Post Treatment Change of Nocturia in Patients with Benign Prostatic Hyperplasia

PURPOSE: It seems that nocturia is not improved even after various forms of treatment in benign prostatic hyperplasia(BPH) patients. We studied the relationship of nocturia with other components of the International Prostate Symptom Score(IPSS) in BPH patients and also evaluated the changes of nocturia score following medical or surgical treatments to determine whether the nocturia score behaves differently. MATERIALS AND METHODS: Between March 2002 and March 2004, a total of 198 men with BPH were enrolled in this study. Baseline symptom scores and the change after treatment were analyzed particularly focused on nocturia score. RESULTS: On baseline score analysis, the nocturia score correlated with frequency and urgency scores(p=0.01). Total IPSS score was changed from 21.8+/-6.5 to 10.1+/-6.7 after treatment(p<0.001). The changes of nocturia score were 2.4+/-1.2 to 1.8+/-1.1 in the younger group and 3.1+/-1.3 to 2.2+/-1.2 in the older group, 2.9+/-1.3 to 2.1+/-1.1 in the surgical treatment group and 2.3+/-1.2 to 1.7+/-1.1 in the medical treatment group. The improvement of nocturia score was minimal after treatment. CONCLUSION: It seems that nocturia score behaves differently in the symptom complex of BPH. These facts should be considered when we consult patients with BPH complaining of nocturia.

Correlation of Clusterin Expression and Apoptosis in Prostate Cancer and Benign Hyperplastic Tissues / 대한비뇨기과학회지

PURPOSE: We studied the apoptotic index in prostate cancer tissues and investigated the relationship of apoptosis and clusterin expression. MATERIALS AND METHODS: Forty-two archival prostatectomy specimens of varying grades of prostate cancer and 10 of benign prostatic hyperplasia were subjected to immunohistochemical clusterin staining with anti- clusterin antibody. Staining intensities were classified from 0 to 3. Apoptotic index was calculated with TUNEL positive cells under fluorescence microscope. We performed double staining for clusterin and TUNEL using immunofluorescence technique to determine the relationship between apoptosis and clusterin expression. RESULTS: Immunohistochemistry of clusterin showed a weak intensity in all benign tissues. Clusterin was localized mainly in the epithelial cells. Staining intensity was increased according to Gleason grade of cancer. Apoptotic indices of cancer were 0.86+/-0.8%, 0.76+/-1.0%, 0.39+/-0.4% and 0.14+/-0.09% in grades 2, 3, 4 and 5, respectively. In immunofluorescence localization study, apoptosis was not detected in the cancer cells stained with clusterin. Conversely, clusterin was not expressed in the cells showing apoptosis. CONCLUSIONS: These results more clearly show that clusterin acts as a survival protein protecting from apoptosis in prostate cancer. In addition, our findings revealed that the apoptotic index is lower in high grade prostate cancer. These findings have significant clinical implications for identifying the value of apoptotic index and clusterin expression in prostate cancer. Further study is needed to define the role of clusterin in the development and progression of prostate cancer.

Early Results of SPARC (Suprapubic Arc) Procedures for the Female Patients with Stress Urinary Incontinence

PURPOSE: The Suprapubic Arc (SPARC) procedure has recently been introduced as a new surgical treatment option for stress urinary incontinence in women. We have reported our early results of SPARC procedures. MATERIALS AND METHODS: A total of 23 patients received SPARC procedures at our hospital between November 2002 and August 2003. All the patients were evaluated with history taking, physical examination, urodynamic study and cystography preoperatively. The procedure was carried out under IV propofol or spinal anesthesia. The enrolled patients were followed-up for more than 3 months postoperatively. The cure rate was evaluated and perioperative and postoperative complications were assessed. RESULTS: The mean age of the patients was 48.8 years (ranges from 32 to 67 years) and eight patients had past history of previous abdominal or pelvic surgery. The mean hospital stay was 1.9 days (ranges from 1 to 7 days). Mean follow-up period was 7.9 months (ranges from 3.7 to 14.0 months). Nineteen of the 23 patients (82.6%) were completely cured and 2 patients (8.7%) were much improved, hence the total success rate of the procedure was 91.3%. Bladder perforation during procedure occurred in 7 patients (30.4%) but conservative management sufficed. No serious complication was occurred. CONCLUSION: Our early results show that the SPARC procedure is a effective treatment option for the management of stress urinary incontinence. But we suggest that surgeons should be careful to avoid the bladder injury especially in their early period of experience.