Validation of the Korean Ankylosing Spondylitis Quality of Life Questionnaire.

Background: Measuring accurate and reliable scores of quality of life in patients with ankylosing spondylitis (AS) is important in both decision-making and treatment planning for the disease. Questionnaire, The ankylosing spondylitis quality of life (ASQoL), is one of the representative tools for assessing how seriously AS patients view their disease severity, activity, as well as their overall health. To make these types of questionnaires readable and understandable, local language translation of surveys should be required. A Korean version of the ASQoL questionnaire has accordingly been developed. This study assessed the Korean version of the ASQoL survey to evaluate the reliability and validity of it. Methods: Translation and reverse translation of the English ASQoL survey were conducted. A total of 120 consecutive AS patients received a mail including the Korean-translated 36-Item Short Form Survey (SF-36), the ASQoL survey, and the visual analog scale (pain). The coefficient of intraclass correlation and Cronbach's alpha were computed, and factor analysis, as well as reliability assessments utilizing the kappa agreement statistics for each item, was undertaken. By analyzing the responses to SF-36 and ASQoL questionnaire utilizing Pearson's correlation coefficient, construct validity was calculated. Results: Factor analysis was performed regarding pain, physical function, and mental function. The kappa statistic of agreement was larger than 0.6 for all items. The ASQoL questionnaire had adequate test and re-test reliability (0.814). Furthermore, Cronbach'sα, the internal consistency, was very good (0.877). The Korean-translated ASQoL questionnaire demonstrated a significantly strong correlation between the single domain and total SF-36 scores. Conclusions: The Korean version of the ASQoL questionnaire showed acceptable properties of measurement and successful translation. Thus, it can be said that the questionnaire is appropriate for evaluating the outcomes of Korean patients with AS.

Semen quality and sperm DNA fragmentation in cancer patients undergoing sperm cryopreservation.

PURPOSE: We compared semen quality and sperm DNA fragmentation in cancer patients who underwent sperm banking and controls who underwent sperm cryopreservation for assisted reproductive technology (ART). MATERIALS AND METHODS: A total of 132 men, 65 cancer patients and 67 controls, were prospectively enrolled and performed sperm cryopreservation for fertility preservation from May 2019 to February 2021. Sperm quality was determined by measuring semen volume, sperm concentration, sperm motility, and sperm DNA fragmentation index (DFI). Sperm quality and sperm DFI were compared in cancer patients and controls. RESULTS: The major cancers of the 65 cancer patients were leukemia (26.2%), testicular cancer (23.1%), and lymphoma (20.0%). Sperm concentration, sperm total motility, and sperm progressive motility were significantly lower in cancer patients than in controls. Sperm DFI was significantly higher in cancer patients than in controls (24.32%±15.69% vs. 19.11%±11.63%; p=0.033). After excluding 8 cancer patients who received chemotherapy before sperm banking, sperm concentration, sperm total motility, and sperm progressive motility were significantly lower in cancer patients than in controls, but there was no significant difference in sperm DFI for cancer patients and controls (23.14%±12.79% vs. 19.11%±11.63%; p=0.069). CONCLUSIONS: Sperm quality was lower in cancer patients than in controls. There was no difference in the sperm DFI of cancer patients prior to chemotherapy and men presenting for sperm cryopreservation for ART. We recommend that all men who are planning cancer therapy should be offered sperm banking prior to gonadotoxic chemotherapy as a standard of fertility preservation.

Auxiliary liver xenotransplantation technique in a transgenic pig-to-non-human primate model: A surgical approach to prolong survival.

Xenotransplantation using pigs' liver offers a potentially alternative method to overcome worldwide donor shortage, or more importantly as a bridge to allotransplantation. However, it has been challenged by profound thrombocytopenia and fatal coagulopathy in non-human primate models. Here we suggest that a left auxiliary technique can be a useful method to achieve extended survival of the xenograft. Fifteen consecutive liver xenotransplants were carried out in a pig-to-cynomolgus model. Right auxiliary technique was implemented in two cases, orthotopic in eight cases, and left auxiliary in five cases. None of the right auxiliary recipients survived after surgery due to hemorrhage during complex dissection between the primate's right lobe and inferior vena cava. Orthotopic recipients survived less than 7 days secondary to profound thrombocytopenia and coagulopathy. Two out of five left auxiliary xenotransplants survived more than 3 weeks without uncontrolled thrombocytopenia or anemia, with one of them surviving 34 days, the longest graft survival reported to date. Left auxiliary xenotransplant is a feasible approach in non-human primate experiments, and the feared risk of thrombocytopenia and coagulopathy can be minimized. This may allow for longer evaluation of the xenograft and help better understand histopathological and immunological changes that occur following liver xenotransplantation.

Relationships between Clinical Status and Gait Parameters in Ankylosing Spondylitis.

Background: This study aimed to identify the relationship between gait parameters and health-related quality of life (HRQOL) in patients with ankylosing spondylitis (AS). Methods: The study group comprised 134 patients with AS and 124 patients were enrolled as controls. All study participants underwent instrumented gait analysis and completed clinical questionnaires. The kinematic parameters of gait were walking speed, step length, cadence, stance phase, single support, double support, phase coordination index (PCI), and gait asymmetry (GA). For each patient, a visual analog scale (VAS; 0-10) score was used to assess back pain, 36-item short form survey (SF-36) questionnaire was administered to evaluate the HRQOL, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was calculated. Using kinematic parameters and questionnaires, statistical analyses were done to investigate significant differences between the groups. Relationship of gait kinematic data and questionnaires of clinical outcome was also evaluated. Results: Among the 134 patients with AS, 34 were women and 100 were men. In the control group, 26 were women and 98 were men. The patients with AS and control group patients had significant differences in terms of walking speed, step length, single support, PCI, and GA. However, such differences were not observed in cadence, stance phase, and double support (p > 0.05). In correlation analyses, gait kinematic parameters and clinical outcomes were significantly related with each other. In multiple regression analysis performed to identify predictive factors for clinical outcome, walking speed was found to predict VAS, and walking speed and step length were found to predict the BASDAI and SF-36 scores. Conclusions: Patients with and without AS had significant differences in the gait parameters. Correlation analysis showed significant correlation between the gait kinematic data and clinical outcomes. In particular, walking speed and step length successfully predicted clinical outcomes in patients with AS.

Fibromyalgia in Axial Spondyloarthritis: A Meta-analysis.

OBJECTIVES: This study aimed to compare the demographic characteristics, disease activity, functional status, and quality of life between patients with axial spondyloarthritis and fibromyalgia and patients with axial spondyloarthritis without fibromyalgia. METHODS: We searched MEDLINE via PubMed, Cochrane, Scopus, and Embase databases, from the earliest available indexing date to March 30, 2019, for comparative studies evaluating fibromyalgia in patients with axial spondyloarthritis. Two authors extracted data independently, and all discrepancies were resolved through consensus. RESULTS: Seven comparative studies were identified. No statistically significant differences were observed in terms of age, levels of inflammatory markers, and prevalence of extra-articular manifestations such as uveitis, psoriasis, and inflammatory bowel disease between patients with Axial spondyloarthritis fibromyalgia and those without it. Sex ratios (female to male) were approximately 3:2 and 1:3 in patients with and without fibromyalgia, respectively. The ratios concerning human leukocyte antigen B27-positive patients with and without fibromyalgia were 45.1% and 65.6%, respectively. Patients with fibromyalgia had significantly higher Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life scores. CONCLUSIONS: Our meta-analysis showed that patients with Axial spondyloarthritis fibromyalgia had considerably higher pain severity, disease activity, and worse quality of life than patients without fibromyalgia. The sex ratios (female to male) were approximately 3:2 and 1:3, and ratios for human leukocyte antigen B27-positive patients were 45.1% and 65.6% in patients with and without fibromyalgia, respectively. Further well-designed studies are needed to substantiate our results.

Clinical characteristics and prognosis of elderly patients with colorectal cancer: Comparison between surgical resection and supportive care.

ABSTRACT: Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.

Macroprolactinoma in a young man presenting with erectile dysfunction.

Hyperprolactinemia due to a pituitary adenoma is a rare cause of erectile dysfunction (ED). The prevalence of clinically apparent prolactinomas is reported to be from 6-10 to 50 per 100,000. A few reports have been published of prolactinoma presenting with ED. Here, we report a rare case of a young man who presented with ED as a chief complaint and who was diagnosed with a huge prolactinoma, and we discuss a related fertility issue.

Neonate with a parameatal urethral cyst.

Parameatal urethral cyst is an ultra rare benign condition, and only a few cases have been reported in the literature. These cysts are usually asymptomatic, and may resolve spontaneously, although surgical excision is necessary for symptomatic patients. Here, we report a neonate with a parameatal urethral cyst without symptoms.

Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel.

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%-15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

Long-Term Experience of Sperm Cryopreservation in Cancer Patients in a Single Fertility Center.

PURPOSE: Sperm cryopreservation before cancer treatment is the most effective method to preserve the fertility of male patients. We present our 21 years experience with sperm cryopreservation for cancer patients, including an examination of semen quality, the current status of cryopreserved sperm, and the rate of sperm use for assisted reproductive technology (ART). MATERIALS AND METHODS: A total of 721 cancer patients at Fertility Center of CHA Gangnam Medical Center successfully performed sperm cryopreservation for fertility preservation from January 1996 to December 2016. Medical chart review was used to analyze patient age, marital status, cancer type, semen volume, sperm counts and motility, length of storage, and current banking status. RESULTS: The major cancers of the 721 patients were leukemia (28.4%), lymphoma (18.3%), testis cancer (10.0%). The mean age at cryopreservation was 27.0 years, and 111 patients (15.4%) performed sperm cryopreservation during or after cancer treatment. The mean sperm concentration was 66.7±66.3 ×106/mL and the mean sperm motility was 33.8%±16.3%. During median follow-up duration of 75 months (range, 1-226 months), 44 patients (6.1%) used their banked sperm at our fertility center for ART and 9 patients (1.2%) transferred their banked sperm to another center. The median duration from cryopreservation to use was 51 months (range, 1-158 months). CONCLUSIONS: Sperm cryopreservation before gonadotoxic treatment is the most reliable method to preserve the fertility of male cancer patients. Sperm cryopreservation should be offered as a standard of care for all men planning cancer therapy.

Spinopelvic Orientation on Radiographs in Various Body Postures: Upright Standing, Chair Sitting, Japanese Style Kneel Sitting, and Korean Style Cross-Legged Sitting.

BACKGROUND: Several previous studies reported on the impact of upright standing and chair sitting on the sagittal spinopelvic alignment. However, there are no studies on the impact of the two Asian (Korean and Japanese) style floor-sitting positions on the sagittal spinopelvic alignment. The purpose of this study was to evaluate the impact of four different body postures (standing, chair sitting, kneel sitting, and cross-legged sitting) on the sagittal spinopelvic alignment. METHODS: Sixteen selected healthy volunteers (10 males and six females) were subjects of this pilot study. In all subjects, radiographs were taken in comfortable standing and sitting positions. All spinal curvatures including lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on the radiographs. RESULTS: In standing position, the average LLA, SS, PT, and PI were 37.1°, 35.3°, 15.7°, and 51.0°, respectively. In chair sitting, the average LLA, SS, PT, and PI were 17.9°, 20.3°, 28.2°, and 49.5°, respectively. In kneel sitting (Japanese style), the average LLA, SS, PT, and PI were 31.8°, 38.3°, 14.2°, and 52.5°, respectively. In cross-legged sitting (Korean style), the average LLA, SS, PT, and PI were 9.8°, 13.4°, 38.3°, and 51.7°, respectively. LLA in standing (37.1°) and kneel sitting (31.8°) were very similar. Remarkable reduction in LLA was observed in Korean-style cross-legged sitting (9.8°), and LLA in chair sitting (17.9°) was about half of that in standing. SS was similar in standing (35.3°) and kneel sitting (38.3°), and it was reduced remarkably in cross-legged sitting (13.4°). PT was largest in cross-legged sitting (38.3°), and it was similar between standing (15.7°) and kneel sitting (14.2°). PIs were similar in all positions. CONCLUSIONS: The kneel sitting position did not show significant differences with the standing position when assessed using four parameters related to the sagittal spinopelvic alignment, whereas chair sitting and cross-legged sitting positions significantly altered the spinopelvic alignment compared to the standing position.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT. METHODS: Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated. RESULTS: The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine. CONCLUSIONS: The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

p73 gene in dopaminergic neurons is highly susceptible to manganese neurotoxicity.

Chronic exposure to elevated levels of manganese (Mn) has been linked to a Parkinsonian-like movement disorder, resulting from dysfunction of the extrapyramidal motor system within the basal ganglia. However, the exact cellular and molecular mechanisms of Mn-induced neurotoxicity remain elusive. In this study, we treated C57BL/6J mice with 30mg/kg Mn via oral gavage for 30 days. Interestingly, in nigral tissues of Mn-exposed mice, we found a significant downregulation of the truncated isoform of p73 protein at the N-terminus (ΔNp73). To further determine the functional role of Mn-induced p73 downregulation in Mn neurotoxicity, we examined the interrelationship between the effect of Mn on p73 gene expression and apoptotic cell death in an N27 dopaminergic neuronal model. Consistent with our animal study, 300µM Mn treatment significantly suppressed p73 mRNA expression in N27 dopaminergic cells. We further determined that protein levels of the ΔNp73 isoform was also reduced in Mn-treated N27 cells and primary striatal cultures. Furthermore, overexpression of ΔNp73 conferred modest cellular protection against Mn-induced neurotoxicity. Taken together, our results demonstrate that Mn exposure downregulates p73 gene expression resulting in enhanced susceptibility to apoptotic cell death. Thus, further characterization of the cellular mechanism underlying p73 gene downregulation will improve our understanding of the molecular underpinnings of Mn neurotoxicity.

Small dose of propofol combined with dexamethasone for postoperative vomiting in pediatric Moyamoya disease patients: a prospective, observer-blinded, randomized controlled study.

BACKGROUND: For effective postoperative antiemetic management in pediatric moyamoya disease patients receiving fentanyl based postoperative analgesia, a multimodal approach has been recommended. The uncertain efficacy of ondansetron for pediatric neurosurgical patients or the possible antiemetic effect of small dose of propofol motivated us to evaluate the preventive effect of a subhypnotic dose of propofol combined with dexamethasone on postoperative vomiting (POV), especially during immediate postoperative periods. METHODS: In a prospective observer-blind randomized controlled study, we compared dexamethasone 0.15 mg/kg alone (Group D) with dexamethasone combined with propofol of 0.5 mg/kg (Group DP) in 60 pediatric patients, aged 4-17 years, who underwent indirect bypass surgery and received fentanyl-based postoperative analgesia. Occurrence of vomiting and pain score (Wong-Baker facial score) and requirement of rescue analgesic and antiemetic were continually measured (0-2, 2-6, 6-12 and 12-24 postoperative hours). For statistical analysis, in addition to the Fisher's exact test, a generalized linear mixed model (GLMM) and the linear mixed model (LMM) for repeated measures were used for vomiting and pain scores, respectively. RESULTS: There was no statistical significance of POV incidence, requirement of rescue analgesic and pain score between the two groups at any measured intervals. The incidence of POV was 53.3% during 24 hours in both groups, and was especially 6.7% and 13.3% (P = 0.671) during 0-2 hr and 16.7% and 23.3% (P = 0.748) during 2-6 hr in group D and group DP, respectively. CONCLUSIONS: A small dose of propofol combined with dexamethasone appears ineffective to preventing POV in pediatric moyamoya patients receiving continuous fentanyl infusion.

Prostate cancer in patients with metabolic syndrome is associated with low grade Gleason score when diagnosed on biopsy.

PURPOSE: Studies on the relationship of metabolic syndrome (MS) and prostate cancer are controversial. We evaluated the association between MS and prostate cancer characteristics in patients who underwent transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: From October 2003 to May 2011, patients with a prostate-specific antigen (PSA) value≥4 ng/ml or abnormal digital rectal examination (DRE) result underwent transrectal ultrasound-guided prostate biopsy. MS was diagnosed according to the Adult Treatment Panel III. Clinicopathologic factors including PSA, DRE, prostate volume, age, waist circumference, body mass index (BMI), lipid profiles, fasting blood sugar level, and MS were considered for analysis. RESULTS: Three hundred fifty-four patients were enrolled (mean age, 68.86±8.95 years; mean PSA, 13.97±20.42 ng/ml). Seventy-five patients (21.2%) had MS and 90 patients (25.4%) were diagnosed as having prostate cancer, including 27 (30%) with MS and 63 (70%) without MS. Total PSA value and prostate volume were significant predictors for prostate cancer. However, MS and BMI were not significantly related to increased cancer risk. Prostate cancer patients with MS had significantly lower Gleason scores (average, 6.63±1.92) than did prostate cancer patients without MS (average, 7.54±1.71; p=0.029). CONCLUSIONS: Presence of MS was associated with a significantly decreased risk of high-grade prostate cancer. A larger, prospective, multicenter investigation is mandatory to clarify the relationship between MS and prostate cancer.

MGMT gene promoter methylation as a potent prognostic factor in glioblastoma treated with temozolomide-based chemoradiotherapy: a single-institution study.

PURPOSE: Recently, cells deficient in O(6)-methylguanine-DNA methyltransferase (MGMT) were found to show increased sensitivity to temozolomide (TMZ). We evaluated whether hypermethylation of MGMT was associated with survival in patients with glioblastoma multiforme (GBM). METHODS AND MATERIALS: We retrospectively analyzed 93 patients with histologically confirmed GBM who received involved-field radiotherapy with TMZ from 2001 to 2008. The median age was 58 years (range, 24-78 years). Surgical resection was total in 39 patients (42%), subtotal in 30 patients (32%), and partial in 17 patients (18%); only a biopsy was performed in 7 patients (8%). Postoperative radiotherapy began within 3 weeks of surgery in 87% of the patients. Radiotherapy doses ranged from 50 to 74 Gy (median, 70 Gy). MGMT gene methylation was determined in 78 patients; MGMT was unmethylated in 43 patients (55%) and methylated in 35 patients (45%). The median follow-up period was 22 months (range, 3-88 months) for all patients. RESULTS: The median overall survival (OS) was 22 months, and progression-free survival (PFS) was 11 months. MGMT gene methylation was an independently significant prognostic factor for both OS (p = 0.002) and PFS (p = 0.008) in multivariate analysis. The median OS was 29 months for the methylated group and 20 months for the unmethylated group. In 35 patients with methylated MGMT genes, the 2-year and 5-year OS rates were 54% and 31%, respectively. Six patients with combined prognostic factors of methylated MGMT genes, age ≤50 years, and total/subtotal resections are all alive 38 to 77 months after operation, whereas the median OS in 8 patients with unmethylated MGMT genes, age >50 years, and less than subtotal resection was 13.2 months. CONCLUSION: We confirmed that MGMT gene methylation is a potent prognostic factor in patients with GBM. Our results suggest that early postoperative radiotherapy and a high total/subtotal resection rate might further improve the outcome.

Optimal timing to evaluate prediagnostic baseline erectile function in patients undergoing robot-assisted radical prostatectomy.

INTRODUCTION: Accurate assessment of prediagnostic baseline erectile function (EF) is crucial when evaluating postoperative changes of EF in patients undergoing bilateral nerve sparing robot-assisted laparoscopic radical prostatectomy (RLRP). Because score domains of the International Index of Erectile Function-5 (IIEF-5) can be affected by factors such as recall intervals and psychological stress or discomfort due to cancer diagnosis and treatment, it is important to assess the prediagnostic baseline EF at appropriate times. AIM: To determine optimal timing to evaluate prediagnostic baseline EF in patients undergoing bilateral nerve sparing RLRP. METHODS: Between March 2009 and February 2010, 54 patients ranging in age from 48 to 74 years were asked to complete IIEF-5 questionnaires before prostate biopsy, 1 day before RLRP, and 1 month after RLRP to assess preoperative baseline EF. MAIN OUTCOME MEASURES: Differences in the mean scores of IIEF-5 were analyzed using paired t-tests. The strengths of the linear relationships among the three IIEF-5 scores were quantified using Pearson's correlation coefficient. An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement among the IIEF-5 scores. RESULTS: The mean IIEF-5 score before RLRP was significantly higher than the mean IIEF-5 score before prostate biopsy (P < 0.001). There was no significant difference between the mean IIEF-5 scores before prostate biopsy and 1 month following RLRP (P = 0.931). Scores of the IIEF-5 taken before prostate biopsy and 1 month following RLRP showed substantial agreement (kappa = 0.712), whereas scores of the IIEF-5 taken before prostate biopsy and before RLRP showed lower agreement (kappa = 0.325). CONCLUSION: To more accurately assess the prediagnostic baseline EF in patients with localized prostate cancer, the IIEF-5 questionnaire should be administered before prostate biopsy rather than before RLRP as cancer diagnosis-related symptoms and depression can affect IIEF-5 scores.

Standardized video-assisted retroperitoneal minilaparotomy surgery for 615 living donor nephrectomies.

To increase the rate of living kidney donation, the long-term safety of nephrectomy must be demonstrated to potential donors. We analyzed long-term donor outcomes and evaluated the standardization of surgical technique. We evaluated 615 donors who underwent Video-assisted minilaparotomy living donor nephrectomy (VLDN) at Yonsei Severance Hospital between 2003 and 2009. Perioperative data and predictors of outcomes were prospectively analyzed. The mean operative time and mean warm ischemia time were 192.7 and 2.2 min, respectively. Mean estimated blood loss was 195.3 ml. The mean post-transplant serum creatinine levels and Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate were 1.1 mg/dl and 68 ml/min/1.73 m(2) , respectively at 5 years after VLDN. The intra-operative and postoperative complication rate were 3.1% and 6.3%, respectively. Delayed renal function, 5-year graft survival, and complication rates of recipients were 1.1%, 98.4%, and 0.4%, respectively. Predictors of operative time were medical history, vessel anomaly, and surgeon experience (>50 cases). The single predictor of intra-operative complications was vessel anomaly. Standardized VLDN is feasible and safe. Our data on long-term outcomes can assist in demonstrating the long-term safety of donor nephrectomy to potential donors. To compare VLDN to other types of donor nephrectomy, a prospective multicenter study must be performed.

Factors affecting the improvement of the initial peak urinary flow rate after transurethral resection of the prostate or photoselective vaporization of the prostate for treating benign prostatic hyperplasia.

PURPOSE: We evaluated the factors that affect the improvement of the initial peak flow rate after transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) patients by using noninvasive tools. METHODS: One hundred and twenty seven BPH patients who had undergone TURP or PVP between January 2005 and May 2009 were evaluated. They were divided into 2 groups: the postoperative initial peak urinary flow rate (Qmax) was less than 10 mL/sec (Group 1; n=37, TURP=11, PVP=26) and more than 10 mL/sec (Group 2; n=90, TURP=41, PVP=49). We confirmed the patients' preoperative check lists. The check list were the international prostate symptom score (IPSS), the quality of life score, a past history of acute urinary retention (AUR), body mass index and/or pyuria, the serum prostate-specific antigen (PSA) level and the prostate volume, the prostate transitional zone volume and prostatic calcification. The initial Qmax was measured at the outpatient clinic one week after discharge. RESULTS: The improvement rate was not significant difference between the TURP group (78.8%) and the PVP group (65.3%). The efficacy parameters were the IPSS-storage symptom score, the prostate volume, the PSA level and a past history of AUR. The IPSS-storage symptom scores of Group 1 (12.3±3.3) was higher than those of Group 2 (10.5±1.7). The prostate volume of Group 2 (42.3±16.6 g) was bigger than that of Group 1 (36.6±7.8 g). The PSA level of Group 2 (3.8±2.6 ng/mL) was higher than that of Group 1 (2.6±2.6 ng/mL). A past history of AUR in Group 1 (35.1%) was more prevalent than that of Group 2 (15.6%). CONCLUSIONS: The non-invasive factors affecting the initial Qmax after TURP or PVP were the IPSS-storage symptom score, the prostate volume and a past history of AUR. Accordingly, in patients who have a higher IPSS-storage symptom score, a smaller prostate volume and a history of AUR, there might be a detrimental effect on the initial Qmax after TURP or PVP. These factors might also be used as long-term prognostic factors.

Robot-assisted laparoendoscopic single-site surgery: partial nephrectomy for renal malignancy.

OBJECTIVES: To describe our experience with robot-assisted laparoendoscopic single-site surgery (LESS) to perform partial nephrectomy and evaluate a hybrid homemade port system as an effective access technique. METHODS: From December 2008 to September 2009, robot-assisted LESS to perform partial nephrectomy through a hybrid homemade port was performed to treat 14 cases of renal cell carcinoma. The data, including patient characteristics, operative records, complications, and pathologic results, were analyzed. RESULTS: The mean tumor size was 3.2 cm, the mean ischemic time was 30 minutes, and the mean operative time was 233 minutes. We used the hybrid homemade port technique in 10 cases. All surgical margins after partial nephrectomy were negative for malignancy. No port-related complications were reported. Two cases required conversion to mini-incisional partial nephrectomy. CONCLUSIONS: Robot-assisted LESS for performing partial nephrectomy using a hybrid homemade port system is a safe and feasible treatment technique. It provided access for meticulous suturing on the renal parenchyma using articulating robot arms and ready access to the surgical field for the assistant.