Effects of metabolic syndrome on renal stone progression.

PURPOSE: Studies on howmetabolic syndrome affects renal stone progression in untreated asymptomatic patients are lacking. Therefore, we investigated the effect of metabolic syndrome on changes in renal stone size. MATERIALS AND METHODS: We retrospectively analyzed 820 patients with renal stones incidentally detected on CT during regular health examinations and who underwent follow-up CT evaluations for > 1 year. The patients were divided into two groups according to the presence of metabolic syndrome. Changes in stone size during the follow-up were assessed, and differences were compared according to various factors. Predictors of stone size change on CT were assessed using linear regression analysis. RESULTS: Overall, 820 asymptomatic patients without a history of stone treatments and with a mean follow-up of 52.4 months were included. Of these, 104 (12.7%) had metabolic syndrome and 335 (40.9%) showed stone size increase during the follow-up. The stone size at diagnosis was not significantly different between patients with and without metabolic syndrome (225.3 ± 332.6 vs. 183.9 ± 310.2 mm3, p = 0.159); however, a significant difference was observed in the change in stone size at follow-up (148.5 ± 352.0 vs. 81.5 ± 222.4 mm3, p = 0.001). Multivariable analysis showed that age (ß = - 0.11; - 5.92 to -0.69; p = 0.013), fasting glucose level ≥ 100 mg/dl (ß = 0.11; 9.78-99.73; p = 0.017), and metabolic syndrome (ß = 0.10; 9.78-99.73; p = 0.017) were factors predictive of stone size changes. CONCLUSION: Metabolic syndrome, fasting glucose level ≥ 100 mg/dl and young age are positively related to renal stone size changes. Therefore, periodic follow-up and metabolic syndrome management are required in asymptomatic patients with renal stones, especially in young age.

Epidemiology and Management Trend of Renal Trauma: Results of a Nationwide Population-Based Study.

BACKGROUND: To analyze the incidence of renal trauma using the National Health Insurance Service Database (NHISD). METHODS: Using the NHISD, representative of all upper urinary tract injuries in Korea, data regarding renal trauma were analyzed. The International Classification of Diseases, Tenth Revision Clinical Modification codes were used to identify the diagnoses. The incidence estimates of renal traumas were analyzed using Poisson regression analysis. Risk factors for high-grade renal trauma were estimated using multivariable logistic regression analyses. RESULTS: Patients with renal trauma were identified from a nationwide database collected by the National Health Insurance Service of Korea between 2012 and 2016. Among 37,683 individuals with renal trauma, 1,293 (3.4%) were diagnosed with high-grade renal trauma. Surgical therapy was performed in 995 (2.6%) patients with renal trauma and 184 (14.2%) patients with high-grade renal trauma. Renal trauma occurred in all age groups, and the ratio between men and women was approximately 3:1. Men and women experienced 8,000 (31.82/100,000) and 2,365 (9.52/100,000) renal trauma in 2013 (total 10,365, 20.73/100,000) and 5,243 (20.56/100.000) and 2,168 (8.58/100,000) in 2016 (total 7,411, 14.60/100,000), respectively. In multivariable analysis, female sex, age (age; 41-60 and 61-80 years), and comorbidity of peripheral vascular disease, renal disease, and malignancy were revealed as risk factors for high-grade renal trauma. CONCLUSION: Annual incidence of renal trauma is 17.33 per 100,000 population from 2012 to 2016. The incidence of kidney damage decreased gradually from 2013 to 2016, and the majority of renal trauma cases were low-grade. Conservative management was the preferred treatment modality in most patients with renal trauma, including those with high-grade renal trauma.

Varying Outcomes among Patients with Large Angiomyolipomas according to the Treatment Method.

PURPOSE: This study aimed to evaluate the outcomes of large angiomyolipoma (AML) treatment by selective arterial embolization (SAE) versus nephron-sparing surgery (NSS) using a robotic surgical system. MATERIALS AND METHODS: Between January 2011 and June 2018, we retrospectively reviewed 25 patients who underwent robot-assisted partial nephrectomy (RAPN) or SAE for large AMLs. Ten patients underwent RAPN, and 15 underwent SAE. Patient demographics, AML characteristics, and operative and postoperative clinical outcomes were recorded and analyzed. Outcomes were compared between patients who underwent RAPN and patients who underwent SAE. Specifically, changes in renal function and size were evaluated after the treatment. RESULTS: The mean age of the patients was 52.9 years, and 22 of 25 patients were female. The mean maximum AML diameter on computed tomography was 8.9 cm, and 8 patients had multiple masses. Twenty-two of 25 patients had moderate to high RENAL complexity. Patients who underwent SAE had more symptoms (p = 0.018) and higher RENAL complexity scores (p = 0.013) on average. On average, tumor size decreased by 99% among RAPN patients and by 58% among SAE patients (p = 0.001). Although the mean pretreatment estimated glomerular filtration rate (eGFR) was higher among RAPN patients (99.8 vs. 80.0 mL/min/1.73 m2, p = 0.043), there were no significant changes in eGFR in either group after the treatment. One patient in the RAPN group experienced complications, but the postoperative ileus resolved without intervention. CONCLUSIONS: Both RAPN and SAE were effective and feasible treatment options for large AMLs. The AML characteristics and the condition of the patient might be important in determining the appropriate treatment method.

Reduced bladder capacity without daytime voiding symptoms with nocturnal enuresis.

BACKGROUND: This study aimed to evaluate the prevalence of monosymotomatic nocturnal enuresis (MSNE) with reduced bladder capacity in children with primary nocturnal enuresis (NE) and to suggest treatment outcomes. METHODS: This study retrospectively evaluated 54 children (30 males, 24 females; median age: 8; range: 5-14) who were newly diagnosed with primary NE from November 2017 to October 2019. Reduced bladder capacity in MSNE was defined when a patient's maximal voided volume (MVV) from his or her voiding diary was 75% or less than estimated functional bladder capacity ([age + 1] x 30 mL) for his or her age and there were no daytime lower urinary tract symptoms (LUTS) as assessed using history taking and questionnaires. RESULTS: Nineteen (35.2%) of 54 children with newly diagnosed primary NE did not report daytime LUTS. Fifteen children (27.8%) had a reduced bladder capacity and were prescribed anticholinergic or beta-3 agonist. After three months of medication, MVV significantly increased from 117.5 mL to 183.3 mL (P = 0.010), but frequency showed no significant change from 5.7 to 4.9 times a day. Improvement in enuresis occurred completely and partially in 41.7% and 25% of participants, respectively. CONCLUSIONS: The prevalence of reduced bladder capacity without daytime voiding symptoms was relatively high as 27.8% in children newly diagnosed with primary NE. In primary MSNE, reduced bladder capacity should be investigated using a frequency-volume chart in addition to thorough history taking or questionnaires. Anticholinergics or beta-3 agonists for MSNE with reduced bladder capacity are effective at increasing the bladder capacity of these patients.

Diagnosis of urine leakage after bladder repair: a prospective comparative study of ultra-low-dose CT cystography and conventional retrograde cystography.

PURPOSE: We performed this prospective cohort study to compare the accuracy and technical characteristics of ultra-low-dose CT cystography with those of conventional retrograde cystography. MATERIALS AND METHODS: A cohort of 31 patients referred for cystography after bladder repair were enrolled. To detect urine leakage, we initially performed conventional cystography after retrograde distention of the bladder with dilute iodinated contrast material, followed by ultra-low-dose CT cystography. The diagnostic accuracy of these two modalities was compared, and the technical characteristics of ultra-low-dose CT cystography were examined. RESULTS: All 31 referred patients were included in this study. Of the 31 patients, 27 (87.1%) underwent bladder repair after radical prostatectomy, 3 (9.7%) after radical cystectomy, and 1 (3.2%) after bladder diverticulectomy. Four of the 31 patients were diagnosed with urine leakage by conventional cystography. These four patients were confirmed to have urine leakage by ultra-low-dose CT cystography. Another five patients who did not have urine leakage according to conventional cystography were diagnosed with urine leakage by ultra-low-dose CT cystography. Moreover, performing ultra-low-dose CT cystography enabled us to identify the precise location and amount of urine leakage in all nine patients. Based on these findings, we were able to establish a proper treatment plan. CONCLUSIONS: Ultra-low-dose CT cystography is an accurate method for evaluating urine leakage after bladder repair, and this technique may help determine the most appropriate treatment strategy for patients with urine leakage after bladder repair.

Kidney diseases and tissue engineering.

Kidney disease is a worldwide public health problem. Renal failure follows several disease stages including acute and chronic kidney symptoms. Acute kidney injury (AKI) may lead to chronic kidney disease (CKD), which can progress to end-stage renal disease (ESRD) with a mortality rate. Current treatment options are limited to dialysis and kidney transplantation; however, problems such as donor organ shortage, graft failure and numerous complications remain a concern. To address this issue, cell-based approaches using tissue engineering (TE) and regenerative medicine (RM) may provide attractive approaches to replace the damaged kidney cells with functional renal specific cells, leading to restoration of normal kidney functions. While development of renal tissue engineering is in a steady state due to the complex composition and highly regulated functionality of the kidney, cell therapy using stem cells and primary kidney cells has demonstrated promising therapeutic outcomes in terms of restoration of renal functions in AKI and CKD. In this review, basic components needed for successful renal kidney engineering are discussed, and recent TE and RM approaches to treatment of specific kidney diseases will be presented.

Influence of Daytime or Nighttime Dosing with Solifenacin for Overactive Bladder with Nocturia: Impact on Nocturia and Sleep Quality.

We compared changes in nocturia and sleep-related parameters between daytime and nighttime solifenacin dosing in patents with overactive bladder (OAB) and nocturia. We comparatively analyzed the data of a 12-week prospective, open-label, multicenter, randomized study. All 127 patients who presented to 5 centers in Korea for the treatment of OAB with nocturia between January 2011 and December 2013 were enrolled in this study. The patients were divided into 2 groups by medication timing: group 1, daytime (n = 62); and group 2, nighttime (n = 65). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to assess OAB symptoms and sleep quality. We evaluated the parameter changes before and 12 weeks after daytime or nighttime solifenacin administration. Baseline data, which included sex, age, body mass index (BMI), total AIS, IPSS, and OABSS, did not differ between the 2 groups. Total IPSS, OABSS, and total AIS significantly improved after solifenacin administration regardless of timing (P < 0.001). After solifenacin administration, the number of nocturia episodes decreased in the group 1 and 2 (P < 0.001). There were no significant intergroup differences in changes in AIS, IPSS, OABSS, and number of nocturia episodes 12 weeks after solifenacin administration. Treating OAB with solifenacin may improve nocturia and sleep quality, but advantages did not differ significantly by medication timing.

Multiple Human Papillomavirus Infection Is Associated with High-Risk Infection in Male Genital Warts in Ulsan, Korea.

Further understanding of male human papillomavirus (HPV) infection is necessary to prevent infection in men, as well as transmission to women. In our current study, we investigated patterns of HPV infection and genotype distributions in male genital warts using the Anyplex II HPV28 Detection kit. We reviewed the medical records of 80 male patients who presented to 5 neighborhood clinics in Ulsan, Korea, for the treatment of genital warts between April 2014 and January 2015. All patients underwent HPV genotyping. The prevalence and characteristics of HPV infection were analyzed, and the patterns of HPV infection according to age were assessed. Among the study patients, 13 (16.3%) were negative for HPV infection, 46 (57.3%) were infected with low-risk HPV, and 21 (26.3%) were infected with high-risk HPV. Patients with multiple HPV infection were more likely to have high-risk HPV infection (P = 0.001). The prevalence of HPV infection was much higher in samples obtained by tissue excision due to a definite lesion (P = 0.001). There were no differences in high-risk HPV infection (P = 0.459), multiple HPV infection (P = 0.185), and recurrence at diagnosis (P = 0.178) according to age. HPV-6 and HPV-11 were the most common type overall (39.7% and 13.8%, respectively). HPV-16 and HPV-18 were the most common high-risk infections (both 3.4%). HPV infection is not only commonly encountered in male genital warts, but is also accompanied by high-risk HPV and multiple infections.

Analysis of trend in the role of national and regional hubs in prostatectomy after prostate cancer diagnosis in the past 5 years: A nationwide population-based study.

PURPOSE: The regions where patients diagnosed with prostate cancer by biopsy receive prostatectomy are divided into national hub and regional hubs, and to confirm the change in the role of regional hubs compared to national hub. MATERIALS AND METHODS: Data from July 2013 to June 2017 encompassing 218,155 patients aged ≥18 years diagnosed with prostate cancer were analyzed using the Health Insurance Review & Assessment Service database. The degree of patient outflow was assessed by dividing the regional diagnosis-to-surgery ratio with the national ratio for each year. Based on this ratio, national and regional hubs were determined. RESULTS: Seoul consistently maintained a patient influx with a ratio above 1.6. Busan and Gyeonggi consistently exceeded 0.9, while Ulsan and Daegu steadily increased, exceeding 1.0 between 2015 and 2016. Jeonnam province also consistently maintained the ratio above 0.7. Jeju, Daejeon, Gangwon, and Incheon remained below 0.5, indicative of substantial patient outflows, whereas Gwangju and Gyeongbuk had the highest patient outflows with ratios below 0.15. Therefore, Seoul was designated as a national hub, whereas Busan, Gyeonggi, Ulsan, Daegu, and Jeonnam were classified as regional hubs. Jeju, Daejeon, Gangwon, and Incheon were the dominant outflow areas, while Gwangju and Gyeongbuk were the highest outflow areas. CONCLUSIONS: Seoul, as the national hub for prostate cancer surgery, operated on 1.76 times more patients than any other region during 2013-2017. Busan, Gyeonggi, Ulsan, Daegu, and Jeonnam functioned as regional hubs, but approximately 10%-20% of patients sought treatment at national hubs.

Safety and efficacy of once daily administration of 50 mg mirodenafil in patients with erectile dysfunction: a multicenter, double-blind, placebo controlled trial.

PURPOSE: We evaluated the improvement in erectile dysfunction and lower urinary tract symptoms as well as the safety of once daily administration of 50 mg mirodenafil in men with erectile dysfunction. MATERIALS AND METHODS: A total of 226 patients visited for treatment of erectile dysfunction and were recruited for the study. Of these men 180 met the study inclusion criteria after completing a 2-week screening period (visit [V]1). The patients were randomly allocated into 2 groups. Group 1 (90 patients) received 50 mg mirodenafil once daily and group 2 (90 patients) received a placebo daily. Blood pressure, heart rate, IIEF-5 (5-item version of the International Index of Erectile Function), and SEP (Sexual Encounter Profile) questions 2 and 3 were assessed at 4 (V2), 8 (V3) and 12 weeks after the start of treatment (V4). I-PSS (International Prostate Symptom Score), maximal flow rate and post-void residual volume were also assessed for the evaluation of lower urinary tract symptoms. RESULTS: Of the 180 patients 71 in group 1 and 63 in group 2 completed the 12-week clinical trial. IIEF-5 and I-PSS significantly improved in group 1 (p <0.001 for both). Facial flushing was the most common adverse effect, followed by headaches. Notably there were no statistically significant differences in either of the variables related to the cardiovascular system. CONCLUSIONS: Once daily administration of 50 mg mirodenafil was efficacious and safe for the treatment of erectile dysfunction and lower urinary tract symptoms.

Docetaxel Enhances Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand-Mediated Apoptosis in Prostate Cancer Cells via Epigenetic Gene Regulation by Enhancer of Zeste Homolog 2.

PURPOSE: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a promising cancer therapeutic agent because of its tumor selectivity and its ability to induce apoptosis in cancer cells while sparing most normal cells. We evaluated whether docetaxel enhances TRAIL-mediated apoptosis in prostate cancer (PCa) cells and its mechanism. MATERIALS AND METHODS: LNCap-LN3, PC3, and DU 145 PCa cell lines were used to investigate the effects of TRAIL with docetaxel treatment (dosages, 1, 3, 5, and 10 nmol). To evaluate the mechanism, death receptor 4 (DR4), DR5, enhancer of zeste homolog 2 (EZH2) and E2F1 levels were assessed in PCa cells. RESULTS: Hormone-sensitive LNCap-LN3 showed apoptosis in proportion to the concentration of docetaxel. Castration-resistant PC3 and DU 145 showed no change irrespective of the docetaxel concentration. However, combinations of docetaxel (2 nM) and TRAIL (100 ng/mL) had a significant effect on apoptosis of DU 145 cells. In DU 145 cells, docetaxel reduced EZH2 and elevated expression of DR4. The decrease of EZH2 by docetaxel was correlated with the E2F1 level, which was considered as the promoter of EZH2. DZNep reduced EZH2 and elevated DR4 in all PCa cells. Additionally, DZNep-enhanced TRAIL mediated reduction of PCa cell viability. CONCLUSIONS: Docetaxel and the EZH2 inhibitor reduced EZH2 and elevated expression of DR4 in all PCa cell lines. Docetaxel-enhanced TRAIL mediated apoptosis in PCa via elevation of DR4 through epigenetic regulation by EZH2. To improve the efficacy of TRAIL for PCa treatment, adding docetaxel or EZH2 inhibitors to TRAIL may be promising.

Management of recurrent stress urinary incontinence after failed midurethral sling: tape tightening or repeat sling?

INTRODUCTION AND HYPOTHESIS: This study was performed to compare surgical outcomes of repeat midurethral sling (MUS) with those of tape shortening in patients who underwent failed initial MUS. METHODS: We assessed 66 patients who underwent failed initial MUS and a second surgical procedure because of recurrent or persistent stress urinary incontinence (SUI), including 36 who underwent repeat MUS and 30 who underwent tape shortening. All patients were followed up for at least 12 months after second surgery. Efficacy was measured by cure rates on the Sandvik questionnaire. Safety was evaluated by assessing maximal urine flow rate, postvoid residual urine volume, and procedure-related complications. RESULTS: The cure rate was significantly higher in patients who underwent repeat MUS (72.2 % vs. 46.7 %, p = 0.034). Among patients with a Valsalva leak point pressure (VLPP) of <60 cmH(2)O or SUI severity of at least moderate, the cure rate was significantly higher in those who underwent repeat MUS than in those who underwent tape shortening (76.5 % vs. 40.0 % and 79.2 % vs. 43.8 %, respectively). Univariate analysis of preoperative factors demonstrated that there were no risk factors associated with the cure rates in either group. One patient who underwent repeat MUS required tape cutting, and one who underwent tape shortening experienced mesh erosion. A limitation of this study is that it was not a randomized, controlled study. CONCLUSIONS: Repeat MUS has a higher cure rate than does tape shortening in surgical treatment of patient with persistent or recurrent SUI, especially those with low VLPP or high SUI grade.

Therapeutic Effect of Human Mesenchymal Stem Cell-Conditioned Medium on Erectile Dysfunction.

PURPOSE: Owing to the safety and cost effectiveness of conditioned medium (CM), its therapeutic effects have attracted significant attention from many researchers. To date, numerous studies have been conducted on CM; however, little has been done with regard to erectile dysfunction (ED). In this research, the potential of human mesenchymal stem cell-derived CM (MSC-CM) for the treatment of ED was investigated. MATERIALS AND METHODS: A high concentration of MSC-CM was prepared through 3D spheroid culturing with bone marrow-derived MSCs and cut-off filtering. The composition of CM was analyzed using biochemical assays, and the effect of the preparation process on the quality of CM was investigated. The therapeutic effects of MSC-CM were evaluated through animal studies using a cavernous nerve (CN) injury rat model. RESULTS: 3D spheroid culturing afforded a 278-fold increase in the total protein content of CM, as compared to that from 2D cultures; the protein concentration increased by 19 times on increasing the centrifugation time for cut-off filtering. Biochemical assays indicated that the CM contains various types of angiogenic, neurotrophic, and anti-inflammatory factors. Histological assay results showed that MSC-CM has angio- and neuro-trophic effect in a CN injury rat model in vivo, and these therapeutic effects appear in a dose-dependent manner. CONCLUSIONS: The experimental results confirmed the therapeutic effect of MSC-CM in healing damaged cavernosal tissue and restoring erectile function. These results successfully demonstrated that MSC-CM has significant potential for the treatment of ED.

Analysis of changes in the pathophysiology of nocturia according to the number of nocturia episode, age, and gender using frequency volume charts: A retrospective observational study.

PURPOSE: To evaluate the pathophysiology of nocturia based on the frequency volume chart, and determine the risk factors for nocturia occurring ≥2 times per night. MATERIALS AND METHODS: In this retrospective study, we reviewed 311 patients with complaints of nocturia from January 2017 to February 2019 at our institution. Nocturnal polyuria (NP) and global polyuria (GP) were defined as NP index >0.35 regardless of age and 24 h urine volume >2.5 L/day, respectively. Decreased bladder capacity (dBC) was when the maximal voided volume was <325 mL. Decreased nocturnal bladder capacity (dNBC) was defined as nocturnal bladder capacity index >0. RESULTS: In total, 273 patients were included in the primary analyses. Of 802 days from 273 frequency volume charts, the median number of nocturia was 1 episode per day. Further, NP (odds ratios [OR] 7.01), GP (OR 4.25), dBC (OR 3.00), dNBC (OR 10.12), and age (OR 1.04) had the association with nocturia ≥2 times per night. There was a significant stepwise increase in NP, dNBC, dBC, and GP with the number of nocturia episodes. As patient age increased, the likelihood of NP (P < 0.001) and dBC (P < 0.001) being the cause for nocturia tended to increase, but that of dNBC (P = 0.022) and nocturia without cause (P = 0.007) tended to decrease. Moreover, dBC was more likely to cause nocturia in female patients than in male patients (P < 0.001). CONCLUSION: NP, dBC, dNBC, and GP are important factors involved in the pathophysiology of nocturia occurring ≥2 times per night.

Mass size is a major predictor of hypertensive attack during surgery in patients with paraganglioma of retroperitoneum.

Background: Surgical manipulation of paraganglioma can induce a massive release of catecholamines leading to hypertensive attack. But it has been not known about risk factors to cause hypertensive attack because paragangliomas of urinary bladder and retroperitoneum are notably rare tumors and have been recorded as case report or series. We investigated the relationship between mass size and hypertensive attack during surgery in patients with paraganglioma. Methods: Our retrospective chart review included 32 patients who had a pathological diagnosis of paraganglioma between March 2006 and May 2021, in single center. We analyzed the risk factors such as age, sex, height, weight, blood pressure before surgery, history of hypertension, pre-operative symptoms, mass location, and mass in 24 patients with retroperitoneal paragangliomas including urinary bladder. Hypertensive attack was defined as systolic blood pressure >180 mmHg during excision of the mass from the electric medical chart. The predictive power was assessed by the area under the curve of the receiver operating characteristic curve. Results: There were 19 retroperitoneal, 5 urinary bladder, 2 middle-ear cavity, 2 mediastinal, 2 neck, 1 spinal cord and 1 duodenal paraganglioma. Seven (29.2%) of the 24 patients had preoperative symptoms such as pain, fluctuation of blood pressure, and palpable mass. Hypertensive attack during surgery occurred in 11 patients (45.8%). There was a significant difference in mass size between groups with (n=11) and without (n=13) fluctuation of blood pressure (P=0.007). The area under curve for predicting surgical complications according to mass size was 0.808 (cutoff size 4.25 cm, sensitivity 72.7%, specificity 76.9%, 95% CI: 0.635-0.981). Conclusions: Mass size impacted occurrence of hypertensive attack during surgery in patients with retroperitoneal paraganglioma. Surgeons have to be watchful regarding of intraoperative hypertension during resection of retroperitoneal masses exceeding 4.25 cm, which are suspected as paraganglioma.

Imaging features of benign solid testicular and paratesticular lesions.

OBJECTIVE: The presence of an intratesticular solid lesion is usually highly suspicious for malignancy. Conversely, most extratesticular solid lesions including paratesticular lesions are benign. The characteristic imaging features of malignant solid testicular lesions are well known, but various unusual causes and imaging features of benign solid testicular lesions can be particularly misleading. Therefore, a careful assessment of solid testicular and paratesticular lesions is warranted. The purpose of this article is to present the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions. METHODS: We demonstrate a variety of benign solid testicular and paratesticular lesions and correlate them with pathologic results. RESULTS: Specific the clinical and imaging features of the spectrum of benign solid testicular and paratesticular lesions have been described. CONCLUSIONS: Familiarity with the clinical setting and imaging features of benign solid testicular and paratesticular lesions should facilitate prompt, accurate diagnosis and treatment.

Nationwide survey to evaluate the prevalence of varicoceles in South Korean middle school boys: a population based study.

OBJECTIVE: We carried out a nationwide epidemiological study to evaluate the prevalence and effect of varicoceles on testicular volume in South Korean adolescents. We also investigated the correlation between varicoceles and body mass index (BMI). METHODS: In this prospective study, physical examinations were carried out to assess the presence and severity of varicoceles in middle school boys from six regions of South Korea. Testicular volume, height and weight of all boys were measured. The prevalence of varicoceles was assessed. The associations between age, testicular volume, BMI, and the presence and severity of varicoceles were examined. RESULTS: A total of 1938 boys with a mean age of 14.1 years (range 13-16 years) were screened. A varicocele was found on the left side in 295 (15.2%) boys and on the right side in 8 (0.4%) boys. Bilateral varicoceles were found in 17 (0.9%) individuals. Of the subjects with a left varicocele, 151 (51.2%), 80 (27.1%) and 64 (25.1%) boys had a grade 1, 2 or 3 varicocele, respectively. The prevalence of varicoceles did not increase with age. The proportion of boys with testicular size discrepancies increased with the severity of the varicocele. After adjusting for age, BMI had a negative correlation with the presence of varicoceles. CONCLUSIONS: The prevalence of varicoceles in South Korean middle school boys is 16.5%. The presence of varicoceles seems to have a negative effect on testicular growth. BMI has a significant inverse relationship with the occurrence of varicoceles.

Outcomes of extracorporeal shock wave lithotripsy for ureteral stones according to ESWL intensity.

BACKGROUND: We evaluated the treatment outcomes of ureteral stones according to energy intensity generated by extracorporeal shock wave lithotripsy (ESWL). METHODS: We retrospectively analyzed 150 patients who underwent ESWL for treatment of ureteral stones between September 2018 and February 2020. All stones were confirmed by a computed tomography examination, and the size, location, skin-to-stone distance, and Hounsfield units (HU) of the stones were assessed. In addition, patient characteristics including body mass index and estimated glomerular filtration rate, which can affect treatment outcome, were also evaluated. The success or failure of ESWL was confirmed according to the session, and the factors affecting the treatment outcome were analyzed using a logistic regression model. RESULTS: Of the 150 patients, 82 (54.7%) had stones in the proximal ureter, 5 (3.3%) in the mid, and 63 (42.0%) in the distal ureter. Patients underwent ESWL an average of 1.5 times, and the success rate according to session was 65.3% for the first, 83.3% for the second, and 90.0% for the third session. A multivariate analysis revealed that stone size [odds ratio (OR) 0.81, 95% confidence interval (CI), 0.66-0.99, P=0.049] and HU (OR 0.99, 95% CI, 0.98-0.99, P=0.001) were significant factors affecting the success rate after the first ESWL session; ESWL intensity was not related to success rate. Stone size (OR 0.78, 95% CI, 0.62-0.96, P=0.022) was the only significant factor affecting the success rate in the third session. CONCLUSIONS: Stone size and HU affected the ESWL success rate. ESWL intensity was not significantly related to the success rate, so it should be adjusted according to patient pain and the degree of stone fragmentation.

Efficacy and tolerability of mirabegron compared with solifenacin for children with idiopathic overactive bladder: A preliminary study.

PURPOSE: To compare the efficacy and tolerability of mirabegron and solifenacin in pediatric patients with idiopathic overactive bladder (OAB) and to identify factors affecting OAB symptom improvement after treatment. MATERIALS AND METHODS: We retrospectively reviewed 103 patients (5-15 years old) who visited our hospital with OAB symptoms between July 2017 and March 2019. All participants had received solifenacin or mirabegron. Those who had secondary OAB or who did not complete the frequency-volume chart either before or after treatment were excluded. The age-adjusted bladder capacity ratio was used to evaluate bladder capacity. Efficacy was assessed on the basis of patient reports and changes in the frequency-volume chart, and ≥90% reduction was regarded as "responding to medication." Tolerability was assessed by obtaining reports from patients about the adverse effects of the drug. RESULTS: After the exclusion of 58 patients, 45 patients (29 in solifenacin-group and 16 in mirabegron-group) were included in the primary analysis. The age-adjusted bladder capacity ratio increased from 0.71 to 0.96 (p<0.001) and from 0.57 to 0.97 (p=0.002) after solifenacin and mirabegron use, respectively. Decreased bladder capacity before medication was associated with responding to medication (odds ratio, 7.41; p=0.044). There was no significant difference in efficacy between the two drugs. Drug-induced adverse effects were reported in only 3 (10.3%) of the solifenacin-treated patients. CONCLUSIONS: Mirabegron showed comparable efficacy to solifenacin in pediatric patients with idiopathic OAB. Additionally, only few adverse effects were reported, suggesting that mirabegron can be a safe alternative for the treatment of idiopathic pediatric OAB.

Developmentally regulated GTP-binding protein 2 levels in prostate cancer cell lines impact docetaxel-induced apoptosis.

PURPOSE: This study aimed to confirm the association between developmentally regulated GTP-binding protein 2 (DRG2) expression and docetaxel-induced apoptosis and to determine whether prostate cancer responses to docetaxel treatment differ with DRG2 expression. MATERIALS AND METHODS: PC3, DU145, and LNCaP prostate cancer cell lines were used. The MTT assay was used to determine cell viability. Western blotting analysis was performed using anti-DRG2 antibodies. Cells were transfected with 50 nmol DRG2 siRNA using an siRNA transfection reagent for DRG2 knockdown. The cell cycle was analyzed by using flow cytometry, and apoptosis was detected by using the Annexin V cell death assay. RESULTS: DRG2 expression differed in each prostate cancer cell line. Docetaxel reduced DRG2 expression in a dose-dependent manner. Upon DRG2 knockdown in prostate cancer cells, an increase in the sub-G1 phase was observed without a change in the G1 or G2/M phases. When 4 nM docetaxel was administered to DRG2 knockdown prostate cancer cell lines, an increase in the sub-G1 phase was observed without increasing the G2/M phase, which was similar to that in DU145 cells before DRG2 knockdown. In PC3 and DU145 cell lines, DRG2 knockdown increased docetaxel-induced Annexin V (+) apoptosis by 8.7 and 2.7 times, respectively. CONCLUSIONS: In prostate cancer cells, DRG2 regulates G2/M arrest after docetaxel treatment. In prostate cancer cells with DRG2 knockdown, apoptosis increases without G2/M arrest in response to docetaxel treatment. These results show that inhibition of DRG2 expression can be useful to enhance docetaxel-induced apoptosis despite low-dose administration in castration-resistant prostate cancer.