A predictive factor in overactive bladder symptoms improvement after combined anterior vaginal wall prolapse repair: a pilot study.

PURPOSE: We aimed to determine whether a preoperative urodynamic parameter is a valuable predictor for the persistence of OAB symptoms after the AVP repair. MATERIALS AND METHODS: 65 OAB patients with concomitant POP-Q stage III, IV anterior vaginal wall prolapse underwent a surgical repair were involved. All the patients were subjected to a preoperative urodynamic study, for whom the OABSS on questionnaire were preoperatively recorded. We firstly analyzed the correlation between the BOOI and the OABSS, then randomly divided patients into two groups: the group A (high PdetQmax, BOOI≥20) and the group B (low PdetQmax, BOOI<20). In each group, the OABSS was repeatedly measured post-operatively and the change were analyzed. RESULTS: 31 patients were classified as the group A and 34 patients were classified as the group B. The group B showed significant decrease of symptom score in daytime frequency (p<0.01), urgency (p=0.04), urge incontinence (p=0.03), nocturnal frequency (p=0.01) and total score (p=0.01). The group A showed no significant decrease of symptom score in daytime frequency (p=0.42), urgency (p=0.61), urge incontinence (p=0.3), total score (p=0.15) except nocturnal frequency (p=0.01). CONCLUSIONS: A preoperative pressure-flow study can be a valuable tool in predicting the OAB symptoms change after the combined AVP repair. While the AVP repair leads to the improvement of OAB symptoms generally, some patients with a higher preoperative PdetQmax are still in need of the additional medical treatment.

Metabolic syndrome, urine pH, and time-dependent risk of nephrolithiasis in Korean men without hypertension and diabetes.

OBJECTIVE: To examine the independent effect of metabolic syndrome (MS) on nephrolithiasis (NL) even with changes in MS status over time. METHODS: From 2002-2003, 3872 men who were reexamined annually or biannually until 2009 were enrolled in the analysis and observed for development of NL. The examination included anthropometric measurements, biochemical measurement, and kidney ultrasonography (US). A standard Cox proportional hazards model and a time-dependent Cox model were used to calculate the adjusted hazard ratio in the NL model. RESULTS: After adjusting for age, baseline glomerular filtration rate, and uric acid level, MS at baseline was associated with a significantly increased risk of NL (HR, 1.771; 95% confidence interval, 1.157-2.711). MS over time as a time-dependent variable also predicted the development of NL (HR, 1.678; 95% CI, 1.151-2.447) after adjusted baseline covariate. After adjustment for potential confounding factors, there was a significant stepwise increase in risk of NL, with each additional MS trait compared with those with no traits of MS at baseline and follow-up. As the numbers of MS traits at baseline and follow-up increased, the urine pH of participants at baseline and follow-up decreased significantly (P <.01). The prevalence of NL in participants with continual MS (6.6%) was higher than those with resolved MS, and continual MS was an independent factor to predict NL. CONCLUSION: Our findings suggest that MS is significantly associated with increased risk of developing urine acidification, even with changes in status of MS observed during follow-up.

Comparative Analysis of the Efficacy and Safety of Conventional Transurethral Resection of the Prostate, Transurethral Resection of the Prostate in Saline (TURIS), and TURIS-Plasma Vaporization for the Treatment of Benign Prostatic Hyperplasia: A Pilot Study.

PURPOSE: This study was conducted to perform a comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate (TUR-P), transurethral resection in saline (TURIS), and TURIS-plasma vaporization (TURIS-V) when performed by a single surgeon for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The clinical data of 73 consecutive men who underwent conventional TUR-P (39), TURIS (19), or TURIS-V (15) for BPH were retrospectively analyzed. All procedures were carried out by a single surgeon between October 2007 and April 2010. The patients were assessed preoperatively and perioperatively and were followed at 1, 3, and 6 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared, and major complications were recorded. RESULTS: In all groups, significant improvements in subjective and objective voiding parameters were achieved and were sustained throughout follow-up. TURIS-V had the shortest operation time compared with conventional TUR-P and TURIS (p=0.211). TURIS-V significantly decreased procedural irrigation fluid volume, postoperative irrigation duration, catheter duration, and hospital stay compared with conventional TUR-P and TURIS. There were no significant differences between the groups in hemoglobin levels or serum sodium levels before and after the operations. There were three transfusions and four clot retentions in the TUR-P group, and one transfusion and one clot retention in the TURIS group. The TURIS-V group had no complications. CONCLUSIONS: TURIS and TURIS-V were effective for the surgical treatment of BPH in addition to conventional TUR-P. TURIS-V was not inferior to conventional TUR-P or TURIS in terms of safety.

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men.

The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen (PSA) levels in healthy men with serum PSA level below 4 ng mL(-1). The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment (HOMA [fasting glucose x fasting insulin]/22.5) and quantitative insulin sensitivity check index (QUICKI; 1/[log (fasting insulin) + log (fasting glucose)]). Age-adjusted body mass index (BMI) was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance (ANOVA) test and Duncan's multiple comparison test (P < 0.001), but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI (P < 0.001). Age, BMI, insulin resistance by HOMA or QUICKI were significantly independent variables to serum PSA level in a multivariate linear regression analysis (P < 0.001). Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI.