The efficacy and safety of tadalafil in the management of erectile dysfunction with diabetes and blood circulation issues.

BACKGROUND: Erectile dysfunction (ED) is a common diabetes-related complication. MATERIALS AND METHODS: This study examined the effect of daily low-dose tadalafil (5 mg) on patients' quality of life (including that of sex life) and blood circulation. Erectile dysfunction questionnaires were administered to 20 patients with type 2 diabetes (T2DM) and ED. The safety and efficacy of tadalafil were evaluated using laboratory tests, and the effect on blood circulation was measured through nail fold capillaroscopy. RESULTS: Daily tadalafil use by patients with T2DM and ED showed a statistically significant increase in the erectile reliability score from of 1.15 to 3.20 (p < .00012). Capillary blood circulation improvement tests showed a statistically significant increase in apical limb width from 13.1 to 14.64 µm (p = .04829) and flow from 9035 to 11946 µm3/s (p = .04405). Although not significant, increased capillary width and speed (rate of blood flow) confirmed improved blood circulation. There were no significant changes in the cardiac indicators (troponin, prostate-specific antigen, or electrocardiogram tests) before and after tadalafil administration, supporting the safety of its low-dose daily administration. CONCLUSIONS: A small dose of daily tadalafil was shown to safely improve erectile dysfunction and peripheral blood flow in patients with T2DM, in which peripheral arterial diseases should not be considered separately but rather as complex entities.

Association between lower urinary tract symptoms and cardiovascular risk scores in ostensibly healthy women.

OBJECTIVES: To investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk in women, as severe LUTS are known to be associated with CVD risk in men but few studies have focused on this issue in women. SUBJECTS AND METHODS: A total of 1014 ostensibly healthy women, who participated in a voluntary health check in a health promotion centre from November 2013 to October 2015, were enrolled. LUTS were assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). CVD risk scores were calculated using the Framingham risk score and the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) score. Correlation, partial correlation, and multiple logistic regression analyses were conducted. RESULTS: The mean age and body mass index (BMI) of the women were 51 years and 22.6 kg/m2 , respectively. The ASCVD score showed significant positive correlations with IPSS items Question 2 (Q2), Q3, Q5, and Q7 (all P < 0.05), total IPSS (P = 0.001), IPSS storage (P = 0.006) and IPSS voiding symptoms scores (P = 0.001) based on partial correlation analysis after adjustment for BMI. For the OABSS, the ASCVD score showed significant positive correlations with OABSS items Q2, Q3, and Q4 (P < 0.001, P = 0.017, and P < 0.001, respectively) and total OABSS (P < 0.001). Multiple logistic regression analysis showed that the moderate-severe risk groups of the OABSS and IPSS were associated with the ASCVD risk score in adjusted models (P < 0.001) compared to the none-mild OABSS and mild IPSS groups. After adjustment for age and BMI, IPSS storage score was significantly related with the ASCVD risk score (B = 0.855, P = 0.016) CONCLUSIONS: LUTS, especially storage symptoms, might be risk factors for predicting future CVD risk in women. Further prospective or cohort studies are needed to validate this possibility.

Relationship between lower urinary tract symptoms and cardiovascular risk scores including Framingham risk score and ACC/AHA risk score.

AIMS: This study attempted to investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk using International Prostate Symptom Score (IPSS) and CVD risk scores and to overcome the limitations of previous relevant studies. METHODS: A total of 2994 ostensibly healthy males, who participated in a voluntary health check in a health promotion center from January 2010 to December 2014, were reviewed. CVD risk scores were calculated using Framingham risk score and American College of Cardiology (ACC)/American Heart Association (AHA) score. Correlation and multivariate logistic regression analysis to predict the CVD risk severity were performed. RESULTS: Correlation between total IPSS with CVD risk scores demonstrated significant positive associations, which showed higher correlation with ACC/AHA score than the Framingham score (r = 0.18 vs 0.09, respectively). For ACC/AHA score, the partial correlation after adjustment of body mass index (BMI) showed significant positive correlations between all LUTS parameters and PSA. For the Framingham score, all variables, except IPSS Q2 and IPSS Q6, showed significant positive correlations. After adjustment of BMI, prostate volume and PSA, only the severe LUTS group showed significant relationship with intermediate-high CVD risk severity, as compared with normal LUTS group (OR = 2.97, 95%CI (1.35-6.99)). CONCLUSION: Using two validated CVD risk calculators, we observed that LUTS is closely associated with future CVD risk. To predict the intermediate-high CVD risk severity, severe LUTS was a sentinel sign, the presence of which warrants the importance of an earlier screening for CVD.

The application rate for urology specialty compared with other specialties from 2007 to 2014 in Korea: is it influenced by social interest manifested by internet trends?

BACKGROUND: Reduced clinical exposure to urology at the undergraduate or internship level is the main explanation for the marked decrease in applicants to urology residencies. This manuscript was to access the application rate for urology specialty compared with that of other specialties and to investigate the relationship between the decreasing trend in urology applications and social interest using internet trend tests. METHODS: We reviewed data collected by the Korean Hospital Association from 2007 to 2014. We assessed internet trends using Naver Trend for domestic social interest and Google Trends for international social interest (2007 to 2014). Trend tests and Spearman correlations were used for statistical analyses. RESULTS: Among the all specialties, the application rates to obstetrics and gynecology, emergency medicine, and occupational medicine are significantly increasing (p = 0.015, 0.012, and 0.048, respectively). Application to other specialties is mostly decreasing. The decreasing trend is highest for urology (beta = - 12.21 and p < 0.001). The application rate and domestic social interest revealed by Naver trends were significantly correlated (r = 0.786 and p = 0.021). No correlation was found between Naver trends and Google trends (r = - 0.19 and p = 0.651). CONCLUSIONS: The rate of application to urology specialty is decreasing the fastest, and this trend is related to domestic social interest. An attempt should be made to increase the number of urologic applicants.

National Trend of Uroflowmetry, Urodynamic Study and Cystoscopy Considering the Change in the Population Structure in Korea from 2010 to 2015.

BACKGROUND: Although lower urinary tract symptoms (LUTS) show a higher prevalence with age, few studies have reported the trend of these examination tools including uroflowmetry, urodynamic study and cystoscopy. METHODS: We evaluated the trend of performance of uroflowmetry, urodynamic study and cystoscopy by using National Health Insurance Data from 2010 to 2015. Primary outcome findings included cumulative number of patients per year, cumulative age-standardized patient rate per year and per age group, and correlation between the number of patients per year and the percentage of population per year in each age group. RESULTS: The overall trend for frequency of uroflowmetry and cystoscopy showed an increasing pattern (P < 0.001, respectively) while the trend for frequency of urodynamic study showed a decreasing pattern (P < 0.001). After age standardization, the overall trend showed similar results. Correlation between the number of patients per year and the percentage of population per year showed a positive correlation in the 50s age group and the above 70s age group (P = 0.003 and < 0.01, respectively) on uroflowmetry and in the above 70s age group (P < 0.01) on cystoscopy. Urodynamic study showed negative correlations in the 50s age group and the above 60s age group (P = 0.001 and 0.01, respectively). CONCLUSION: National trend for frequency of uroflowmetry, urodynamic study and cystoscopy showed a different trend. The increasing trend of uroflowmetry and cystoscopy was related with growth of the aged population. However, urodynamic study showed a decreasing trend regardless of the age group.

Diagnostic accuracy of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging of small renal masses in real practice: sensitivity and specificity according to subjective radiologic interpretation.

BACKGROUND: The aim of this study was to investigate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) of small renal masses in real practice. METHODS: Contrast-enhanced CT and MRI were performed between February 2008 and February 2013 on 68 patients who had suspected small (≤4 cm) renal cell carcinoma (RCC) based on ultrasonographic measurements. CT and MRI radiographs were reviewed, and the findings of small renal masses were re-categorized into five dichotomized scales by the same two radiologists who had interpreted the original images. Receiver operating characteristics curve analysis was performed, and sensitivity and specificity were determined. RESULTS: Among the 68 patients, 60 (88.2 %) had RCC and eight had benign disease. The diagnostic accuracy rates of contrast-enhanced CT and MRI were 79.41 and 88.23 %, respectively. Diagnostic accuracy was greater when using contrast-enhanced MRI because too many masses (67.6 %) were characterized as "4 (probably solid cancer) or 5 (definitely solid cancer)." The sensitivity of contrast-enhanced CT and MRI for predicting RCC were 79.7 and 88.1 %, respectively. The specificities of contrast-enhanced CT and MRI for predicting RCC were 44.4 and 33.3 %, respectively. Fourteen diagnoses (20.5 %) were missed or inconsistent compared with the final pathological diagnoses. One appropriate nephroureterectomy and five unnecessary percutaneous biopsies were performed for RCC. Seven unnecessary partial nephrectomies were performed for benign disease. CONCLUSIONS: Although contrast-enhanced CT and MRI showed high sensitivity for detecting small renal masses, specificity remained low.

Geographic Distribution of Urologists in Korea, 2007 to 2012.

The adequacy of the urologist work force in Korea has never been investigated. This study investigated the geographic distribution of urologists in Korea. County level data from the National Health Insurance Service and National Statistical Office was analyzed in this ecological study. Urologist density was defined by the number of urologists per 100,000 individuals. National patterns of urologist density were mapped graphically at the county level using GIS software. To control the time sequence, regression analysis with fitted line plot was conducted. The difference of distribution of urologist density was analyzed by ANCOVA. Urologists density showed an uneven distribution according to county characteristics (metropolitan cities vs. nonmetropolitan cities vs. rural areas; mean square=102.329, P<0.001) and also according to year (mean square=9.747, P=0.048). Regression analysis between metropolitan and non-metropolitan cities showed significant difference in the change of urologists per year (P=0.019). Metropolitan cities vs. rural areas and non-metropolitan cities vs. rural areas showed no differences. Among the factors, the presence of training hospitals was the affecting factor for the uneven distribution of urologist density (P<0.001). Uneven distribution of urologists in Korea likely originated from the relatively low urologist density in rural areas. However, considering the time sequencing data from 2007 to 2012, there was a difference between the increase of urologist density in metropolitan and non-metropolitan cities.

Measuring the improvement in health-related quality of life using King's health questionnaire in non-obese and obese patients with lower urinary tract symptoms after alpha-adrenergic medication: a preliminary study.

BACKGROUND: The efficacy of medical treatment among obese men with lower urinary tract symptoms (LUTS) has been less clear, especially regarding the improvement of QoL. We aimed to investigate the difference in efficacy and consequent satisfaction of life quality after medical treatment of male LUTS according to obesity. METHODS: An 8-week prospective study was performed for a total of 140 patients >50 years old with International Prostate Symptom Scores (IPSS) > 12 points and prostate volume > 20 mL. Obesity was determined by either body mass index (BMI) or waist circumference (WC). Patients were divided into 2 groups according to BMI or WC. Patients received tamsulosin at a dose of 0.4 mg daily for 8 weeks. The changes from baseline in the IPSS, maximal urinary flow rate (Qmax), post-void residual volume, questionnaire of quality of life (QoL), and King's Health Questionnaire (KHQ) were analyzed. RESULTS: Of the 150 enrolled patients, 96 completed the study. Seventy-five patients (78.1%) had BMI ≥ 23 kg/m2, and 24 (25.0%) had WC > 90 cm. Overall, the IPSS, IPSS QoL, and total KHQ showed significant improvement. Obese (BMI ≥ 23 kg/m2) and non-obese (BMI < 23 kg/m2) both showed improvement of the IPSS and IPSS QoL scores, but only the obese (BMI ≥ 23 kg/m2) group showed improvement of the total KHQ score (P < 0.001 vs. P = 0.55). Only the obese (WC > 90 cm) group showed improvement of the IPSS and total KHQ scores (P < 0.001). CONCLUSIONS: Our preliminary study showed the different efficacy of an alpha-blocker for improvement of LUTS and life quality according to obesity. Obese patients, defined by BMI or WC, showed the tendency toward a more favorable improvement of LUTS and life quality. TRIAL REGISTRATION: Current Controlled Trials 2010-058. Registered 2 September 2010 in Soonchunhyang University Hospital.

Validation and reliability of a smartphone application for the International Prostate Symptom Score questionnaire: a randomized repeated measures crossover study.

BACKGROUND: Smartphone-based assessment may be a useful diagnostic and monitoring tool for patients. There have been many attempts to create a smartphone diagnostic tool for clinical use in various medical fields but few have demonstrated scientific validity. OBJECTIVE: The purpose of this study was to develop a smartphone application of the International Prostate Symptom Score (IPSS) and to demonstrate its validity and reliability. METHODS: From June 2012 to May 2013, a total of 1581 male participants (≥40 years old), with or without lower urinary tract symptoms (LUTS), visited our urology clinic via the health improvement center at Soonchunhyang University Hospital (Republic of Korea) and were enrolled in this study. A randomized repeated measures crossover design was employed using a smartphone application of the IPSS and the conventional paper form of the IPSS. Paired t test under a hypothesis of non-inferior trial was conducted. For the reliability test, the intraclass correlation coefficient (ICC) was measured. RESULTS: The total score of the IPSS (P=.289) and each item of the IPSS (P=.157-1.000) showed no differences between the paper version and the smartphone version of the IPSS. The mild, moderate, and severe LUTS groups showed no differences between the two versions of the IPSS. A significant correlation was noted in the total group (ICC=.935, P<.001). The mild, moderate, and severe LUTS groups also showed significant correlations (ICC=.616, .549, and .548 respectively, all P<.001).There was selection bias in this study, as only participants who had smartphones could participate. CONCLUSIONS: The validity and reliability of the smartphone application version were comparable to the conventional paper version of the IPSS. The smartphone application of the IPSS could be an effective method for measuring lower urinary tract symptoms.

Performance evaluation of Barozen Lipid Plus for point-of-care testing of lipid profiles: a method comparison study.

BACKGROUND: The quick and easy nature of point-of-care (POC) testing devices allows regular monitoring of serum lipid levels to increase efficiency. The purpose of this study was to assess a POC lipid analyzer, Barozen Lipid Plus (MICO Biomed Co., Ltd.), which uses capillary blood to measure total cholesterol (TC), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C). METHODS: Capillary and venous blood samples were collected from 110 participants at a single center in Korea between June 10 and June 26, 2021. TC, TG, and HDL-C measurements using Barozen Lipid Plus were compared with measurements using our reference device, the Roche-Hitachi Cobas 8000 c702 (Hitachi High-Technologies Corporation). This study followed the guidelines of the Clinical and Laboratory Standards Institute and the Clinical Laboratory Improvement Amendments. We surveyed participants regarding the convenience of the POC device using a questionnaire following the completion of blood collection. RESULTS: When compared to the reference equipment, the measurements obtained using Barozen Lipid Plus were more than 95% satisfactory within TC±10%, TG±25%, and HDL-C±30%. The coefficient of variation in the repeatability testing was within 5% for TC, 5% for TGs, and 7% for HDL-C. The survey results indicated high levels of satisfaction. No adverse events were reported. CONCLUSION: These findings suggest that Barozen Lipid Plus is reliable for measuring lipid profiles and can therefore be used to monitor lipid levels at the time and place of patient care.

A Cross-Sectional Study on the Psychological Changes of Medical Personnel in Hospitals Who Experienced Special COVID-19 Situations.

The COVID-19 pandemic contributed to an increase in mental health issues; Psychological changes occur in health professionals who are more susceptible to infection. The purpose of this study was to investigate health professionals' levels of anxiety, rage, and depression in COVID-related special circumstances. A general hospital in Korea experienced a widespread COVID-19 outbreak. There was a total of 149 involved frontline and non-frontline health professionals surveyed. The State-Trait Anger Expression Inventory, General Anxiety Disorder-7, and Korean Screening Tool for Depressive Disorders were utilized in the evaluation of their rage, anxiety, and depression. Anxiety and depression were found to be significantly higher among health professionals by occupation than among non-health professionals. Frontline workers were more depressed than non-frontline workers, according to type of work. These psychological changes can cause PTSD, so it is necessary to check and care for the mental health of health care workers working in medical institutions in the event of mass infections. These issues have been confirmed through studies related to the occurrence of mass infections such as SARS and MERS that the occurrence of mass infections can cause PTSD. The findings proved that the COVID-19 pandemic had a psychological impact on healthcare workers. During the COVID-19 pandemic, it is critical to raise awareness of post-traumatic stress disorder among healthcare professionals.

Efficacy and Safety of Noninvasive Intravesical Instillation of Onabotulinum Toxin-A for Overactive Bladder and Interstitial Cystitis/Bladder Pain Syndrome: Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the efficacy and safety of noninvasive intravesical instillation of onabotulinum toxin-A (OBTX-A) through systematic review and meta-analysis. Recently, several studies of noninvasive intravesical instillation of OBTX-A have been published. However, its efficacy is not well validated yet compared to well-known efficacy of minimally invasive intravesical injection of OBTX-A. METHOD: Systematic review and meta-analysis were performed to evaluate the efficacy of noninvasive intravesical instillation of OBTX-A in patients with overactive bladder and interstitial cystitis/bladder pain syndrome by measuring outcomes such as urgency episode per 72 hours, frequency per 72 hours, urgency urinary incontinence, voided volume (VV), postvoided residual volume, maximum flow rate, and patient perception of bladder condition. RESULT: Six trials in 4 studies that compared instillation of OBTX-A and placebo involving 248 patients (121 experimental and 127 controls) were included for final data extraction. Instillation of OBTX-A significantly increased VV, with a mean difference of 38.48 (95% confidence interval: 76.05, 0.92) compared to the placebo group. However, other outcomes showed statistically insignificant changes. Major adverse events were not reported in the group receiving intravesical instillation of OBTX-A. CONCLUSION: Intravesical instillation of OBTX-A showed limited efficacy with improvement of VV for treatment of overactive bladder or interstitial cystitis/bladder pain syndrome. More studies are needed to overcome the efficacy of current noninvasive bladder instillation of OBTX-A regarding effective drug transport.

Factors affecting the efficacy and safety of phosphodiesterase 5 inhibitor and placebo in treatment for lower urinary tract symptoms: meta-analysis and meta-regression.

PURPOSE: We aimed to investigate the real benefit and safety of phosphodiesterase 5 inhibitor (PDE 5I) for benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) by determining the affecting factors and to overcome the previous meta-analysis studies. METHODS: We conducted a systematic review of improvements in LUTS using International Prostate Symptom Score (IPSS), voiding subscore of IPSS (voiding IPSS), storage subscore of IPSS (storage IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and post-voided residual volume (PVR), and also investigated adverse events and relevant withdrawal rate. RESULTS: Final included studies were 28 studies with 19,820 subjects (9800 treatment group and 10,020 control group). The overall weighted mean differences of total IPSS, voiding IPSS, storage IPSS, and QoL showed significant improvement. Single placebo group showed significant improvement in all outcomes except PVR. The weighted prevalence of overall withdrawal rate and adverse event-specific withdrawal rate was 10 and 3%, respectively. Meta-regression showed that baseline IPSS, dosage of PDE 5I, and country affect clinical improvement compared with placebo. CONCLUSIONS: This study clarifies the efficacy of PDE 5I on treatment of BPH/LUTS as an initial treatment strategy. However, baseline IPSS, dosage of PDE 5I and country affected the clinical improvement. Moreover, adverse event-specific withdrawal rate was not as high as suspected based on the overall withdrawal rate.

Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis.

BACKGROUND: Although combination therapy with 5 alpha-reductase inhibitor (5ARI) and alpha-blocker is one of the standard interventions in symptomatic benign prostatic hyperplasia (BPH), 5ARI monotherapy is seldom the focus of attention. Adverse events associated with 5ARI include depression and suicidal attempts in addition to persistent erectile dysfunction. The aim of this study is to update our knowledge of clinical efficacy and incidence of adverse events associated with 5ARI treatment in symptomatic BPH. METHODS AND FINDINGS: A meta-analysis of randomized controlled clinical trials (RCTs) from 1966 until March, 2017 was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 23395 patients were included in this study and the inclusion criteria were: RCTs with 5ARI and placebo in symptomatic BPH patients. Parameters included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), post-void residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs). A meta-analysis with meta-regression was performed for each effect size and adverse events, sensitivity analysis, cumulative analysis along with the analysis of ratio of means (ROM) in the placebo group. A total of 42 studies were included in this study for review, and a total of 37 studies were included in the meta-analysis, including a total of 23395 patients (treatment group: 11392, placebo group: 12003). The effect size of all variables except PVR showed a significant improvement following 5ARI treatment compared with placebo. However, the effect size of differences showed declining trend in PV, IPSS and Qmax according to recent years of publication. In ROM analysis, PV showed no significant increase in the placebo group, with a ROM of 1.00 (95% CI, 0.88, 1.14). The 5ARI treatment resulted in a significantly higher incidence of decreased libido (OR = 1.7; 95% CI, 1.36, 2.13), ejaculatory disorder (OR = 2.94; 95% CI, 2.15, 4.03), gynecomastia (OR = 2.32; 95% CI, 1.41, 3.83), and impotence (OR = 1.74; 95% CI, 1.32, 2.29). Our study has the following limitations: included studies were heterogeneous and direct comparison of efficacy between alpha blocker and 5ARI was not performed. Adverse events including depression or suicidal attempt could not be analyzed in this meta-analysis setting. CONCLUSIONS: Although there was a significant clinical benefit of 5ARI monotherapy compared with placebo, the effective size was small. Moreover, the risk of adverse events including sexually related complications were high. Additional head-to-head studies are needed to re-evaluate the clinical efficacy of 5ARI compared with alpha-adrenergic receptor blockers.

Does uneven geographic distribution of urologists effect bladder and prostate cancers mortality? National health insurance data in Korea from 2007-2011.

The relationship between distribution of urologists and mortality of bladder and prostate cancers has not been clearly established. The aim of this study was to investigate the relationship between uneven distribution of urologists and urologic cancer specific mortality at country level. Data from the National Health Insurance Service and National Statistical Office in Korea from 2007 to 2011 were analyzed in this ecological study. Univariate and multivariable regression analyses were performed to determine risk factors for age standardized mortality rates (ASMR) of bladder and prostate cancers. Linear regression analysis showed a markedly (p < 0.001) uneven distribution of urologists between metropolitan and non-metropolitan areas. There was no significant difference in cancer specific ASMRs for either bladder cancer or prostate cancer. Univariate analysis after adjusting for time showed that country area, urologist density, and income were significant factors affecting bladder cancer incidence (p < 0.001, p = 0.013, and p < 0.001, respectively). It also showed that the number of training hospitals was a significant factor for prostate cancer incidence (p = 0.002). Although country area showed borderline significance (p = 0.056) for ASMR of bladder cancer, urologist density was not related to ASMR of bladder cancer or prostate cancer. Although there was a marked difference in urologist density between metropolitan and non-metropolitan areas for these years analyzed, mortality rates of bladder and prostate cancers were not significantly affected by country area or urologist density.

Improvement of voiding characteristics in morbidly obese women after bariatric surgery: A single-center study with a 1-year follow-up.

BACKGROUND: It is well known that morbid obesity in women is related to lower urinary tract symptoms, including urinary incontinence. Although several studies have reported on the improvement in urinary incontinence after bariatric surgery, few reports have focused on the detailed changes in other voiding characteristics. OBJECTIVE: To demonstrate the real benefit of bariatric surgery on lower urinary tract symptoms. SETTING: Bariatric Center of Excellence and Health Promotion at Soonchunhyang University Hospital. METHODS: From August to December 2012, a total of 57 women out of 183 women who underwent bariatric surgery agreed to be assessed for voiding dysfunction during their preoperative and 1-year postoperative evaluation using the international prostate symptom score, quality of life score, an overactive bladder symptom score, a patient perception of bladder score, and a Sandvick questionnaire for urinary incontinence. For statistical analysis, the Wilcoxon sign rank and Fisher׳s exact tests were used to assess a significant change in voiding status. RESULTS: Among a total of 183 women in the bariatric center, 57 women completed the full version of the urologic questionnaire. The baseline mean age of those patients was 38.5±9.5 and their baseline mean body mass index (BMI) was 37.5±5.9 (68.4% were over BMI 35). One year after bariatric surgery (Roux-en-Y gastric bypass), BMI showed a significant change, 9.5±3.5 (63.1% were below BMI 28). For specific characteristic changes in voiding status, the international prostate symptom score, quality of life score, overactive bladder symptom score, and patient perception of bladder score revealed significant improvement over baseline: 3.2±4.0, .6±.9, 1.6±2.3, and .5±1.0, respectively. For stress-related urinary incontinence as assessed using the Sandvick questionnaire, preoperative evaluation demonstrated the prevalence to be 40.74%, and 18.51% postoperatively. CONCLUSION: At a 1-year postoperative follow-up after laparoscopic gastric bypass-type bariatric surgery, there were significant improvements in voiding status as assessed by several standard urologic voiding questionnaires/indices.

Efficacy and Safety of Initial Combination Treatment of an Alpha Blocker with an Anticholinergic Medication in Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptoms: Updated Meta-Analysis.

BACKGROUND: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). OBJECTIVE: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis. METHODS: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). RESULTS: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR. CONCLUSIONS: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function.

Pivotal Roles of Ginsenoside Rg3 in Tumor Apoptosis Through Regulation of Reactive Oxygen Species.

BACKGROUND: Elevated production of reactive oxygen species (ROS) is observed in various cancer types and pathophysiological conditions. In cancer cells, ROS induce cell proliferation, genetic instability, and a malignant phenotype. Ginsenoside Rg3 is the main pharmacologically active component in ginseng and has been reported to have an antioxidant effect. To overcome lung cancer by regulating the ROS level, we investigated the antitumor effect and mechanism of Rg3 and its antioxidative property on Lewis lung carcinoma (LLC) cells. MATERIALS AND METHODS: Inhibition of ROS was suppressed in LLC cells by Rg3 treatment, and these cells were used to investigate the antioxidant, antiproliferative, and antitumor effects in LLC cells. RESULTS: ROS production was increased in cells grown in serum-containing media (conditioned media) compared to those grown in serum-free media. The high level of ROS induced LLC cell proliferation, but treatment with Rg3 (200 ng/ml) resulted in reduction of ROS, leading to inhibition of cell proliferation. Treatment with Rg3 significantly reduced cyclin and cyclin-dependent kinase expression in LLC cells. Additionally, Rg3 treatment significantly suppressed activation of mitogen-activated protein kinases and induced LLC cell apoptosis through activation of pro-apoptotic proteins and suppression of anti-apoptotic proteins. CONCLUSION: Taken together, these findings demonstrate the role of Rg3 in reduction of the intracellular ROS level, attenuation of proliferation via augmentation of cell cycle- and cell proliferation-associated proteins, and activation of apoptosis through regulation of apoptosis-associated proteins in LLC. These findings suggest that Rg3 could be used as a therapeutic agent in lung cancer.

Antioxidant effects of Cirsium setidens extract on oxidative stress in human mesenchymal stem cells.

Human mesenchymal stem cells (MSCs) may be used in cell-based therapy to promote neovascularization for the treatment of ischemic diseases. However, high levels of reactive oxygen species (ROS) derived from the pathophysiological ischemic environment induce senescence and apoptosis of MSCs, resulting in reduced functionality and defective neovascularization. Therefore, the present study aimed to determine the protective effects of Cirsium setidens, a natural product, on oxidative stress­induced apoptosis in MSCs. The present study investigated for the change of ROS levels in MSCs using ROS assays. In addition, cell viability determined by MTT and TUNEL assays. Western blot analysis was performed to investigate the change of apoptosis­associated proteins in MSCs. Treatment of MSCs with hydrogen peroxide (H2O2; 200 µM) significantly increased intracellular ROS levels and cell death; however, pretreatment with C. setidens (100 µg/ml) suppressed H2O2­induced ROS generation and increased the survival of MSCs. H2O2­induced ROS production increased the levels of phosphorylated­p38 mitogen activated protein kinase, c­Jun N­terminal kinase, ataxia telangiectasia mutated and p53; these increases were inhibited by pretreatment with C. setidens. In addition, C. setidens inhibited ROS­induced apoptosis of MSCs by increasing the expression levels of the anti­apoptotic protein B­cell lymphoma 2 (BCL­2), and decreasing the expression levels of the proapoptotic protein BCL­2­associated X protein. These findings indicated that pretreatment of MSCs with C. setidens may prevent ROS­induced oxidative injury by regulating the oxidative stress­associated signaling pathway, and suppressing the apoptosis­associated signal pathway. Therefore, C. setidens may be developed as a beneficial broad­spectrum agent for enhancing the effectiveness of MSC transplantation in the treatment of ischemic diseases.

Association between obesity and lower urinary tract symptoms: propensity score matching study between healthy controls and obese patients seeking bariatric surgery.

BACKGROUND: To date, the association between obesity and lower urinary tract symptoms (LUTS) is controversial. OBJECTIVE: To overcome the current inconsistent results regarding the association between obesity and LUTS and to investigate the association between obesity and LUTS using propensity score matching analysis. SETTING: Bariatric center of excellence and health promotion center at university hospital. METHODS: From August 2012 to December 2014, a total of 260 obese patients (77 men and 180 women) visited to our bariatric center to undergo bariatric surgery. Patients' International Prostate Symptom Score (IPSS) and overactive bladder symptom score were compared with those of 844 healthy controls who had visited our health center during the same period. To control for the effects of age, 1:1 propensity score matching was used. RESULTS: After matching propensity score forage, 73 male patients and 176 female patients were included in our study. In men, all IPSS items except "frequency" were significantly different between obese patients and controls; median scores were higher in the obese group. In women, all IPSS items except "feeling of incomplete emptying" were significantly different between the 2 groups. Both voiding and storage subscores also had marked differences in both genders (P<.001). Total IPSS, quality of life, and total overactive bladder symptom score were significantly different in both genders (P< .001). CONCLUSION: There were marked differences in LUTS between obese and nonobese patients, including in voiding and storage symptoms. Considering the relatively young age of both groups, this case-control study supports the hypothesis of a relationship between obesity and bladder pathophysiology.