Practice pattern of non-muscle invasive bladder cancer in Japan, Korea and Taiwan: A Web-based survey.

OBJECTIVES: To investigate the treatment pattern of non-muscle invasive bladder cancer patients among urologists in Japan, Korea and Taiwan, with emphasis on compliance with important treatment guidelines. METHODS: A Web-based questionnaire survey was conceived by representative members of each country's urological oncology society and was open from June 2016 to February 2017 to each society's members. Descriptive statistics and multinomial logistic regression analysis were used. RESULTS: A total of 2334 urologists were invited and 701 responded to the survey with a response rate of 30.0%. Instruments used during transurethral resection of bladder cancer varied significantly between countries and depended on their availability. The re-transurethral resection rate for pT1 or high-grade disease >50% of the time was significantly higher in Japan than in the other two countries, but the collective rate was just 49%. The frequency of intravesical therapy in intermediate- to high-risk disease was generally consistent across countries. However, the choice of agent between chemotherapy and bacillus Calmette-Guérin was significantly different between countries. Maintenance bacillus Calmette-Guérin was used <10% of the time by 45% of respondents, the most important reasons being fear of side-effects, followed by a lack of efficacy and shortage of drug supply. CONCLUSIONS: There are significant differences between Japan, Korea and Taiwan in the management of intermediate- to high-risk non-muscle invasive bladder cancer. The results of this survey can serve as the basis for joint efforts to develop common clinical guidelines.

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma.

This study aimed to evaluate the efficacy, safety, and tolerability of 2-cycled neoadjuvant sunitinib therapy (NST) in patients with inoperable metastatic renal cell carcinoma (mRCC). Between 2009 and 2012, 14 patients with inoperable mRCC from 5 Korean academic centers were prospectively enrolled after collecting their clinicopathological data and completing health-related questionnaires. The best overall response (BOR), safety profile, and changes in quality of life during NST were assessed using the RECIST criteria (version 1.0), CTCAE criteria (version 4.0), and the Cancer Quality of Life Questionnaire (QLQ-C30). Among the 14 patients, 9 patients (64.3%) experienced partial response or stable disease state, and 5 patients (35.7%) did not complete treatment, with 1 case of disease progression (7.1%), 3 grade 3 adverse events (21.4%), and 1 voluntary withdrawal (7.1%). Four patients (28.6%) were successfully converted to an operable state and underwent surgery after NST. The BOR for the primary renal lesions was 22.2%, with a median 1.3-cm diameter reduction (range: 0-2.8 cm) from a baseline diameter of 10.3 cm (range: 6.6-15.8 cm). The other 18 measurable metastatic lesions exhibited a BOR of 55.6%. The QLQ-C30 questionnaire results revealed significant improvements in the quality of life domain, although we observed significant increases in the scores for fatigue, nausea and vomiting, and the financial effects of NST (P < 0.05). Two-cycle NST provided limited efficacy for resectability of inoperable mRCC, despite mild improvements in the BOR of the primary lesion and quality of life (Clinical Trial Registry 1041140-1).

Establishment of Reference Ranges for Prostate Volume and Annual Prostate Volume Change Rate in Korean Adult Men: Analyses of a Nationwide Screening Population.

We aimed to determine normal reference ranges for prostate volume (PV) and annual PV change rate in a Korean nationwide screening population. Data from men who underwent a routine health check-up were collected from 13 university hospitals. The cohort comprised men aged ≥40 yr who had undergone 2 or more serial transrectal ultrasonographies. Men with initial PV>100 mL; serum PSA level>10 ng/mL; PV reduction>20% compared with initial PV, or who had history of prostate cancer or prostate surgery, were excluded. Linear regression and mixed effects regression analyses were used to predict mean PV and longitudinal change in PV over time. A total of 2,967 men formed the study cohort. Age, body mass index (BMI), and serum prostate-specific antigen (PSA) level were found to be significant predictors of PV. A predicted PV table, with a 95% confidence interval (CIs), was developed after adjusting for these 3 variables. Annual PV change rate was 0.51 mL/year (95% CI, 0.47-0.55). Annual PV change rate according to age was 0.68 mL/year, 0.84 mL/year, 1.09 mL/year, and 0.50 mL/year for subjects in their 40s, 50s, 60s, and ≥70 yr, respectively. Predicted annual PV change rate differed depending on age, BMI, serum PSA level and baseline PV. From a nationwide screening database, we established age-, PSA-, and BMI-specific reference ranges for PV and annual PV change rate in Korean men. Our newly established reference ranges for PV and annual PV change rate will be valuable in interpreting PV data in Korean men.

Rapid increase of health care utilization and cost due to benign prostatic hyperplasia in Korean men: retrospective population-based analysis using the Health Insurance Review and Assessment service data.

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.

Sonographic findings of tuberculous vasitis.

The purpose of this series was to describe the sonographic findings of tuberculous vasitis. We conducted a retrospective analysis of 3 cases of tuberculous vasitis. The following grayscale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, epididymal or testicular involvement, presence of hydrocele, and blood flow within the lesion. All 3 patients had focal (n = 2) or multifocal (n = 1) involvement of the scrotal segment of the vas deferens. The sonographic findings for tuberculous vasitis were heterogeneously hypoechoic in all of the cases. On color Doppler sonography, no blood flow was identified within the lesions of the vas deferens. All 3 patients had tuberculous epididymitis in addition to tuberculous vasitis. Tuberculous vasitis presents with infection along with tuberculous epididymitis, and it appears as a heterogeneously hypoechoic lesion in the scrotal segment of the vas deferens adjacent to the epididymal tail.

A nationwide epidemiological study of testicular torsion in Korea.

Testicular torsion is a surgical emergency in the field of urology. Knowledge of the epidemiology and pathophysiology is significant to an urologist. However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. From 2006-2011, the Korean Urologic Association began the patient registry service. The annual number of patients with testicular torsion from 2006 to 2011 were 225, 250, 271, 277, 345, and 210, respectively. The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. Adolescents showed the highest incidence. Total testicular salvage rate was 75.7% in this survey. There was no geographic difference of testicular salvage rate. Minimizing the possibility of orchiectomy for testicular torsion is important to improve public awareness to expedite presentation and provider education to improve diagnosis and surgery.

Vasectomy is not a simple procedure: subtotal testicular infarction.

A 32-year-old man presented with severe scrotal pain after vasectomy. Scrotal ultrasound showed the presence of enlargement and decreased echogenicity of more than the upper two-thirds of the right testis. After orchiectomy, scrotal pain disappeared. This is the first report of simple orchiectomy after subtotal testicular infarction due to a suture tie of vasectomy. During vasectomy, it is important to dissect the bare vas to minimize vascular injury.

Sonographic findings of acute vasitis.

OBJECTIVE: The purpose of this study was to describe the sonographic findings of acute vasitis. METHODS: This was a retrospective analysis of 12 cases of acute vasitis. The following gray scale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, presence of hydrocele, epididymal involvement, and blood flow within the lesion. RESULTS: Of the 12 patients, 10 had acute vasitis in the scrotal segment; 1 had acute vasitis in the suprascrotal segment; and 1 had acute vasitis in both the scrotal and suprascrotal segments. The sonographic finding for acute vasitis of the scrotal segment was a heterogeneously hypoechoic appearance of the vas deferens (n = 11). The vas deferens was thickened (6.4 mm in diameter) in the 2 patients with suprascrotal involvement; it was heterogeneously hypoechoic in 1 and had a normal appearance in the other. On color Doppler sonography, the degree of blood flow was increased in all of the cases. Of the 12 patients, 11 had inflammation of the epididymis. CONCLUSIONS: Acute vasitis usually presents with infection combined with acute epididymitis, and it usually appears as a heterogeneously hypoechoic lesion in the scrotal segment, suprascrotal segment, or both.

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

OBJECTIVES: To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non-dominant and bilateral hemispheric stroke patients. METHODS: We retrospectively reviewed the medical records of patients from a magnetic resonance imaging and urodynamic study. We identified 69 cases among 192 stroke patients who had undergone urodynamic study due to lower urinary tract symptoms from June 2003 to December 2008. RESULTS: Among the analyzed variables in the urodynamic study, total bladder capacity, voided volume, postvoid residual urine volume, maximum flow rate, average flow rate, detrusor pressure at the maximum flow rate, and bladder compliance did not show statistically significant differences among dominant, non-dominant and bilateral hemispheric stroke patients groups (P > 0.05). The dominant hemispheric stroke group had detrusor overactivity in 64.2% of cases and detrusor underactivity in 35.8%; the non-dominant hemispheric stroke group had detrusor overactivity in 66.7% of cases and detrusor underactivity in 33.3%; and the bilateral stroke group had detrusor overactivity in 60.0% of cases and detrusor underactivity in 40.0% (P = 0.946). CONCLUSION: Urodynamic findings cannot be characterized by the laterality of the unilateral hemispheric ischemic lesion. There are no significant differences in lower urinary tract symptoms between dominant, non-dominant and bilateral hemispheric ischemic stroke patients.

Aggressive Paraganglioma of the Urinary Bladder with Local Recurrence and Pelvic Metastasis.

Many pheochromocytoma and extra-adrenal paraganglioma are benign, but some are malignant. Pheochromocytoma of the Adrenal gland Scaled Score analyzed the histological characteristics of the tumor. Tumors with a Pheochromocytoma of the Adrenal gland Scaled Score of 4 or higher have a higher risk of recurrence. This pattern is thought to be applicable to paraganglioma as well, and to future patient follow-up efforts. We report a recurrent and metastatic paraganglioma of the urinary bladder.

Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction.

Korean ginseng and mountain ginseng (Panax ginseng CA Meyer) are important traditional herbal plants whose ginsenosides are generally accepted as serving to improve sexual functions, such as penile erection. We investigated the effects of tissue-cultured mountain ginseng extract (TMGE) on male patients with erectile dysfunction (ED). A double-blind, placebo-controlled study was conducted with 143 patients experiencing ED. Over the course of 8 weeks, one group took 1 000 mg of TMGE twice a day, and the other group took 1,000 mg of placebo twice a day. The effects of the TMGE and the placebo were analyzed using the Korean version of the International Index of Erectile Function (IIEF) questionnaire. A total of 86 patients completed 8 weeks of treatment. The scores on the five domains of the IIEF after medication were significantly higher than the baseline scores in the group treated with TMGE (P<0.05), whereas no significant improvement was observed in the placebo group (P>0.05). Erectile function and overall satisfaction scores after medication were significantly higher in the TMGE group than in the placebo group (P<0.05). Erectile function of patients in the TMGE-treated group significantly improved, suggesting that TMGE could be utilized for improving erectile function in male patients.

Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography.

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.

Squamous cell carcinoma arising from a presacral epidermoid cyst: CT and MR findings.

We report CT and MRI findings in a case of squamous cell carcinoma arising from a presacral epidermoid cyst, which has not been previously reported. CT findings revealed a focal wall thickening of the anterior wall of the huge presacral cystic mass. The squamous cell carcinoma was more hypointense than the cystic fluid on T1- and T2-weighted images and showed heterogeneous enhancement on contrast enhanced T1-weighted image.

Heterogeneous oncologic outcomes according to surgical pathology in high-risk prostate cancer: implications for better risk stratification and preoperative prediction of oncologic outcomes.

PURPOSE: To evaluate the better risk stratification based on surgical pathology, and to predict oncologic outcomes after radical prostatectomy (RP) with a better scoring system in high-risk prostate cancer (PCa) patients. METHODS: We evaluated high-risk PCa patients (PSA >20 ng/ml, ≥cT3a, or Gleason score 8-10) who underwent RP between 2007 and 2013 at our institute. We classified patients into three groups according to their pathologic outcomes: favorable (pT2, Gleason score ≤7, and node negative), intermediate (specimen-confined disease (pT2-3a, node negative PCa with negative surgical margins) but not in the favorable group), and unfavorable (the remaining patients). We developed a risk stratification scoring system to predict prognostic outcomes after RP and validated our scoring system to estimate its predictive accuracy. RESULTS: Among a total of 356 patients, 95 (26.7%), 115 (32.3%), and 146 (41%) were in the favorable, intermediate, and unfavorable prognostic groups, respectively. The 5-year biochemical recurrence-free survival rates of the patients in each group were 87.8, 64.6, and 41.4%, respectively. We developed a scoring system based on preoperative PSA, clinical stage, percentage of tumor positive core, and percentage of cores with a Gleason score 8-10. This demonstrated internally and externally validated concordance indices of 0.733 and 0.772, respectively. CONCLUSIONS: Using our scoring system, we can predict which patients with high-risk PCa would benefit more from RP. Thus, this system can be used in patient counseling to determine an optimal treatment strategy for high-risk PCa.

Suppression of GLTSCR2 expression in renal cell carcinomas.

Nucleolar protein PICT-1/GLTSCR2 (GLTSCR2) has both tumor suppressive and oncogenic activities, depending on the types of cancer tissue and its expression level. The role of GLTSCR2 in renal cell carcinoma (RCC) has not yet been addressed. The aims of this study were to evaluate GLTSCR2 expression in RCC tissue and to determine pathological significance of GLTSCR2 in terms of tumor grade. RCC and adjacent normal tissue from 84 different patients was retrieved from nephrectomy specimens. The expression level of GLTSCR2 in RCC tissues was determined via immunohistochemical staining and invasion was determined using transwell chambers with Matrigel-coated membranes. The expression of GLTSCR2 was suppressed in about 80% of the carcinoma specimens compared to noncancerous renal tissue and inversely correlated with Fuhrman nuclear grade (r=-0.40, p<0.05). Knockdown of GLTSCR2 expression increased the invasiveness of SNU267 RCC cells. The expression of GLTSCR2 was suppressed in RCCs and its downregulation accentuated the malignant phenotype.

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study.

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?

PURPOSE: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (α-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). MATERIALS AND METHODS: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. RESULTS: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95±2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. CONCLUSIONS: Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.

The effect of bone-associated growth factors and cytokines on the growth of prostate cancer cells derived from soft tissue versus bone metastases in vitro.

Prostate cancer metastasis to bone may be mediated by preferential proliferation of these cells in the bone's microenvironment. We hypothesize that this preferential proliferation is mediated by bone-associated growth factors (GFs) and cytokines. To test our hypothesis, human prostate cancer cells, derived from both soft tissue (LNCaP, DuCaP, DU145) and bone metastases (PC-3, VCaP, MDA-2a, MDA-2b), were treated with bone-associated GFs and cytokines (PDGF, IGF-1, TGF-beta, EGF, bFGF, TNF-alpha, IL-1, and IL-6) for 48 h, and their growth responses were compared. The responses of soft tissue-derived prostate cancer cell lines to bone GFs and cytokines were variable. LNCaP cell growth was stimulated by IGF-1 but was inhibited by TNF-alpha. DU145 cell growth was stimulated with EGF. Prostate cancer cell lines derived from bone metastases also responded variably to bone GFs and cytokines. IL-1 stimulated the growth of MDA-2a and 2b cell lines in a dose-dependent manner. PDGF and bFGF both demonstrated variable effects on bone-derived prostate cancer cell lines. TNF-alpha inhibited proliferation of the VCaP cells. These findings demonstrate that human prostate cancer cell lines derived from bone metastases may not respond preferentially to bone-associated GFs and cytokines.