Clinical significance of 5-α reductase inhibitor and androgen deprivation therapy in bladder cancer incidence, recurrence, and survival: a meta-analysis and systemic review.

PURPOSE: This study aimed to investigate the effect of androgen suppression therapy (AST), comprising a 5-α reductase inhibitor (5-ARi) and androgen deprivation therapy (ADT), on the risk of bladder cancer incidence, recurrence, and mortality. MATERIALS AND METHODS: We used the PRISMA statement to report the methods and results of this meta-analysis. Bladder cancer incidence, recurrence, and mortality after 5-ARi treatment and ADT were assessed using risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs). The protocol of this study is registered in the PROSPERO database (No. CRD42018118627). RESULTS: We analyzed nine studies (n = 377,427) assessing the secondary effect of AST, with a mean follow-up period of 6 years (range, 2-13 years). Our result showed that the incidence of bladder cancer was significantly reduced when 5-ARi treatment (RR, 0.69; 95% CI, 0.58-0.81; I2 =0%) and ADT (HR, 0.81; 95% CI, 0.70-0.94; I2 =33%) were initiated before diagnosing bladder cancer. When treatment was initiated after diagnosing bladder cancer, 5-ARi treatment reduced cancer-specific mortality (RR, 0.29; 95% CI, 0.20-0.42; I2 =4.1%), whereas ADT reduced bladder cancer recurrence (HR, 0.30; 95% CI, 0.19-0.49; I2 =0%). CONCLUSIONS: This study corroborates that the use of 5-ARi and ADT could be helpful in managing bladder cancer and should not be limited to prostatic abnormalities.

Retropubic versus Transobturator Mid Urethral Slings in Patients at High Risk for Recurrent Stress Incontinence: A Systematic Review and Meta-Analysis.

PURPOSE: The efficacy and safety of retropubic and transobturator tension-free vaginal tape mid urethral slings remain controversial in patients with stress urinary incontinence and risk factors for recurrence. We compared the techniques after initial mid urethral sling insertion in select groups, including patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence. MATERIALS AND METHODS: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to report the methods and results of the current review. Randomized controlled trials and observational studies were included. We assessed the objective and subjective cure rates, and the complication rate using the OR with the 95% CI. The protocol of the current meta-analysis was registered on PROSPERO (No. CRD42018102233). RESULTS: We retrieved 28 studies in a total of 2,607 patients to compare the efficacy and safety of retropubic vs transobturator tension-free vaginal tape in select groups (mean followup 26.9 months). Meta-analysis of the objective cure rate showed the significant superiority of retropubic compared to transobturator tension-free vaginal tape in patients overall (OR 3.37, 95% CI 2.55-4.43, p <0.00001, I2 = 37%) and in each subpopulation. The subjective cure rate of retropubic tension-free vaginal tape was also significantly superior to that of transobturator tension-free vaginal tape in in patients overall (OR 2.01, 95% CI 1.45-2.80, p <0.0001, I2 = 0%) and in those with intrinsic sphincter deficiency and recurrent stress urinary incontinence after mid urethral sling insertion. There was no significant difference in overall complications between retropubic and transobturator tension-free vaginal tape (OR 1.22, 95% CI 0.89-1.66, p = 0.21, I2 = 0%). CONCLUSIONS: The meta-analysis showed the superiority of retropubic tension-free vaginal tape over transobturator tension-free vaginal tape in terms of the objective and subjective cure rates in patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence after mid urethral sling insertion. Retropubic tension-free vaginal tape also has morbidity comparable to that of transobturator tension-free vaginal tape.

Clinical outcome of single-incision slings, excluding TVT-Secur, vs standard slings in the surgical management of stress incontinence: an updated systematic review and meta-analysis.

The aim of the present paper was to assess and compare the long-term efficacy and safety of single-incision mini-slings (SIMSs), except tension-free vaginal tape (TVT)-Secur, with standard midurethral slings (SMUSs) for female stress urinary incontinence through an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing these two surgical methods. A literature review of all RCTs comparing SIMSs (Mini-Arc, Contasure-Needleless, Ophira, Tissue Fixation System and Ajust), except TVT-Secur, with SMUSs was performed. The Medline, Embase, Scopus, Web of Science and Cochrane Controlled Trial Register databases were reviewed. We retrieved 29 RCTs (including a total of 2 986 patients) that compared SIMSs, except TVT-Secur, with SMUSs. Meta-analysis of long-term results showed no significant difference in the patient-reported cure rate (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.44-1.60); however, we found that SMUSs had a significantly superior objective cure rate (OR 0.68, 95% CI 0.47-0.99; P = 0.04). SIMSs were associated with a significantly shorter operation time, lower immediate postoperative pain based on a visual analogue scale score, lower intra-operative blood loss, and lower postoperative voiding dysfunction. The meta-analysis showed clear evidence of the superiority of SMUSs over SIMSs, except TVT-Secur, in terms of the objective cure rate, after long-term follow-up; however, SIMSs were superior with respect to immediate postoperative pain, intra-operative blood loss, and postoperative voiding dysfunction.

The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis.

INTRODUCTION: The efficacy and safety of arginine supplements in erectile dysfunction (ED) remain debatable. AIM: To assess the potential role of arginine supplements on ED as alternatives to phosphodiesterase inhibitors. METHODS: Studies published up to April 2018 that evaluated the efficacy of arginine supplements were identified from multiple databases (Google Scholar, PubMed, Medline, Embase, Kiss, DBpia, and Cochrane databases). Studies comparing arginine supplements with placebo or no treatment; focusing only on patients with mild to moderate severity of ED; and presenting outcomes such as improvement rate, International Index of Erectile Function (IIEF) score, and adverse effects were included. Subgroup analysis for arginine alone and arginine in combination with other substances was further conducted to increase interpretability. MAIN OUTCOME MEASURE: The strength of the association between arginine supplements and ED was assessed using relative odds ratios and weighted mean differences with 95% CI. RESULTS: In total, 10 randomized controlled trials met the inclusion criteria, reporting the outcomes of 540 patients with ED. The analysis demonstrated that arginine supplements with dosage ranging from 1,500 to 5,000 mg significantly improved ED compared with placebo or no treatment (odds ratios, 3.37 [1.29, 8.77], P = .01, I2 = 44). Arginine supplements also caused significant improvements in the IIEF subdomain scores of overall satisfaction, intercourse satisfaction, orgasmic function, and erectile function, whereas the IIEF sexual desire score remain unchanged. The adverse effect rate in the arginine-treated group was 8.3%, and that in the placebo group was 2.3%, none of which were severe. CLINICAL IMPLICATIONS: Arginine supplements can be recommended to patients with mild to moderate ED. STRENGTH & LIMITATIONS: The strength of this study is that it is the first meta-analysis to assess the potential role of arginine supplements in ED compared with placebo or no treatment. A limitation is that the treatment dosage and duration varied among studies, which may have contributed to study heterogeneity. CONCLUSION: The results of our systematic review and meta-analysis provide evidence on the effectiveness of arginine supplements for mild to moderate ED. Rhim HC, Kim MS, Park Y-J, et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med 2019;16:223-234.

Novel symptom questionnaire for the differential diagnosis of detrusor underactivity and bladder outlet obstruction in men.

OBJECTIVE: To develop a questionnaire for the differential diagnosis of detrusor underactivity (DUA) and bladder outlet obstruction (BOO) without performing invasive pressure flow studies. STUDY DESIGN AND METHODS: Symptoms of men with DUA were analyzed and compared with those of men with BOO using eight questions from the developing questionnaire. Patients with DUA have a bladder contractility index (PdetQmax+5xQmax) less than 100, whereas those with BOO have a BOO index (PdetQmax-2xQmax) greater than 40 in urodynamic studies (UDS). Men with detrusor overactivity in UDS and neurogenic issues were excluded from the analysis. One urologist reviewed patients' medical records, and responded to eight questions without using information from UDS. Scores in the developing questionnaire were then compared to make a differential diagnosis between DUA and BOO. RESULTS: Overall, 318 men who underwent UDS were included. Symptoms were compared in patients diagnosed with DUA without BOO (n = 165) and BOO without DUA (n = 153). Questions 1, 2, 4, 5, 6, and 7 were significantly different between groups. The sensitivity and specificity of the questionnaire were 95.8% and 95.4%, respectively, for predicting DUA in patients with scores greater than 45 points (cutoff value). CONCLUSIONS: Men with DUA and BOO may be distinguished using a developing questionnaire without invasive evaluation. Men with scores greater than 45 points would be expected to have DUA but not BOO.

Clinical Significance of Substaging and HER2 Expression in Papillary Nonmuscle Invasive Urothelial Cancers of the Urinary Bladder.

The study aimed to verify the prognostic utility, therapeutic application and clinical benefits of tumor substaging and HER2 status in papillary non-muscle invasive bladder cancer (NMIBC). Select NMIBC transurethral resection specimens from 141 patients were used to construct tissue microarrays for assessing the substaging, HER2 protein expression by immunohistochemistry (HER2-IHC) and gene amplification by dual-color silver in situ hybridization (HER2-SISH). Substages were identified by the differing depth of tumor invasion (pTa / pT1a / pT1b / pT1c). HER2 protein expression was semiquantitatively analyzed and grouped into negative (score 0, 1+) and positive (score 2+, 3+). Other clinicopathological variables were also investigated. For NMIBC, HER2-IHC and HER2-SISH showed positive results in 6/141 (4.3%) and 4/141 (2.8%) respectively, which correlated well with tumor substaging. In multivariate analysis, substaging, HER2-IHC, and HER2-SISH were found to be independent predictors of progression-free survival (P < 0.001, P < 0.001, P = 0.031). HER2-IHC was the sole independent predictor of recurrent free survival in NMIBC (P = 0.017). It is suggested that tumor substaging and HER2 status are independent predictive markers for tumor progression or recurrence, and thus could be included in diagnostic and therapeutic management for NMIBC.

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

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

Clinical value of acute pyelonephritis grade based on computed tomography in predicting severity and course of acute pyelonephritis.

PURPOSE: This study aimed to evaluate the efficacy of computed tomography (CT)-based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. MATERIALS AND METHODS: This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). RESULTS: A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. CONCLUSIONS: This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Lack of effect of concomitant stage II cystocele repair on lower urinary tract symptoms and surgical outcome after tension-free vaginal tape procedure: randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the lower urinary tract symptom changes and surgical outcome between the tension-free vaginal tape (TVT) procedure with and without concomitant stage II pelvic organ prolapse (cystocele) repair in a randomized clinical trial setting. METHODS: Patients with urodynamically proven stress urinary incontinence (SUI) and asymptomatic stage II cystocele were randomly and equally allocated to either a TVT and concomitant cystocele repair group or TVT only group. SUI was corrected with TVT in all cases. The cystocele repair procedure was performed with Gynemesh. Lower urinary tract symptoms and surgical outcome were assessed at postoperative year 1. Lower urinary tract symptoms were assessed with the American Urological Association Symptom Score (AUASS) questionnaire, uroflowmetry, and postvoid residual (PVR). RESULTS: The cure rate of TVT only and the concomitant repair group was 87 and 91%, respectively (p > 0.05). Cystocele was cured in all patients in the concomitant repair group. After the operation, the total AUASS were 6.4 and 8.4 in the TVT only group and concomitant repair group, respectively, with no statistical difference. There was no difference in the change in peak flow rate (Qmax) and PVR between the two groups. The prevalence of postoperative mixed incontinence was not different between the two groups. CONCLUSIONS: In patients with stage II cystocele and SUI, there was no difference in the surgical outcome and lower urinary tract symptoms between the TVT sling only group and concomitant repair group. Cystocele repair can be safely omitted in patients with stage II cystocele.

Korean guideline of desmopressin for the treatment of nocturia in men.

PURPOSE: Nocturia is the most bothersome of lower urinary tract symptoms in men. Desmopressin, a synthetic analog of the human hormone vasopressin, has been used for the treatment of nocturia. However, the guidelines include varying recommendations for the use of desmopressin for the management of nocturia in men. Therefore, the Korean Urological Association (KUA) developed recommendations for desmopressin for the treatment of nocturia in men. MATERIALS AND METHODS: A rigorous systematic review was performed and Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to rate the certainty of evidence for patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of members of the Korean Continence Society, Korean Society of Geriatric Urological Care, and KUA, respectively, who were involved in the guidelines development process. RESULTS: The guidelines address the benefits, harms, patients' values and preferences, costs, and resources related to desmopressin by using a single clinical question: What is the effectiveness of desmopressin compared to that of placebo, behavior modification, or other pharmacological therapies? CONCLUSIONS: The guidelines development panel suggests desmopressin for men with nocturia instead of placebo, behavior modification, or alpha-blocker monotherapy (low certainty of evidence, weak recommendation). Additionally, the panel suggests desmopressin combination therapy with alpha-blockers for men with nocturia instead of alpha-blocker monotherapy or alpha-blocker combination therapy with anticholinergic agents (low certainty of evidence, weak recommendation).

Temporary placement of covered retrievable expandable nitinol stents with barbs in high-risk surgical patients with benign prostatic hyperplasia: work in progress.

PURPOSE: To report the use of a newly constructed, covered, retrievable, expandable nitinol stent with barbs to overcome the problem of stent migration associated with conventional covered prostatic expandable stents and to evaluate prospectively the technical feasibility and clinical effectiveness of the stents in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A covered retrievable expandable nitinol stent with four barbs was placed with use of an 18-F stent delivery system in seven consecutive patients with symptomatic BPH who had high operative risks. Age range of patients was 62-83 years (mean 74 years). In cases in which the stent migrated, it was replaced with a stent with eight barbs. The stents were routinely removed 4 months after placement using a 21-F stent removal set. RESULTS: Stent placement was technically successful and well tolerated in six of the seven patients. The remaining patient needed a second stent placement after removal of the first stent. The stent with four barbs migrated into the urinary bladder in four patients (57%); three of these patients received a second stent with eight barbs with good results, and the fourth patient did not need further treatment because his symptoms improved. Routine removal of the stent 4 months after placement was performed in three of the seven patients with good results. CONCLUSIONS: Retrievable stents with eight barbs seem to overcome the problem of stent migration associated with conventional prostatic expandable stents. Preliminary results suggest that stents with barbs are both feasible and effective in patients with BPH.

Intraoperative maximal urethral closing pressure measurement: a new technique of tape tension adjustment in transobturator sling surgery?

PURPOSE: Tape tension adjustment is an essential procedure in mid-urethral sling surgery. The goal of this study was to determine if intraoperative maximal urethral closing pressure (MUCP) elevation could be used as a reference value for adequate tape tension adjustment and predict transobturator (TOT) sling surgery outcome. MATERIALS AND METHODS: A prospective study was performed using MUCP measurements just before tape insertion and just after tension adjustment during surgery. Clinical data including preoperative urodynamic results were collected. The cure rate was determined by questionnaire. Patients were divided into two groups. The MUCP elevation group included patients with a MUCP elevation of more than 10 cmH(2)O before tape insertion; the others were regarded as the non-elevation group. The cure rate and pre- and postoperative clinical variables were compared between the two groups. RESULTS: A total of 48 patients had TOT surgery. The MUCP elevation group (n = 19) and the non-elevation group (n = 29) were similar with regard to patient characteristics and the preoperative parameters including age, mixed incontinence prevalence, Q-tip angle, peak flow rate, MUCP and the valsalva leak point pressure (VLPP). The mean follow-up period was nine months. The cure rate was significantly higher in the group with MUCP elevation than in the non-elevation group (84% vs. 52%, p = 0.02). There was no significant difference in the mean postoperative peak flow rate between the two groups and there was no retention episode. CONCLUSIONS: MUCP elevation of more than 10 cmH(2)O just after tape insertion was a prognostic factor.

Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study.

OBJECTIVE: To investigate and compare the postoperative efficacy and complications of the transurethral resection of prostate (TURP) and holmium laser enucleation (HoLEP) using the nationwide insurance database of Korea. METHODS: We created a cohort of benign prostatic hyperplasia (BPH) patients treated with TURP and HoLEP between 2011 and 2017 from the nationwide database of reimbursement. We compared the postoperative effects between the two surgical groups. RESULTS: We retrieved a total of 58,346 patients (TURP 38,308 and HoLEP 20,038 patients). The mean follow-up duration was 51.6 and 47.6 months, respectively. The rate of reoperation was significantly higher in the TURP group (4.50%) than in the HoLEP group (1.27%) (P < .01). The postoperative use of alpha-blockers and dutasteride/finasteride was significantly higher in the TURP group until 24 months postoperatively. The rate of the postoperative use of medications for symptoms of overactive bladder was lower in the TURP group than in the HoLEP group until 12 months postoperatively, but it did not differ after 12 months postoperatively. Overall, urethral surgeries were less frequently performed in the TURP group than in the HoLEP group (P < .05); however, more severe cases required surgeries under general anesthesia in the TURP group (P < .05). Postoperative surgery for stress incontinence was performed in 0.10% and 0.31% of patients after TURP and HoLEP, respectively (P < .01). CONCLUSION: This study showed the superiority of HoLEP compared to TURP in terms of postoperative efficacy and its inferiority in terms of complications of stress incontinence in real life practice.

What is the Cause of Recurrent Urinary Tract Infection? Contemporary Microscopic Concepts of Pathophysiology.

Urinary tract infections (UTIs) are the most common infectious disease and are mainly caused by Escherichia coli. In this review, we introduce the current concept of recurrent UTI (rUTI) based on recent research dealing with pathophysiology of the disease. Although urine is considered sterile, recent studies dealing with microbiome have proposed different ideas. UTIs have typically been considered as extracellular infections, but recently, uropathogenic Escherichia coli (UPEC) has been shown to bind and replicate in the urothelium to make intracellular bacterial communities. Binding UPECs might proceed in many ways including extracellular expulsion for clearance or survival and quiescent intracellular reservoirs that can cause rUTI. Moreover, it is also suggested that other important factors, such as lipopolysaccharide and multimicrobial infection, can be the cause of rUTI. This review article reveals a key mechanism of recurrence and discusses what makes a pathway of resolution or recurrence in a host after initial infection.

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms.

PURPOSE: The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS). METHODS: This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality). RESULTS: Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004). CONCLUSION: This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location.

OBJECTIVE: To assess the sensitivity of digital abdominal radiography in the detection of ureteral stones by stone size and location. MATERIALS AND METHODS: We retrospectively reviewed the digital abdominal radiography of 163 patients for the detection of ureteral stones. Each ureteral stone was confirmed by unenhanced computed tomography (CT) in the emergency department between January and December, 2009. Stone location was defined as proximal or distal by the level where the ureter crossed anterior to iliac vessels, and the stone size was defined as small if smaller than 5 mm and large if larger than 5 mm on unenhanced CT. The interpretation of digital abdominal radiography was classified as visible, invisible, or equivocal. RESULTS: In 163 ureteral stones, 77 stones (47.2%) were in the proximal ureter and 86 stones (52.8%) were in the distal ureter. The mean (SD) size of the ureteral stones was 3.4 (1.7) mm (range, 1-9 mm). Overall sensitivity of digital radiography for ureteral stones was 29.4%. The sensitivity of digital radiography for the proximal ureteral stones was 37.7% and that for the distal ureteral stones was 22.1% (P < 0.05). The sensitivity of digital radiography for small ureteral stones was 23.6% and that for large ureteral stones was 50.0% (P < 0.05). As a group, the sensitivity of digital radiography for large proximal ureteral stones was the highest sensitivity-72.2%-in all groups (P < 0.05). CONCLUSION: Digital abdominal radiography is useful in detecting large proximal ureteral stones.

Urodynamic and histological changes in a sterile rabbit vesicoureteral reflux model.

This study aimed to investigate pressure changes of renal pelvis and histological change of kidneys in a surgically induced sterile rabbit vesicoureteral reflux (VUR) model. Five rabbits served as a control group, 7 as the sham-operated group, and 8 served as the VUR group. Three weeks later, urodynamic studies were performed, and histological examinations evaluated degree of inflammation, fibrosis, and tubular damage in the kidneys. At a low infusion rate, renal pelvic pressure in the VUR group was stable until late filling phase and then increased slightly. At a high infusion rate, the renal pelvic pressures of the sham-operated and control groups were stable until late filling phase and then increased slightly, whereas the renal pelvic pressure in the VUR group steadily increased from mid filling phase. Focal thinning of the tubular epithelium and interstitial widening were observed in certain cortical areas of refluxing kidneys, without inflammatory cell infiltration. Obvious changes in the mean diameters of distal tubules and extracellular matrix volume fractions were observed in two highly refluxing kidneys. High pressure reflux with bladder instability may result in renal cortical changes.

Korean ureter length: A computed tomography-based study.

Purpose: We measured ureter length in healthy Koreans using reformatted computed tomography (ULCT) and found ways to indirectly estimate ureter length by measuring LLCT, the length between the ureteropelvic junction and the ureterovesical junction, and standing and sitting height. Materials and Methods: A total of 508 ureters of 254 healthy patients (median age, 55.0 years; 148 males and 106 females) were included in this retrospective study. ULCT, LLCT, and sitting and standing body height were measured. Results: The mean left and right ULCT were 25.2±2.2 and 25.0±2.2 cm, respectively. The mean left and right LLCT were 21.1±1.8 and 20.3±1.9 cm, respectively. Standing and sitting body height were 164.1±8.9 and 88.3±4.3 cm, respectively. Height was significantly correlated with ULCT, but this relation was not linear (r2=0.064 standing height, 0.062 sitting height). However, LLCT showed a significant linear correlation with ULCT (r2=0.485). ULCT can be estimated indirectly by the following equation: ULCT=0.823×LLCT+8.093. Conclusions: We could measure the ureteral length of healthy Koreans by ULCT. ULCT could be estimated indirectly by LLCT and standing and sitting height. Of these variables, LLCT provided the most accurate estimate of ureteral length.

Genomic Landscape of Young-Onset Bladder Cancer and Its Prognostic Implications on Adult Bladder Cancer.

Due to the rare occurrence of young-onset bladder cancer (YBC), its genomic characteristics remain largely unknown. Twenty-nine biopsy-proven YBC cases were collected using a nation-wide search for bladder cancer diagnosed at 20 years or younger. Whole exome sequencing and RNA sequencing were carried out in 21 and 11 cases, respectively, and compared with those of adult bladder cancer (ABC) cases obtained from public databases. Almost all YBCs were low grade, non-invasive papillary tumors. YBC had a low mutation burden and less complex copy number alterations. All cases harbored putative driver mutations. Mutations were most commonly found in HRAS (10 cases), with a preference for exon 5. FGFR3 gene fusions were noted with various partner genes (7 cases). The alterations on HRAS and FGFR3 occurred in a mutually exclusive manner. Others included KRAS mutations (2 cases), chromosomes 4p and 10q arm-level deletions (1 case), and ERCC2 mutation (1 case). There were no point mutations in TP53 and FGFR3. The gene expression profiles of YBC were similar to those of the ABC group with good prognosis. None of the YBCs and ABCs with YBC-like mutations showed progression to muscle-invasive tumors. Our results suggest that bladder cancer with YBC-like mutations represents an indolent bladder tumor, regardless of age.

Effect of combined solifenacin and aclatonium in preventing dry mouth in patients with overactive bladder.

OBJECTIVE: The aim of the present study was to prospectively evaluate the effect of aclatonium on dry mouth in patients with overactive bladder (OAB) after treatment with solifenacin. METHODS: A multicenter randomized double-blind controlled trial was conducted. The study subjects were men and women who had been diagnosed with OAB for ≥3 months and presented with a total Overactive Bladder Symptom Score (OABSS) ≥3. Eligible subjects were randomized to receive 5 mg solifenacin with placebo or 5 mg solifenacin with 150 mg aclatonium once daily for 8 weeks. Subjects rated dry mouth using a visual analog scale (VAS) and completed the OAB-questionnaire (OAB-q) short form (SF) and OABSS questionnaires at baseline and after 8 weeks treatment. Dry mouth was defined as a VAS score >30 points (range 0-100). RESULTS: Overall, 92 patients (49 and 43 in the placebo and aclatonium groups, respectively) completed the 8-week treatment. In patients who had dry mouth at baseline, no differences were detected in changes in the dry mouth VAS, OABSS, or OAB-q SF scores between the 2 groups. However, in patients who had no dry mouth at baseline, the change in dry mouth VAS score was significantly lower in the aclatonium- than placebo-treated group: the VAS score increased 20 points in the placebo group compared with 9 points in the aclatonium group (P = .03). However, there were no significant differences in changes in the OABSS and OAB-q SF scores between the 2 groups. CONCLUSIONS: Aclatonium decreased dry mouth without disturbing treatment efficacy in patients who did not have dry mouth before treatment.