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.

Superiority of dutasteride 0.5 mg and tamsulosin 0.2 mg for the treatment of moderate-to-severe benign prostatic hyperplasia in Asian men.

OBJECTIVES: To assess the effectiveness and safety of dutasteride 0.5 mg + tamsulosin 0.2 mg combination compared with tamsulosin 0.2 mg in Asian men with moderate-to-severe benign prostatic hyperplasia. METHODS: A 4-week, single-blind, placebo, run-in was followed by a 2-year double-blind randomized controlled trial in men age ≥50 years with symptomatic benign prostatic hyperplasia, International Prostate Symptom Score ≥12, prostate volume ≥30 cc, prostate-specific antigen ≥1.5 and ≤10 ng/mL, peak urinary flow >5 and ≤15 mL/s, and voided volume of ≥125 mL. Participants were randomized to oral daily dutasteride 0.5 mg + tamsulosin 0.2 mg combination or tamsulosin 0.2 mg. The primary efficacy end-point was change in International Prostate Symptom Score at year 2. RESULTS: Data from 607 participants showed a significant reduction in International Prostate Symptom Score (P < 0.05) at month 24, along with greater improvements (P ≤ 0.006) in peak urinary flow at every assessment and significant prostate volume reduction at months 12 and 24 (P < 0.001) in the combination group. Combination therapy was associated with a significant reduction in the risk of acute urinary retention or benign prostatic hyperplasia-related surgery (P = 0.012), primarily due to a significant reduction in the risk of acute urinary retention (P = 0.005). The safety and tolerability profile of combination therapy was consistent with the known profiles for the individual monotherapies. CONCLUSIONS: Dutasteride 0.5 mg + tamsulosin 0.2 mg combination therapy showed better clinical outcomes than tamsulosin 0.2 mg monotherapy, making it an effective and safe treatment option for Asian men with moderate-to-severe benign prostatic hyperplasia.

Artificial intelligence in urologic oncology: the actual clinical practice results of IBM Watson for Oncology in South Korea.

Background: Artificial intelligence (AI) is changing our life, including the medical field. Repeated machine learning using big data made various fields more predictable and accurate. In medicine, IBM Watson for Oncology (WFO), trained by Memorial Slone Kettering Cancer Center (MSKCC), was first introduced and applied in 14 countries worldwide.Our study was designed to assess the feasibility of WFO in actual clinical practice. We aimed to investigate the concordance rate between WFO and multidisciplinary tumor board (MTB) in Urologic cancer patients. Materials and methods: We reviewed retrospectively collected data for consecutive patients who underwent WFO and MTB simultaneously in the diagnosis of urologic malignancy before determining further treatment between August 2017 and September 2020. We compared the recommendation of the AI system, WFO (IBM Watson Health, Cambridge, MA), with the opinion of MTB for further managing all patients diagnosed with urologic malignancies such as prostate, bladder, and kidney cancer. Results: A total of 55 patients were enrolled in our study. The number of patients with prostate cancer was 48. The number of bladder and kidney cancer patients was 5 and 2, respectively. The overall concordance rate between WFO and MTB was 92.7%. Three patients could not suggest proper treatment options using WFO, and the recommended choice of WFO was not feasible in the Korean Health Insurance Review and Assessment Service. Conclusions: The decision of WFO showed a high concordance rate with a multidisciplinary tumor board for urologic oncology. However, some recommendations of WFO were not feasible in actual practice, and WFO still has some points to improve and modify. Interestingly, applying WFO is likely to facilitate a multidisciplinary team approach.

Dutasteride, who is it more effective for? Second to fourth digit ratio and the relationship with prostate volume reduction by dutasteride treatment.

UNLABELLED: Study Type--Prognosis (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? The second to fourth digit ratio (hereafter the digit ratio) of the right hand is related to the activity of the androgen receptor. Five α-reductase inhibitor (5ARI) reduces the prostate volume of patients with BPH. In terms of prostate volume reduction, large-scale placebo-controlled studies show that patients with BPH do not always respond well to 5ARI treatment. Patients with a higher digit ratio respond well to dutasteride treatment compared to those with a lower digit ratio. These results suggest that the digit ratio might be a predictor of the response to dutasteride treatment. OBJECTIVE: • To investigate the relationship between second to fourth digit ratio (hereafter the digit ratio) and prostate volume reduction by dutasteride treatment. PATIENTS AND METHODS: • A total of 142 men aged ≥ 40 years with a clinical diagnosis of benign prostatic hyperplasia and an enlarged prostate (prostate volume ≥ 30 mL) were prospectively enrolled. • Before prostate-specific antigen (PSA) level determination and transrectal ultrasonography (TRUS), the lengths of the second and fourth digits of the right hand were measured by an investigator using a digital vernier calliper. • Using TRUS, pre- and post-treatment prostate volume (PV1 and PV2) were measured by an uroradiologist who was unaware of finger lengths. We investigated the change in prostate volume and PSA level at least 6 months after the initiation of dutasteride therapy. RESULTS: • When the patients were divided into two groups according to digit ratio (A: digit ratio <0.95, n = 71; B: digit ratio ≥ 0.95, n = 71), there was a greater reduction in prostate volume in group B compared to group A (PV2-PV1: -9.4 mL vs -13.2 mL, P = 0.042; [PV2-PV1]/PV1: -17.5% vs -24.5%, P = 0.027; [PV2-PV1]/duration: -1.1 mL/month vs -1.6 mL/month, P = 0.041; [PV2-PV1]/PV1/duration: -2.0%/month vs -3.0%/month, P= 0.016). • Significant negative correlations were found between the digit ratio and reduction rate ([PV2-PV1]/duration: r = -0.165, P = 0.049; [PV2-PV1]/PV1/duration: r = -0.191, P = 0.023). CONCLUSIONS: • Patients with higher digit ratios respond well to dutasteride treatment. • The results obtained in the present study suggest that the digit ratio is a predictor of the response to dutasteride treatment.

Association between the self-perception period of lower urinary tract symptoms and the International Prostate Symptom Score.

OBJECTIVES: The timing of visiting a hospital after self-perception of lower urinary tract symptoms (LUTS) is different between individuals. The association between the self-perception period (S-PP) of LUTS and the progression of LUTS has seldom been documented. The aim of this study was to investigate the association between the S-PP of LUTS and the International Prostate Symptom Score (IPSS). SUBJECTS AND METHODS: This was a cross-sectional study comprising 267 men aged 40 years and older who participated in a prostate examination survey between February and May 2009. Survey questionnaires included items on the IPSS, the S-PPs of seven individual LUTSs assessed in the IPSS. RESULTS: The S-PP of LUTS became significantly longer as the severity of LUTS increased. Of the seven symptoms, a weak urinary stream and nocturia showed longer S-PPs than others. Partial correlation between the S-PP and IPSS showed a statistically significant positive correlation. Linear regression analysis showed a statistically significant relationship that unstandardized coefficients included 0.051 and 0.005 for IPSS and quality of life. CONCLUSIONS: These findings suggest that the S-PP is an independent risk factor for LUTS progression. S-PPs have to be considered for treatment or prevention of LUTS.

Second to fourth digit ratio: its relationship with core cancer volume and Gleason score in prostate biopsy.

OBJECTIVE: To investigate the relationships between 2nd to 4th digit ratio (digit ratio) and prostate cancer detection rate and biopsy findings, including Gleason score. MATERIALS AND METHODS: In 770 consecutive men aged 40 years or older that presented with lower urinary tract symptoms (LUTS), right hand 2nd and 4th digit lengths were measured prior to PSA determinations, DRE and transrectal ultrasonography (TRUS). Among these, 166 men with a prostate specific antigen (PSA) level ≥ 3 ng/mL or abnormal digit rectal examination (DRE) prospectively underwent prostate biopsies. The relationship between digit ratio and prostate cancer detection rate and biopsy findings was investigated. RESULTS: The study subjects were allocated to two groups by digit ratio (group A: digit ratio < 0.95; n = 420; group B: digit ratio ≥ 0.95; n = 350). Despite similar biopsy rates (22.4% vs. 20.6%, p = 0.544), group A had higher cancer detection rate (46.8% (44/94) vs. 23.6% (17/72), p = 0.002; OR = 2.847, 95% CI = 1.445-5.610). When we analyzed 408 positive biopsy cores (group A: digit ratio < 0.95, n = 282; group B: digit ratio ≥ 0.95, n = 126), group A had higher percentage of core cancer volume (46.7% vs. 37.1%, p = 0.005) and more biopsy cores with high Gleason score (sum of Gleason score ≥ 9: 18/282 (6.4%) vs. 1/126 (0.8%), p = 0.010; primary Gleason score = 5: 12/282 (4.3%) vs. 0/126 (0.0%), p = 0.021). CONCLUSIONS: A lower digit ratio is related to an increased detection rate of prostate cancer, a high percentage of core cancer volume and a high Gleason score.

Smart syringe using actuator and force sensor for epidural anesthesia injection.

The anesthesia process in the epidural space is quite difficult as it requires a high level of skill. Therefore, a medical accident occurs, and intensive training is required. In order to reduce these medical accidents, medical technology is being developed, which provides safe and accurate treatment services. This paper proposes a smart syringe design for safe and accurate anesthesia in the epidural space. The smart syringe is designed to measure the electrical sensing waveform by using a sensor instead of the sense of the hand during anesthesia and show the position of the needle through external monitoring. To design a smart syringe, a force sensor, actuator, and CPU were used, and a 3D printer was used to produce the outer shape. An animal test was conducted to evaluate the performance test of the smart syringe, and satisfactory results were obtained by measuring the needle insertion process of the smart syringe and the position of the needle through the animal experiment.

MRI Findings of Renal Myxoma: A Case Report and Literature Review.

Renal myxomas are very rare benign tumors. To date, a few cases have been reported in English literature, mostly in pathology and urology journals. Thus, there are few reports on the radiological findings associated with renal myxomas. We report on the imaging findings in a case of renal myxoma in a 62-year-old male. MRI demonstrated a well-defined mass in the left renal sinus, with intermediate high signal intensity on T2-weighted images and low signal intensity on T1-weighted images. The tumor showed gradual enhancement on contrast-enhanced T1-weighted images.

Second to fourth digit ratio: a predictor of prostate-specific antigen level and the presence of prostate cancer.

OBJECTIVE: To investigate the relationships between the 2nd to 4th digit ratio (digit ratio) and prostate volume, prostate-specific antigen (PSA) level, and the presence of prostate cancer. PATIENTS AND METHODS: Of the men that presented with lower urinary tract symptoms (LUTS) at a single tertiary academic center, 366 men aged 40 or older with a PSA level ≤ 40 ng/mL were prospectively enrolled. Right-hand 2nd and 4th digit lengths were measured prior to the PSA determinations and transrectal ultrasonography (TRUS). Prostate volumes were measured by TRUS without information about digit length. Patients with a PSA level ≥ 3 ng/mL underwent prostate biopsy. RESULTS: No relationship was found between prostate volume and digit ratio [correlation coefficient (r) = -0.038, P = 0.466]. But, significant negative correlations were found between digit ratio and PSA (r = -0.140, P = 0.007). When the patients were divided into two groups (Group A: digit ratio < 0.95, n = 184; Group B: digit ratio ≥ 0.95, n = 182), Group A had a higher mean PSA level than Group B (3.26 ± 5.54 ng/mL vs 1.89 ± 2.24 ng/mL, P = 0.002) and had significantly higher risks of prostate biopsy [odds ratio (OR) = 1.75, 95% CI = 1.07-2.84] and prostate cancer (OR = 3.22, 95% CI = 1.33-7.78). CONCLUSIONS: Patients with a lower digit ratio have higher risks of prostate biopsy and prostate cancer.

Clinical and urodynamic effect of methylphenidate for the treatment of giggle incontinence (enuresis risoria).

AIMS: We retrospectively investigated the efficacy of methylphenidate (MPH) in giggle incontinence (GI), and the relationship between GI and urodynamic parameters. METHODS: Nine (n = 9) female GI patients underwent 1 year of treatment with 5 mg MPH. Three questionnaires, voiding diaries, and UDS were conducted before and after treatment. The severity of GI was classified into mild, moderate, and severe. Clinical success was characterized as: full response, response, partial response, and non-response. RESULTS: The mean age of all patients was 16.2 ± 2.3 years. Five patients had mild, one had moderate, and three had severe grade incontinent. All patients reported complete cessation of wetting after MPH treatment. The mean duration of asymptomatic period was 7 ± 3.2 months. There were no statistically significant score changes in all three questionnaires: Urgency Perception Scale (UPS), Overactive Bladder Symptom Score (OABSS) and Primary Overactive Symptom Questionnaire (POSQ), and voiding diaries (P > 0.05). In UDS, there were no statistically significant altered parameters, except maximum urethral closure pressure (MUCP) and maximum urethral pressure (MUP). After treatment, the mean MUCP was increased from 52.2 ± 6.8 to 73.0 ± 5.4 cmH(2) O (P < 0.05), and the mean MUP was increased from 48.6 ± 7.3 to 70.2 ± 5.0 cmH(2) O (P < 0.05). CONCLUSIONS: MPH can be a viable option for the primary treatment of GI, and it may be related to increasing urethral closure pressure. It was not possible to establish if a relationship between GI and detrusor overactivity exists.

Perfectionism, Mood States, and Choking in Asian University Baseball Players under Pressure during a Game.

The purpose of this study was to investigate relationships among mood states, perfectionism, and choking, and to identify a mediating effect of perfectionism on the relationship between mood states and choking experienced by Asian university baseball players in extremely stressful situations during a game. Data collected from a total of 209 male university baseball players were analyzed using SPSS 21 and AMOS 21 statistical software. The mean age of study subjects was 20.25 years. Results are as follows. First, mood states had a positive influence on perfectionism. Second, mood states had no significant influence on choking. Third, perfectionism had a positive influence on choking. Lastly, perfectionism had a complete mediating effect on the relationship between mood states and choking. The study findings will provide basic data to relieve athletes' psychological burdens, and prevent manifestations of extreme perfectionism and choking, which can ultimately help athletes maintain high self-control of their mood states and perfectionism for better performance.

Intermediate versus low or high prostate-specific antigen density level: comparison of cancer detection rate between 12- and 18-core prostate biopsy.

OBJECTIVE: To compare the diagnostic values of 12- and 18-core biopsies with respect to prostate-specific antigen (PSA) levels, prostate volumes (PV) and prostate-specific antigen density (PSAD). MATERIAL AND METHODS: Transrectal ultrasound-guided prostate biopsies were performed on 233 patients at a single tertiary academic center. Patients were prospectively randomized to the two protocols (12 or 18 core). The cancer detection rates achieved using these two methods were analyzed at different PSA levels, PVs and PSADs. RESULTS: Considering PSA level and PV simultaneously, patients were stratified into four groups (group A: PSA < 7 ng/ml and PV ≥ 45 cm(3); group B: PSA < 7 ng/ml and PV < 45 cm(3); group C: PSA ≥ 7 ng/ml and PV ≥ 45 cm(3); group D: PSA ≥ 7 ng/ml and PV < 45 cm(3)). 18-core biopsy had a higher cancer detection rate than 12-core biopsy only in group C (55.2% vs 24.1%, p = 0.015). The 233 patients were also stratified into three groups according to PSAD level: the low PSAD group (PSAD < 0.15 ng/ml/cm(3)), the intermediate PSAD group (0.15 ng/ml/cm(3) ≤ PSAD < 0.25 ng/ml/cm(3)) and the high PSAD group (PSAD ≥ 0.25 ng/ml/cm(3)). In the intermediate PSAD group, 18-core biopsy had a higher cancer detection rate than 12-core biopsy (54.2% vs 28.9%, p = 0.048). CONCLUSION: An 18-core biopsy is more useful than a 12-core biopsy for detecting prostate cancer in patients with high PSA and large PV, that is, with intermediate PSAD level.

Primary squamous cell carcinoma in the testis: a case report.

A 51-yr-old man presented with an enlarged right testis for two months. The radically resected testis showed a relatively well-circumscribed ovoid mass, nearly replacing the normal architecture with central cystic changes. Microscopically, the mass was composed of ovoid shaped tumor cells of a moderately differentiated squamous cell carcinoma (SCC). The central portion of the mass was filled with well-formed laminated keratinous materials and the remnant cavity lined by dysplastic squamous epithelium, indicated SCC may be derived from an epidermal cyst. SCC is among the most common types of neoplasm afflicting human beings, but it is rare in the testis. To our knowledge, this is the second report of the testicular squamous cell carcinoma occurring in a patient without other primary tumors, and the firstly reported case in Korea.

Distal urethral polypropylene sling surgical management for urodynamic stress incontinence in Korean women.

INTRODUCTION: The purpose of the present study was to assess the objective and subjective efficacy of the distal urethral polypropylene sling (DUPS) for urodynamic stress incontinence (USI) in Korean women. PATIENTS AND METHODS: We performed DUPS in 89 consecutive patients with USI. The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to evaluate the surgical outcomes. RESULTS: The mean operative time was 29.4 min (range 25-40). Concomitant procedures were performed including rectocele repair (n = 48), laparoscopically assisted vaginal hysterectomy (n = 12) and laparoscopic myomectomy (n = 1). There were no intraoperative complications or major postoperative complications. The average follow-up was 15 months (range 12-18). Both mean IIQ-7 and UDI-6 scores decreased significantly after DUPS. In addition, 87% of the patients reported no symptoms of USI under any circumstances and 95% of the patients reported never or rarely being bothered by USI. CONCLUSIONS: DUPS is a safe, inexpensive, simple, and effective surgical method for USI. The procedure provides a high cure rate in Korean women.

Vardenafil increases cell proliferation in the dentate gyrus through enhancement of serotonin expression in the rat dorsal raphe.

This study was conducted to evaluate the effects of vardenafil (Levitra), a phosphodiesterase-5 (PDE-5) inhibitor, on cell proliferation in the hippocampal dentate gyrus and on 5-hyroxytryptamine (5-HT, serotonin) synthesis and tryptophan hydroxylase (TPH) expression in the rat dorsal raphe nucleus. Male Sprague-Dawley rats were divided into 6 groups (n=5 in each group): a control group, a 0.5 mg/kg-1 day vardenafil-treated group, a 1 mg/kg-1 day vardenafil-treated group, a 2 mg/kg-1 day vardenafil-treated group, a 1 mg/kg-3 day vardenafil-treated group, and a 1 mg/kg-7 day vardenafil-treated group. 5-bromo-2'-deoxyuridine (BrdU) immunohistochemistry was then performed to evaluate cell proliferation in the dentate gyrus. In addition, 5-HT and TPH immunohistochemistry was conducted to evaluate serotonin expression in the dorsal raphe. The results revealed that treatment with vardenafil increased cell proliferation in the dentate gyrus and enhanced 5-HT synthesis and TPH expression in the dorsal raphe in a dose- and duration-dependent manner. The findings demonstrate that the increasing effect of vardenafil on cell proliferation is closely associated with the enhancing effect of vardenafil on serotonin expression under normal conditions.

Trauma to male genital organs: a 10-year review of 156 patients, including 118 treated by surgery.

OBJECTIVE: To assess testicular rupture, scrotal haematoma, penile fracture and penile injury, comparing the prognoses of surgery and conservative management, as trauma to male external genital organs can cause devastating effects on patients and their partners. PATIENTS AND METHODS: We reviewed the medical records of 156 male patients who presented to our emergency centre with trauma to the external genital organs between January 1996 and March 2006. RESULTS: In all, 74 patients had testicular rupture, 32 penile fracture, 26 a penile injury and 24 a scrotal haematoma (mean age 27.8 years). The main cause of trauma was assault (52, 33%). Four of 14 patients with penile trauma who were managed conservatively had complications. Of 20 patients, 17 had a partial orchidectomy and were followed for a month after surgery; scrotal ultrasonography showed three cases of testicular atrophy. The mean hospital stay was less for patients with surgical intervention, at 6.4 days, than for those managed conservatively, at 8.7 days (P < 0.05). A visual analogue pain scale showed less pain in patients who were surgically treated (P < 0.05). CONCLUSION: Prompt surgical intervention is crucial; it should be considered by urologists, and is strongly recommended. Ultrasonography was highly sensitive and specific, and should be used in all patients with trauma to the external genital organs, to aid diagnosis and evaluation before surgery.

An open-label, multicenter, flexible dose study to evaluate the efficacy and safety of Viagra (sildenafil citrate) in Korean men with erectile dysfunction and arterial hypertension who are taking antihypertensive agents.

INTRODUCTION: Erectile dysfunction (ED) is common among men taking antihypertensive agents to control blood pressure. AIM: We evaluated the efficacy and safety of sildenafil citrate in men with ED taking antihypertensive agents. METHODS: A total of 198 male subjects, aged 20 years and older were enrolled. This study was conducted for 10 weeks as an open-label, multicenter and flexible dose trial with a 2-week screening period and an 8-week treatment phase. MAIN OUTCOME MEASURES: Subjects were asked to complete Event Log Worksheets, as well as the International Index of Erectile Function (IIEF) and the Global Efficacy Assessment Questions (GEAQ) questionnaires during the study period. RESULTS: The average age among the 167 subjects who completed the study was 55.8 (31.7 to 77.1). The scores for questions 3 and 4 of IIEF improved from 2.3 and 1.8 at baseline to 3.7 and 3.4 at week 4 and 3.8 and 3.4 at week 8, respectively. There were 86.3% of the patients reported improved erectile function at week 8; 88.3% of the patients reported improved ability to achieve sexual intercourse at week 8. There were no significant differences observed in the responses to questions 3 and 4 of IIEF and GEAQ by the number of antihypertensive agents taken. The adverse events were facial flushing (20.1%), headache (11.7%), palpitation (5.0%), rhinitis (2.8%), URI (2.8%), dizziness (2.2%), dyspnea (2.2%), and nausea (1.7%). CONCLUSIONS: Sildenafil citrate is an effective treatment for ED; it is safe and well tolerated by patients with ED taking multiple antihypertensive agents for arterial hypertension.

Comparative kinematic analysis of the baseball pitching motions of high school athletes in relation to pitching conditions.

To analyze changes in pitching motions in relation to pitching conditions during practice versus game comparatively, seven high school over-throwing pitchers served as subjects in this study, who then performed pitches in various conditions. Data were processed using the statistical analysis program SPSS 21.0, and the moving distances and angles of the joints at the point of ball release were analyzed using repeated measurements one-way analysis of variance, followed by Bonferroni post hoc tests. Statistical significance was determined at P<0.05, and the following conclusion was obtained. According to the pitching conditions, the elbow joint was lengthened, and the torso leaned towards the nonpitching arm during pitching. Further, the pitching stride increased, causing the forward transfer of the landing foot and the pitching hand. Based on these observations, it is important to establish a pitching training method that minimizes inconsistency in pitching motions by simulating game-like conditions during pitching practices and developing various training programs. Further investigation is required for a comprehensive mechanical analysis of muscle usage and damage in pitching motions in relation to various pitching conditions.

Urology as rehabilitation medicine: a literature review.

As a urologist, we usually encounter with two representative functional behaviors, namely, voiding and sexual function. These are not only important but also complex and synchronized so if these functions are impaired, patients need active functional rehabilitation to recover. These functional impairments should be recognized and corrected early because they could not only cause direct damage to the affected functions but also have harmful consecutive consequences such as kidney damage due to voiding abnormality and self-esteem damage due to decreased sexual function. Numerous rehabilitative methods are currently available, which help minimize the negative effects of these functional impairments. In terms of voiding function, pelvic floor muscle exercise, biofeedback, functional magnetic stimulation, neuromodulation, and clean intermittent self-catheterization are representative rehabilitation modalities. In case of children, extra-attention should be paid because this might affect their entire life. In impairment of sexual function, early intervention to maintain male erection is the main target of rehabilitation to prevent corporal fibrosis and penile deformity and increase recovery chance in patients who underwent radical prostatectomy or major surgery. In this review, we will elucidate various rehabilitation methods in urology to further increase our understanding of the rehabilitative characteristics of urology and widen our view of rehabilitation medicine.

The Association of A Number of Risk Factors With Depression in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy.

PURPOSE: To identify factors affecting depressive symptoms in patients undergoing androgen-deprivation therapy (ADT) to treat prostate cancer. MATERIALS AND METHODS: The patients with prostate cancer visiting the psychiatry department without referral because of depressive symptoms while undergoing ADT participated. To assess depressive symptoms, the Beck Depression Inventory (BDI) was used. To identify the risk factors affecting depressive symptoms, univariate regression and multiple linear regression analyses were implemented. RESULTS: The mean (± SD) age, age when initiating ADT, duration of ADT, serum testosterone level and BDI scores of participants (n = 45) were 73.9 ± 7.9 years, 72 ± 8.5 years, 33 ± 31.6 months, 214.9 ± 219.5 ng/dL and 18 ± 13.5 points. The androgen dependent and independent were 26 and 9 patients. Eight of these androgen-independent patients underwent concurrent chemotherapy. Twenty-one patients were treated with bicalutamide and 24 with leuprolide. Of the clinical variables affecting BDI scores, the type of ADT drug (P < 0.001), serum testosterone level (P = 0.003), and age at diagnosis (P < 0.001) were significant. CONCLUSION: Efforts to diagnose and treat depression appropriately, especially if depressive symptoms change in patients undergoing ADT to treat prostate cancer who are using an LHRH agonist (leuprolide), have low testosteronelevel, or are older at the age when initiating ADT.