Inhibition of Proliferation of Prostate Cancer Cell Line DU-145 in vitro and in vivo Using Salvia miltiorrhiza Bunge / 中国结合医学杂志

OBJECTIVE@#To investigate the antiproliferative activity of Salvia miltiorrhiza Bunge. (SM) on the castration-resistant prostate cancer (CRPC) cell line DU-145, in vitro and in vivo.@*METHODS@#Prostate cancer cell line (DU-145) and normal prostate cell line (RWPE-1) were treated with SM at different concentrations (3.125, 12.5, 25 and 50 μg/mL) to investigate the antiproliferative effects. DNA laddering analysis was performed to investigate the apoptosis of DU-145 cells. Molecular mechanism was investigated by Western blot analysis of p53, Bcl-2, prostate specific antigen (PSA), and androgen receptor (AR). Six-week-old male BALB/c nude mice were randomly divided into normal control group (n=101) and treated group (n=101) which administered 500 mg/kg SM for 2 weeks. Tumor volumes were measured.@*RESULTS@#Treatment with SM resulted in a dose-dependent decrease in cell number of DU-145 cells in comparison with RWPE-1. DNA laddering analysis indicated the apoptosis of DU-145 cells. Treatment with SM increased the expression of p53 and reduced the expression of Bcl-2 proteins. The levels of PSA were considerably reduced in SM-treated group compared to the controls, and a decrease in AR expression was observed when cells were treated with SM in the same pattern as a reduction in PSA. In the tumour xenograft study, SM given once a day for 2 weeks significantly inhibited tumour growth.@*CONCLUSION@#SM might contribute to the anticancer actions such as induction of apoptosis and inhibition of proliferation of prostate cancer cells.

Effect of Nerve-Sparing Radical Prostatectomy on Urinary Continence in Patients With Preoperative Erectile Dysfunction / 대한배뇨장애요실금학회지

PURPOSE: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared to non-nerve-sparing radical prostatectomy (nnsRP) in patients with localized prostate cancer and preoperative erectile dysfunction. METHODS: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary's Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. RESULTS: Urinary continence recovered in 279 patients (77.5%) within the mean follow-up period of 22.5 months (range, 6-123 months). Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022). All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002-1.478; P=0.026) and nerve-sparing status (HR, 0.713; 95% CI, 0.548-0.929; P=0.012) were independently associated with recovery of urinary continence. CONCLUSIONS: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes.

Effects of Moderate Alcohol Intake in the Bladder of the Otsuka Long Evans Tokushima Fatty Diabetic Rats

Diabetes is related with a number of cystopathic complications. However, there have been no studies about the influence of alcohol consumption in the bladder of type 2 diabetes. Thus, we investigated the effect of moderate alcohol intake in the bladder of the Otsuka Long Evans Tokushima Fatty (OLETF) diabetic rat. The non-diabetic Long-Evans Tokushima Otsuka (LETO, n=14) and the OLETF control group (n=14) were fed an isocaloric diet; the LETO (n=14) and the OLETF ethanol group (n=14) were fed 36% ethanol 7 g/kg/day. After ten weeks, muscarinic receptors, RhoGEFs, myogenic change, and the level of oxidative stress were evaluated. Moderate alcohol intake significantly decreased excessive muscarinic receptor and Rho kinase expressions in the OLETF rats compared with the LETO rats. In addition, iNOS and collagen expression were not changed in the OLETF rats in spite of alcohol consumption. Superoxide dismutase levels, which is involved in antioxidant defense, in the LETO rats were significantly decreased after alcohol consumption, however those in the OLETF rats were similar. Moderate alcohol consumption reduces the oxidative stress, and may prevent molecular and pathologic changes of the bladder of rats with type 2 diabetes.

Changes in Nocturia and Lower Urinary Tract Symptoms after Radical Prostatectomy

PURPOSE: The goal of this study was to evaluate changes in nocturia and other lower urinary tract symptoms (LUTS) after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: We reviewed the medical records of 96 patients who underwent LRP or RALP for clinically localized prostate cancer and completed the International Prostate Symptom Score (IPSS) questionnaire, which provided a basis for assessing their symptoms. We also evaluated maximal flow rate and post-void residual urine volume over a follow-up period of at least 24 months. We divided the patients into three groups according to postoperative changes in the frequency of nocturia. RESULTS: Voiding symptoms significantly improved over the course of 24 months in patients who underwent LRP or RALP. However, most patients showed persistent or increased nocturia after LRP or RALP. Moreover, more than one third of the patients (33/96) presented with exacerbated nocturia (1.0+/-0.9 episodes of preoperative nocturia vs. 3.0+/-1.3 episodes of postoperative nocturia). Multiple regression analysis showed that preoperative IPSS storage sub-score had negative association with the nocturia after radical prostatectomy (p=0.005). However, patients' age, body mass index, preoperative prostate specific antigen, Gleason score, T-stage, and prostate volume had no association. CONCLUSIONS: The present study showed that nocturia was influenced by a range of factors, including other storage LUTS and the relief of bladder outlet obstruction after radical prostatectomy. Moreover, the preoperative storage symptoms are regarded as an important factor which influences the changes of nocturia after radical prostatectomy.

Role of Nicotinic Acetylcholine Receptor alpha3 and alpha7 Subunits in Detrusor Overactivity Induced by Partial Bladder Outlet Obstruction in Rats / 대한배뇨장애요실금학회지

PURPOSE: To investigate the role of alpha3 and alpha7 nicotinic acetylcholine receptor subunits (nAChRs) in the bladder, using a rat model with detrusor overactivity induced by partial bladder outlet obstruction (BOO). METHODS: Forty Sprague-Dawley rats were used: 10 were sham-operated (control group) and 30 were observed for 3 weeks after partial BOO. BOO-induced rats were further divided into 3 groups: Two groups of 10 rats each received intravesicular infusions with hexamethonium (HM group; n=10) or methyllycaconitine (MLC group; n=10), which are antagonists for alpha3 and alpha7 nAChRs, respectively. The remaining BOO-induced rats received only saline infusion (BOO group; n=10). Based on the contraction interval measurements using cystometrogram, the contraction pressure and nonvoiding bladder contractions were compared between the control and the three BOO-induced groups. Immunofluorescent staining and Western blotting were used to analyze alpha3 and alpha7 nAChRs levels. RESULTS: The contraction interval of the MLC group was higher than that of the BOO group (P<0.05). Nonvoiding bladder contraction almost disappeared in the HM and MLC groups. Contraction pressure increased in the BOO group (P<0.05) compared with the control group and decreased in the HM and MLC groups compared with the BOO group (P<0.05). Immunofluorescence staining showed that the alpha3 nAChR signals increased in the urothelium, and the alpha7 nAChR signals increased in the urothelium and detrusor muscle of the BOO group compared with the control group. Western blot analysis showed that both alpha3 and alpha7 nAChR levels increased in the BOO group (P<0.05). CONCLUSIONS: Alpha3 and alpha7 nAChRs are associated with detrusor overactivity induced by BOO. Furthermore, nAChR antagonists could help in clinically improving detrusor overactivity.

Anthocyanin Induces Apoptosis of DU-145 Cells In Vitro and Inhibits Xenograft Growth of Prostate Cancer

PURPOSE: To investigate the effects of anthocyanins extracted from black soybean, which have antioxidant activity, on apoptosis in vitro (in hormone refractory prostate cancer cells) and on tumor growth in vivo (in athymic nude mouse xenograft model). MATERIALS AND METHODS: The growth and viability of DU-145 cells treated with anthocyanins were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and apoptosis was assessed by DNA laddering. Immunoblotting was conducted to evaluate differences in the expressions of p53, Bax, Bcl, androgen receptor (AR), and prostate specific antigen (PSA). To study the inhibitory effects of anthocyanins on tumor growth in vivo, DU-145 tumor xenografts were established in athymic nude mice. The anthocyanin group was treated with daily oral anthocyanin (8 mg/kg) for 14 weeks. After 2 weeks of treatment, DU-145 cells (2x106) were inoculated subcutaneously into the right flank to establish tumor xenografts. Tumor dimensions were measured twice a week using calipers and volumes were calculated. RESULTS: Anthocyanin treatment of DU-145 cells resulted in 1) significant increase in apoptosis in a dose-dependent manner, 2) significant decrease in p53 and Bcl-2 expressions (with increased Bax expression), and 3) significant decrease in PSA and AR expressions. In the xenograft model, anthocyanin treatment significantly inhibit tumor growth. CONCLUSION: This study suggests that anthocyanins from black soybean inhibit the progression of prostate cancer in vitro and in a xenograft model.

Outcome of postoperative radiotherapy following radical prostatectomy: a single institutional experience

PURPOSE: This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. MATERIALS AND METHODS: A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary's Hospital of the Catholic University of Korea, was included. They received 45-50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63-72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. RESULTS: After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. CONCLUSION: The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.

Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia

PURPOSE: To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). MATERIALS AND METHODS: The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. RESULTS: Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45+/-0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. CONCLUSIONS: It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

Influence of Type of Nocturia and Lower Urinary Tract Symptoms on Therapeutic Outcome in Women Treated With Desmopressin

PURPOSE: To investigate the type of nocturia and concomitant voiding dysfunction (VD) and the effect of desmopressin treatment on nocturia in women. MATERIALS AND METHODS: We reviewed 84 women who experienced more than 2 nocturia episodes as recorded on a pretreatment frequency volume chart and who were treated with desmopressin. All patients underwent history taking, physical examination, urinalysis, International Prostate Symptom Score assessment, completion of a urinary sensation scale, and completion of a 3 day frequency volume chart. Nocturia was divided into nocturnal polyuria (NP), reduced nocturnal bladder capacity (RNBC), and mixed type. After treatment with desmopressin, a reduction in nocturia of over 50% compared with baseline was regarded as effective. RESULTS: Among 84 women, the most common concomitant VD was overactive bladder (OAB, 60.7%). NP was observed in 70.2% (59/84) of the women, RNBC in 7.1% (6/84), and mixed type in 22.6% (19/84). After medication with desmopressin, 73 women (86.9%) showed a significantly reduced number of nocturia episodes (1.4+/-1.5) compared with baseline (3.7+/-1.3, p<0.05). Eleven women (13.1%) did not show improvement. Of the 73 women who showed improvement, 41 women showed a reduction of more than 50% over baseline, and these women had a lower baseline urgency grade. CONCLUSIONS: In the majority of women, nocturia coexisted with other VD such as OAB. Treatment with desmopressin effectively reduced the nocturia. However, other lower urinary tract symptoms (LUTS) such as urgency may reduce the effect of desmopressin. Therefore, consideration of concomitant LUTS seems to be necessary to increase the treatment effect of desmopressin on nocturia in women.

Preliminary Report on the Safety of a New Herbal Formula and Its Effect on Sperm Quality

PURPOSE: Male infertility is a serious problem, and its prevalence has been increasing. Therefore, we investigated the safety of a new herbal formula and its effects on sperm quality. MATERIALS AND METHODS: An in vitro cytotoxicity test in TM3 Leydig cells was performed to evaluate cell viability after administration of five types of herbs separately and of a new herbal formula containing these five. An in vivo test in male mice was performed to evaluate the influence of the new herbal formula on the reproductive organs and sperm quality. After the 8- and 28-day oral administration of the new herbal formula, the weights of the reproductive organs were measured and the sperm count and motility were evaluated. RESULTS: In the in vitro cytotoxicity test, less than 80% cell viability at concentrations of 500 mg/L and 1,000 mg/L of Rubus coreanus Miquel and Cuscuta chinensis Lam was observed. However, more than 80% cell viability was observed at all the tested concentrations of the new herbal formula. After the 8- and 28-day oral administration, there were no considerable changes in body weight. The weights of the testes, epididymis, and seminal vesicles after the 8- and 28-day oral administration were similar to those of the control. The sperm count and activity were significantly improved compared with those of the control group at 8 and 28 days after 100, 200, and 400 mg of oral administration. CONCLUSIONS: The safety of the new formula and its positive effect on the sperm quality were observed after the oral administration of the formula.

Preliminary Report about the Efficacy of Prototype Pressure Sensor for the Real-Time Intravesical Pressure Monitoring in the Rabbit / 대한남성과학회지

PURPOSE: To maintain physiologic intravesical pressure is important in preventing secondary renal functional impairment in patients with voiding problems like neurogenic bladder or severe bladder outlet obstruction. Therefore, if real-time monitoring of the intravesical pressure were possible, physicians could not only monitor voiding status more precisely but also manage patients with voiding problems appropriately to protect renal function. In this study, we evaluate the validity of the prototype intravesical pressure sensor in a rabbit model. MATERIALS AND METHODS: The manufactured prototype intravesical pressure sensor was placed into the intravesical space of each of 3 rabbits. Conventional cystometry was performed and the intravesical pressure was measured by the prototype intravesical pressure sensor at the same time in all of the animals. The measured intravesical pressure by the prototype intravesical pressure sensor was compared with the measured value by conventional cystometry. The reliability between the two methods was determined using cross-table analysis. RESULTS: In each of the 3 animals, the index of coincidence was observed as 0.70, 0.79, and 0.77, respectively. This result meant that the intravesical pressure monitoring by the prototype intravesical pressure sensor showed good reproducibility with respect to the continuous intravesical pressure monitoring by conventional cystometry. CONCLUSIONS: In this study, we demonstrated the reliability of the prototype intravesical pressure sensor to monitor intravesical pressure change compared with the conventional cystometric result. Further investigations to overcome the limitations of the prototype intravesical pressure sensor will be necessary for real clinical application.

The Anti-inflammatory and Antimicrobial Effects of Selenium-rich Hot Spring Water on a Chronic Bacterial Prostatitis Rat Model / 대한남성과학회지

PURPOSE: The conventional primary therapy for chronic bacterial prostatitis (CBP) is the use of antibiotics. However, the therapy has a low cure rate and long-term use of antibiotics can lead to adverse effects including bacterial resistance. For these reasons, a new therapy for CBP is strongly needed. MATERIALS AND METHODS: To evaluate the anti-inflammatory and antimicrobial effects of selenium-rich hot spring water on CBP, rats were divided into four groups and treatment was administered for four weeks as follows: (1) control (n=8), (2) ciprofloxacin (n=8), (3) selenium-rich hot spring water (n=8), and (4) selenium-rich hot spring water with ciprofloxacin (n=8). Drip infusion of bacterial suspension (E. coli Z17 O2:K1;H-) into Spargue-Dowley rats was then conducted to induce CBP. Four weeks later, the results of prostate tissue and urine culture and histological analysis on the prostate were analyzed in each group. RESULTS: The use of ciprofloxacin, and selenium-rich hot spring water with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in prostatic inflammation compared with the control group (p<0.05). The selenium-rich hot spring water with ciprofloxacin group showed a statistically significantly lower rate of bacterial growth and and greater improvements in prostatic inflammation than the ciprofloxacin group (p<0.05). CONCLUSIONS: These results suggest that spring water may be an effective material in the treatment of CBP. Notably, the combination treatment of selenium-rich hot spring water and ciprofloxacin has synergistic effects. Therefore, we can suggest that the combination of selenium-rich hot spring water and ciprofloxacin may be effective in the treatment of CBP, and with a higher success rate than ciprofloxacin alone.

Induction of Apoptosis of Bladder Cancer Cells by Zinc-Citrate Compound

PURPOSE: Zinc is one of the trace minerals in the body and is known to have an anticancer effect by inducing apoptosis in prostate cancer. We aimed to investigate the antiproliferative effects of a zinc-citrate compound in bladder cancer. MATERIALS AND METHODS: A bladder cancer cell line (MBT-2) was treated with a zinc-citrate compound at different time intervals and concentrations. Mitochondrial (m)-aconitase activity was determined by use of the aconitase assay. DNA laddering analysis was performed to investigate apoptosis of MBT-2 cells. The molecular mechanism of apoptosis was investigated by Western blot analysis of p53, p21waf1, Bcl-2, Bcl-xL, and Bax and also by caspase-3 activity analysis. RESULTS: Treatment with the zinc-citrate compound resulted in a time- and dose-dependent decrease in cell number of MBT-2 cells. M-aconitase activity was significantly decreased. DNA laddering analysis indicated apoptosis of MBT-2 cells. The zinc-citrate compound increased the expression of p21waf1 and p53 and reduced the expression of Bcl-2 and Bcl-xL proteins but induced expression of Bax protein. The zinc-citrate compound induced apoptosis of MBT-2 cells by activation of the caspase-3 pathway. CONCLUSIONS: We have shown that a zinc-citrate compound induces apoptotic cell death in a bladder cancer cell line, MBT-2, by caspase-3 activation through up-regulation of apoptotic proteins and down-regulation of antiapoptotic proteins.

Synergistic Effect of Mesenchymal Stem Cells Infected with Recombinant Adenovirus Expressing Human BDNF on Erectile Function in a Rat Model of Cavernous Nerve Injury

PURPOSE: To evaluate the combined role of mescenchymal stem cells (MSCs) infected with recombinant adenoviruses expressing human BDNF (rAd/hBDNF) on the erectile dysfunction in rat with cavernous nerve injury. MATERIALS AND METHODS: Rats divided into 4 groups: control group, bilateral cavernous nerve crushing group (BCNC group), BCNC with MSCs group and BCNC with MSCs infected with rAd/hBDNF group. After 4-week, functional assessment was done. PKH26 and BDNF staining of major pelvic ganglion and masson's trichrome staining of corpus cavernosum were performed. Western blot analysis of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) was done in corpus cavernosum. RESULTS: After 4 weeks, BCNC with MSCs and MSCs infected with rAd/hBDNF groups showed significantly well-preserved erectile function compared with BCNC group. Moreover, the erectile function of MSCs infected with rAd/hBDNF group was significantly well-preserved than BCNC with MSCs group. The smooth muscle of corpus cavernosum was significantly preserved in BCNC with MSCs and MSCs infected with rAd/hBDNF groups compared with BCNC group. More preservation of smooth muscle was observed in rats with MSCs infected with rAd/hBDNF than with MSCs alone. Significant increase expression of eNOS and nNOS was noted in rats with MSCs infected with rAd/hBDNF than with MSCs alone. CONCLUSIONS: The erectile function was more preserved after injection with MSCs infected with rAd/hBDNF in rat with ED caused by cavernous nerve injury. Therefore, the use of MSC infected with rAd/hBDNF may have a better treatment effect on ED cause by cavernous nerve injury.

Long-Term Follow-Up Results of Photoselective Vaporization of the Prostate with the 120 W Greenlight HPS Laser for Treatment of Benign Prostatic Hyperplasia

PURPOSE: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. MATERIALS AND METHODS: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean age of the patients was 71.1+/-7.7. The baseline mean prostate-specific antigen level was 3.8+/-2.7 ng/ml, the mean prostate size was 43.9+/-20.6 g, the mean preoperative IPSS was 18.4+/-8.5, the mean QoL score was 4.1+/-1.0, the mean Qmax was 9.9+/-5.5 ml/sec, and the mean PVR was 89.6+/-207.1 ml. During surgery, the mean operation time was 21.8+/-11.3 minutes, the mean lasing time was 16.9+/-10.5 minutes, and the mean total applied energy was 170,068+/-63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5+/-6.7, p<0.05), voiding symptom score (6.1+/-5.4, p<0.05), and QoL score (2.2+/-1.5, p<0.05); however, there were no significant improvements in storage symptom score (4.8+/-3.8, p=0.06), Qmax (12.6+/-10.2, p=0.06), and PVR (40.1+/-30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. CONCLUSIONS: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

Effect of Oral Administration of Acetaminophen and Topical Application of EMLA on Pain during Transrectal Ultrasound-Guided Prostate Biopsy

PURPOSE: Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer. We compared with pain-relieving effect of acetaminophen, a known drug for enhancing the pain-relieving effect of tramadol, and eutectic mixture of local anesthetics (EMLA), a local anesthetic agent, with that of the conventional periprostatic nerve block method. MATERIALS AND METHODS: This was a prospective, randomized, single-blinded study. A total of 430 patients were randomly assigned to three groups. Group 1 received a periprostatic nerve block with 1% lidocaine, group 2 received acetaminophen 650 mg, and group 3 received EMLA cream for pain control. All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure. At 3 hours after completion of the procedure, the patients were asked to grade their pain on a horizontal visual analogue scale (VAS). The patients were also asked whether they were willing to undergo future biopsy if required. RESULTS: There were no significant differences between the three groups in terms of age, prostate-specific antigen, prostate size, or numbers of biopsy cores. The pain scores for groups 2 and group 3, which were 3.47+/-1.92 and 3.50+/-1.36, respectively, were similar and were significantly lower than that of group 1, which was 5.24+/-2.07. CONCLUSIONS: Acetaminophen and EMLA cream with intravenous injection of tramadol are safe, easy, and effective methods of controlling pain during the procedure. These methods were more effective for pain relief than was the conventional periprostatic nerve block method.

Effectiveness and Safety of Photoselective Vaporization of the Prostate with the 120 W HPS Greenlight Laser in Benign Prostatic Hyperplasia Patients Taking Oral Anticoagulants

PURPOSE: To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications. MATERIALS AND METHODS: This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change. RESULTS: At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed. CONCLUSIONS: The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.

The Changes of Testis and the Effects of Anthocyanin on Spermatogenesis in Rat Induced Varicocele / 대한남성과학회지

PURPOSE: Varicocele is known as a main cause of primary male infertility and it supposed to be associated with oxidative stress. Anthocyanin is known as a natural plant pigment and novel antioxidant. This study was designed to investigate the effects of anthocyanin on a rat model of varicocele. MATERIALS AND METHODS: Twenty four male rats, induced varicocele by partial obstruction of left renal vein, were divided into four experimental groups: the group induced varicocele for four weeks without anthocyanin, the group received anthocyanin (80 mg/kg) right after varicocele induction, group induced varicocele for eight weeks without anthocyanin, and the group received anthocyanin (80 mg/kg) after four weeks observation following varicocele induction. After anthocyanin treatment, testes from the rats in all groups were removed, weighed, and subjected to histological examination. Apoptosis in the testes was measured by the TUNEL assay. And the oxidative stress was evaluated by measurement of 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: Induction of varicocele led to decreasing left testis weight, decreasing spermatogenic cell density significantly (p<0.05). Also it led to increasing apoptotic body counts and increasing concentration of 8-OHdG significantly (p<0.05). However administration of anthocyanin right after varicocele induction prevent this change meaningfully (p<0.05). In group received anthocyanin after four weeks observation following varicocele induction, interestingly, there was no significant difference in testis weight, spermatogenic cell density, apoptotic body count and concentration of 8-OHdG compared to group induced varicocele for eight weeks without anthocyanin administration. CONCLUSIONS: These results suggest that anthocyanin is effective in decreasing the oxidative stress of testis in rat induced varicocele and may be effective in making a healthy sperm in patient of varicocele in early stage. However in patient under way in advanced stage, it is supposed that the anthocyanin cannot help having a protective effect from oxidative stress narrowly unless the condition of oxidative stress by varicocele is corrected. Further studies are needed to better understand the mechanisms and actions of anthocyanin and varicocele, and these studies may lead to the clinical application of anthocyanin in preventing male infertility by varicocele.

120 W Greenlight HPS Laser Photoselective Vaporization of the Prostate for Treatment of Benign Prostatic Hyperplasia in Men with Detrusor Underactivity

PURPOSE: Most men with benign prostatic hyperplasia (BPH) have bothersome lower urinary tract symptoms (LUTS). This study aimed to investigate the safety and efficacy of high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) for the treatment of BPH in men with detrusor underactivity (DU). MATERIALS AND METHODS: From March 2009, 371 patients with BPH were divided into 2 groups according to the findings of preoperative urodynamic study: 239 (64.4%) patients with bladder outlet obstruction (BOO) and 132 (35.6%) patients with bladder outlet obstruction with detrusor underactivity (BOO+DU). 120 W HPS laser PVP was performed to resolve the BOO. The perioperative data and postoperative results at 1 month and 12 months, including the International Prostate Symptom Score (IPSS), maximum urinary flow (Qmax), and postvoid residual urine (PVR) values, were evaluated. RESULTS: Compared with the preoperative parameters, significant improvements in IPSS, Qmax, and PVR were observed in each group at 1 and 12 months after the operation. In addition, IPSS, Qmax, and PVR were not significantly different between the BOO and BOO+DU groups at 1 and 12 months after the operation. CONCLUSIONS: Surgery to relieve BOO in the patients with BPH seems to be an appropriate treatment modality regardless of the existence of DU.

Clinical Significance of a Large Difference (> or = 2 points) between Biopsy and Post-prostatectomy Pathological Gleason Scores in Patients with Prostate Cancer

We investigated the clinical significance of large difference (> or = 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS > or = 2, n = 30), B (changed in pGS or = 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.