Lower Urinary Tract Symptoms in Prostate Cancer Patients Treated With Radiation Therapy: Past and Present

권휘안,이서연,정태융,문홍상 대한배뇨장애요실금학회 2021 International Neurourology Journal Vol.25 No.2

The incidence of prostate cancer (PCa) is increasing concomitantly with population aging. Accordingly, interest in radiation therapy (RT) and the frequency of RT are also increasing. The types of RT can be broadly divided into external beam RT (EBRT), brachytherapy (BT), and combination therapy (EBRT+BT). Lower urinary tract symptoms (LUTS) after RT for the treatment of PCa are common; however, there are few reviews on the relationship between RT and LUTS. Herein, we review the causes and incidence of LUTS, as well as the evaluation and treatment options. Because of the reported risks of RT, patients undergoing RT should be counseled regarding the challenges of treatment and informed that they may have higher failure rates than nonirradiated patients. Moreover, thorough evaluation and treatment strategies are needed to support treatment recommendations. With a review of the existing literature, this narrative article provides an overview to aid urologists in treating patients presenting with complications associated with RT for the treatment of PCa. Further research is required to provide evidence of the effectiveness and feasibility of the management approach to the care of patients with LUTS after RT for the treatment of PCa.

19세 남성에서 발생한 원발성 방광 대세포신경내분비암

권휘안,하윤석,이옥준,김용준,윤석중,이상철,김원재 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.7

Primary large cell neuroendocrine carcinomas of the urinary bladder are extremely rare. To date, only six cases of large cell neuroendocrine carcinoma have been reported. We present a case of a 19-year-old man who presented with gross hematuria and who was subsequently found to have a solitary tumor on the dome of the urinary bladder. The patient underwent transurethral resection of the bladder tumor for histological confirmation. A diagnosis of large cell neuroendocrine carcinoma was made based upon immunohistochemical reactivity for synaptophysin and CD56. Based on the pathologic diagnosis, he subsequently had a partial cystectomy. Histologically, the tumor penetrated the perivesical fat. It has now been 6 months since the surgery, and the patient is preparing to receive his 5th cycle of chemotherapy. There is no evidence of tumor recurrence or metastasis.

요실금 환자에서 Transobturator Tape 수술이 배뇨 양상에 미치는 영향

권휘안,우승효,김용준,이상철,김원재,윤석중 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.7

Purpose: A lot of patients with stress urinary incontinence(SUI) have lower urinary tract symptoms. So we evaluated the changes of voiding pattern following transobturator tape(TOT) operation, and investigated the factors for predicting persistent urinary frequency after operation. Materials and Methods: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart and symptoms questionnaire. Patients with anticholinergics or any neurologic diseases that affect the voiding pattern were excluded. Between January to November 2006, 46 patients with TOT operation were enrolled, and were reevaluated with physical examination, 3 day frequency-volume chart and symptom questionnaires, postoperatively. Results: The patients who voided 8 or more times per day had shorter symptom duration and higher body mass index(BMI) than those who voided under 8 times per day(each p<0.05). In 30 patients who void 8 or moretimes per day preoperatively, 17(56.7%) patients became void under 8 times, postoperatively. In each patient who had urgency or urge incontinence symptoms preoperatively, respective 72.7 and 82.8% resolved their symptoms, postoperatively. No one complained de novo urgency or urge incontinence, postoperatively. In a multivariate analysis, the patient with a history of previous pelvic surgery or moderate to severe urge incontinence was tightly associated with an increased likelihood of persistent urinary frequency after TOT operation (odd ratio[OR] 24.8, 95% confidence interval[CI] 2.044-301.284, p=0.012 and OR 31.9, 95% CI 1.662- 613.619, p=0.022, respectively). Conclusions: The TOT operation can improve the symptoms of urinary frequency, urgency and urge incontinence in patients with SUI. However, the patients who had previous pelvic surgeriesor moderate to severe urge incontinence should be fully advised for the risk of sustaining frequency, postoperatively. Purpose: A lot of patients with stress urinary incontinence(SUI) have lower urinary tract symptoms. So we evaluated the changes of voiding pattern following transobturator tape(TOT) operation, and investigated the factors for predicting persistent urinary frequency after operation. Materials and Methods: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart and symptoms questionnaire. Patients with anticholinergics or any neurologic diseases that affect the voiding pattern were excluded. Between January to November 2006, 46 patients with TOT operation were enrolled, and were reevaluated with physical examination, 3 day frequency-volume chart and symptom questionnaires, postoperatively. Results: The patients who voided 8 or more times per day had shorter symptom duration and higher body mass index(BMI) than those who voided under 8 times per day(each p<0.05). In 30 patients who void 8 or moretimes per day preoperatively, 17(56.7%) patients became void under 8 times, postoperatively. In each patient who had urgency or urge incontinence symptoms preoperatively, respective 72.7 and 82.8% resolved their symptoms, postoperatively. No one complained de novo urgency or urge incontinence, postoperatively. In a multivariate analysis, the patient with a history of previous pelvic surgery or moderate to severe urge incontinence was tightly associated with an increased likelihood of persistent urinary frequency after TOT operation (odd ratio[OR] 24.8, 95% confidence interval[CI] 2.044-301.284, p=0.012 and OR 31.9, 95% CI 1.662- 613.619, p=0.022, respectively). Conclusions: The TOT operation can improve the symptoms of urinary frequency, urgency and urge incontinence in patients with SUI. However, the patients who had previous pelvic surgeriesor moderate to severe urge incontinence should be fully advised for the risk of sustaining frequency, postoperatively.

신녹각석을 가진 70세 이상 환자에서 경피적 신절석술의 안전성 및 효율성

권휘안,서일영,한동엽 대한노인병학회 2013 Annals of geriatric medicine and research Vol.17 No.4

Background: The aim of this study was to analyze the safety and efficacy of percutaneous nephrolithotomy (PNL) for staghorn calculi in patients 70 years and older. Methods: From March 1990 to December 2011, 76 patients with staghorn calculi underwent PNL. They divided into two groups according to age: 70 years and older (group I, n=32) and younger than 70 years (group II, n=46). Preoperative parameters (stone type, stone volume, concomitant diseases, and preoperative urine culture results) and perioperative parameters (operative time, complication rate, transfusion rate, and success rate) were evaluated. Additionally, we analyzed the composition of the urinary stones using the chemical analysis method. Results: There were no significant differences between the groups for stone size, urine culture rate, operative time, success rate, and complication rate. But comorbidity, American Society of Anaesthesiology score, postoperative hemoglobin level, and transfusion rate were different (p<0.05). There were no serious complications or deaths. Magnesium ammonium phosphate component was found in 53.1% of group I and 60.9% of group II. Conclusion: Outcomes of PNL for staghorn calculi in patients 70 years and older were comparable to those seen in younger patients. PNL for this condition can be considered a safe and effective surgical option for appropriately selected elderly patients. 연구배경: 신녹각석은 감염석의 일종으로 알려져 있으며, 연령이 증가함에 따라서 증가한다. 고령 환자는 생리적, 해부적 기능의 저하 및 면역기능의 약화로 다양한 내과적 질환을가지고 있는 경우가 많다. 이러한 환자에서 수술을 시행할 때가장 요구되는 선결 조건은 높은 성공률, 짧은 수술시간과 술후 빠른 회복이며, 이를 충족시키는 가장 좋은 수술 방법은경피적신절석술이다. 이에 저자들은 노인 환자에서 발생하는신녹각석 치료에 있어 경피적신절석술의 안전성과 효율성에대해서 알아보고자 하였다. 방법: 1990년 3월부터 2011년 12월까지 본원에서 신녹각석으로 경피적신절석술을 시행받은 환자 중 3개월 이상 추적관찰이 가능하였던 환자 76명을 대상으로 의무기록과 영상학적 검사를 후향적으로 분석하였다. 70세 이상의 환자군(제 I 군)은 32명이며, 70세 미만인 환자군(제 II군)은 46명이었다. 양 군 간 수술 전 비교 인자로 성별, 결석의 크기, 증상, 수신증의 정도, 동반질환, American Society of Anaesthesiology score, 체질량지수(body mass index), 혈중 혈색소 수치 및크레아티닌 수치, 요배양 검사 등을 비교하였으며, 수술 전후비교 인자로, 수술시간, 수술 후 헤모글로빈 변화 및 크레아티닌 수치의 변화, 재원일수, 성공률, 합병증 발생률 등을 비교하였다. 또 획득된 결석을 가지고 화학적 분석법을 이용하여성분을 분석하였다. 결과: 수술시간은 양 군 간에 유의한 차이가 없었으나, 수술후 헤모글로빈 수치는 제 I군에서 9.6±2.3 mg/dL, 제 II군에서 11.9±1.5 mg/dL로 I군에서 낮았지만 II군에 비해 낮았지만, 통계학적으로 유의한 차이는 보이지 않았다(p=0.079). 수술 전후로 시행한 헤모글로빈 수치의 변화에서는 양 군 간에유의한 차이가 있고(p=0.030), 수혈빈도도 I군에서 유의하게 높았다(p=0.036). 합병증 발생빈도는 I군에서 15명(46.8%)에서 발생하였고, II군에서는 18명(39.1%)에서 발생하였으며, 양 군 간에 유의한 차이는 없었다(p=0.642). 신녹각석 종류에따른 초기 성공률은 I군에서 73.7%/50%, II군에서 73.3%/56.3% 로 양군 간에 유의한 차이는 없었다(p=0.663). 저자들의 결석성분 분석 결과에서 magnesium ammonium phosphate 성분을 보인 경우는 I군에서 17명(53.1%)이며, II군에서는 28명(60.9%)였고 calcium carbonate 성분을 보인 경우는 각각 3 명(9.4%), 4명(8.7%)이었다. 결론: 경피적 신절석술은 고령의 신녹각석을 가진 환자에서 안전하고 성공적인 치료법이다. 그러나 수술 후 수혈빈도가 많은 고령 환자 군에서 수술 전후로 좀더 세밀한 환자 관찰이 필요하다고 생각한다.

Emerging agents for the treatment of metastatic urothelial cancer

권휘안,서호경 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.3

Over the past few decades, platinum-based combination chemotherapy (PBCC) has been the preferred initial therapy for metastatic urothelial cancer (mUC). However, despite a response rate of approximately 50%, a small proportion of patients with distant metastases may be cured by cisplatin-based combination chemotherapy (CBCC). In addition, up to 50% of patients are not eligible for CBCC due to age or comorbidities. Furthermore, adverse effects from PBCC are a major concern. The emergence of check-point inhibitors (CPIs), particularly those with antibodies directed against programmed cell death 1 protein (PD-1) or its ligand (PD-L1), advanced the treatment of mUC. Avelumab switch-maintenance therapy is recommended in patients with locally advanced or mUC who did not progress on initial PBCC. With the recent advances in tumor molecular biology and the discovery of actionable therapeutic targets, the clinical application of targeted therapy is now being explored for mUC. Erdafitinib, a tyrosine kinase inhibitor of FGFR1–4, has shown positive outcomes in patients with advanced UC with FGFR alterations. Another recent technological development is antibody-drug conjugates (ADCs), which are complex molecules composed of an antibody linked to a biologically active cytotoxic drug (payload) that targets and kills tumor cells while sparing healthy cells. Enfortumab vedotin, a monoclonal antibody targeting nectin-4 conjugated to monomethyl auristatin E, has demonstrated clinically significant efficacy in patients who do not respond to both cytotoxic chemotherapy and CPIs. In this review, we describe switch-maintenance therapies using CPI, various targeted agents, and ADCs that have been investigated for mUC treatment.

Effect of Low-Dose Triple Therapy Using Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug for Overactive Bladder Symptoms in Patients With Bladder Pain Syndrome

권휘안,안성훈,오태훈,이재환,한동엽,정희종 대한배뇨장애요실금학회 2013 International Neurourology Journal Vol.17 No.2

Purpose: Patients with bladder pain syndrome/interstitial cystitis (BPS/IC) can have pain as a main symptom and overactive bladder (OAB) symptoms that are directly or indirectly related to a major mechanism that causes pain. The primary purpose of this study is firstly to identify the prevalence rate of OAB symptoms in patients with BPS/IC, secondly to identify changes in OAB symptoms after low-dose triple therapy, and thirdly to build a theoretical foundation to improve quality of life for patients. Methods: Patients who met the inclusion criteria of BPS/IC through basic tests including the O’Leary-Sant symptom index, overactive bladder symptom score (OABSS), and visual analog scale (VAS) were identified. Treatment-based changes in OAB symptoms were identified using the IC Symptom Index and IC Problem Index (ICSI/ICPI), OABSS, and VAS before, and 4 and 12 weeks after low-dose triple therapy. Results: The patients consisted of 3 men and 20 women, and their mean age was 61.9 years (41.0–83.2 years). Comparing values before treatment, and 4 and 12 weeks after treatment (baseline vs. 4 weeks to baseline vs. 12 weeks), the rates of improvement were as follows: ICSI, 44.2% to 63.7%; ICPI, 46.9% to 59.4%; OABSS, 34.3% to 58.2%; and VAS, 53.6% to 75.0%, which showed statistically significant differences (P<0.05). However, comparing values at 4 and 12 weeks after treatment (4 weeks vs. 12 weeks), the ICSI and VAS showed a statistically significant decrease (P<0.05). The ICPI and OABSS showed slight improvement, but no statistically significant differences (P>0.05). Conclusions: Low-dose triple therapy in BPS/IC results in a clear decrease in OAB symptoms in the first 4 weeks after treatment, and additional treatment for 8 weeks had a partial effect with varied statistical significances depending on the questionnaires.

Use of docetaxel plus androgen deprivation therapy for metastatic hormone-sensitive prostate cancer in Korean patients: A retrospective study

권휘안,정재영,이정은,최세영,김성한,서호경,이강현,김청수 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.3

Purpose: We aimed to evaluate the efficacy and safety of the use of docetaxel plus androgen deprivation therapy (ADT) for metastatic hormone-sensitive prostate cancer (mHSPC) in Korean patients. Materials and Methods: This study was conducted retrospectively. In total, 61 Korean patients with mHSPC who used docetaxel plus ADT were identified from medical records. Patients received docetaxel plus ADT at a dose of 75 mg/m2 every 3 weeks for 6 cycles. We evaluated prostate-specific antigen (PSA) response, PSA progression, progression to castration-resistant prostate cancer (CRPC), clinical progression, and adverse events. Results: Most of the patients had high volume disease (98.3%) and 83.6% had a Gleason score of 8 or higher. The median PSA level at the start of ADT was 131.4 ng/mL. The percentage of patients whose PSA levels decreased to less than 0.2 ng/mL at 3, 6, and 12 months were 28.3%, 41.0%, and 45.0%, respectively. During a median of 12.0 months after treatment, PSA progression occurred in 13.3% of patients. Clinical progression and progression to CRPC were observed in 15.1% and 14.8%, respectively. Neutropenia grade ≥3 and febrile neutropenia occurred in 63.5% and 11.5%, respectively. Conclusions: Comparing our findings with those of the prior chemohormonal therapy versus androgen ablation randomized trial for extensive disease in prostate cancer (CHAARTED) study, in Korean patients, the use of docetaxel plus ADT for mHSPC showed similar results for early oncologic outcomes including PSA response and time to clinical progression. However, we observed a higher rate of adverse events, which should be considered seriously.

Learning From Heart Failure: How Will We Lead Bladder Failure Into the Future?

권휘안,이택 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.1

Animal Model of Interstitial Cystitis/Bladder Pain Syndrome

권휘안 대한배뇨장애요실금학회 2018 International Neurourology Journal Vol.22 No.S2

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신세포암에서 RUNX3 비활성화와 병리학적 특성과의 관계

권휘안,박철,김은정,하윤석,김용준,윤석중,이상철,김원재 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.5

PURPOSE: DNA methylation is a key regulator of gene transcription and genomic stability, and alterations in DNA methylation are frequently detected in human tumors. Recent study has suggested that inactivation of runt-related transcription factor 3 (RUNX3), primarily epigenetic alterations in DNA methylation, is closely associated with bladder tumor stage, grade, and prognosis. The aim of this study was to evaluate the association between RUNX3 inactivation and renal cell carcinoma (RCC). MATERIALS AND METHODS: RCC tissues (n=56) were obtained from patients who underwent radical nephrectomy. The methylation pattern of RUNX3 was determined by using methylation specific-polymerase chain reaction (MS-PCR) and direct DNA sequencing. RESULTS: Methylation of the RUNX3 promoter was observed in 75.0% of the samples (42/56). The tumor stage and grade were significantly associated with the methylation status (p<5, respectively). However, recurrence and progression of RCC were not significantly related to the methylation of the RUNX3 promoter region (log-rank test, p>0.05, respectively). CONCLUSIONS: This study demonstrated that promoter methylation of RUNX3 is frequently observed in RCC. In addition, RUNX3 methylation is closely associated with aggressive pathologic features. PURPOSE: DNA methylation is a key regulator of gene transcription and genomic stability, and alterations in DNA methylation are frequently detected in human tumors. Recent study has suggested that inactivation of runt-related transcription factor 3 (RUNX3), primarily epigenetic alterations in DNA methylation, is closely associated with bladder tumor stage, grade, and prognosis. The aim of this study was to evaluate the association between RUNX3 inactivation and renal cell carcinoma (RCC). MATERIALS AND METHODS: RCC tissues (n=56) were obtained from patients who underwent radical nephrectomy. The methylation pattern of RUNX3 was determined by using methylation specific-polymerase chain reaction (MS-PCR) and direct DNA sequencing. RESULTS: Methylation of the RUNX3 promoter was observed in 75.0% of the samples (42/56). The tumor stage and grade were significantly associated with the methylation status (p<5, respectively). However, recurrence and progression of RCC were not significantly related to the methylation of the RUNX3 promoter region (log-rank test, p>0.05, respectively). CONCLUSIONS: This study demonstrated that promoter methylation of RUNX3 is frequently observed in RCC. In addition, RUNX3 methylation is closely associated with aggressive pathologic features.