Management of Patients With Advanced Prostate Cancer: Establishment ofTreatment Guidelines Through Prostate Cancer Summit (PCAS) 2016Composed of Korean Prostate Cancer Experts

Purpose@#The Advanced Prostate Cancer Consensus Conference (APCCC) 2015 was based on topics withcontroversy in the field of advanced prostate cancer. To understand the Korean urologists perspective regardingthe issues, we have conducted a questionnaire named Prostate Cancer Summit (PCAS) 2016, with 9 importantsubtopics. @*Materials and Methods@#Total 9 subtopics have been decided and questions were developed regarding eachsubtopic. The questions were based on that of APCCC 2015 and translated into Korean for better understanding.Total 51 panelists have voted online on 85 different questions. @*Results@#The survey concluded that testosterone should be measured as a diagnostic criterion for castrationresistance prostate cancer (CRPC) and that consensus was reached on issues such as the use of androgenreceptor pathway inhibitors in the treatment of predocetaxel and postdocetaxel in CRPC patients. In addition,76% of the participants agreed that imaging tests were needed before new treatment in CRPC patients, anda majority of participants agreed that periodic imaging tests are necessary regardless of symptoms during treatmentfor CRPC. However, some issues, such as the use of prostate-specific antigen-based triggers for remediationin CRPC patients, the endocrine manipulation in nonmetastatic CRPC patients, and the onset of treatment inasymptomatic metastatic CRPC patients, were not agreed. @*Conclusions@#The results from PCAS 2016 has addressed some of the issues with controversy. Although thevoting results are subjective, it will help guide treatment decisions in topics with less evidence.

Health-Related Quality of Life, Perceived Social Support, and Depression in Disease-Free Survivors Who Underwent Curative Surgery Only for Prostate, Kidney and Bladder Cancer: Comparison among Survivors and with the General Population / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to compare health-related quality of life (HRQoL) of disease-free prostate (PC), kidney (KC), and bladder cancer (BC) survivors with that of the general population. MATERIALS AND METHODS: Our study included 331 urological cancer (UC) survivors (114 PC, 108 KC, and 109 BC) aged ≥ 50 years disease-free for at least 1 year after surgery. The control group included 1,177 subjects without a history of cancer. The HRQoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30, the Duke-UNC Functional Social Support Questionnaire, and the Patient Health Questionnaire-9. RESULTS: There was no significant difference between the groups in terms of any of the functioning sub-scales and symptoms, except significantly lower social functioning observed in BC survivors than that observed in KC survivors. Although the three groups of UC survivors showed essentially similar functioning sub-scales and symptoms when compared to the general population, PC and BC survivors showed significantly lower social functioning and a lower appetite than that observed in controls. KC survivors showed lower physical functioning, as well as higher pain and dyspnea. Although all three groups of UC survivors reported higher financial difficulties, they also reported higher perceived social support than that reported by the non-cancer control group. No statistically significant difference was observed in terms of depressive symptoms between each group of UC survivors and the general population. CONCLUSION: Disease-free survivors of the three major types of UCs showed generally similar HRQoL compared to the general population, as well as compared to each other.

Health-Related Quality of Life Changes in Prostate Cancer Patients after Radical Prostatectomy: A Longitudinal Cohort Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Health-related quality of life (HRQOL) information related to radical prostatectomy (RP) is valuable for prostate cancer (PC) patients needing to make treatment decisions. We aimed to investigate HRQOL change in PC patients who underwent three types of RP (open, laparoscopic, or robotic) and compared their HRQOL with that of general population. MATERIALS AND METHODS: Patients were prospectively recruited between October 2014 and December 2015. European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) and PC-specific module (PR25) were administered before surgery (baseline) and at postoperative 3 and 12 months. At each time point, HRQOL was compared, and a difference of 10 out of 0-100 scale was considered clinically significant. RESULTS: Among 258 screened patients, 209 (41 open, 63 laparoscopic, and 105 robotic surgeries) were included. Compared to baseline, physical, emotional, and cognitive functioning improved at 12 months. Role functioning worsened at 3 months, but recovered to baseline at 12 months. Pain, insomnia, diarrhea, and financial difficulties also significantly improved at 12 months. Most PR25 scales excluding bowel symptoms deteriorated at 3 months. Urinary symptoms and incontinence aid recovered at 12 months, whereas sexual activity and sexual function remained poor at 12 months. Clinically meaningful differences in HRQOL were not observed according to RP modalities. Compared to the general population, physical and role functioning were significantly lower at 3 months, but recovered by 12 months. Social functioning did not recover. CONCLUSION: Most HRQOL domains showed recovery within 12 months after RP, excluding sexual functioning and social functioning. Our findings may guide patients considering surgical treatment for PC.

Predictive Factors for Premature Discontinuation of Docetaxel-Based Systemic Chemotherapy in Men With Castration-Resistant Prostate Cancer

PURPOSE: The objective was to determine predictive factors for premature discontinuation of docetaxel-based systemic chemotherapy in men with castration-resistant prostate cancer (CRPC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of men who were treated with docetaxel-based systemic chemotherapy for CRPC in a single institution between May 2005 and April 2010. After being screened, 30 patients fit the eligibility criteria for inclusion in this study. Group 1 included 12 patients who were treated with five or fewer cycles of docetaxel chemotherapy for CRPC, and group 2 included 18 patients who were treated with six or more cycles of docetaxel chemotherapy for CRPC. The treatment consisted of 5 mg prednisolone twice daily and 75 mg/m2 docetaxel once every 3 weeks. RESULTS: The median age was 72 years, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 0. The median baseline prostate-specific antigen (PSA) level was 33.8 ng/mL. The median cycle of docetaxel-based chemotherapy was 5.8. Of 30 patients, 13 patients (48.2%) had a decline in PSA of >50% from baseline; 3 of 22 patients (13.6%) with measurable disease had achieved partial response on imaging. No differences in age, ECOG performance status, hemoglobin, serum creatinine, or PSA response were observed between the two groups. Body mass index was significantly lower (p=0.034) in group 1 (21.8 kg/m2) than in group 2 (23.6 kg/m2). Group 1 included more patients with prior systemic chemotherapy (p=0.039), and group 1 had a shorter overall survival rate (p=0.039). CONCLUSIONS: Premature discontinuation of docetaxel-based systemic chemotherapy is associated with lower body mass index and prior systemic chemotherapy. Premature discontinuation of docetaxel-based chemotherapy is associated with a shorter overall survival rate.

Long-Term Outcome of Primary Endoscopic Realignment for Bulbous Urethral Injuries: Risk Factors of Urethral Stricture / 대한배뇨장애요실금학회지

PURPOSE: Although endoscopic realignment has been accepted as a standard treatment for urethral injuries, the long-term follow-up data on this procedure are not sufficient. We report the long-term outcome of primary endoscopic realignment in bulbous urethral injuries. METHODS: Patients with bulbous urethral injuries were treated by primary endoscopic realignment between 1991 and 2005. The operative procedure included suprapubic cystostomy and transurethral catheterization using a guide wire, within 72 hours of injury. The study population included 51 patients with a minimum follow-up duration of 5 years. RESULTS: The most common causes of the injuries were straddle injury from falling down (74.5%), and pelvic bone fracture (7.8%). Gross hematuria was the most common complaint (92.2%). Twenty-three patients (45.1%) had complete urethral injuries. The mean time to operation after the injury was 38.8+/-43.2 hours. The mean operation time and mean indwelling time of a urethral Foley catheter were 55.5+/-37.6 minutes and 22.0+/-11.9 days, respectively. Twenty out of 51 patients (39.2%) were diagnosed with urethral stricture in 89.1+/-36.6 months after surgery. A multivariate analysis revealed that young age and operation time were independent risk factors for strictures as a complication of urethral realignment (hazard ratio [HR], 6.554, P=0.032; HR, 6.206, P=0.035). CONCLUSIONS: Urethral stricture commonly developed as a postoperative complication of primary endoscopic urethral realignment for bulbous urethral injury, especially in young age and long operation time.

The Reliability of 1-Day Frequency-Volume Charts in Assessing Lower Urinary Tract Symptoms in Patients with Benign Prostate Hyperplasia

PURPOSE: The aim of this study was to evaluate the reliability of 1-day frequency-volume charts in assessing lower urinary tract symptoms (LUTS) in patients with benign prostate hyperplasia (BPH). MATERIALS AND METHODS: Between Jan. 2006 and Dec. 2006, we retrospectively analyzed the medical records of men with LUTS due to BPH who visited our out-patient department. All of 70 men completed 3-days frequency-volume chart for the initial evaluation of their LUTS. We compared mean values of variables with values from respective days. Test-retest reliability was evaluated by calculating intraclass correlation coefficient. RESULTS: The mean age was 66.7 years, mean prostate size was 33.6ml, mean IPSS was 18, and mean maximal flow rate was 13.8ml/s. The mean total voided volume was 1716.3ml/day, mean number of voids was 9.2/day, mean number of daytime voids was 7.1, and mean number of nocturnal voids was 2.0. No significant differences were found between the three 24-hr periods for the variables from the charts by ANOVA test. The intraclass correlation coefficients were mostly 0.7-0.9. But nocturnal bladder capacity was slightly less reliable than other variables, 0.557. Mean voiding volume, total voiding number, and daytime frequencyhad the high reliability. CONCLUSIONS: A 1-day frequency-volume charts can be sufficiently reliable to provide an insight into a patient's voiding behavior. But more research of high quality is required, especially into the relationship of frequency-volume charts duration with compliance.

Clinical Significance of Infected Prostate Tissue in Patients with Benign Prostatic Hyperplasia

PURPOSE: Benign prostatic hyperplasia (BPH) and prostatitis are the most common benign diseases of the prostate gland and over time affect a significant majority of men. We evaluated the relation between BPH and infection in prostatic tissue in men who underwent transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This prospective study included 63 consecutive patients diagnosed with BPH and scheduled for TURP. During the TURP, 1-2 g chips were collected after resection of the prostatic urethra, and specimens were transported to the laboratory in sterile saline. Homogenized specimens were incubated for 7 days. The patients were divided into 2 groups (group 1: culture positive, group 2: culture negative). We compared prostate volume, prostate calculi, serum prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine, and ratio of the transitional zone prostate to total prostate (transitional zone ratio). RESULTS: Mean age was 72 years and mean serum PSA was 4.36 ng/dl. Group 1 included 7 patients (11.1%) and group 2 included 57 patients (88.9%). There were no significant differences in prostate volume, prostate calculi, serum PSA, IPSS, Qmax, or post-void residual urine between groups, but the transitional zone ratio was higher in group 1 (45.4%) than in group 2 (30.3%) (p<0.05). CONCLUSIONS: About 11% of the prostate tissue cultures showed bacterial growth. The transitional zone ratio was higher in patients with bacteria growth. Bacterial infection may be related to benign prostatic hyperplasia.

Predictors of Gleason Score Upgrading after Radical Prostatectomy in Low-Risk Prostate Cancer

PURPOSE: The Gleason score is an important predictor of outcome that is used in conjunction with clinical stage and prostate-specific antigen to guide clinical decision making. The prostate biopsy Gleason grade frequently differs from the radical prostatectomy grade. The aim of this study was to determine the risk factors of Gleason upgrading in patients with low-risk prostate cancer after radical prostatectomy. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 146 patients who underwent radical prostatectomy between 1998 and 2008 in two hospitals of Jeonbuk province in Korea. Pathological Gleason score upgrading was defined as an increase in the Gleason score from or =7 between the biopsy and radical prostatectomy specimen. Pretreatment clinical and pathological parameters were used to identify predictors of pathological upgrading. RESULTS: Of the total 146 patients, 51 (34.9%) were upgraded postoperatively. Small prostate volume (p=0.008), abnormality on the digital rectal examination, and positive surgical margin (p=0.001) were significantly and positively associated with upgrading after radical prostatectomy. A total of 17 of 65 patients with low-risk prostate cancer (26.2%) were upgraded postoperatively. Small prostate volume (<30 ml) was significantly (p=0.026) and positively associated with upgrading after radical prostatectomy in patients with low-risk prostate cancer. CONCLUSIONS: Overall, 26% of patients with low-risk disease were upgraded postoperatively. Small prostate volume was associated with an increased risk for pathological upgrading after radical prostatectomy. These conclusions should be kept in mind when making treatment decisions for men with low-risk prostate cancer.

A Neurofibroma Confused with Sarcomatous Transformation on F-18 FDG PET/CT in Neurofibromatosis-1 / 핵의학분자영상

We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.

The Clinical Characteristics of Malignant Ureteral Obstruction Secondary to Non-genitourinary Malignancy / 대한비뇨기과학회지

PURPOSE: We assessed the success rate of internal ureteral stenting and the complications for patients with ureteral obstruction secondary to non-genitourinary malignancy. MATERIALS AND METHODS: Between January 2001 and December 2005, ureteral stenting were attempted in 62 patients with ureteral obstruction secondary to non-genitourinary malignancy. Their medical records were reviewed for the primary diagnosis, the symptoms, the degree of hydronephrosis, the location of obstruction, stent failure, the time period until stent replacement due to stent failure, the complications and the status at the last followup. RESULTS: A total 62 patients underwent an attempt at retrograde ureteral stenting for malignant extrinsic obstruction. The mean patient age was 57.6 years(range: 32-84) and the mean follow-up was 12.6 months. 44 patients(71%) were women, and the most common cancer diagnoses were cervical cancer(19), rectal cancer(16) and stomach cancer(11). A total of 23 patients(37%) required immediate percutaneous nephrostomy(PCN) referral. A total of 14 patients experienced late failure and required PCN. A total of 39 patients underwent stent replacement at a mean interval of 3.5 months. CONCLUSIONS: At almost 1 year follow-up, stent failure due to extrinsic compression occurred in 55.7% of the patients(37 of 62). We should carefully monitor patient who undergo ureteral stenting for ongoing obstruction and complication.

The Clinical Features of Complicated Urinary Tract Infections by Pseudomonas aeruginosa / 대한비뇨기과학회지

PURPOSE: Pseudomonas aeruginosa is an important pathogen in complicated urinary tract infections(UTIs). The aim of this study was to evaluate the isolation rate of Pseudomonas from patients with UTIs and to define the accompanying clinical features. MATERIALS AND METHODS: Between January 2000 and December 2006, we retrospectively reviewed the medical records of 170 urology patients with Pseudomonas UTIs. We analyzed the isolation rate of Pseudomonas in patients with UTIs and determined the antibiotic susceptibilities. We also analyzed the clinical features and underlying diseases in patients with Pseudomonas UTIs. RESULTS: Pseudomonas was cultured in the urine from 234 of 3,470 patients (6.6%) with positive urine cultures. One hundred seventy of 234 patients had underlying urologic disease. Eighty-two patients(48.2%) had indwelling urinary catheters and 34 patients(20.0%) had diabetes. Patients with catheters tended to have febrile UTIs compared to patients without catheters(70.7% vs. 42.0%, respectively). The isolation rate of Pseudomonas increased between 2000 and 2006(2.8% vs. 13.1%, respectively). The sensitivity of Pseudomonas to most antibiotics decreased between 2000 and 2006. Patients with neurogenic disease and catheters were more easily infected with Pseudomonas. CONCLUSIONS: The isolation rate of Pseudomonas in urine cultures is on the rise. Patients with UTIs and catheters, unlike those without, have high fevers. Because the sensitivity of Pseudomonas to antimicrobial agents has decreased, we need to choose appropriate antibiotics through urine cultures and antibiotics sensitivity tests in treating complicated UTIs.

Leiomyosarcoma at the Ureterovesical Junction / 대한비뇨기과학회지

Non-urothelial neoplasms of the bladder account for less than 5% of all bladder tumors. Leiomyosarcoma is the most common malignant mesenchymal tumor that arises in the adult bladder. Leiomyosarcomas of the bladder are considered to be highly aggressive tumors. Most patients present at an advanced stage, with less than 30% of patients presenting with stage T1 disease. Surgical resection still remains the cornerstone of treatment with the status of the surgical margin being a strong predictor of the outcome. A 59-year-old man presented to our institution with urinary urgency, and cystoscopic examination revealed a huge submucosal mass on the lateral bladder wall. A radical cystoprostatectomy and ileal neobladder procedure was performed. The patient was diagnosed with a primary leiomyosarcoma of the bladder. After 1 year of follow-up, there has been no recurrence or metastasis.

Predictive Variables of the Progression to Androgen Independent Prostate Cancer after Combined Androgen Blockade / 대한비뇨기과학회지

PURPOSE: Despite of the effectiveness of androgen deprivation therapy for prostate cancer, it progress to androgen independent prostate cancer (AIPC) after various periods of time. The objective of this study was to analyze the clinical and pathological variables that predict progression to AIPC after combined androgen blockade (CAB). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 343 patients who were treated with CAB for prostate cancer. Binary logistic regression test was used to analyze the independent predictors for the progression to AIPC. The time to AIPC, according to variables, was assessed by the Kaplan-Meier method and the variables were compared using the Log-Rank test. RESULTS: The mean follow-up was 42.1 months (range: 12-120). Seventy seven patients (33.3%) experienced progression to AIPC at a median of 20.2 months (range: 6-72). On univariate analysis, the percentage of positive prostate biopsies, the Gleason score, the T stage, the extent of bone metastasis, lymph node metastasis, the pretreatment PSA level, the nadir PSA and the PSA level at 3 and 6 months all had a significant relationship with the progression to AIPC. The receiver operating characteristic curve analysis for the nadir PSA showed that the optimal cut-off point to predict progression to AIPC was 0.5ng/ml with an area under curve of 0.769. A multivariate analysis demonstrated that the Gleason score (>7), the nadir PSA (>0.5ng/ml), and the PSA level at 6 months (>4.0ng/ml) were significantly correlated with the progression to AIPC. CONCLUSIONS: This study suggested that Gleason score, the nadir PSA and the PSA level at 6 months were independent variables to predict progression to AIPC after CAB. The PSA level at 6 months may be the most accurate variable to predict progression to AIPC.

Laparoscopic Simple Prostatectomy

Simple prostatectomy has been a mainstay of therapy for patients with benign prostate hyperplasia. In recent years, laparoscopic radical prostatectomy has emerged as a feasible treatment option for patients with localized prostate cancer. The advantages of laparoscopic procedures are minor surgical scars, shorter hospital stay, fewer analgesics utilization, and more rapid return to daily normal activities. We describe the use of laparoscopic resection of large hyperplastic prostate adenomas as an alternative to open prostatectomy.

Early Experience with Transobturator Vaginal Tape Inside-out(TVT-O) Procedure for the Treatment of Female Stress Urinary Incontinence

PURPOSE: Tension free vaginal tape, which has become the common therapy for female stress urinary incontinence, has a complication associated with a blind passage. Transobturator vaginal tape inside-out (TVT-O) is a technique for the passage of the tape through the obturator foramens from inside to outside. We intend to evaluate the efficacy and safety of the TVT-O. MATERIALS AND METHODS: From September 2004 to December 2004, 35 patients underwent TVT-O under spinal anesthesia. Among them, 30 patients have been followed-up more than 12 months. The preoperative assessment included past history, physical examination, voiding diary, 1-hour pad test, urinalysis, voiding cystourethrography (VCUG), urodynamic study. Post-operatively a 16 Fr urethral Foley catheter was left for 24 hours. The procedural outcome, subjective satisfaction and complications were assessed retrospectively. RESULTS: The mean operative time was 15 minutes (range 12~20). Average hospital stay was 3.5 days (range 2~14). No intraoperative or postoperative complications were noted. One patient had immediate voiding difficulty, which was resolved after 2 weeks of clean intermittent catheterization. Three out of 10 patients (30%) with urge incontinence improved after the operation. The mean followed-up period was 13 months. Of 30 patients, 29 patients (96.6%) were cured and 1 patient (3.3%) improved. Subjective cure was present in 29 patients (96.6%). CONCLUSION: TVT-O is a simple, safe and effective surgical treatment for female stress urinary incontinence. However, a longer follow-up will be necessary to determine its long-term effect.

Surgical Intervention for the Complications of the Sling Operation in Patients with Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Stress urinary incontinence is a quality of life issue for millions of women worldwide. Mid-urethral slings are becoming the treatment of choice for the management of stress urinary incontinence. Although it is a minimally invasive procedure, the widespread use of this procedure has led to an increasing number of severe complications. In our series, there were 6 patients with complications that necessitated surgery. MATERIALS AND METHODS: Six patients underwent the sling procedure and they required surgical intervention for their complications, including permanent urinary retention, de-novo urgency, intravesical polypropylene mesh tape, intravesical suture material, vaginal mucosal erosion, and urethral shortening. RESULTS: For the patients with urinary retension, they underwent resection of periurethral sling transvaginally. The intravesical tapes were resected by the transurethral approach, and this was supported by suprapubic laparoscopic trocar puncture. The intraravesical suture material was removed by same approach. In the case of vaginal erosion, the periurethral part of the tape was resected transvaginally. A patient with urethral shortening was treated with urethroplasty. CONCLUSIONS: Complications from the sling operation that require surgical intervention are rare. Nevertheless, the surgeon must be aware that complications may occur that require surgical intervention with high morbidity.

The Risk Factor of Delirium after Transurethral Resection of the Prostate / 대한비뇨기과학회지

Purpose: Transurethral resection of the prostate (TURP) is the surgical treatment for symptomatic benign prostate hyperplasia with a good result, but some cases of postoperative delirium have been associated with this treatment. The purpose of this study is to develop and validate clinical prediction of postoperative delirium using the preoperative and postoperative data. Materials and Methods: We analyzed 417 patients who were admitted for TURP between January 1999 and December 2004. All patients underwent evaluations, including a medical history and laboratory tests, and we recorded the operative time, resection volume, complications, medications and length of stay from the medical records. Postoperative delirium was diagnosed using DMS-IV. Logistic regression test was used to assess the data of the patients and to determine the risk factor of postoperative delirium. Results: Postoperative delirium occurred in 33 patients (7.9%) of the 417 patients. The hospital stay of the patients with delirium was longer than that of the patients without delirium. Delirium was associated with an age>or=70 years, a postoperative Hbor=2.0g/dl (por=2.0g/dl were associated with an increased risk of delirium on the multivariate analysis (odds ratio=4.6 and 5.7). Conclusions: The incidence of postoperaitve delirium in elderly patients with symptomatic benign prostate hyperplasia was 7.9%, and a postoperative Hbor=2.0g/dl were identified as risk factors. Because delirium was associated with a variety of adverse outcomes, difficult treatment and high mortality, those patients with risk factor for delirium must be kept under close observation after TURP.

The Correlation between the Prostatic Morphology Seen on Cystourethroscopy, the Clinical Findings and the Outcomes of Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: Cystourethroscopy provides information on the cause, size and severity of obstruction and the patency of the bladder neck, prostatic occlusion of the urethra and the estimated prostatic size. We evaluated the relationship between the prostatic morphology on the cystourethroscopic findings and the clinical findings and the outcomes of transurethral resection of the prostate (TURP). MATERIALS AND METHODS: We evaluated 291 patients who underwent TURP between January 1999 and June 2004. The prostate volume, the preoperative maximal flow rate (MFR), the postvoid residual urine volume (PVR) and the International Prostate Symptom Score (IPSS) were determined. The patients were divided into 4 groups by the cystourethroscopic findings before TURP: group I - isolated middle lobe enlargement, group II - isolated lateral lobe enlargement, group III - middle and lateral lobe enlargement, group IV - posterior commissural hyperplasia (median bar type). RESULTS: The analyses included 250 patients who had a mean age of 71.2 years, a mean prostate volume of 46.2g, a mean preoperative MFR of 7.8ml/s, a PVR of 73.1ml and an IPSS of 25.6. The prostate volume was larger in group II and III than in group l. The preoperative MFR and IPSS were not correlated with the prostatic morphology, but the storage symptom score was significantly higher in group IV. The postoperative parameters were not correlated with the prostatic morphology noted on cystourethroscopy. CONCLUSIONS: The cystourethroscopic findings are not prognostic factors for the expected surgical outcomes in TURP. TURP is a good surgical therapeutic tool for treating benign prostatic hyperplasia regardless of the prostatic morphology seen on cystourethroscopy. Cystourethroscopy might need to be performed only in limited cases.

Can Serum PSA Predict Prostate Volume in Men with Benign Prostatic Hyperplasia? / 대한비뇨기과학회지

PURPOSE: To analyze the ability of serum prostate specific antigen (s-PSA) to predict the prostate volume by characterizing the relationship between the prostate volume and serum PSA in men with benign prostate hyperplasia. MATERIALS AND METHODS: We evaluated 1,254 patients, with lower urinary tract symptoms, who had visited our hospital between Jan. 2002 and Aug. 2004. All patients with prostate cancer, prostatitis, and a history of prostatic surgery and alpha-blocker or 5-alpha reductase inhibitor medication were excluded from the study. The baseline s-PSA and prostate volume were determined using standard techniques. Pearson's correlation coefficient was used to analyze the relationship between the s-PSA and prostate volume, and a linear regression model to estimate the prostate volume. Receiver operating characteristics (ROC) curves were constructed to evaluate the ability of the s-PSA to predict cut-off values for assessing prostate enlargement. RESULTS: The analyses included 959 patients, with mean age, baseline s-PSA and prostate volume of 68.2 years, 3.4ng/ml and 34.4ml, respectively. The s-PSA and prostate volume increased with age. The prostate volume correlated positively with s-PSA (r=0.292, p30ml and 2.0ng/ml to detect a prostate volume>40ml. CONCLUSIONS: The prostate volume is strongly related to the s-PSA and age in men with benign prostatic hyperplasia (BPH). Since treatment outcomes and the risk of long-term complications depend on the prostate volume, the serum PSA may sufficiently estimate prostate enlargement to be useful in therapeutic decision making in men with BPH.

Laparoscopic Pyeloplasty with Transperitoneal Approach for Ureteropelvic Obstruction / 대한비뇨기과학회지

PURPOSE: Laparoscopic pyeloplasty is an alternative, minimally invasive approach for the repair of an ureteropelvic junction obstruction (UPJO). However, it has a technical difficulty, and various laparoscopic approaches are available. We present our initial experience of laparoscopic pyeloplasty using a transperitoneal approach in patients with an UPJO. MATERIALS AND METHODS: Between January 2002 and January 2004, 11 patients underwent laparoscopic pyeloplasty using a transperitoneal approach. Of these 11, 10 patients were followed up and enrolled in this study. They were comprised of 6 males and 4 females, with a mean age of 44 years (19-62). The chief complaints were flank pain in 8 patients, with a further 2 incidental detected. Three patients had had previous abdominal surgeries. The mean length of stricture was 1.1cm in the radiologic studies, and the degree of hydronephrosis was grade 3/4 in 6 patients and grade 4/4 in 4. An obstructive pattern in the 99mTc-MAG3 renal scan was present in 9 patients. RESULTS: Eight patients were treated with dismembered Anderson-Hynes pyeloplasty and 2 patients with Fenger pyeloplasty. The mean operating time and hospital stay were 225 minutes (120-450) and 7.4 days (5-10), respectively. During the operation, crossing vessels were found in 4 patients and an ureteral polyp in 1. One patient had an ascending colon injury, which was postoperatively detected and repaired. The mean follow- up period was 42.5 weeks (26-135). Follow-up excretory urography and a 99mTc-MAG3 renal scan showed improvements in 8 of the 10 patients (80%) at the 3 month follow-up. The flank pain disappeared in all the patients (100%) who had previously complained of this symptom. CONCLUSIONS: Laparoscopic pyeloplasty could be an alternative treatment for an ureteropelvic junction obstruction, especially using a transperitoneal approach, which seems to have a technical convenience over that of the retroperitoneal approach.