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1.
J Korean Med Sci ; 39(38): e259, 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39376189

RESUMO

BACKGROUND: While polystyrene microplastics (PS-MPs) are emerging as potentially significant health threats, linked to cancer and reproductive dysfunction, their precise effects on human health remain largely unknown. We aimed to investigate the underlying mechanisms promoting microplastic-induced damage in the reproductive system. METHODS: Thirty C57BL/6 male mice were randomly allocated into six equal-sized groups. Mice were exposed to fluorescent PS-MPs (5 µm, < 18%, green) at a dose of 1 and 3 mg/dL via oral gavage for 28 and 56 days, respectively (control, 0 mg/dL). The presence of antibodies and inflammatory and oxidative stress markers were evaluated using western blotting. Sperm analysis was also performed. Mouse testis Sertoli TM4 cells were divided into two groups: control (medium only) and PS-MPs (medium containing, 1,000 µg/mL) groups and cultured in vitro for 1, 24, 48, or 72 hours. The cells were cultured in a Ham's F12: Dulbecco's Modified Eagle Medium medium with 0.25% fetal bovine serum at 37°C with humidified atmosphere of 5% carbon dioxide in the air. Protein analyses for interleukin (IL)-6, IL-10, NADPH-oxidase (NOX)-2, NOX-4, hypoxia-inducible transcription factor (HIF)-2α, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-ß were performed using western blotting. RESULTS: The testes were evaluated after 28 and 56 days of exposure. Varying sizes of PS-MPs were detected in the testes (ranging from 5.870 to 7.768 µm). Significant differences in sperm concentration, motility, and the proportion of normal sperm were observed between the two groups. An increase in TGF-ß, HIF-2α, and NOX-4 levels was observed using western blot analysis. However, no dose-dependent correlations were observed between the two groups. In vitro evaluation of the PS-MPs group displayed PS-MP penetration of the lumen of Sertoli cells after 1 hour. Further PS-MP aggregation within Sertoli cells was observed at 24, 48, and 72 hours. A significant increase in inflammatory protein expressions (IL-10, TGF-ß, MCP-1, IL-6, TNF-α, and HIF-2α) was observed through western blotting, although oxidative agents did not show a significant increase. CONCLUSION: PS-MPs induced reproductive dysfunction in male mice provide new insights into PS-MPs-associated toxicity in mammals.


Assuntos
Camundongos Endogâmicos C57BL , Microplásticos , Estresse Oxidativo , Poliestirenos , Células de Sertoli , Masculino , Células de Sertoli/metabolismo , Células de Sertoli/efeitos dos fármacos , Animais , Microplásticos/toxicidade , Microplásticos/efeitos adversos , Poliestirenos/química , Poliestirenos/efeitos adversos , Camundongos , Estresse Oxidativo/efeitos dos fármacos , Fertilidade/efeitos dos fármacos , Interleucina-6/metabolismo , Motilidade dos Espermatozoides/efeitos dos fármacos , Testículo/metabolismo , Testículo/efeitos dos fármacos , Testículo/patologia , Testículo/citologia , Espermatozoides/efeitos dos fármacos , Espermatozoides/metabolismo , Interleucina-10/metabolismo , Quimiocina CCL2/metabolismo , Células Cultivadas , Fator de Necrose Tumoral alfa/metabolismo
2.
Int J Urol ; 31(10): 1080-1086, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39039659

RESUMO

OBJECTIVES: This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF). MATERIALS AND METHODS: A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time. RESULTS: Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern. CONCLUSION: Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary.


Assuntos
Laparoscopia , Duração da Cirurgia , Fístula Vesicovaginal , Humanos , Feminino , Fístula Vesicovaginal/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Resultado do Tratamento , Idoso , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva de Aprendizado
3.
World J Urol ; 42(1): 261, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38668858

RESUMO

INTRODUCTION: This study investigated the learning curve of retrograde intrarenal surgery (RIRS) in patients with medium-sized stones using cumulative sum analysis (CUSUM) to evaluate the competence and proficiency of three new surgeons during their first RIRS procedures. MATERIALS AND METHODS: We conducted a retrospective review of 227 patients from 2019 to 2022 at a single institution. The patients were divided into four groups based on the operating surgeon: tutor surgeon (85 patients), newbie surgeon A (21 patients), newbie surgeon B (85 patients), and newbie surgeon C (36 patients). Patients had one or multiple stones with the largest stone diameter fell within the range of 10-30 mm. Fragmentation efficacy was calculated as "removed stone volume (mm3) divided by operative time (minutes)." CUSUM analysis monitored changes in fragmentation efficacy and validated surgical outcomes. RESULTS: No statistically significant differences were observed in the total stone volume, maximum stone size, or total operation time between the three newbie surgeons and the tutor surgeon. The mean fragmentation efficacy value was comparable among the newbie surgeons, but significantly different from that of the tutor surgeon. The minimum acceptable fragmentation efficacy level was set at 25.12 mL/min, based on the tutor's average value. The CUSUM curves for the three surgeons initially remained relatively flat until Cases 12-15, after which they increased and eventually plateaued. Stone-free rates and postoperative complications did not differ significantly among the surgeons. CONCLUSION: Learning curve analysis for the three newbie surgeons indicated that approximately 12-15 cases were required to reach a plateau.


Assuntos
Competência Clínica , Cálculos Renais , Curva de Aprendizado , Humanos , Cálculos Renais/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso
4.
World J Mens Health ; 42(1): 237-244, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38171378

RESUMO

PURPOSE: Patients with cancer have a high risk of depression. However, a few studies have assessed differences in the incidence of depression among patients with prostate cancer (PC) based on whether they received radiotherapy (RTx) or surgical treatment. MATERIALS AND METHODS: We analyzed data from the National Health Insurance Sharing Service database regarding the entire Korean adult population with PC (n=210,924) between 2007 and 2017. The adjusted hazard ratios (HRs) of depression associated with treatment were estimated using propensity score-matched Cox proportional hazards models and Kaplan-Meier survival analyses. RESULTS: Our final cohort comprised 9,456 patients with PC; of which, 8,050 men underwent surgery. During a mean follow-up duration of 7.1 years, 503 (5.3%) patients were newly diagnosed with depression. A significant difference in the incidence of depression was noted between the RTx and surgery groups (RTx vs. surgery: 5.55% vs. 5.28%; p=0.011) in the unmatched cohort. In the matched cohort, older age (≥70 years, HR: 1.596, p<0.001) and poor Charlson comorbidity index scores (HR: 1.232, p=0.039) were correlated with the risk of depression. In addition, the adjusted HR for depression in the surgery group was 0.843 (p=0.221) compared with that in the RTx group. Kaplan-Meier analyses revealed that no significant difference in the cumulative probability of persistent depression was detected between the RTx and surgery groups in matched cohort (p=0.3386). CONCLUSIONS: In this nationwide population-based study, no significant differences in the risk of depression were observed between the surgical and RTx groups.

5.
Investig Clin Urol ; 64(4): 412-417, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37417567

RESUMO

PURPOSE: To analyze the presentation of mumps and mumps orchitis using the National Health Insurance Service Database (NHISD). MATERIALS AND METHODS: Using information from the NHISD representing all cases of mumps in Korea, data regarding mumps orchitis were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification codes were used for diagnosis. The incidence estimates of the number of mumps cases were analyzed using the Statistical Analysis System (SAS) software. RESULTS: Based on the NHISD, 199,186 people were diagnosed with mumps, and males accounted for 62.3% cases. Teen males accounted for 69,870 cases, the largest number of patients diagnosed with mumps. The annual incidence of mumps increased every year (poisson regression, hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.024-1.027; p<0.025). The risk of mumps was lower in females than that in males (poisson regression, HR 0.594, 95% CI 0.589-0.599; p<0.001). Of the 199,186 patients diagnosed with mumps, 3,872 patients (1.9%) had related complications. Among the mumps complications, the most diagnosed complication was mumps orchitis, which was seen in 41.8% of the males. Mumps orchitis cases accounted for less than 1.5% of the patients with mumps in minors under the age of 20 years and was somewhat higher in 2009 and 2013-2015. CONCLUSIONS: Among the complications related to mumps, meningitis was most common in females, while orchitis was dominant in males. Mumps orchitis also shows periodic outbreaks but is particularly prevalent in adults, which suggests the potential need for additional vaccination against mumps.


Assuntos
Caxumba , Orquite , Masculino , Adulto , Adolescente , Feminino , Humanos , Adulto Jovem , Caxumba/complicações , Caxumba/epidemiologia , Caxumba/diagnóstico , Orquite/epidemiologia , Orquite/etiologia , Orquite/diagnóstico , Incidência , Programas Nacionais de Saúde , República da Coreia/epidemiologia
6.
J Korean Med Sci ; 37(47): e333, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36472084

RESUMO

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.


Assuntos
Nefropatias , Rim , Masculino , Humanos , Feminino , Rim/lesões , Incidência , Fatores de Risco , Bases de Dados Factuais , Estudos Retrospectivos
7.
Investig Clin Urol ; 63(3): 334-340, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35437959

RESUMO

PURPOSE: The prevalence of catheter-associated urinary tract infections (CAUTIs) varies from 5% to 8.2%, and the risk of infection increases by 5% to 7% per day of primary indwelling. We investigated whether a novel biofilm inhibitory mechanism using an inhibitory silicone urethral catheter (a coated Foley catheter) can reduce CAUTIs compared to conventional non-coated Foley catheters. MATERIALS AND METHODS: This study prospectively analyzed the difference in the incidence of CAUTIs in patients who underwent radical cystectomy with an orthotopic neobladder for bladder cancer and received a coated or conventional non-coated catheter. Additionally, differences in bacterial colonization between the groups were analyzed using a catheter-tip bacterial culture test. RESULTS: Eighty-five patients were randomized into the "coated Foley catheter" group (abbreviated as "case" group; 41 patients) and a control group (44 patients). The two groups were identical except for their surgical history. The incidence of CAUTIs 2 weeks after radical cystectomy was 21.95% (case) and 27.27% (control), with no significant difference between the two groups. However, when the catheter was removed 2 weeks after surgery, the catheter tip culture test revealed significant bacterial colonies in 25 (60.98%) and 38 (86.36%) patients in the case and control group, respectively. No catheter-related postoperative side effects were observed in either group. CONCLUSIONS: The incidence of CAUTIs in the two groups did not differ according to the catheter material. However, the catheter bacterial culture test showed that bacterial colonization was significantly suppressed on the Bi-Fi Free technology catheter, which comparatively inhibited biofilm formation.


Assuntos
Infecções Relacionadas a Cateter , Neoplasias da Bexiga Urinária , Infecções Urinárias , Antibacterianos/farmacologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cistectomia/efeitos adversos , Feminino , Humanos , Masculino , Estudos Prospectivos , Silicones , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/cirurgia , Cateteres Urinários/efeitos adversos , Infecções Urinárias/complicações , Infecções Urinárias/prevenção & controle
8.
J Clin Med ; 11(4)2022 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-35207416

RESUMO

Bladder cancers have high recurrence rates and are usually removed via transurethral resection of bladder tumor (TURBT). Recently, some reports showed that the anesthetic method may affect the recurrence rates of bladder cancers. The purpose of this population-based study was to compare the effect of anesthetic methods with the recurrence rates of bladder cancers in South Korea. A total of 4439 patients were reviewed retrospectively using the data of the Korean National Health Insurance (NHI) claims database from January 2007 to December 2011. Patients were divided into 2 groups who received general (n = 3767) and regional anesthesia (n = 582), and were followed up until September 2017. Propensity score matching was conducted to reduce the effect of confounding factors. After using propensity score matching with a multivariable Cox regression model, age (p < 0.001), sex (p < 0.001), hypertension (p = 0.003), diabetes mellitus (p = 0.001), and renal disease (p < 0.001) were significantly associated with bladder cancer recurrence. However, there were no significant differences in the recurrence rates of bladder cancers in patients who received general anesthesia and spinal anesthesia for TURBTs. This study revealed that there is no relationship between the anesthetic method and bladder cancer recurrence. Either general anesthesia or regional anesthesia can be used depending on the situation in patients receiving TURBT. Future prospective studies are warranted to confirm the association between the anesthetic method and the recurrence rates of bladder cancer.

9.
Investig Clin Urol ; 63(1): 92-98, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34983127

RESUMO

PURPOSE: We aimed to analyze the characteristics and management of bladder and urethral injuries in Korea by use of the National Health Insurance Service (NHIS) database. MATERIALS AND METHODS: Data from the NHIS database representative of all cases of Korean bladder injury (n=4,631) and urethral injury (n=17,858) reported between 2012 and 2016 were analyzed. We used the International Classification of Diseases, 10th revision, clinical modification codes to identify the diagnoses. RESULTS: A total of 491 males (1.97/100,000) and 590 females (2.39/100,000) experienced bladder injury in 2012, and 449 males (1.76/100,000) and 624 females (2.47/100,000) in 2016. The risk of bladder injury was higher in female than in male (hazard ratio [HR], 1.267; p<0.001). The annual incidence of bladder injury did not increase (HR, 0.992; p=0.409). A total of 2,886 (62.3%) patients were managed with conservative treatment, and 1,745 (37.7%) patients underwent surgical treatment. A total of 4,114 males (16.5/100,000) and 285 females (1.2/100,000) had urethral injury in 2012, while 4,465 males (17.5/100,000) and 303 females (1.2/100,000) had urethral injury in 2016. The incidence of urethral injury is increasing annually (HR, 1.010; p=0.036). CONCLUSIONS: The incidence of urethral injury increased continuously over the years studied, whereas that of bladder injury remained unchanged in Korea. The incidence of bladder injury was higher in females, and more than 90% of total urethral injuries were reported in males. This is the first study to evaluate the epidemiology of bladder and urethral injury using a nationwide population database.


Assuntos
Uretra/lesões , Bexiga Urinária/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Epidemiológicos , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
10.
Investig Clin Urol ; 62(4): 430-437, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34085787

RESUMO

PURPOSE: To evaluate the clinical impact of strict selection criteria for active surveillance (AS) of prostate cancer in a Korean population. MATERIALS AND METHODS: A single-center, prospectively collected AS cohort from December 2016 to February 2019 was used. Following pre-determined criteria, patients were categorized into "strict AS" and "non-strict AS" groups. Clinicopathological progression-free survival (PFS) and treatment-free survival (TFS) of the two groups were compared using the Kaplan-Meier curve and log-rank test. Age-adjusted hazard ratios for clinicopathological progression was calculated using Cox proportional regression analysis. RESULTS: Of 54 eligible patients, 25 and 29 were assigned to "strict AS" and "non-strict AS," respectively. Clinicopathological progression and definitive treatment rates were 24.0% (6 of 25 patients) vs. 51.7% (15 of 29 patients) and 32.0% (8 of 25 patients) vs. 62.1% (18 of 29 patients) in "strict AS" and "non-strict AS" groups. Progress to high-risk cancer (pathologic T3 or surgical Gleason Grade 2 over) in radical prostatectomy was higher in "non-strict AS" than "strict AS". PFS (mean 34.6±2.9 mo vs. 22.6±2.7 mo; p=0.025) and TFS (mean 31.8±3.2 mo vs. 19.6±2.4 mo; p=0.018) favor the "strict AS" group than "non-strict AS" group. Age-adjusted hazard ratio for clinicopathological progression of strict criteria was 0.36 (95% confidence interval, 0.14-0.94; p=0.04). CONCLUSIONS: PFS and TFS were better in the "strict AS" group than in the "non-strict AS" group. This finding should be informed to relevant patients during decision making and considered in Korean guidelines.


Assuntos
Seleção de Pacientes , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Conduta Expectante , Idoso , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Prospectivos , Prostatectomia , República da Coreia , Medição de Risco
13.
Int Neurourol J ; 24(3): 231-240, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33017894

RESUMO

Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

14.
Investig Clin Urol ; 61(3): 260-268, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32377601

RESUMO

Purpose: To develop the clinical calculator for mortality of patients with metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database. Materials and Methods: Data from 1,115 patients with mRCC treated in 4 hospitals joining KRoCS between 1993 and 2016 were pooled. Five-year survival rates were calculated using Kaplan-Meier curve. A clinical calculator for 5-year mortality was developed using multivariable logistic regression analysis and validated externally using dataset including 916 patients from 4 other hospitals. Results: Overall survival rates and cancer specific survival rate at 5 years were 28.5% and 29.4%, respectively. Among baseline factors, increased neutrophil-lymphocyte ratio (≥4), synchronous metastasis, low albumin (<3.0 g/dL), and low hemoglobin (

Assuntos
Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida
15.
Int. braz. j. urol ; 46(2): 244-252, Mar.-Apr. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090589

RESUMO

ABSTRACT Purpose To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). Materials and Methods The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK Vue® Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specific antigen (PSA) level (>20ng/mL), or history of taking 5-alpha-reductase inhibitor or testosterone replacement therapy were excluded. Results A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specificity of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). Conclusions The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Próstata/diagnóstico , Células Matadoras Naturais/metabolismo , Antígeno Prostático Específico/sangue , Neoplasias da Próstata , Neoplasias da Próstata/sangue , Células Matadoras Naturais/fisiologia , Biomarcadores/metabolismo , Biomarcadores/sangue , Projetos Piloto , Estudos Retrospectivos , Curva ROC , Sensibilidade e Especificidade , Biópsia Guiada por Imagem , Pessoa de Meia-Idade
16.
Int Braz J Urol ; 46(2): 244-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022514

RESUMO

PURPOSE: To evaluate the usefulness of natural killer cell activity (NKA) in diagnosing prostate cancer (PC). MATERIALS AND METHODS: The medical records of patients who underwent transrectal prostate biopsy (TRBx) at Korea University Ansan Hospital between May 2017 and December 2017 were retrospectively reviewed. NKA levels were measured using NK VueR Tubes (ATgen, Sungnam, Korea). All blood samples were obtained at 8 AM on the day of biopsy. Patients with other malignancies, chronic inflammatory conditions, high prostate-specifi c antigen (PSA) level (>20ng/mL), or history of taking 5-alphareductase inhibitor or testosterone replacement therapy were excluded. RESULTS: A total of 102 patients who underwent TRBx for PC diagnosis were enrolled. Among them, 50 were diagnosed with PC. Significant differences in age and NKA level were observed between the PC and no-PC groups. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off of NKA level for the prediction of PC was 500pg/dL, with a sensitivity of 68.0% and a specifi city of 73.1%. In addition, NKA level (0.630) had the greatest area under the ROC curve compared to those for the ratio of total PSA to free PSA (0.597) and PSA density (0.578). CONCLUSIONS: The results of this pilot study revealed that low NKA and high PSA levels were likely to be associated with a positive TRBx outcome. NKA detection was easy and improved the diagnostic accuracy of PC.


Assuntos
Células Matadoras Naturais/metabolismo , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Biomarcadores/sangue , Biomarcadores/metabolismo , Humanos , Biópsia Guiada por Imagem , Células Matadoras Naturais/fisiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
17.
Investig Clin Urol ; 61(1): 51-58, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31942463

RESUMO

Purpose: To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial carcinoma (UTUC) undergoing surgery. Materials and Methods: We retrospectively reviewed the medical records of patients who were diagnosed with UTUC from October 2003 to December 2016 at Korea University Medical Center. Sterile pyuria was defined as urine containing five or more white blood cells per high-power field in the absence of bacteria in urine culture. We used a stepwise multivariable Cox proportional hazards model to assess the independent effects of the prognostic factors for IVR and OS. Results: We investigated a total of 176 patients who were diagnosed with UTUC. Among them, 91 (51.7%) patients had preoperative sterile pyuria. There were no significant differences in the baseline characteristics between the pyuria and non-pyuria groups concerning tumor grade, T stage, tumor multiplicity, and recurrence history. However, there was a significant difference in the IVR between the two groups. In the multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion were revealed as independent risk factors for IVR, and only lymphovascular invasion was identified as an independent risk factor for OS. Conclusions: Preoperative sterile pyuria is significantly associated with IVR in patients with UTUC undergoing surgery, but it is not associated with OS. Furthermore, diabetes mellitus, high-grade tumor, and lymphovascular invasion are also independent prognostic factors for these patients.


Assuntos
Carcinoma de Células de Transição , Contagem de Leucócitos , Recidiva Local de Neoplasia , Piúria , Neoplasias Urológicas , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Idoso , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/urina , Feminino , Humanos , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/etiologia , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Período Perioperatório , Valor Preditivo dos Testes , Prognóstico , Piúria/diagnóstico , Piúria/urina , Medição de Risco/métodos , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia , Neoplasias Urológicas/urina , Procedimentos Cirúrgicos Urológicos/métodos
18.
Transl Androl Urol ; 9(6): 2997-3006, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33457272

RESUMO

Herein, we review the assessment of quality-of-life (QoL) in radical cystectomy (RC) patients, summarize the result of studies for different surgical approaches, and provide an overview of patient management, as well as other considerations. In this review article, we reviewed the QoL research and research tools for patients undergoing RC, including urinary diversion methods, gender differences, and surgical methods (open surgery vs. robotic surgery). This narrative review focused primarily on articles indexed in PubMed, Embase, Scopus, and Google Scholar databases. We did not used formal search strategy and meta-analysis was not performed.

19.
Transl Cancer Res ; 9(10): 6583-6588, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35117268

RESUMO

Treatment strategies for metastatic urothelial carcinoma (mUC) have evolved dramatically over the last decade. The emergence of immunotherapeutic agents, especially immune checkpoint inhibitors, has been the most significant development. Immunotherapy increased the overall survival rate of patients with mUC and provided a durable response. The success of immune checkpoint inhibitors further led to the development of novel agents that regulate the immune system within the tumor microenvironment. However, despite some success with immune checkpoint inhibitors, researchers are still developing new agents, including small molecule tyrosine kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and novel fusion proteins, tailored for targets other than immune checkpoint inhibitors. Novel treatment strategies are being developed rapidly with ongoing pre-clinical trials. Here, we outline promising new therapies that are expected to improve survival rates for patients with mUC.

20.
Eur Urol ; 78(2): 221-228, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31103393

RESUMO

BACKGROUND: Potency preservation often does not meet expectation despite nerve-sparing prostatectomy. OBJECTIVE: To set the protocol for intraoperative cavernous nerve monitoring and mapping during robot-assisted radical prostatectomy (RARP), and to evaluate its safety and clinical feasibility. DESIGN, SETTING, AND PARTICIPANTS: A prospective phase I/II, feasibility study was performed. A total of 30 patients with prostate cancer who underwent RARP at a high-volume tertiary academic hospital were enrolled. SURGICAL PROCEDURE: Pudendal somatosensory evoked potential, bulbocavernosus reflex, spontaneous corpus cavernosum electromyography (CC-EMG), median nerve stimulation evoked CC-EMG, and neurovascular bundle (NVB)-triggered CC-EMG with various stimulation protocols were assessed during conventional RARP under total intravenous anesthesia with controlled muscle relaxation. MEASUREMENTS: The primary endpoint was the completion rate of planned surgery and assessment. Adverse events, and erectile and urinary functions were evaluated within 1 yr. CC-EMGs were graded and correlated with functional outcomes. RESULTS AND LIMITATIONS: The completion rate was 100%. Only one patient experienced adverse events, which were not related to study intervention. Grades of CC-EMGs including NVB-triggered CC-EMG before prostate removal were associated with baseline five-item International Index of Erectile Function (IIEF-5) score (grades 0-1, 4.6±2.7; grade 2, 13.2±6.8; grades 3-4, 16.6±5.9; p=0.003). Furthermore, grades of CC-EMGs including NVB-triggered CC-EMG after prostate removal were significantly associated with potency recovery (grade 0, 12.5%; grade 1, 0%; grade 2, 33.3%; grades 3-4, 100% at 12 mo; p=0.005) and postoperative IIEF-5 scores at all evaluation time points (grades 0-1, 2.6±2.8; grade 2, 4.3±5.8; grades 3-4, 15.7±11.0 at 12 mo; p=0.003). CONCLUSIONS: We successfully established the protocol for safe intraoperative cavernous nerve monitoring and mapping using CC-EMG during RARP. Its grades were well correlated with erectile function. PATIENT SUMMARY: In this first-in-human feasibility study, we successfully established the protocol for safe intraoperative cavernous nerve monitoring and mapping method during robot-assisted radical prostatectomy. The results were significantly associated with erectile function. Evaluation of clinical efficacy to preserve potency seems worthy of further optimization and investigation in confirmatory clinical trials.


Assuntos
Monitorização Intraoperatória/métodos , Pênis/inervação , Complicações Pós-Operatórias/prevenção & controle , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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