A Prospective Multi-center Trial of Escherichia coli Extract for the Prophylactic Treatment of Patients with Chronically Recurrent Cystitis

We have assessed the efficacy and safety of Escherichia coli extract (ECE; Uro-Vaxom(R)) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2+/-5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.

Prostate Cancer Detection Rate of Rebiopsy in Patients with an Initial Diagnosis of Atypical Small Acinar Proliferation of the Prostate

PURPOSE: Atypical small acinar proliferation (ASAP) denotes the presence of suspicious glands with insufficient cytological architecture for a definitive prostate cancer diagnosis. We evaluated the subsequent prostate cancer detection rate of rebiopsy in patients with an initial diagnosis of ASAP. MATERIALS AND METHODS: Between January 2003 and December 2006, 1,416 men with suspected prostate cancer underwent a transrectal ultrasound-guided prostate biopsy, and 214 (15.1%) were diagnosed as having ASAP. Ninety-five of the 215 patients underwent at least one more biopsy. We evaluated the cancer detection rates after rebiopsy. RESULTS: In men with ASAP, 36 patients (37.9%) had prostate cancer. The cancer detection rates of the 1st, 2nd, and 3rd rebiopsies were 30.5%, 23.8%, and 40%, respectively. Mean patient age and prostate-specific antigen did not differ significantly between the prostate cancer and noncancer groups after rebiopsy. Prostate volume, however, was significantly smaller in the cancer group (p<0.05). CONCLUSIONS: Our results showed a detection rate for prostate cancer of 37.9% after an initial diagnosis of ASAP, which indicates that an initial diagnosis of ASAP mandates rebiopsy.

Accuracy of a High Prostate-Specific Antigen Level for Prostate Cancer Diagnosis upon Initial Biopsy in Korean Men

PURPOSE: This study aimed to evaluate the cancer detection rate in a Korean population with prostate-specific antigen (PSA) levels greater than or equal to 20.0ng/mL. MATERIALS AND METHODS: A total of 174 men 50 to 79 years old (median 69) included in the study. The median prostate volume of the patients was 44.8mL (range 14.1 to 210.0) and their serum PSA ranged from 20.0 to 9725.0ng/mL (median 44.8). RESULTS: Of 174 men 141 (81.0%) were diagnosed with prostate cancer on initial biopsy. In the total number of patients, the positive predictive value (PPV) was 62.9% for PSA 20 to 29.9, 72.7% for PSA 30 to 39.9 and 100% for PSA 40 to 49.9 ng/mL. In patients with an abnormal digital rectal examination (DRE), the values for these PSA ranges increased to 89.5%, 91.7% and 100%, respectively. The PPV was 81.0% for PSA cutoff of 20, 89.2% for a cutoff of 30, 95.4% for a cutoff of 40, and 94.7% for a cutoff of 50 ng/mL. In conjunction with an abnormal DRE, the values for these PSA cutoffs increased to 95.9%, 98.1%, 100%, and 100%, respectively. CONCLUSION: Our data suggest the ability to predict the presence of prostate cancer reliably on initial biopsy when PSA threshold is greater than or equal to 50ng/mL. This PSA threshold may be lowered to 40ng/mL in the presence of an abnormal DRE. In Korean men with high PSA, the detection rate of prostate cancer on biopsy appears to be comparable to that for American men.

Risk Factors for Urinary Stone Formation in Male Patients with Spinal Cord Injury: A 17-Year Follow-Up Study / 대한비뇨기과학회지

PURPOSE: This study was initiated to establish the hazard ratios for risk of urinary stone formation in chronic spinal cord injury (SCI) patients. MATERIALS AND METHODS: A total of 140 male patients who were injured before 1987 were eligible for this investigation and they were followed up on a yearly basis from January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (27.9%) and 21 patients (15.0%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. On multivariate analysis, bladder stone was more common for the patients who were injured at 24 years old or older than is was for those patients who were injured at less than 24 years old (odds ratio [OR]: 2.490; 95% confidence interval [CI]: 1.092-5.677; p=0.030). In another model, the patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (OR: 4.095; 95% CI: 1.295-12.944; p=0.016). We also found that renal stone was more common for the patients with urethral catheterization (UC) than for the patients who could spontaneous void (OR: 5.668; 95% CI: 1.306-24.604; p=0.021), and for patients with bladder stone than for those without bladder stone (OR: 4.678; 95% CI: 1.447-15.126; p=0.010). CONCLUSIONS: Injury characteristics are important for the development of urinary stone in chronic traumatic SCI patients. In addition, our findings suggest that for the cases who cannot undergo intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than UC is regards to renal stone formation in this population.

An Open-label, Multicenter, Flexible Dose Study to Evaluate the Efficacy and Safety of Viagra(R)(Sildenafil Citrate) in Males with Erectile Dysfunction and Arterial Hypertension Who are Taking Antihypertensive Treatment / 대한비뇨기과학회지

PURPOSE: To evaluate the safety and efficacy of sildenafil citrate in men with erectile dysfunction, who had been taking antihypertensive agents, and to provide supportive scientific data, which can be used as a reference when prescribing sildenafil citrate. MATERIALS AND METHODS: 198 male subjects, aged 20 years or older, between September 2002 and June 2003, were enrolled. The subjects were comprised of those patients with arterial hypertension, taking one or more antihypertensive agents, and who had been diagnosed with erectile dysfunction of more than 3 months duration. This study was conducted for 10 weeks as an open-label, multi-center and flexible dose clinical study, with a 2-week screening period and 8-week treatment phase. At all visits, the heart pressure and heart rate were measured, with any concomitant medications and adverse events recorded for each subject. Subjects were asked to complete the Event Log Worksheets, questionnaires of the International Index of Erectile Function (IIEF) and the Global Efficacy Assessment Question (GEAQ) during the study period. RESULTS: 167 subjects completed this study. The average age and duration of erectile dysfunction were 55.8 (31.7 to 77.1) years old and 3.3 years, respectively. The scores for questions 3 and 4 of IIEF improved from 2.3 and 1.8 at baseline, to 3.7 and 3.4 at week 4 and to 3.8 and 3.4 at week 8, respectively. 86.3 and 88.3% of patients answered that they had an improved erectile function and ability to have sexual intercourse, respectively, by week 8. There were no significant differences in responses to questions 3 and 4 of the IIEF and GEAQ in relation to the number of antihypertensive agents taken. The adverse events experienced during the study were facial flushing (20.1%), headache (11.7%), palpitation (5.0%), rhinitis (2.8%), URI (2.8%), dizziness (2.2%), chest pain (2.2%) and nausea (1.7%). Only 4 patients discontinued treatment due to adverse events. CONCLUSIONS: According to the results of this study, sildenafil citrate was concluded to not only be effective at improving erections, but was also well tolerated and safe in the treatment of men with erectile dysfunction who were also taking multiple antihypertensive agents for arterial hypertension.

Analysis of Urological Complications according to the Voiding Method for Spinal Cord Injury Patients / 대한비뇨기과학회지

PURPOSE: Our study was designed to compare the incidence of urological complications for patients with spinal cord injury in relation to their voiding method, and then we wished to suggest a proper voiding method. MATERIALS AND METHODS: Based on their medical records, questionnaires and upper tract imaging, a total of 301 male spinal cord injury patients were retrospectively analyzed for the outcomes of their voiding method. Our study was performed on 50 patients with urethral Foley catheterization, 106 patients with clean intermittent catheterization, 67 patients with suprapubic catheterization, 51 patients within self voiding and 27 patients with condom catheters. Urological complications such as urinary infection, stone disease, urethral complications, vesicoureteral reflux, radiographic upper tract abnormality and bladder tumor were recorded for each patient. RESULTS: Of the 262 complications that were recorded, 89 developed in 24 (48.0%) patients having urethral Foley catheterization, 41 in 23 (21.7%) patients having clean interemittent catheterization, 72 in 26 (38.8%) patients having suprapubic catheterization. 36 in 15 (39.4%) patients with self voiding and 24 in 9 (33.3%) patients having condom catheters. The urethral Foley catheterization group had the highest complication rates relative to all other voiding methods, and the clean intermittent catheterization group had significantly lower complication rates except for having the highest rate of urethral stricture. CONCLUSIONS: Our study shows that clean intermittent catheterization for spinal cord injury patients significantly reduces the incidence of urological complications and it may be the optimal voiding method.

Analysis of Urological Complications according to the Voiding Method for Spinal Cord Injury Patients / 대한비뇨기과학회지

PURPOSE: Our study was designed to compare the incidence of urological complications for patients with spinal cord injury in relation to their voiding method, and then we wished to suggest a proper voiding method. MATERIALS AND METHODS: Based on their medical records, questionnaires and upper tract imaging, a total of 301 male spinal cord injury patients were retrospectively analyzed for the outcomes of their voiding method. Our study was performed on 50 patients with urethral Foley catheterization, 106 patients with clean intermittent catheterization, 67 patients with suprapubic catheterization, 51 patients within self voiding and 27 patients with condom catheters. Urological complications such as urinary infection, stone disease, urethral complications, vesicoureteral reflux, radiographic upper tract abnormality and bladder tumor were recorded for each patient. RESULTS: Of the 262 complications that were recorded, 89 developed in 24 (48.0%) patients having urethral Foley catheterization, 41 in 23 (21.7%) patients having clean interemittent catheterization, 72 in 26 (38.8%) patients having suprapubic catheterization. 36 in 15 (39.4%) patients with self voiding and 24 in 9 (33.3%) patients having condom catheters. The urethral Foley catheterization group had the highest complication rates relative to all other voiding methods, and the clean intermittent catheterization group had significantly lower complication rates except for having the highest rate of urethral stricture. CONCLUSIONS: Our study shows that clean intermittent catheterization for spinal cord injury patients significantly reduces the incidence of urological complications and it may be the optimal voiding method.

Complete Remission of Renal Cell Carcinoma with Metastases to Lung and Bone Following Initial Interferon-alpha Immunotherapy and Adjuvant Nephrectomy / 대한비뇨기과학회지

Patients with metastatic renal cell carcinomas have a median survival of less than 1 year and a 0-20% 5-year survial. The immunotherapy agent interferon-alpha has consistently produced objective responses rarely exceeding 20% of treated patients. Moreover, in patients with metastases to brain, liver or bone, the prognosis is extremely poor. A 66-year-old man, with a right renal cell carcinoma, with metastases to lung and bone who had entered a remarkable complete radiological remission of the metastases to lung and bone by 82 months following interferon-alpha immunotherapy, underwent a nephrectomy. The patient has remained recurrence free for 16 months after the nephrectomy.

The Long-Term Outcomes of Augmentation Cystoplasty in Spinal Cord Injury Patients / 대한비뇨기과학회지

PURPOSE: The long-term outcomes of augmentation cystoplasty were investigated in spinal cord injury (SCI) patients with a neurogenic bladder, and included a study of the complications and patients' satisfaction. MATERIALS AND METHODS: 19 SCI patients that underwent an augmentation cystoplasty, between 1988 and 1994, were retrospectively reviewed. The mean follow-up period was 120, ranging from 94 to 169 months. The changes in the intravesical pressure, bladder capacity and complications were investigated. Urological examinations, including history taking, medical records, radiological evaluations and urodynamic studies were undertaken. All the patients were interviewed by direct contact. RESULTS: Six months postoperatively, the urodynamic results showed significantly decreased intravesical pressures and increased bladder capacities. The intravesical pressure (cmH2O) was decreased from 89.0+/-16.49 to 28.0+/-5.69 (p<0.05), and the functional bladder capacity (ml) was increased from 125.0+/-53.30 to 480.0+/-43.33 (p<0.05). From the long-term follow-up, 10 years postoperatively, the results were similar to the previous data (21.0+/-3.88cmH2O and 510.0+/-60.27ml). The symptomatic urinary tract infections had disappeared, but the asymptomatic bacteriuria continued. The vesicoureteral reflux was eliminated, and the renal function normalized, in all patients. The hydronephrosis had disappeared in most patients (89%). A few postoperative complications were reported. Most patients were very satisfied symptomatically (89%), with no patient expressing dissatisfaction. A clean intermittent catheterization (CIC) was performed every 4 to 6 hours, with the mean volume of drained urine was 450, ranging from 400 to 600ml. CONCLUSIONS: Augmentation cystoplasty could be an excellent method of treatment in selected patients with SCI. There were no significant complications, and a high degree patients' satisfaction, on the long-term follow-up.

Effect of Prostate Size on Cancer Detection Rate of Traditional Sextant Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: We aimed to evaluate whether cancer detection rates could vary with prostate size using a systematic sextant biopsy. MATERIALS AND METHODS: We performed a systematic sextant biopsy in 225 consecutive men from January 1997 to August 2002. Indications for biopsy included an elevated prostate specific antigen(PSA) level(more than 4.0ng/ml), or the hypoechoic lesion on TRUS. Prostate volume was calculated using the following fomula: volume=0.52 x length x width x height. We examined biopsy yield according to gland-volume intervals of 10cc. RESULTS: Adenocarcinoma was detected in 68 out of 225 patients(30.22%). The mean volume of prostate in all patients was 51.5cc. The highest biopsy rate(65.7%) was recorded among men with prostates between 20 to 29.9cc. The lowest biopsy rate (17.2%) was recorded among men with prostates larger than 80cc. Decreasing yield of sextant biopsy was strongly associated with increasing gland volume(p or =30cc)(62.63% and 22.09%, respectively, p or =30cc) prostate groups. CONCLUSION: Our cancer detection rate using a systematic sextant biopsy was higher in men with prostates less than 30cc. Our results suggest that significant sampling error may occur in men with large glands, and more biopsies may be needed under these circumstances.

Primary Squamous Cell Carcinoma of the Ureter after Reterocutaneoustomy / 대한비뇨기과학회지

Primary squamous cell carcinomas of the renal pelvis and ureter are rare tumors, accounting for less than 1% of all primary tumors of the upper urinary tract. The ratio of renal pelvis to ureter tumors is approximately 6:1. The pathogenesis is assumed to begin with an urothelial metaplasia, as a result of a reaction to chronic irritation and infection, which lead to dysplasia, and ultimately to a squamous cell carcinoma. Only one case of a squamous cell carcinoma of the ureter has been reported in the Korean literature. We report a case of a primary squamous cell carcinoma of the ureter, as a result of a reaction to chronic irritation and infection in a 48-year-old male patient.

Effect of Finasteride According to the Histological Types of Benign Prostatic Hyperplasia as Predicted by Transrectal Ultrasonography / 대한비뇨기과학회지

PURPOSE: Finasteride is being used as a medical therapy of benign prostatic hyperplasia (BPH), but there are no appropriate selection criteria for finasteride therapy. Our objective was to determine the usefulness of finasteride according to histological nature of the BPH, as determined by the transrectal ultrasonography (TRUS) findings. MATERIALS AND METHODS: Forty-two patients with symptomatic BPH were treated with finasteride (5mg/day) for more than 6 months. The patients were categorized into two groups of 21, according to their TRUS findings: the stromal, and the glandular, component dominant groups. The changes in prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI) of each group, following at least 6 months of finasteride treatment, were evaluated and compared. RESULTS: In the stromal group the PV, TZV and TZI decreased from 69.3 11.5cc to 65.6 9.3cc, 43.5 13.2cc to 40.8 8.8cc and 0.63 to 0.62, respectively, but these changes were not statistically significant. While, in the glandular group, the PV, TZV and TZI decreased from 67.4+/-26.7cc to 56.2+/-25.2cc, 43.9+/-24.9cc to 32.4+/-19.9cc, and 0.63 to 0.54 (P<0.05), respectively. There was a linear correlation, only in the glandular group, between the TZI and TZV reductions following finasteride therapy (R=0.47, p=0.009). CONCLUSIONS: We suggest the prediction of the histological nature of BPH, by TRUS, would be helpful prior to the initiation finasteride treatment for effective reduction in the prostate volume with BPH. The effective reduction in the volume of the prostate in BPH would be possible only in glandular component dominant patients, as discriminated by TRUS.

Early Experience of Intravesical Capsaicin for Treatment of Detrusor Hyperreflexia in Patients with Spinal Cord Injury

PURPOSE: The clinical and urodynamic effects of intravesical capsaicin, a neurotoxic substance causing a reversible suppression of unmyelinated C fiber afferent neuronal activity, were investigated for treatment of detrusor hyperreflexia in patients with spinal cord injury. MATERIALS AND METHODS: Capsaicin solution (2mM) dissolved in 30% alcohol was instilled intravesically in 7 men with detrusor hyperreflexia due to spinal cord injury. Effects on bladder function and subjective symptoms were evaluated before and after intravesical instillation of capsaicin. RESULTS: Bladder function was improved in all but 1 patient. The improvement was expressed as an increase from 108ml to 270ml in maximal bladder capacity and a decrease from 75cmH2O to 44cmH2O in maximal detrusor pressure. Four patients had subjective improvement following treatment and the effects lasted for 4 to 6 weeks. Immediately after capsaicin instillation the ice water test was negative in 2 patients. Autonomic dysreflexia was observed in 4 patients, suprapubic discomfort in 3 patients and gross hematuria in 1 patient. CONCLUSION: Intravesical capsaicin seems to be a promising method for treatment of detrusor hyperreflexia, but the general use of intravesical capsaicin was limited due to side effects.

Effect of Terazosin on Low Compliant Bladder in Patients with Spinal Cord Injury / 대한비뇨기과학회지

No abstract available.

Early Experience of Intravesical Instillation of Resiniferatoxin (RTX) for Treatment of Detrusor Hyperreflexia in Patients with Spinal Core Injury: Refractoryto Previous Oxybutynin Therapy / 대한비뇨기과학회지

No abstract available.

Urodynamic Study in Spinal Cord Injured Patients : Classification and Analysis of High Risk Parameters for Upper Tract Deterioration / 대한비뇨기과학회지

No abstract available.

Effect of Terazosin for the Treatment of Autonomic Dysreflexta in Patients with Spinal Cord Injury / 대한비뇨기과학회지

PURPOSE: Autonomic dysreflexia represents one of the most serious medical emergencies in the care and rehabilitation of patients with spinal cord injury. We evaluated the effect of terazosin for the prevention of symptoms due to autonomic dysreflexia in patients with spinal cord injury. MATERIALS AND METHODS: The effect of terazosin was evaluated in 20 spinal cord injury patients with autonomic dysreflexia. All patients received terazosin as the only medication for the autonomic dysreflexia. Baseline measurements of blood pressure, the autonomic dysreflexia severity score and autonomic dysreflexia frequency score were recorded before terazoxin medication. Follow-up measurements were taken at 1 week, 1 month and 3 month after medication. All the data were statistically evaluated and the following results were obtained. RESULTS: The majority of patients(95%) had manifested headache and sweating. The autonomic dysreflexia severity score after terazosin medication decreased from an average of 9.0+/-0.6 at baseline to 6.8+/-0.7, 5.2+/-0.7 and 4.9+/-0.6 at 1 week, 1 month and 3 months repectively(p=0.001). And the autonomic dysreflexia frequency score after terazosin medication decreased from an average of 2.4+/-0.5 to 1.2+/-0.4 at 3 months. CONCLUSION: Tetazosin appears to be effective in preventing symptoms due to autonomic dysreflexia.

Long-term Follow-up for Penile Prostheses in Patients with Spinal Cord Injury / 대한비뇨기과학회지

PURPOSE: Recently the use of penile prostheses in patients with spinal cord injury(SCI) has been beneficial for sexual dysfunction, maintenance of external devices and the treatment of penile skin lacerations. We reviewed 50 patients with SCI who had been followed for more than five years after penile prosthetic implantation, particularly in regard to surgical success rate and complication rate. MATERIALS AND METHODS: From 1988 to 1993, 102 penile prostheses were implanted in 50 patients with SCI. Penile prosthetic implantation was done for sexual dysfunction in 29 patients and for sexual dysfunction and urinary management in 21 patients. The types of penile prostheses were malleable in 13 patients, Dynaflex in 35 patients and AMS 700 CXM in two patients. RESULTS: We experienced prosthetic infection in six patients, mechanical failure in three patients, urethral erosion in two patients and penile skin necrosis in one patient. The overall surgical success rate was 88% and the five-year complication rate was 24%. CONCLUSIONS: Though the complication rate of penile prosthetic implantation in patients with SCI was higher than in the general population, penile prosthetic implantation improves the quality of life with regard to sexual function and urinary management in patients with SCI.

A Case of Retroperitoneal Liposarcoma / 대한비뇨기과학회지

We report a case of retroperitoneal liposarcoma mimicking lipoma which was found on follow-up studies in a 67-year old man with stomach cancer. Preoperative computerized tomography of abdomen and biopsy confirmed the diagnosis of right retroperitoneal liposarcoma, which was treated with surgery and radiation therapy.

The Effect of Desmopressin in Neurogenic Bladder due to Spinal Cord in Jury / 대한비뇨기과학회지

PURPOSE: Nocturia and enuresis are common voiding problems in spinal cord injured patients despite a variety of management. The purpose of this study is to determine the efficacy of desmopressin, a synthetic analogue of antidiuretic mono, as an alternative treatment in the management of spinal cord injured(SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. MATERIALS AND METHODS: Fourteen SCI patients with nocturia or enuresis were included in this study. The patients received 10microgram desmopressin intranasally at bedtime once every 24 hours. RESULTS: There was a significant decrease in nocturnal urinary volume, frequency of nocturia and nocturnal enuresis during nighttime after desmopressin administration. Two patients stopped desmopressin because of side effects. 8 of 12 patients improved with desmopressin and the remainder had no effect. There was no serum abnormality, although there were side effects in three cases, such as gastro-intestinal trouble, chest discomfort or nasal congestion. CONCLUSIONS: Desmopressin is safe and effective in the management of nocturia or enuresis due to neurogenic bladder dysfunction in selected SCI patients.