Trends of First-Line Targeted Therapy in Korean Patients With Metastatic Clear Cell Renal Cell Carcinoma: Sunitinib Versus Pazopanib, a Multicenter Study

Purpose@#There have been few reports on comparison between sunitinib and pazopanib as first-line targeted therapy in Korean metastatic clear cell renal cell carcinoma (ccRCC). We sought to analyze the treatment trends of metastatic ccRCC by comparing the effects and adverse events of sunitinib and pazopanib. @*Materials and Methods@#Data of 357 metastatic RCC patients who received the sunitinib or pazopanib as the first-line targeted therapy from the Daegyeong Oncology Study Group database was obtained and analyzed. Among these patients, patients who only clear cell type was confirmed after needle biopsy or nephrectomy were included, and patients who underwent target therapy for less than 3 months were excluded. @*Results@#Of 251 patients who met the inclusion criteria, sunitinib and pazopanib group were identified in 156 (62%) and 95 patients (38%), respectively. Pazopanib group was older (66 years vs. 61 years, p=0.001) and more symptomatic (65% vs. 52%, p=0.037) and had more patients with Karnofsky performance status <80 (20% vs. 11%, p=0.048) and fewer number of organ metastases (p=0.004) compared to sunitinib group. There was no significant difference in disease control rate (88.5% vs. 87.3%, p=0.744), the median progression-free survival (19 months vs. 15 months, p=0.444) and overall survival (25 months vs. 19 months, p=0.721) between sunitinib and pazopanib. The most common grade 3/4 adverse events with sunitinib and pazopanib were anemia (5%) and hand-foot syndrome (3%), respectively. There was no significant difference between sunitinib and pazopanib in number of patients who experienced grade 3/4 adverse events (15% vs. 11%, p=0.275). However, there were more patients who discontinued treatment due to only adverse events in sunitinib group compared to pazopanib group (12% vs. 3%, p=0.020). @*Conclusions@#In Korean metastatic ccRCC, pazopanib tended to be used in patients with poorer health status compared to sunitinib. Sunitinib and pazopanib had no significant difference in treatment effect and survival, but pazopanib had more tolerable adverse events.

The current status of hormone treatment for prostate cancer patients in Korean real-world practice: a multi-institutional observational study / 亚洲男科学杂志(英文版)

We aimed to evaluate the current nationwide trend, efficacy, safety, and quality of life (QoL) profiles of hormone treatment in real-world practice settings for prostate cancer (PCa) patients in Korea. A total of 292 men with any biopsy-proven PCa (TanyNanyMany) from 12 institutions in Korea were included in this multi-institutional, observational study of prospectively collected data. All luteinizing hormone-releasing hormone (LHRH) agonists were allowed to be investigational drugs. Efficacy was defined as (1) the rate of castration (serum testosterone ≤50 ng dl-1) at 4-week visit and (2) breakthrough (serum testosterone >50 ng dl-1 after castration). Safety assessments included routine examinations for potential adverse events, laboratory tests, blood pressure, body weight, and bone mineral density (BMD, at baseline and at the last follow-up visit). QoL was assessed using the Expanded Prostate Cancer Index Composite-26 (EPIC-26). The most common initial therapeutic regimen was LHRH agonist with anti-androgen (78.0%), and the most commonly used LHRH agonist for combination and monotherapy was leuprolide (64.0% for combination and 58.0% for monotherapy). The castration and breakthrough rates were 78.4% and 6.6%, respectively. The laboratory results related to dyslipidemia worsened after 4 weeks of hormone treatment. In addition, the mean BMD T-score was significantly lower at the last follow-up (mean: -1.950) compared to baseline (mean: -0.195). The mean total EPIC-26 score decreased from 84.8 (standard deviation [s.d.]: 12.2) to 78.3 (s.d.: 8.1), with significant deterioration only in the urinary domain (mean: 23.5 at baseline and 21.9 at the 4-week visit). These findings demonstrate the nationwide trend of current practice settings in hormone treatment for PCa in Korea.

Is the Expression of p53, c-erb-B2 and Ki-67 Influence the Prognosis of the Non-muscle Invasive Urothelial Bladder Cancer?

PURPOSE: The immunohistochemial markers can be used to predict prognosis more accurately for several cancers. In non-muscle invasive urothelial carcinoma, p53, c-erb-B2 and Ki-67 are applicable. We investigated a retrospective analysis of the relation between the markers and clinical prognostic factors of urothelial bladder cancer. MATERIALS AND METHODS: Data from 268 non-muscle invasive urothelial bladder cancer (Ta, T1) patients from one single center were collected. Immunohistochemical evaluation was carried out on 268 (p53, c-erb-B2, Ki-67) cases. Clinical prognostic factors are as follows; number of tumor, tumor invasiveness, tumor grade and recurrence. The sum of all positivity of 3 markers was made as a new factor and evaluation of correlation between this factor and prognostic factors was also done. Statistical analysis was done by chi-squares test and Pearson's correlation test. RESULTS: Through chi-square test, there were significant relations between all markers and tumor invasiveness (p<0.001), tumor grade (p<0.001). Number of tumor is significantly related with Ki-67 (p=0.043). Recurrence is related with c-erb-B2 (p=0.010) and Ki-67 (p=0.043). There was also significant correlations between the sum of the markers and prognostic factors-tumor invasiveness (p<0,001), tumor grade (p<0.001) and recurrence (p=0.007). CONCLUSIONS: In this study, evaluated markers were closely related with clinical prognostic factors and may contribute to decision making on risk-assessment and management strategy for non-muscle invasive urothelial bladder cancer.

Pathological upgrading in prostate cancer patients eligible for active surveillance: Does prostate-specific antigen density matter?

PURPOSE: To evaluate prospectively the role of prostate-specific antigen (PSA) density in predicting Gleason score upgrading in prostate cancer patients eligible for active surveillance (T1/T2, biopsy Gleason score< or =6, PSA< or =10 ng/mL, and < or =2 positive biopsy cores). MATERIALS AND METHODS: Between January 2010 and November 2013, among patients who underwent greater than 10-core transrectal ultrasound-guided biopsy, 60 patients eligible for active surveillance underwent radical prostatectomy. By use of the modified Gleason criteria, the tumor grade of the surgical specimens was examined and compared with the biopsy results. RESULTS: Tumor upgrading occurred in 24 patients (40.0%). Extracapsular disease and positive surgical margins were found in 6 patients (10.0%) and 8 patients (17.30%), respectively. A statistically significant correlation between PSA density and postoperative upgrading was found (p=0.030); this was in contrast with the other studied parameters, which failed to reach significance, including PSA, prostate volume, number of biopsy cores, and number of positive cores. Tumor upgrading was also highly associated with extracapsular cancer extension (p=0.000). The estimated optimal cutoff value of PSA density was 0.13 ng/mL2, obtained by receiver operating characteristic analysis (area under the curve=0.66; p=0.020; 95% confidence interval, 0.53-0.78). CONCLUSIONS: PSA density is a strong predictor of Gleason score upgrading after radical prostatectomy in patients eligible for active surveillance. Because tumor upgrading increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients eligible for active surveillance.

Clinicopathologic Differences Between Prostate Cancers Detected During Initial and Repeat Transrectal Ultrasound-Guided Biopsy in Korea

PURPOSE: The aim of this study was to investigate clinicopathologic differences between prostate cancer (PCa) detected at initial and repeat transrectal ultrasound-guided prostate biopsy in a large Korean cohort. MATERIALS AND METHODS: From 2000 through 2012, a total of 7,001 patients underwent transrectal ultrasound-guided prostate biopsy at 6 centers in Daegu and Gyeongbuk provinces. Of these 7,001 patients, the initial biopsy was positive for PCa in 2,118 patients. Repeat biopsy was performed in 374 of the 4,883 patients with an initial negative finding and a persistently elevated prostate-specific antigen (PSA) level, nodules or asymmetry by digital rectal examination (DRE), high-grade prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Numbers of biopsy cores varied from 6 to 12 according to center and biopsy date. RESULTS: Cancer was diagnosed in 2,118 of the 7,001 patients (30.3%) at initial biopsy and in 86 of the 374 patients (23.0%) at repeat biopsy. The repeat biopsy rate was 5.3%. Mean PSA values were 68.7+/-289.5 ng/mL at initial biopsy and 18.0+/-55.4 ng/mL at repeat biopsy (p<0.001). The mean number of cancer-positive cores per biopsy was 5.5+/-3.5 for initial biopsy and 3.0+/-2.9 for repeat biopsy (p<0.001). Mean Gleason score was 7.5+/-1.4 at initial biopsy and 6.6+/-1.3 at repeat biopsy (p<0.001). For detected cancers, the low-stage rate was higher for repeat biopsy than for initial biopsy (p=0.001). CONCLUSIONS: Cancers detected at repeat biopsy tend to have lower Gleason scores and stages than cancers detected at initial biopsy. The present study shows that repeat biopsy is needed in patients with a persistently high PSA or abnormal DRE findings.

Adolescent Varicocele: Are Somatometric Parameters a Cause?

PURPOSE: It has been reported that varicocele is found less frequently in obese men. Accordingly, we evaluated varicocele patients and statistically analyzed the correlation between varicocele and somatometric parameters. MATERIALS AND METHODS: A total of 211 patients underwent surgery for varicoceles. All patients underwent history taking, physical examination, and scrotal ultrasound to determine the presence and severity of varicocele. An age-matched control group consisted of 102 patients who were found not to have varicocele according to physical examinations and scrotal ultrasound. The age, weight, height, and body mass index (BMI) of the two groups were compared. The statistical analyses were performed by use of PASW Statistics ver. 18.0. A p-value of less than 0.05 was used for statistical significance. RESULTS: In the varicocele group, the mean age, height, weight, and BMI were 29.42+/-14.01 years, 168.53+/-9.97 cm, 62.14+/-13.17 kg, and 21.66+/-3.21 kg/m2, respectively. The distribution of varicocele grade was as follows: 103 (48.8%) grade III, 72 (34.1%) grade II, and 36 (17.1%) grade I. In the control group, the mean age, height, weight, and BMI were 30.83+/-17.31 years, 161.93+/-19.83 cm, 64.69+/-17.86 kg, and 24.04+/-3.64 kg/m2, respectively. Analyzing these data specifically in adolescents, they showed significant differences in age, height, and BMI (p=0.000, p=0.000, and p=0.004, respectively) between two groups. There were no significant differences in somatometric parameters between patients with different grades of varicocele. CONCLUSIONS: Our results showed that patients with varicoceles were significantly taller and had a lower BMI than did patients without varicoceles, especially among adolescents. Carefully designed future studies may be needed.

Renal Function Following Curative Surgery for Renal Cell Carcinoma: Who Is at Risk for Renal Insufficiency?

PURPOSE: To investigate the incidence and predictive factors associated with the development of chronic kidney disease (CKD) in patients undergoing curative surgery for renal cell carcinoma. MATERIALS AND METHODS: From 2003 to 2010, we retrospectively investigated 108 patients undergoing partial nephrectomy or radical nephrectomy (RN) for renal tumors with a preoperative glomerular filtration rate (GFR)> or =60. The GFR was calculated by use of the four-variable modification of diet in renal disease (MDRD) formula. CKD was defined as an estimated GFR (eGFR) less than 60 mL/min per 1.73 m2. Demographic and clinicopathologic parameters were evaluated by using the chi-square and Student t-tests and multivariate regression analysis to determine the variables independently associated with the development of postoperative CKD. RESULTS: Of the 108 patients without preoperative CKD, CKD developed in 43 patients (39.8%). In the analysis of clinical factors between patients with and those without CKD development, gender, body mass index, diabetes mellitus, hypertension, and tumor size were not significant clinical factors. Statistical significance for CKD development was found for age of 60 years or greater (p=0.013), decreased preoperative eGFR (p<0.001), and RN group (p<0.001). In the multivariate analysis, decreased preoperative eGFR (p=0.001) and RN group (p=0.002) were significant independent predictors. CONCLUSIONS: The results of our study show that decreased preoperative renal function and RN were significant independent predictors of postoperative CKD. In patients who had a relatively decreased preoperative eGFR, especially when estimated by use of the MDRD formula, nephron-sparing surgery should be considered for the treatment of small renal tumors.

Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux

PURPOSE: Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)]. RESULTS: Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0+/-8.2 months) than in boys (5.8+/-4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean+/-SD age at diagnosis of VUR in patients with breakthrough infection (1.14+/-3.14) was significantly younger than in those without breakthrough infection (5.05+/-3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028). CONCLUSION: Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.

Is Increased Prostatic Urethral Angle Related to Lower Urinary Tract Symptoms in Males with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms?

PURPOSE: The prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) was recently reported. We investigated the statistical significance of an increased PUA on the International Prostate Symptom Score (IPSS) in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptom (LUTS). MATERIALS AND METHODS: A retrospective analysis was done of 270 men with BPH/LUTS from July 2009 to June 2011. Prostate volume, PUA, and intravesical prostatic protrusion (IPP) were measured by transrectal ultrasonography (TRUS). The IPSS was analyzed separately as storage and voiding symptom score. In order to minimize the effect of prostate size on voiding, patients with prostate size over 40 ml were excluded. RESULTS: The mean age was 62.0+/-9.3 years. The mean prostate volume was 29.0+/-5.5 ml (range, 20 to 40 ml), and median PUA and IPP were 34degrees (range, 12 to 52degrees) and 1.7 mm (range, 0 to 5.3 mm), respectively. The mean IPSS, mean IPSS-ss, and mean IPSS-vs were 19.0+/-8.2, 7.3+/-4.0, and 11.6+/-5.5, respectively. The prostate volume had no statistically significant correlation with IPSS, IPSS-ss, or IPSS-vs. IPP had a statistically significant correlation with IPSS (p or =34degrees) with a lower PUA (<34degrees), patients with a higher PUA had a higher IPSS (p=0.001) and a higher IPSS-vs (p=0.001). There was no significant difference in IPSS-ss, prostate volume, or PSA between the two groups. CONCLUSIONS: IPP showed significantly correlated with the IPSS and voiding symptom score was affected by the PUA but not by the prostate volume. As the PUA increased, the patients' voiding symptoms worsened. Further study may be needed.

Malignant Mesothelioma of the Spermatic Cord

Primary tumors arising from the spermatic cord are very rare. Mesothelioma derives from the mesothelial cells lining the serous membrane, such as the pleura, peritoneum, and tunica vaginalis of testis. Paratesticular malignant mesothelioma (MM), which usually presents as a hydrocele or intrascrotal mass, accounts for 0.3% to 1.4% of MMs. MMs of the spermatic cord account for less than 10% of paratesticular MMs. We report a case of MM of the spermatic cord in a 65-year-old man who primarily presented to the hospital with a left inguinal mass. Following the diagnosis after surgery, he was found to have a contralateral right inguinal mass and died in 6 months. Despite their rare occurrence in the spermatic cord, MMs need to be suspected, especially in patients with a history of asbestos exposure.

Primary Vesico-Ureteral Reflux: Comparison of Factors between Infants and Children

PURPOSE: The association of age, sex and renal parenchymal damage (RPD) in vesicoureteral reflux (VUR) is well known. We compared various factors between infants and children in a cohort of patients with primary VUR. MATERIALS AND METHODS: Medical records of 147 patients diagnosed as VUR between 1997 and 2010 were reviewed. Of these children 91 (61.9%) were boys and 56 (38.1%) were girls. 99 (67.3%) of the 147 patients were younger (Group 1), and 48 (32.7%) were older than 1 year (Group 2). The impact of patient's gender and age as well as VUR grade on RPD were analyzed in each patient. The Fisher's exact test and chi square test was done with SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA). RESULTS: VUR was unilateral in 88 patients (59.9%) and bilateral in 59 patients (40.1%). Abnormal renal scan was found in 78 (37.7%) renal units. The incidence of VUR was significantly higher in male in group 1 (p0.05). CONCLUSIONS: Our data showed that VUR in infant was significantly higher in male than in female, whereas VUR in children was significantly higher in female. This may be due to that characteristic of a population where neonatal circumcision is not a common procedure in infant and urinary tract infections are more common in female children. Further study may be needed to identify gender difference in RPD in infant with high grade reflux.

Clinical Significance of PTEN and Ki-67 Expression in Prostate Cancer

PURPOSE: Phosphatase and tensin homolog (PTEN) is a novel tumor suppressor gene located at chromosome 10q23. Ki-67 antigen is a human nuclear protein that is expressed in all active parts of the cell cycle. We evaluated the significance of PTEN and Ki-67 expression in prostate cancer and investigated the relation of this expression with clinico-pathological factors in prostate cancer. MATERIALS AND METHODS: Initially, we did two kinds of immunohistochemical staining for PTEN and Ki-67. Immunohistochemical staining was performed on 75 formalin-fixed paraffin-embedded cancer specimens. Staining on paraffin blocks from prostate carcinomas was compared with that for adjacent normal prostate. Stainings were considered positive if nuclear staining was seen. Positive stainings were analyzed with the patient's clinico-pathological findings. Statistical analysis was performed by using chi-square test with p0.05). PTEN expression was negatively correlated with lymph node or distant metastases (p<0.05). Ki-67 was positively correlated with the serum PSA level, the Gleason score, and metastases (p<0.05). CONCLUSIONS: PTEN and Ki-67 staining correlated well with Gleason score and PSA level in prostate cancer. These could be a possible predictor of prostatic neoplasms.

The Correlation of Duplex Doppler Ultrasonographic Retrograde Venous Flow Volume and Testicular Volume Difference in Patients with Adolescent Varicocele / 대한남성과학회지

PURPOSE: The aim of this study is to assess effects of testicular volume difference and retrograde venous flow of pampiniform plexus measured by Duplex Doppler Ultrasonograpy (DDU) in patients with adolescent varicocele. MATERIALS AND METHODS: Physical examinations and DDU were performed to assess varicocele in fifty five patients with left sided adolescent varicocele. During both normal respiration and the Valsalva's maneuver, the maximum venous diameter (MVD), maximal velocity of reflux and the peak retrograde flow volume (RFV) was measured by DDU. The percentage testicular volume difference (%) between the right and left testicle was calculated as (right testicular volume-left testicular volume)x100/right testicular volume and divided into 3 group; below 10%, 10~20%, >20%. Grade of varicocele, MVD and peak RFV were analyzed as possible determinants of testicular hypotrophy in adolescent varicocele. RESULTS: A total of 55 patients (mean age 17.8 years, range 12 to 20) were included in this study. Of these, physical examination reviewed that 7 (12.7%), 18 (32.7%), 30 (54.6%) patients had grade I, II or III varicoceles on the left side respectively. The mean MVD was significantly higher according to grade of varicocele. The mean maximal velocity of reflux was significantly higher in the patients grade II and III than grade I, but was not significant between grade II and III. The mean peak RFV was significantly higher according to grade of varicocele. RFV was the only significant parameter of predictive value for percentage testicular volume difference. CONCLUSIONS: Patients with peak RFV >35ml minutes showed significant reduction of testicular volume. Measurement of RFV is recommended as predictive tools for assessing the percentage testicular volume difference in patients with adolescent varicocele.

The Effect of Renal Scarring on Spontaneous Resolution and Breakthrough Infection in Children with Vesicoureteral Reflux

PURPOSE: Primary treatment of children with vesicoureteral reflux (VUR) is antibiotic prophylaxis until the reflux resolves. But, it is not easy to determine in which patients the reflux resolves. We sought to determine whether renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. MATERIALS AND METHODS: A total of 90 children, 54 boys and 36 girls, mean age 15.1 (range: 1-98) months, with VUR were analyzed retrospectively. Eighty-six presented with febrile urinary tract infection (UTI) and 4 with prenatal hydronephrosis. Technetium Tc 99m dimercaptosuccinic acid (DMSA) scans were performed at 4 months after resolution of a febrile UTI. All children were initially treated with antibiotic prophylaxis (Bactrim(R); TMX-SMX 2 mg/kg/day) and 40 underwent antireflux surgery. Median follow-up was 26.1 (range: 6-52) months. Reflux grade was defined by use of the International Classification System. We analyzed the incidence of renal scarring according to reflux grade, reflux resolution, and reason for antireflux surgery. RESULTS: Normal DMSA scans were documented in 63 (70%) children and renal scarring in 27 (30%). Children with renal scarring presented high grade (III-V) VUR. VUR with renal scarring was not resolved spontaneously and increased the risk for breakthrough UTI. Renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. VUR grade, however, did not help to predict the prognosis of reflux. CONCLUSIONS: We conclude that VUR with renal scarring has a low spontaneous resolution rate and a high risk for breakthrough UTI. This information would be helpful when counseling the families of patients with VUR.

A Patient with Hinman's Syndrome who Underwent Renal Transplantation Using a Pre-existing Cutaneous Ureterostomy / 대한비뇨기과학회지

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

The Effect of Ring-type NF-kappa B(NF-kB) Decoy Oligodeoxynucleotide on the Kidney for an Experimental Unilateral Ureteral Obstruction in Mice / 대한비뇨기과학회지

PURPOSE: The transcription factor, NF-kB, is important in the coordinated expressions of various pro-inflammatory and adhesion molecules. Our hypothesis is that inhibiting the action of NF-kB using a synthetic decoy oligodeoxynucleotide(ODN) can block the underlying inflammatory response in glomerulonephritis. MATERIALS AND METHODS: Forty two male C57BL6 mice, weighting 25g, were divided into four groups; in group 1, 2 mice were used as normal controls; in group 2, a unilateral ureteral obstruction(UUO) was induced in 12 mice; in group 3, 20 UUO mice were treated using ring-type NK-kB decoy ODN; and in group 4, 8 UUO mice were treated using scramble type NF-kB decoy ODN. The mice were killed 1, 3, 5 and 7 days after the NF-kB decoy ODN injections, and the blood urea nitrogen(BUN), and expressions of tumor necrosis factor-alpha (TNF-alpha), interleukin-beta(IL-beta), fibronectin, vascular cell adhesion molecule(VCAM) and monocyte chemotactic protein-1(MCP-1), as well as the histopathological findings, analyzed in each group. RESULTS: The serum levels of BUN, TNF-alpha, IL-beta, fibronectin, VCAM and MCP-1 were increased in group 2, but decreased in group 3. The histopathological findings of the kidneys in group 3 were most similar to those found in the control(group 1). CONCLUSIONS: NF-kB decoy ODN treatment substantially inhibited the disease, with reductions in the histological damage and the renal expressions of inflammatory cytokines.

The Suppressive Effect of Lentinus Edodes on Renal Scarring Secondary to Pyelonephritis / 대한비뇨기과학회지

PURPOSE: Lentinus edodes is used in both foods and drugs, and is also known to be an antioxidant agent. Some investigators have noted that renal scarring following pyelonephritis is closely related to inflammation or free oxygen radicals, rather than to direct injury due to bacterial infection. The efficiency of the antioxidant agent, lentinus edodes, in preventing the renal scarring caused by experimental pyelonephritis was evaluated in rats. MATERIALS AND METHODS: Twenty eight male Sprague Dawley rats (n=28) were injected into both renal parenchyma with 0.1ml of a solution containing Escherichia coli (10(8)/ml). The control group, consisting of 4 rats, received an injection of isotonic saline instead of the bacterial solution. Three days after surgery, the animals were given the following treatments: in the pyelonephritis group, 7 rats received isotonic saline for 5 days; in the antibiotics treatment group, 6 rats were treated with an antibiotic only, ciprofloxacin, for 5 days. In the lentinus edodes treatment group, 5 rats were treated with lentinus edodes only. In the combined group, 6 rats received both lentinus edodes and ciprofloxacin. The kidneys were harvested 6 weeks after infection, and histopathologically examined for renal scarring. RESULTS: Delayed treatment with antibiotics-only or lentinus edodes-only had no effect on the scarring compared with the untreated controls. However, the addition of lentinus edodes to the delayed antibiotic therapy significantly inhibited the renal scarring compared with the pyelonephritis, antibiotic-only treated and the lentinus edodes-only treated groups (p<0.05). CONCLUSIONS: The administration of lentinus edodes in combination with antibiotics significantly reduced the renal scar formation in pyelonephritis.

The Value of Diagnostic Laparoscopy for Impalpable Testes

There have been no definitive preoperative diagnostic imaging studies for impalpable testes. We observed the effectiveness of laparoscopy for detecting impalpable testes not identified with ultrasonography (USG) or careful physical examination under general anesthesia. We retrospectively reviewed 117 patients (118 testes) who were operated upon for undescended testes from January 1998 to December 2004. The testes of these patients were palpable in 97(82 %) and impalpable in 21 (18 %). We analyzed the preoperative diagnostic method, site of the testes, operative method and operative findings of the 21 impalpable testes. Preoperative USG and physical examination under general anesthesia were performed on 20 patients, and 12 patients' testes could be localized. Eight patients whose testes could not be localized with USG and physical examination underwent laparoscopy. Seven of the 8 patients had testes in inguinal canal and 4 of these were atrophied and underwent orchiectomy because of atrophy (2) and vanishing (2). Only 1 patient had bilateral intraabdominal testes and one of the testes was atrophied. Laparoscopy was a useful method for detecting impalpable testes, but the clinical application might be limited because the location of atrophic or vanishing testes was mainly inferior to internal inguinal ring.

Mixed Gonadal Dysgenesis Mimicking True Hermaphroditism

A differential diagnosis between the true hermaphroditism (TH) and mixed gonadal dysgenesis (MGD) has important clinical implications for gender assignment and the decision for early gonadectomy; however, variable clinical and histological features frequently lead to the confusion of TH with MGD. A 17- month-old boy was presented with proximal hypospadias with chordee and right non-palpable testis in his scrotum. He also had right auricular anomaly including a separated tragus with skin tag. Left testis was well palpable in his left scrotum. Diagnostic right inguinal exploration showed Mullerian structures such as a gonad like an ovary and a fallopian tube with a uterus, which were removed. Repair of hypospadias and right auricular anomaly was also done. Following ultrasonography (USG) showed a normal looking testis in left scrotum. His chromosome was 45, XO/46, XY. We report a difficult case of mixed gonadal dysgenesis mimicking true hermaphroditism which combines ipsilateral congenital auricular anomaly.