medical centers after randomization and divided into the RF and RU groups. RIRS was performed using a flexible ureteroscope with a holmium:YAG laser. The primary end point of this study was the success rate, defined as complete stone-free or residual fragments with asymptomatic kidney stones ≤ 3 mm. The secondary end point of this study was ascertaining the safety of RF RIRS. The success rates were analyzed using a noninferiority test. RESULTS: Of the 140 consecutive randomized participants, 128 patients completed this study (RF: 63; RU: 65). The success rates (78% vs 80%, P = .8) were not significantly different between the groups. The rate of high-grade (grade 2-4) ureter injury was not significantly higher in the RF group compared to the RU group (RF = 3 [4.8%] vs RU = 2 [3.1%], P = .6). In RF RIRS, the success rate was noninferior compared to RU RIRS (the difference was 2.2% [95% CI, 0.16-0.12]). CONCLUSIONS: This study demonstrated that the surgical outcomes of RF RIRS were noninferior to RU RIRS.

Holmium Laser Enucleation of the Prostate for Advanced Prostate Cancer-Related Bladder Outlet Obstruction: Assessing Effectiveness and Unraveling Factors Impacting Postoperative Urinary Incontinence.

PURPOSE: This study investigated the factors associated with transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP) as a palliative treatment in patients with severe bladder outlet obstruction (BOO) and advanced prostate cancer (PCA). MATERIALS AND METHODS: Data of 28 patients with advanced PCA (≥cT3) who underwent palliative HoLEP between October 2018 and March 2021 were included in this retrospective study. After collection of the pre-, intra-, and postoperative (1, 3, and 12 months) data of patients from their medical records, variables of patients with and without TUI at 1 and 3-12 months postoperatively were statistically compared. Multivariate analysis was performed to investigate the factors associated with postoperative TUI. RESULTS: Compared to baseline, the mean total international prostate symptom score, quality of life score, maximum flow rate (Qmax), and postvoid residual (PVR) were significantly improved 1 month postoperatively, and this was maintained until 12 months postoperatively (p<0.001). Of the 28 patients, 14 (50.00%) and 6 (21.43%) presented with TUI at 1 and 3-12 months postoperatively, respectively. Patients with TUI at 1 month follow-up showed a significantly lower preoperative Qmax (p=0.027), larger preoperative PVR (p=0.004), and higher likelihood of bladder neck tumor invasion (p=0.046). Conversely, patients with TUI at 3-12 months postoperatively were significantly older (p=0.033) and had a longer enucleation time (p=0.033). Multivariate analysis demonstrated that the factors affecting TUI were preoperative Qmax (odds ratio [OR]=0.61; 95% confidence interval [CI]=0.39-0.93; p=0.016) and bladder invasion of the tumor (OR=26.72; 95% CI=1.83-390.42; p=0.022) after 1 month; however, none of the variables correlated significantly with TUI at 3-12 months. CONCLUSIONS: Palliative HoLEP is an effective management option in patients with advanced PCA-related BOO. Lower preoperative Qmax and bladder neck tumor invasion are the factors affecting TUI at 1 month postoperatively.

A Randomized, Double-Blind, Placebo-Controlled, Bridging Study to Evaluate the Efficacy and Safety of Vibegron in Treating Korean Patients With Overactive Bladder.

PURPOSE: Vibegron, a novel, potent ß3 agonist, has been approved for clinical use in overactive bladder (OAB) treatment in Japan and the Unites States. We performed a bridging study to investigate the efficacy and safety of a daily 50-mg vibegron (code name JLP-2002) dose in Korean patients with OAB. METHODS: A multicenter, randomized, double-blind, placebo-controlled study was conducted from September 2020 to August 2021. Adult patients with OAB with a symptom duration of more than 6 months entered a 2-week placebo run-in phase. Eligibility was assessed at the end of this phase and selected patients entered a double-blind treatment phase after 1:1 randomization to either the placebo or vibegron (50 mg) group. The study drug was administered once daily for 12 weeks and follow-up visits were scheduled at weeks 4, 8, and 12. The primary endpoint was the change in mean daily micturition at the end of treatment. The secondary endpoints included changes in OAB symptoms (daily micturition, nocturia, urgency, urgency incontinence, and incontinence episodes, and mean voided volume per micturition) and safety. A constrained longitudinal data model was used for statistical analysis. RESULTS: Patients who took daily vibegron had significant improvements over the placebo group in both primary and secondary endpoints, except for daily nocturia episodes. The proportions of patients with normalized micturition and resolution of urgency incontinence and incontinence episodes were significantly higher in vibegron group than in the placebo. Vibegron also improved the patients' quality of life with higher satisfaction rates. The incidence of adverse events in the vibegron and placebo groups was similar with no serious, unexpected adverse drug reactions. No abnormality in electrocardiographs was observed as well as no significant increase in postvoid residual volume. CONCLUSION: Once daily vibegron (50 mg) for 12 weeks was effective, safe, and well-tolerated in Korean patients with OAB.

Efficacy and Safety of DA-8010, a Novel M3 Antagonist, in Patients With Overactive Bladder: A Randomized, Double-Blind Phase 2 Study.

PURPOSE: DA-8010 is a novel muscarinic M3 receptor antagonist with significant selectivity for bladder over salivary gland in preclinical studies. We evaluated the clinical efficacy and safety of DA-8010 in overactive bladder (OAB) patients. METHODS: This phase 2, randomized, double-blind, parallel-group, active reference- and placebo-controlled trial was conducted at 12 centers in South Korea (NCT03566134). Patients aged ≥19 years with OAB symptoms for ≥3 months were enrolled. Three hundred six patients (30.07% male) were randomized to 12 weeks of treatment among 4 groups; 2 experimental groups (DA-8010 2.5 or 5 mg), an active reference group (solifenacin 5 mg), and a placebo group. The change from the baseline of (=∆) 24-hour frequency at 12 weeks (primary endpoint), episodes of urgency, overall/urgency urinary incontinence, average/ maximum voided volume, nocturia, and patients' subjective responses were analyzed. RESULTS: In the full analysis set, the mean (standard deviation) [median] values for ∆ 24-hour frequency at 12 weeks were -1.01 (2.44) [-1.33] for placebo, -1.22 (2.05) [-1.33] for DA-8010 2.5 mg, and -1.67 (2.25) [-1.67] for DA-8010 5 mg; DA-8010 5 mg showed a significant decrease compared with placebo (P=0.0413). At 4 and 8 weeks, both DA-8010 2.5 mg (P=0.0391 at 4 weeks, P=0.0335 at 8 weeks) and DA-8010 5 mg (P=0.0001 at 4 weeks, P=0.0210 at 8 weeks) showed significant decrease in ∆ 24-hour frequency compared with placebo. DA-8010 5 mg achieved a significant decrease in ∆ number of urgency episodes, compared with placebo at 4 (P=0.0278) and 8 (P=0.0092) weeks. Adverse drug reactions (ADRs) were observed in 3.95% of placebo, 6.67% of DA-8010 2.5 mg, 18.42% of DA-8010 5 mg, and 17.33% of solifenacin 5 mg groups. No serious ADRs were observed in any patient. CONCLUSION: Both DA-8010 2.5 mg and 5 mg showed therapeutic efficacy for OAB without serious ADRs. Therefore, both dosages of DA-8010 can advance to a subsequent large-scale phase 3 trial.

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy.

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Mirabegron as a treatment for overactive bladder symptoms in men (MIRACLE study): Efficacy and safety results from a multicenter, randomized, double-blind, placebo-controlled, parallel comparison phase IV study.

AIMS: To evaluate the efficacy and safety of mirabegron in males with overactive bladder (OAB) symptoms. METHODS: In total, 464 males with OAB symptoms were enrolled from 14 institutes and were sorted into either the mirabegron 50 mg (n = 310) or placebo (n = 154) groups. The change in (i) the mean number of 24-h micturition episodes; (ii) OAB Symptom Scale (OABSS); and (iii) International Prostate Symptom Score (IPSS) from baseline to 12 weeks of treatment were compared between the two groups. Safety assessments included treatment-emergent adverse events, blood pressure, pulse rate, postvoid residual volume, and maximum urinary flow rate. After 12 weeks, the study was extended for 14 additional weeks by administering mirabegron 50 mg to both groups. RESULTS: The reduction in the mean number of 24-h micturition episodes from baseline to 12 weeks of treatment was similar between the two groups. However, significantly greater changes from baseline to 12 weeks were observed in total OABSS, OABSS urgency incontinence score (Q4), IPSS storage subscore (Q2 + Q4 + Q7), and IPSS urgency score (Q4) in the mirabegron group (P = 0.01 for all). According to the extended study, the changes of all efficacy variables from baseline to 26 weeks were similar between both groups. The safety assessment results were also similar between the two groups at 12 and 26 weeks. CONCLUSION: A daily 50 mg dose of mirabegron for 12 weeks reduced OAB symptoms in men, and no significant adverse events compared to the placebo group were noted.

Evaluation of Performance Parameters of the Disposable Flexible Ureterorenoscope (LITHOVUE) in Patients with Renal Stones: A Prospective, Observational, Single-arm, Multicenter Study.

We investigated performance parameters of disposable flexible ureterorenoscopy (LITHOVUE) in patients with renal stones in a prospective, multicenter, observational study. Sixty two patients who underwent ureterorenoscopic surgery by LITHOVUE were included. Surgeons using a numerical scale, evaluated the maneuverability of the scopes and general perceptions of visibility related to the monitor and irrigation systems. General pain and fatigue scores were evaluated and compared to existing scopes. Mean patient age was 57.3 years and stone size was 15.4 mm. Clinical success of overall stone removal was 82.3%. Complications occurred in 4 cases of the Clavien classification grade I in a single case and II in 3 cases. Comparative parameters of maneuverability, perception of the monitor system and perception of the irrigation channel were 2.5, 2.5, and 3.0, respectively. The most favorable evaluation of physical strain was about 'shoulder fatigue' and 'hand fatigue'. Unfavorable evaluations were recorded for 'wrist stiffness' and 'thumb fatigue'. Maximal deflection angles of 270° were preserved in 53 cases (85.5%). No pre-stenting procedure and the longer operative time were significant predictors of poorly-preserved deflection angles <270°. LITHOVUE showed good maneuverability and perception scores for the monitor and irrigation systems. LITHOVUE received favorable evaluations on pain and fatigue scores.

New Surgical Instruction Method for Homium Laser Enucleation of the Prostate, "Hand-Grab Navigated Technique," to Shorten the Learning Curve: The Results of Multicenter Analysis.

OBJECTIVES: To introduce a new surgical mentorship, the "hand-grab navigated technique," to shorten the learning curve for Holmium laser enucleation of the prostate. METHODS: Patients with benign prostatic hyperplasia were managed at six institutions with Holmium laser enucleation of the prostate. An analysis was done in the 200 of these patients (the set of first 20 patients treated with Holmium laser enucleation of the prostate by 10 surgeons) who were sorted into two groups depending on the surgeon's instructional group. Surgeons in group I learned Holmium laser enucleation of the prostate by self-study by using videos and written information, whereas those in group II were instructed by "the hand-grab navigated technique" along with the self-study. To evaluate the efficiency of hand-grab navigated technique, enucleation and morcellation efficiencies between the two groups were compared. RESULTS: The mean prostate volume was 49.5 ± 23.8 and 51.1 ± 25.2 g in group I and II, respectively, showing no significant difference. The enucleation efficiency was significantly greater (P = 0.01) in group II (0.35 ± 0.20 g/min) than in group I (0.21 ± 0.12 g/min). Morcellation efficiency was also significantly greater (P = 0.03) in group II (3.08 ± 3.27 g/min) than in group I (2.43 ± 2.68 g/min). CONCLUSION: The learning curve for Holmium laser enucleation of the prostate can be shortened with the "hand-grab navigated technique" when combined with the self-study.

Clinical Application of a Transurethral Holmium Laser Excision of Exposed Polypropylene Mesh at Lower Urinary Tract: Single Surgeon Experience With Long-term Follow-up.

PURPOSE: The aim of this study was to evaluate the clinical application of a transurethral holmium laser excision of exposed polypropylene mesh as an effective minimally invasive surgical approach in patients with lower urinary tract mesh erosion following the transvaginal placement of polypropylene mesh. METHODS: A retrospective analysis was conducted on the data of 22 patients with exposed polypropylene mesh in the lower urinary tract that was managed using the transurethral holmium laser technique. The patients were divided into 2 groups based on the type of mesh surgery: a midurethral sling (MUS) group (n = 18) and a pelvic organ prolapse (POP) group (n = 4). The surgical outcomes were compared. RESULTS: The mean time follow-up after the first surgery was 23.2 months, and 14 patients (64%) reported symptomatic improvement. During outpatient follow-up, eroded residual mesh and failed re-epithelialization were discovered in 6 patients. The recurrence rates in the MUS and POP groups after the first surgery were 22% and 50%, respectively. The recurrence-free periods of each group were 30.5 versus 13.5 months, respectively. Whereas 5 patients had successful epithelialization of the surgical wound following the second endoscopic surgery, 1 patient in the POP group required a third endoscopic surgery because of persistent mesh erosion. CONCLUSIONS: The excision of exposed polypropylene mesh using a transurethral holmium laser following MUS appears to be a feasible option because of potentially low rates of complication and recurrent stress incontinence. However, minimally invasive approach using holmium laser may not be as successful for mesh erosion after transvaginal mesh repair for POP.

Evaluation of Electrical Impedance Spectroscopy-on-a-Needle as a Novel Tool to Determine Optimal Surgical Margin in Partial Nephrectomy.

A hypodermic needle has been introduced incorporating an electrical impedance spectroscopy (EIS) sensor, called micro-EIS-on-a-needle for depth profiling (µEoN-DP). The µEoN-DP can locate endophytic renal tumors as well as determine tumor margins by detecting the impedance difference between normal and cancer tissues. To evaluate the µEoN-DP as a novel tool to determine the optimal surgical margin during partial nephrectomy (PN), the electrical impedance differences between renal parenchymal tissues and renal cell carcinoma (RCC) tumors are investigated with regard to the distance from the tumors. Optimal frequencies at which the discrimination extent is maximized are suggested based on the discrimination index. The resistance and capacitance of normal and cancer tissues are extracted using electrical equivalent circuit by excluding the influences of other electrical components on the sensor output. The extracted resistance and capacitance of cancer tissues are 37.8% larger and 25.7% smaller than that of normal tissues, respectively. Additionally, high sensitivity and specificity are obtained by using extracted resistance and capacitance, thus implying that the µEoN-DP shows promise as a supplementary tool for PN margin evaluation and decreasing the prevalence of positive surgical margins while maximizing parenchymal preservation.

A multicenter real-life study of the efficacy of an alpha-blocker with or without anticholinergic agent (imidafenacin) treatment in patients with lower urinary tract symptoms/benign prostatic hyperplasia and storage symptoms.

AIMS: To evaluate the efficacy and safety of combination therapy comprising a short-acting anticholinergic, imidafenacin and an alpha-blocker compared with monotherapy with an alpha-blocker only in men with lower urinary tract symptoms (LUTS) and storage symptoms. METHODS: The 12-week, prospective, double-blind, randomised trial enrolled men with LUTS and storage symptom. The inclusion criteria were a total International Prostate Symptom Score (IPSS) ≥12, an IPSS question 4 score ≥2, ≥8 micturitions in 24 hours, and a prostate volume >20 mL. The primary outcome was a change in the micturition number from baseline. Bladder diary variables, Patient Perception of Intensity of Urgency Scale (PPIUS) scores, IPSS and safety were assessed. RESULTS: Of 260 patients screened, 221 completed the study. Patients were randomly assigned to receive an alpha-blocker only (n=111, group 1) or combination therapy comprising an alpha-blocker and an anticholinergic (n=110, group 2) for 12 weeks. Group 1 and 2 showed significant improvement in their 24-hour micturition numbers (-1.87 and -2.08, respectively), nocturia episodes (-0.48 and -0.53, respectively), total IPSS (-9.9 and -8.8, respectively), and PPIUS scores (-0.19 and -0.24, respectively). Micturition number per 24 hours, daytime frequency, urgency, the PPIUS score, the IPSS question 4 score and IPSS QoL score improved significantly in the combination therapy group, but changes in total IPSS, nocturia episodes, and safety outcomes did not differ significantly between the groups. CONCLUSIONS AND CLINICAL IMPLICATIONS: Compared with treatment with an alpha-blocker alone, combination therapy comprising an anticholinergic and an alpha-blocker showed superior efficacy and its safety was similar in patients with LUTS and storage symptoms.

Micro electrical impedance spectroscopy on a needle for ex vivo discrimination between human normal and cancer renal tissues.

The ex-vivo discrimination between human normal and cancer renal tissues was confirmed using µEoN (micro electrical impedance spectroscopy-on-a-needle) by measuring and comparing the electrical impedances in the frequency domain. To quantify the extent of discrimination between dissimilar tissues and to determine the optimal frequency at which the discrimination capability is at a maximum, discrimination index (DI) was employed for both magnitude and phase. The highest values of DI for the magnitude and phase were 5.15 at 1 MHz and 3.57 at 1 kHz, respectively. The mean magnitude and phase measured at the optimal frequency for normal tissues were 5013.40 ± 94.39 Ω and -68.54 ± 0.72°, respectively; those for cancer tissues were 4165.19 ± 70.32 Ω and -64.10 ± 0.52°, respectively. A statistically significant difference (p< 0.05) between the two tissues was observed at all the investigated frequencies. To extract the electrical properties (resistance and capacitance) of these bio-tissues through curve fitting with experimental results, an equivalent circuit was proposed based on the µEoN structure on the condition that the µEoN was immersed in the bio-tissues. The average and standard deviation of the extracted resistance and capacitance for the normal tissues were 6.22 ± 0.24 kΩ and 280.21 ± 32.25 pF, respectively, and those for the cancer tissues were 5.45 ± 0.22 kΩ and 376.32 ± 34.14 pF, respectively. The electrical impedance was higher in the normal tissues compared with the cancer tissues. The µEoN could clearly discriminate between normal and cancer tissues by comparing the results at the optimal frequency (magnitude and phase) and those of the curve fitting (extracted resistance and capacitance).

Evaluation of a Polymeric Flap Valve-Attached Ureteral Stent for Preventing Vesicoureteral Reflux in Elevated Intravesical Pressure Conditions: A Pilot Study Using a Porcine Model.

OBJECTIVE: To evaluate the effectiveness of a polymeric flap valve-attached ureteral stent for preventing vesicoureteral reflux (VUR) in an animal model. MATERIALS AND METHODS: One female Yorkshire pig was included in this study. A flap valve-attached and a conventional stent was inserted in the right and left ureters, respectively. The bladder was filled with contrast medium until the intravesical pressure reached 20 cm H2O. Subsequently, simulated voiding cystourethrography (VCUG) was performed 50 times by manually compressing the suprapubic area until the intravesical pressure reached 50 cm H2O. Intravenous pyelography (IVP) was performed thereafter to evaluate the urinary drainage. In addition, an in vitro durability test of the function of the flap valve was conducted under continuous hydrostatic pressure for 24 h. RESULTS: The volume of contrast medium needed to achieve an intravesical pressure of 20 cm H2O was 1740 mL. In the repeated simulated VCUG for the right ureter, VUR grades of 0 and I were recorded in 82.0 (n = 41) and 18.0% (n = 9) tests, respectively, whereas for the left ureter, grades of I, II, and III were recorded in 14.0 (n = 7), 82.0 (n = 41), and 4.0% (n = 2), respectively. Thus, a significantly lower VUR grade was recorded for the right ureter than for the left ureter (p < 0.001). In the bilateral VUR condition, the pressure for VUR occurrence was significantly greater in the right ureter than in the left ureter (p = 0.007). No urinary obstruction was caused by the flap valve-attached ureteral stent according to the IVP findings. The in vitro durability test demonstrated slightly enhanced antireflux function and slightly decreased intraluminal drainage at 12 h, and these findings sustained thereafter. CONCLUSION: A flap valve-attached ureteral stent effectively prevented VUR under conditions of elevated intravesical pressure without urinary obstruction.

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses.

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

Reasons for prescription change of α1-blockers in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

OBJECTIVE: To investigate the reasons for prescription change of α1-blockers in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. METHODS: The ratio and interval of prescription change were assessed in 3200 patients who were eligible for the study and took 1 of 4 different α1-blockers (doxazosin, alfuzosin, tamsulosin, or silodosin). The reasons for prescription change and evaluation of efficacy were analyzed in 444 patients whose medical records were complete. RESULTS: Prescription change to another α1-blocker occurred in 694 of 3200 patients (21.7%), and the mean duration of taking their first α1-blocker was 10.8 ± 8.2 weeks. Lack of efficacy (52.7%) was the main reason for changing α1-blockers, followed by adverse events (33.1%), relatively high cost compared with other α1-blockers (7.0%), inconvenience of taking drugs (4.1%), and cardiovascular comorbidity (3.2%). The mean duration of treatment according to each reason is as follows: increased adverse events: 6.3 ± 5.2 weeks, relatively high cost compared with other α1-blockers: 8.7 ± 4.5 weeks, cardiovascular comorbidity: 10.5 ± 6.8 weeks, inconvenience of taking drugs: 10.8 ± 3.9 weeks, and lack of efficacy: 14.8 ± 6.8 weeks. The proportion of prescription change (16.3%) and prescription change because of hemodynamic adverse events (2.4%) in the silodosin group were low compared with those in the other groups (P <.05 and P <.006, respectively), but prescription change because of a ejaculation disorder was high in the silodosin group (30.1%, P <.001). CONCLUSION: Major reasons for prescription change in patients taking α1-blockers were lack of efficacy and adverse events. In the silodosin group, the proportion of prescription change was significantly low compared with that in the other 3 groups.

Recovery of overall exercise ability, quality of life, and continence after 12-week combined exercise intervention in elderly patients who underwent radical prostatectomy: a randomized controlled study.

OBJECTIVE: To examine the changes from a combined exercise intervention after radical prostatectomy (RP) in elderly patients with prostate cancer, because randomized controlled trials addressing exercise intervention after RP have been lacking. METHODS: From May 2009 to May 2010, all patients who underwent laparoscopic RP were assessed for eligibility. A total of 66 patients were randomized to an exercise or a control group. The exercise group received a combined exercise intervention (resistance, flexibility, and Kegel exercises) twice a week for 12 weeks, and the control group received only Kegel exercises. The primary outcome was physical function, and the secondary outcomes were continence status and quality of life after the exercise intervention. RESULTS: A total of 49 patients completed follow-up to the end of study. After the 12-week exercise intervention, except for grip strength, all physical functions were better in the exercise group than in the control group. The 24-hour pad test results (12.2 g in the exercise group, 46.2 g in the control group) and continence rate (73.1% in exercise group, 43.5% in the control group) recovered more promptly in the exercise group. On a questionnaire study using the International Consultation on Incontinence questionnaire, Beck Depression Inventory, and Medical Outcomes Study 36-item short-form health survey, only the exercise group showed improvement at the last follow-up visit. CONCLUSION: A 12-week combined exercise intervention after RP results in improvement of physical function, continence rate, and quality of life. These results could help with prompt recovery of daily activities.

Intrauterine device embedded into the bladder wall with stone formation: laparoscopic removal is a minimally invasive alternative to open surgery.

Spontaneous perforation of the uterus and intravesical intrauterine device (IUD) is very rare. The treatment options for an intravesical IUD are open surgery or cystoscopic removal. Open surgery has been used generally for the removal of IUDs with formation of big stones or partial penetration of the bladder wall. In this case, we removed an IUD (multiload Cu 375) with calculus that had sunk deeply into the bladder wall via laparoscopic partial cystectomy.

Laparoscopic removal of a broken sewing needle in a patient with irritative bladder symptoms.

A foreign body near the bladder is rare. Although foreign bodies in the bladder can be easily found and removed by endoscopic transurethral removal, extravesical foreign bodies may require the use of an open or laparoscopic procedure. Here, we report a case of a patient complaining of frequency and urgency in whom an extravesical sewing needle was successfully removed by a laparoscopic approach. A 4.5 cm rusty sewing needle was found between the bladder and the left external iliac vessels and was removed through a 5 mm trocar port by use of endo forceps with no complications.

Effect of the Amount of Hours Spent Studying on the Prevalence of Overactive Bladder in College Women.

OBJECTIVES: We conducted a questionnaire survey to access whether the amount of hours spent studying has an effect on the prevalence of OAB in college women. METHODS: A total of 126 (63%; mean: 23.2 years) of 200 women participants completed the questionnaire. They were divided into two groups: group A (weekly studying hour >40 h) consisted of medical female students and group B (weekly studying hour <25 h) consisted of French literature woman students. The factors related to OAB were analyzed by the chi-squared test. RESULTS: Of 126 respondents, the prevalence of OAB was prevalent in 38 (30.2%) women. There was significant difference in prevalence between the two groups: 7.0% for group A and 42.2% for group B. In group B, OAB prevalence was 66.7% for ≤2 h, 41.2% for 2-≤4 h, 46.5% for 4-≤6 h, and >6 h was 23.5%. This survey showed that there is no relationship between the amount of hours spent studying and OAB. CONCLUSION: Although the amount of hours spent studying had no association with OAB in college women, OAB prevalence showed a decreasing pattern as the quantity of studying hour increases. Consequently, it is thought that the attitude toward study has more association with OAB than the quantity of studying hours.

Free radical scavenger effect of rebamipide in sperm processing and cryopreservation.

AIM: To study the effect of rebamipide added to semen samples and cryoprotectant on reactive oxygen species (ROS) production. METHODS: Semen samples from 30 fertile and healthy volunteers were collected by masturbation after 2 days approximately 3 days of abstinence. After liquefaction, the specimens were diluted with sperm wash media to a uniform density of 20 x 10(6)/mL. Rebamipide was added to semen samples and cryoprotectant to a final concentration of 10 micromol/L, 30 micromol/L, 100 micromol/L or 300 micromol/L. Specimens were incubated at 37 degree C in a 0.5 % CO(2) incubator for 1 h or cryopreserved at -196 degree C LN(2) for 3 days. The sperm motility and viability and the levels of ROS and lipid peroxidation of sperm membrance were assessed before and after incubation and cryopreservation by means of computer assisted semen analyzer, eosin-nigrosin stain, chemiluminescence and thiobarbituric acid assay, respectively. RESULTS: The sperm motility was significantly increased after incubation with 100 micromol/L and 300 micromol/L rebamipide (P<0.05). After cryopreservation, the sperm motility was significantly decreased in all concentrations (P<0.05), but the decrease was less with 100 micromol/L and 300 micromol/L rebamipide than that with other concentrations. The sperm viability showed no significant difference before and after incubation (P>0.05). The levels of ROS and lipid peroxidation in semen were significantly decreased in proportion to the concentrations of rebamipide both after incubation and cryopreservation (P<0.05). CONCLUSION: Rebamipide is an effective free radical scavenger in semen in vitro.