Comparison of Short-Term Outcomes and Safety Profiles between Androgen Deprivation Therapy+Abiraterone/Prednisone and Androgen Deprivation Therapy+Docetaxel in Patients with De Novo Metastatic Hormone-Sensitive Prostate Cancer.

PURPOSE: This study aimed to compare the short-term outcomes and safety profiles of androgen-deprivation therapy (ADT)+abiraterone/prednisone with those of ADT+docetaxel in patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC). MATERIALS AND METHODS: A web-based database system was established to collect prospective cohort data for patients with mHSPC in Korea. From May 2019 to November 2022, 928 patients with mHSPC from 15 institutions were enrolled. Among these patients, data from 122 patients who received ADT+abiraterone/prednisone or ADT+docetaxel as the primary systemic treatment for mHSPC were collected. The patients were divided into two groups: ADT+abiraterone/prednisone group (n=102) and ADT+docetaxel group (n=20). We compared the demographic characteristics, medical histories, baseline cancer status, initial laboratory tests, metastatic burden, oncological outcomes for mHSPC, progression after mHSPC treatment, adverse effects, follow-up, and survival data between the two groups. RESULTS: No significant differences in the demographic characteristics, medical histories, metastatic burden, and baseline cancer status were observed between the two groups. The ADT+abiraterone/prednisone group had a lower prostate-specific antigen (PSA) progression rate (7.8% vs. 30.0%; p=0.011) and lower systemic treatment discontinuation rate (22.5% vs. 45.0%; p=0.037). No significant differences in adverse effects, oncological outcomes, and total follow-up period were observed between the two groups. CONCLUSIONS: ADT+abiraterone/prednisone had lower PSA progression and systemic treatment discontinuation rates than ADT+docetaxel. In conclusion, further studies involving larger, double-blinded randomized trials with extended follow-up periods are necessary.

The assessment of erectile dysfunction after radical prostatectomy using pudendal somatosensory evoked potential.

Erectile dysfunction in patients who underwent radical prostatectomy was evaluated with pudendal somatosensory evoked potentials (PSEP) to measure and predict erectile dysfunction objectively. Fifty-seven patients who completed requirements were included in the study. Patients were divided into 2 groups (potency/non-potency). Erectile function recovery was defined as question 2 and 3 on the IIEF-5 questionnaire at 12 months after surgery. The two-channel PSEP test was performed at the day before RP and 3-6 months after RP. Twenty patients were assigned to the potency group and 37 to the non-potency group. Mean age was less in the potency group. Other clinical variables were similar in two groups. The non-potency group had prolonged lumbar and cortical latencies in postoperative PSEP, and the mean differences of latencies between pre- and postoperative PSEP in lumbar and cortical regions were also greater in the non-potency group. Logistic regression analysis showed that age, lumbar post-operative latency, cortical post-operative latency, and difference of latency in lumbar region were associated with non-potency; odds ratios were 1.292 (p = 0.018), 0.425 (p = 0.047), 1.637 (p < 0.001), and 3.272 (p = 0.010), respectively. This study suggests that PSEP is an effective means of evaluating erectile dysfunction in prostate cancer patients after surgery.

Corrigendum: Correction of the Figure. Trends of stratified prostate cancer risk in a single Korean province from 2003 to 2021: A multicenter study conducted using regional training hospital data.

This corrects the article on p. 140 in vol. 64, PMID: 36882172.

Changes of resistance indices after medication in benign prostatic hyperplasia: a prospective study.

Background: This study aimed to determine the relationship between resistive indices (RIs) and changes in prostate size after medical treatment in patients with benign prostatic hyperplasia (BPH). Methods: A total of 86 patients with BPH were included in the study, excluding 42 patients with a total prostate volume (TPV) of <30 cc or taking α1-adrenergic blockers and 5α-reductase inhibitors (5ARI) before study participation. Therefore, the data for 44 patients were analyzed. All patients were treated with α1-adrenergic blockers and 5ARIs. The variables examined were prostate-specific antigen, International Prostate Symptom Score, quality of life score, maximal urinary flow rate, residual urine volume, TPV, transition zone volume, and RIs of the urethral artery and left and right capsular arteries. These variables were assessed at baseline and after 3 and 6 months of treatment. Results: The mean TPV was 43.5 ± 10.9 and decreased to 35.2 ± 11.5 and 33.9 ± 9.8 after 3 and 6 months of treatment, respectively (p < 0.001). The mean RI of the urethral artery, right capsular artery, and left capsular artery at pretreatment did not decrease significantly. However, comparing the baseline with 3-month data, TPV at 3 months/TPV at baseline was significantly correlated with RI changes in the left capsular artery (r = 758; P < 0.001). Conclusion: In patients with BPH, α1-adrenergic blocker and 5ARI medications for 3 and 6 months did not result in a significant reduction in the RI of the urethral artery and both capsular arteries. Larger scale, prospective studies are needed to evaluate the relationship between TPV and RI reductions.

Trends of stratified prostate cancer risk in a single Korean province from 2003 to 2021: A multicenter study conducted using regional training hospital data.

PURPOSE: To identify changes in prostate cancer (PCa) risk-stratification during the last two decades in Korea, where the social perception of PCa was limited due to a relatively low incidence but has recently been triggered by the rapidly increasing incidence of benign prostate hyperplasia. MATERIALS AND METHODS: Retrospective data of patients who had received a diagnosis of PCa in a single Korean province (Daegu-Gyeongsangbuk) at all seven training hospitals in the years 2003, 2007, 2011, 2015, 2019, and 2021 were subjected to analysis. Changes in PCa risk-stratification were investigated with respect to serum prostate-specific antigen (PSA), Gleason score (GS), and clinical stage. RESULTS: Of the 3,393 study subjects that received a diagnosis of PCa, 64.1% had high-risk disease, 23.0% intermediate, and 12.9% low-risk disease. The proportion diagnosed with high-risk disease was 54.8% in 2003, 30.6% in 2019, but then increased to 35.1% in 2021. The proportion of patients with high PSA (>20 ng/mL) steadily decreased from 59.4% in 2003 to 29.6% in 2021, whereas the proportion with a high GS (>8) increased from 32.8% in 2011 to 34.0% in 2021, and the proportion with advanced stage disease (over cT2c) increased from 26.5% in 2011 to 37.1% in 2021. CONCLUSIONS: In this retrospective study, conducted in a single Korean province, high-risk PCa accounted for the largest proportion of newly registered Korean PCa patients during the last two decades and increased in the early 2020s. This outcome supports the adoption of nationwide PSA screening, regardless of current Western guidelines.

Current treatment patterns within 1 year after prostate cancer diagnosis in Korean patients over 75 years old: a retrospective multicenter study.

Background: We aimed to evaluate the current status of first-line treatment options for prostate cancer in patients aged ≥75 years in Korea. Materials and methods: The study included 873 patients diagnosed with biopsy-proven prostate cancer at 5 institutions in Korea from January 2009 to December 2018. Inclusion criteria were aged ≥75 years at diagnosis, prostate biopsy with ≥12 cores, and follow-up period ≥1 year. Clinical data were retrospectively collected from electronic medical records. Results: Primary treatment for prostate cancer in patients aged ≥75 years included androgen deprivation therapy (ADT) (n = 614), radical prostatectomy (RP) (n = 114), and radiation therapy (n = 62). Among patients with RP, nine patients received ADT before RP. The RP group was younger with better Eastern Cooperative Oncology Group Performance Status (ECOG PS), lower initial prostate-specific antigen (PSA), Gleason score (GS), max percent positive cores, less positive cores, and less advanced clinical Tumor Node Metastasis (TNM) stage compared with the ADT group. Multivariate analysis showed that age, ECOG PS, and PSA were independent prognostic factors for RP. When the ADT group was classified by therapeutic regimens, the most common therapeutic regimen was maximal androgen blockade (MAB) (n = 571), and leuprolide + bicalutamide (n = 330) was the most common MAB regimen. Multivariate analysis for secondary treatment showed that age, ECOG PS, GS, and clinical N1 or M1 stage were independent predictive factors. Enzalutamide was the most preferred treatment for tertiary treatment. Conclusion: In patients with prostate cancer aged ≥75 years, the most common treatment option was MAB, and the leuprolide + bicalutamide was the most common MAB regimen. Age, ECOG PS, and PSA are the useful indicators of surgical treatment, which increased during the study period. Younger patients with high GS and advanced clinical stage were more likely to undergo secondary treatment.

Clinical and microbiological characteristics of men with nonobstructive acute pyelonephritis: A multicenter retrospective observational study.

ABSTRACT: To investigate the differences in clinical and microbiological features in men hospitalized with community-acquired (CA) and healthcare-associated (HA) nonobstructive acute pyelonephritis (APN), as well as the predictive factors associated with bacteremia.Men discharged from urological centers with nonobstructive APN were identified using an electronic medical records system. We compared the clinical and microbiological data between subjects with CA-APN and HA-APN.Of the 245 men with nonobstructive APN, 175 had CA-APN, and 70 had HA-APN. The HA group was significantly older, had a longer hospital stay, and had more underlying diseases, bacteremia, and intensive care unit admissions than the CA group. The most commonly cultured microorganism was Escherichia coli. The susceptibility of the cultured bacteria to fluoroquinolone was 68.7% in the CA group and 45.3% in the HA group (P = .005). The proportion of extended-spectrum beta-lactamase-producing bacteria was 22.7% for CA and 53.5% for HA (P < .001). The sensitivity to piperacillin/tazobactam was 94.9% for CA and 90.0% for HA, and the sensitivity to amikacin was more than 95% for both groups. The multivariate analysis revealed that an age ≥65 years and chronic liver disease were independent predictive factors for bacteremia.The incidence of antibiotic resistance and bacteremia was higher in the HA group than in the CA group. However, resistance to fluoroquinolone and the presence of extended-spectrum beta-lactamase-producing bacteria were high in both groups. Piperacillin/tazobactam and amikacin may be suitable treatment options in men with nonobstructive APN.

Optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy to prevent postoperative systemic inflammatory response syndrome in patients presenting with urolithiasis-induced obstructive acute pyelonephritis.

PURPOSE: There is no consensus on the optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy in patients presenting with urolithiasis-induced obstructive acute pyelonephritis (APN). We aimed to identify surgeon-modifiable, preoperative risk factors associated with postoperative systemic inflammatory response syndrome (SIRS) in these patients. MATERIALS AND METHODS: This multicenter retrospective study evaluated 115 patients who presented with urolithiasis-induced obstructive APN between January 2008 and December 2019. All patients were administered intravenous third-generation cephalosporin until culture sensitivity confirmation or until ureteroscopic lithotripsy. Data were collected for age, sex, diabetes mellitus, performance status, stone features, hydronephrosis grade, preoperative renal collecting system drainage, laboratory data, operative time, and duration of preoperative antibiotic treatment. Sensitivity analysis using Youden's index and logistic regression analysis were used to assess risk factors of postoperative SIRS. RESULTS: Postoperative SIRS was identified in 32 (27.8%) patients. The incidence of postoperative SIRS was higher in patients who received preoperative antibiotic treatment for fewer than 14 days (38.8% vs. 12.5%; p=0.001). Backward variable selection logistic regression analysis revealed maximal stone diameter ≥15 mm, duration of preoperative antibiotic treatment <14 days, and preoperative C-reactive protein (CRP) level ≥6.0 mg/L to be associated with higher risk of postoperative SIRS. CONCLUSIONS: Patients with urolithiasis-induced obstructive APN planned for ureteroscopic lithotripsy should be administered at least 14 days of preoperative antibiotic administration and achieve a serum CRP level ≤6.0 mg/L to minimize the risk of postoperative SIRS.

Association between cystographic anastomotic urinary leakage following retropubic radical prostatectomy and early urinary incontinence.

BACKGROUND: This study was performed to investigate the association between cystographic anastomotic urinary leakage (UL) after retropubic radical prostatectomy (RRP) and early urinary incontinence (UI). METHODS: The medical records of 53 patients who had undergone cystography after RRP at our institution between January 2015 and December 2018 were retrospectively analyzed. Cystography was performed 7 to 10 days after surgery. The duration of catheterization depended on the degree of UL, which was classified as mild, moderate, or severe. The study subjects were divided into the non-UL group and the UL group. Continence was defined as the use of no pads. The prostate was dissected in an antegrade fashion, and urethrovesical anastomosis was performed with a continuous suture. RESULTS: Incontinence rates at 1 and 3 months postoperatively were significantly higher in the UL group than the non-UL group (83.3% vs. 52.2%, p=0.014 and 76.7% vs. 47.8%, p=0.030, respectively); however, those at 6 and 12 months were not significantly different (23.3% vs. 17.4%, p=0.597 and 4.3% vs. 10.0%, p=0.440, respectively). The severity of UL was not found to influence the duration of incontinence. The presence of cystographic anastomotic UL was found to be predictive of UI during the first 3 postoperative months (odds ratio, 3.3; p=0.045). CONCLUSION: The presence of anastomotic UL on cystography was associated with higher rates of UI in the early postoperative periods. However, incontinence rates in patients with or without anastomotic UL immediately after RRP equalized at 6 months and the severity of UL did not affect the duration of postoperative UI.

The Remaining Ipsilateral Ureteral Orifice Provokes Intravesical Tumor Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Study With a Mid-Term Follow-Up.

OBJECTIVES: To investigate the impact of the remnant ureteral orifice (RUO) on the prognosis of upper tract urothelial carcinoma (UTUC), because the presence of an ipsilateral intact ureteral orifice is not an uncommon finding during follow-up cystoscopy despite the clinical relevance of bladder cuffing during radical nephroureterectomy (RNU) for the management of UTUC. METHODS: The records of patients who underwent RNU in all tertiary hospitals in Daegu province (2011-2018) were retrospectively reviewed. Subjects were allocated to RUO or non-RUO groups. Cox proportional hazard models were used to identify variables. The primary endpoint was a 5-year intravesical recurrence-free survival (RFS). RESULTS: Of the 164 patients enrolled, 45 (27.4%) had an RUO by postoperative cystoscopy. The characteristics of the RUO and non-RUO groups were similar. During mean follow-up of 76.4 months (range: 69.5-83.4), 21 (46.7%) subjects in the RUO group and 25 (21.0%) in the non-RUO group experienced intravesical recurrence (P = .001). Among them, 3 (6.7%) and 14 (8.5%) developed distant metastasis (P = .339), and 3 (6.7%) and 9 (7.6%) succumbed to UTUC (P = .844), respectively. The 5-year RFS was lower in the RUO group than in the non-RUO counterpart (45.6% vs 77.8%, P = .003). Multivariate analysis showed lymphovascular invasion (hazard ratio [HR] = 3.593, P = .002), lymph nodal involvement (HR = 2.336, P = .038), and the presence of RUO (HR = 2.058, P = .026) predicted 5-year RFS. CONCLUSION: The presence of RUO after RNU was found to be significantly associated with intravesical tumor recurrence, and this finding emphasizes the quality of bladder cuffing during RNU, which could be assessed by complete removal of the natural orifice.

Efficacy of adding mirabegron to alpha-adrenoreceptor blocker in patients with benign prostatic hyperplasia with persistent overactive bladder symptoms: A prospective study.

Purpose: To compare the efficacies of mirabegron 50 mg addition after alpha-adrenoreceptor blocker in terms of reducing storage symptoms in patients with BPH. Materials and Methods: Fifty-eight patients that had been taking alpha-adrenoreceptor blocker for more than 8 weeks, but had an OABSS of greater than 3 points, were initially enrolled. One group added any alpha-adrenoreceptor blocker with mirabegron 50 mg (n=39; the mirabegron group) and the other group received alpha-adrenoreceptor blocker only (n=19; the control group) for 8 weeks. Results: In the control group, mean total IPSS decreased from 15.7 to 13.1 (p=0.298) and in mirabegron group, mean total IPSS decreased from 19.4 to 16.5 (p=0.024). Mean storage symptom scores reduced in the control and mirabegron groups from 8.5 to 7.9 (p=0.584) and from 9.1 to 7.6 (p=0.015), respectively, and mean QoL scores from 3.7 to 3.1 (p=0.052) and 3.6 to 3.2 (p=0.027), respectively. Mean overall OABSS in the control and mirabegron groups reduced from 8.4 to 7.2 (p=0.173) and from 8.8 to 7.3, respectively (p=0.005); mean OABSS Q3 from 3.6 to 2.9 (p=0.073) and from 3.5 to 2.7 (p=0.002), respectively; and mean OABSS Q4 from 2.4 to 2.0 (p=0.306) and from 2.7 to 2.0 (p=0.016), respectively. The change of mean Qmax and PVR was insignificant in 2 groups. Conclusions: IPSS total scores, storage symptom scores, QoL, overall OABSS, OABSS Q3 and Q4 were more improved significantly by alpha-adrenoreceptor blocker with mirabegron 50 mg in BPH patients with persistent overactive symptoms. Mirabegron 50 mg addition is considered to patients with persistent storage symptoms after alpha-adrenoreceptor blocker.

A randomised, placebo-controlled, multicentre, Phase 2 clinical trial to evaluate the efficacy and safety of GV1001 in patients with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the efficacy and safety of three dosing schemes of GV1001 in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Eligible patients were men aged ≥50 years, with an International Prostate Symptom Score (IPSS) of ≥13, maximum urinary flow rate (Qmax ) of 5-15 mL/s, post-void residual urine volume (PVR) of ≤200 mL, and prostate volume of ≥30 mL. After a 4 week run-in period, patients were randomly assigned to one of three treatment schedules: Group 1, GV1001 0.4 mg, 2-week interval; Group 2, GV1001 0.56 mg, 2-week interval; Group 3, GV1001 0.56 mg, 4-week interval) or placebo (Group 4). The eligible patients were administered GV1001 or placebo, for a total of seven intradermal injections that were administered at 2-week intervals at weeks 0, 2, 4, 6, 8, 10, and 12. Treatment continued for 12 weeks, and efficacy was evaluated at weeks 4, 8, 12, 13, and 16. Safety was evaluated throughout the 16-week period. The primary efficacy variable was change from baseline (CFB) in total IPSS. Secondary endpoints were CFB in Qmax , PVR, prostate volume, International Index of Erectile Function score, plasma testosterone level, dihydrotestosterone level, and prostate-specific antigen level. RESULTS: A total of 161 patients were included (Group 1, n = 41; Groups 2-4, n = 40). Most patients (88.8%) received all planned doses of the study treatment. At week 13, a statistically significant difference in the mean CFB in IPSS was seen in GV1001 treatment Groups 1 and 2 vs the control group for the full analysis population (-3.5 [control] vs -7.2 and -6.8 in Groups 1 and 2, respectively; both P < 0.05). There were also statistically significant differences in CFB at weeks 8, 12, 13, and 16 in treatment Groups 1 and 2 vs control in the per-protocol population. There was a statistically significant reduction in prostate gland volume at week 16 vs control in all treatment groups (0.8 [control] vs -4.6, -2.5, and -4.2 mL in Groups 1-3, respectively; all P < 0.05). There were no statistically significant differences found in other secondary outcome measures. Adverse event (AE) reporting was similar across all four groups. No treatment-emergent AEs were considered to be related to the study drug. CONCLUSIONS: The results indicate that GV1001 was effective and well tolerated, and may provide potential beneficial effects in patients with BPH. Compared with medical therapies that require daily dosing, the convenient dosing regimen of GV1001 may provide greater patient adherence. Further investigation of these observations will require large-scale clinical evaluation.

Comparison of the Effect of Naftopidil 75 mg and Tamsulosin 0.2 mg on the Bladder Storage Symptom With Benign Prostatic Hyperplasia: Prospective, Multi-institutional Study.

OBJECTIVE: To compare the efficacies of naftopidil and tamsulosin in terms of reducing storage symptoms in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: This prospective randomized study was performed at 10 centers. Ninety-four patients that had been taking tamsulosin for more than 8 weeks, but had an Overactive Bladder Symptom Score (OABSS) of greater than 3 points, were initially enrolled. After a 1-week washout period, patients were divided into 2 groups. Forty-five patients were treated with tamsulosin 0.2 mg daily, and 49 patients were treated with naftopidil 75 mg daily for 8 weeks. Total International Prostate Symptoms Score (IPSS), storage symptom scores, nocturia times, OABSS, maximal flow rates (Qmax), and postvoid residual volumes were checked before and after the 8-week treatment period. RESULTS: Mean patient ages in the tamsulosin and naftopidil groups were 64.8 and 66.0 years, respectively. Baseline characteristics were not significantly different. In the tamsulosin group, mean total IPSS decreased from 19.1 to 15.1 after the 8-week treated period (P = .001), and in the naftopidil group, mean total IPSS decreased from 16.9 to 13.1 (P = .001). Mean storage symptom scores were reduced in the tamsulosin and naftopidil groups from 8.0 to 6.6 (P = .002) and from 7.6 to 6.1 (P = .001), respectively. Mean nocturia times in the naftopidil groups decreased significantly from 2.5 to 1.9 (P = .001), and mean OABSSs were reduced from 7.7 to 6.0 (P = .001) and from 7.4 to 6.0 (P = .001), respectively. CONCLUSION: Total IPSS, storage symptom scores, nocturia times, and OABSS were significantly reduced by naftopidil and tamsulosin. Moreover, the naftopidil group showed better improvements in nocturia than the tamsulosin group.

Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis

ABSTRACT Purpose: To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP. Materials and Methods: Demographics, perioperative and functional outcomes of the 322 patients that underwent RRP (N=99) or RALP (N=223) at our institution from January 2011 through June 2013 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deference and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After a Rocco suture was applied, and then urethrovesical anastomosis was performed with continuous suture as for RALP. Results: Perioperative characteristics and complication rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 3 and 12 months after RRP decreased from 67.6% to 10.1 and after RALP decreased from 53.4% to 5.4%. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respectively). Overall postoperative potency rate at 12 months was not significant different in RRP and RALP groups (34.3% and 43.0%). Conclusions: RRP reproducing RALP was found to have surgical outcomes comparable to RALP. This technique might be adopted by experienced urologic surgeons as a standard procedure.

Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis.

PURPOSE: To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP. MATERIALS AND METHODS: Demographics, perioperative and functional outcomes of the 322 patients that underwent RRP (N=99) or RALP (N=223) at our institution from January 2011 through June 2013 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deference and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After a Rocco suture was applied, and then urethrovesical anastomosis was performed with continuous suture as for RALP. RESULTS: Perioperative characteristics and complication rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 3 and 12 months after RRP decreased from 67.6% to 10.1 and after RALP decreased from 53.4% to 5.4%. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respectively). Overall postoperative potency rate at 12 months was not significant different in RRP and RALP groups (34.3% and 43.0%). CONCLUSIONS: RRP reproducing RALP was found to have surgical outcomes comparable to RALP. This technique might be adopted by experienced urologic surgeons as a standard procedure.

Hypoxia Enhances Cell Properties of Human Mesenchymal Stem Cells.

Atmospheric (in vitro) oxygen pressure is around 150 mm Hg (20% O2), whereas physiologic (in vivo) oxygen pressure ranges between 5 and 50 mm Hg (0.7-7% O2). The normoxic environment in cell culture does not refer to a physiological stem cell niche. The aim of this study is to investigate the effect of oxygen concentration on cell properties of human mesenchymal stem cells (MSCs). We analyzed cell proliferation rate, senescence, immunophenotype, stemness gene expression and differentiation potency with human urine stem cells (USCs), dental pulp stem cells (DPSCs), amniotic fluid stem cells (AFSCs), and bone marrow stromal cells (BMSCs). USCs, DPSCs, AFSCs and BMSCs were cultured under either 5% O2 hypoxic or 20% O2 normoxic conditions for 5 days. MSCs cultured under hypoxia showed significantly increased proliferation rate and high percentage of S-phase cells, compared to normoxic condition. In real-time PCR assay, the cells cultured under hypoxia expressed higher level of Oct4, C-Myc, Nanog, Nestin and HIF-1α. In immunophenotype analysis, MSCs cultured under hypoxia maintained higher level of the MSC surface markers, and lower hematopoietic markers. Senescence was inhibited under hypoxia. Hypoxia enhances osteogenic differentiation efficiency compared to normoxia. Hypoxia showed enhanced cell proliferation rate, retention of stem cell properties, inhibition of senescence, and increased differentiation ability compared to normoxia.

Risk factors for hypertensive attack during pheochromocytoma resection.

PURPOSE: We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge. MATERIALS AND METHODS: Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. RESULTS: In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d. CONCLUSIONS: In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.

Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia.

PURPOSE: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). METHODS: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. RESULTS: The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. CONCLUSIONS: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.

Predictive factors for conservative treatment failure in grade IV pediatric blunt renal trauma.

BACKGROUND: Most children with grade IV renal injury are treated using a conservative approach with a high success rate. However, a small minority of patients with grade IV renal injury require urological intervention because of symptomatic urinomas. The challenge lies in predicting which of the patients receiving initial conservative treatment may require delayed interventional management because of urological complications. OBJECTIVE: To identify clinical factors and radiological features associated with the need for urological intervention in grade IV pediatric, blunt renal trauma patients who were initially treated with a conservative approach. STUDY DESIGN: The medical records of consecutive 26 children presenting to our center between 1996 and 2014 with grade IV renal injury, were retrospectively reviewed. Clinical factors, radiological features on computed tomography (CT), use of urological intervention, and patient outcomes were analyzed. RESULTS: The population algorithm of this study is shown in the figure. The patients who required urological intervention had a higher transfusion rate and larger perinephric hematomas (>2.2 cm) than those who did not require intervention. The main laceration was located in the antero-medial portion of the kidney, and intravascular contrast extravasation was observed more often in patients who underwent urological intervention compared with patients with successful conservative management. DISCUSSION: The authors recommend the use of cautious observation and timely imaging studies for unresolved or expanding urinomas in children with grade IV renal trauma with predictive factors. Moreover, most patients received urological intervention 4-8 days after the trauma. Therefore, it is suggested that a follow-up image study for early detection of urological complications should be conducted 4-5 days after trauma in grade IV renal trauma children with predictive factors. If none of these factors are observed on the initial CT or during the clinical course, follow-up imaging study may be avoided during hospitalization. CONCLUSION: The need for transfusion, and the presence of specific image features on initial CT, such as the main laceration location in the antero-medial portion of kidney, intravascular contrast extravasation, and a large perinephric hematoma, served as useful predictive factors for urological intervention in grade IV pediatric blunt renal trauma patients who were initially treated with a conservative approach. The findings indicate that early detection and appropriate intervention should be considered a priority in the conservative treatment of grade IV pediatric renal trauma with predictive factors.

The efficacy and safety of Collagen-I and hypoxic conditions in urine-derived stem cell ex vivo culture.

Upper urinary tract-derived urine stem cells (USCs) are considered a valuable mesenchymal stem cell source for autologous cell therapy. However, the reported culture condition for USCs is not appropriate for large-quantity production, because cells can show limited replicativity, senescence, and undesirable differentiation during cultivation. These drawbacks led us to reconstitute a culture condition that mimics the natural stem cell niche. We selected extracellular matrix protein and oxygen tension to optimize the ex vivo expansion of USCs, and compared cell adhesion, proliferation, gene expression, chromosomal stability, differentiation capacity, immunity and safety. Culture on collagen type I (ColI) supported highly enhanced USC proliferation and retention of stem cell properties. In the oxygen tension analysis (with ColI), 5% O2 hypoxia showed a higher cell proliferation rate, a greater proportion of cells in the S phase of the cell cycle, and normal stem cell properties compared to those observed in cells cultured under 20% O2 normoxia. The established reconstituted condition (ColI/hypoxia, USCsrecon) was compared to the control condition. The expanded USCsrecon showed highly increased cell proliferation and colony forming ability, maintained transcription factors, chromosomal stability, and multi-lineage differentiation capacity (neuron, osteoblast, and adipocyte) compared to the control. In addition, USCsrecon retained their immune-privileged potential and non-tumorigenicity with in vivo testing at week 8. Therefore, reconstituted condition allows for expanded uUSC cell preparations that are safe and useful for application in stem cell therapy.