Long Term Result of Modified 6+3 Bacillus Calmette-Guerin Maintenance Therapy for Non-muscle-invasive Bladder Cancer in Korea: Comparison of 6-week Therapy

강필문,서원익,정재일 대한비뇨기종양학회 2014 대한비뇨기종양학회지 Vol.12 No.2

Purpose: We report our experience with modified 6+3 maintenance BCG therapy compared with a 6-week induction course over the past 10 years and its effects on recurrence and progression. Materials and Methods: Between January 2001 and June 2012, a total of 181 patients treated with NMIBC underwent TUR and intravesical BCG. BCG was administered over a 6-week course in 88 patients, and was administered for six weeks followed by three weekly instillations at 3, 6, 9, 12, 18, 24, and 36 months (modified 6+3 regimen) in 93 patients. The recurrence rate, time to recurrence, and progression rate were assessed and analyzed. Results: A total of 30 of 181 patients were ineligible. Seventy-three patients in the 6-week induction group and seventy-eight patients in maintenance group were eligible. Median follow-up was 37.4 months in the maintenance group and 32.9 months in the 6-week course group. The estimated overall recurrence rate and median recurrence-free survival were 21.8% (17/78) and 23.4 months (95% confidence interval [CI] 7-84) in the maintenance group and 35.6% (26/73) and 21.5 months (6-80) in the 6-week course group (log rank p=0.002), respectively. Estimated median times for progression-free survival were 44.0 months (95% CI 7-84) in the maintenance group and 25.7 months (14-41) in the 6-week course group (log rank p=0.0815). The overall rates of adverse effects were 27.9% (26/93) in the maintenance group and 25.0% (22/88) in the 6-week course group. Conclusions: Compared to the standard 6-week course, maintenance BCG immunotherapy was beneficial for preventing recurrence in patients with non-muscle-invasive bladder cancer.

신낭종 내 발생한 외상성 출혈

강필문,서원익,최익준,정성환,곽호섭,박오환,정수진,강동일 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.10

Spontaneous and post-traumatic renal intracystic hemorrhages are extremely rare, but are a potential danger to patients with cystic kidney disease. We report two cases of post-traumatic intracystic massive hemorrhage in renal cysts. One patient was a 27-year-old male who presented with left flank pain and gross hematuria after slipping on the stairs 2 days previously. The other patient was a 58-year-old male who presented with back pain due to an accident. The circulatory states of the two patients were deteriorated and renal intracystic hemorrhages were detected on computed tomography. One patient underwent a simple nephrectomy and the other patient was treated with arterial embolization. We present two cases of renal intracystic hemorrhage, emphasizing early diagnosis and the treatment of choice.

요로결석의 성분분석: 최근 5년간 단일기관 분석 결과(2009년- 2013년)

강필문,서원익,강동일 대한요로생식기감염학회 2014 Urogenital Tract Infection Vol.9 No.1

Purpose: Analysis of urinary stone composition is essential for treatment and prevention of urolithiasis. We evaluated the effect of age, gender, and stone location on urinary stone components during the last five years.Materials and Methods: We conducted a retrospective analysis of the medical records of 375 patients ranging in age from 15 years old to 93 years old (241 males and 134 females) who underwent conventional or endoscopic surgery, shock wave lithotripsy, or passed their stones spontaneously between 2009 and 2013. Stone analysis was performed using a chemical analysis method to determine the molecular composition of each stone.Results: Of the 375 patients with urolithiasis, 152 patients (40.5%) had predomi-nantly calcium oxalate, 85 patients (21.5%) had uric acid, 17 patients (4.5%) had calcium phosphate, 17 patients (4.5%) had magnesium ammonium phosphate, 16 patients (4.3%) had calcium carbonate, and 86 patients (22.9%) had mixed stone type. There was a decreasing prevalence of calcium oxalate stone with age group (42.5% in young adult (20-39 years, n=40), 45.0% in adult (40-60 years, n=151), and 32.7% in elderly (≥60 years, n=180) as opposed to increasing prevalence in uric acid stone (7.5% in young adult, 15.2% in adult and 32.2% in elderly). Uric acid stones were more common in males and in lower urinary tract stones. Conclusions: In this study, the incidence of calcium oxalate decreased with age and that of uric acid increased with age and in male. In comparison of the results of previous studies for several decades, the incidence of uric acid increased in the last five years.

사정관 낭종 및 폐색이 동반된 혈정액증 환자에서 경요도 사정관 소작술

강필문,정재일 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.3

Purpose: To evaluate the usefulness and effectiveness of transurethral coagulation and incision of the ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction. Materials and Methods: Twenty-six patients with hematospermia were enrolled. Ejaculatory duct cyst or obstruction was diagnosed by transrectal ultrasound or MRI, revealing seminal vesicle hypertrophy and cystic dilated ejaculatory ducts. One patient had hematospermia associated with infertility. The mean age of the patients and their duration of symptoms were 42.7 years (range, 25-67 years) and 16 months (range, 1-60 months), respectively. All patients underwent transurethral management for treatment of their ejaculatory duct obstruction in the form of incision and coagulation of the ejaculatory duct. We used a 9.5 Fr rigid ureteroscope (StortzⓇ, Germany) and a Bugbee electrode. Patients were followed for more than 3 months after the procedure. Results: All patients reported improvement of hematospermia and disappearance of midline cysts, except for one patient. The one case, ureteroscope failed to pass through verumontanum. A ejaculatory duct cyst was found in 18 cases. Calculi were present in the seminal vesicle and ejaculatory ducts in 7 patients and were removed with endoscopic instruments. One infertile patient regained reproductive ability after the procedure. Postoperative complications, such as epididymitis, orchitis, or retrograde ejaculation were not observed. Conclusions: Transurethral incision and coagulation was a safe and effective treatment option for hematospermia caused by ejaculatory duct obstruction and is considered to be a successful treatment option for infertility secondary to ejaculatory duct obstruction. Purpose: To evaluate the usefulness and effectiveness of transurethral coagulation and incision of the ejaculatory duct for hematospermia caused by ejaculatory duct cyst and obstruction. Materials and Methods: Twenty-six patients with hematospermia were enrolled. Ejaculatory duct cyst or obstruction was diagnosed by transrectal ultrasound or MRI, revealing seminal vesicle hypertrophy and cystic dilated ejaculatory ducts. One patient had hematospermia associated with infertility. The mean age of the patients and their duration of symptoms were 42.7 years (range, 25-67 years) and 16 months (range, 1-60 months), respectively. All patients underwent transurethral management for treatment of their ejaculatory duct obstruction in the form of incision and coagulation of the ejaculatory duct. We used a 9.5 Fr rigid ureteroscope (StortzⓇ, Germany) and a Bugbee electrode. Patients were followed for more than 3 months after the procedure. Results: All patients reported improvement of hematospermia and disappearance of midline cysts, except for one patient. The one case, ureteroscope failed to pass through verumontanum. A ejaculatory duct cyst was found in 18 cases. Calculi were present in the seminal vesicle and ejaculatory ducts in 7 patients and were removed with endoscopic instruments. One infertile patient regained reproductive ability after the procedure. Postoperative complications, such as epididymitis, orchitis, or retrograde ejaculation were not observed. Conclusions: Transurethral incision and coagulation was a safe and effective treatment option for hematospermia caused by ejaculatory duct obstruction and is considered to be a successful treatment option for infertility secondary to ejaculatory duct obstruction.

의료인과 비의료인의 발기부전 치료제 비아그라의 인식에 대한 실태조사

서원익,강필문,민권식,김학민,엄재두,전지연 대한남성과학회 2009 The World Journal of Men's Health Vol.27 No.2

Purpose: Sildenafil citrate(ViagraⓇ), a PDE-5 inhibitor in the corpus carvenosum to facilitate penile erection has improved impaired erectile responses in men and has been accepted as a primary treatment of erectile dysfunction. However, complications occurred by Viagra have increased due to its overuse and misuse. Therefore, we have performed a survey to compare physicians and general population in Busan, Korea to assess their understanding of Viagra. Methods and Materials: In 2007, printed surveys were mailed to randomly sampled candidates of 197 primary physicians and 696 individuals from general population, 327 medical students in Busan were surveyed by door-to-door visits. We assessed opinions associated with Viagra eliciting their understanding about its safety, direction, and complications. Data were analyzed using SPSS and were identified by crosstabulation analysis using Ki-square test. Results: Of 1,265 eligible responses, several differences were found between the 3 groups. Compared to general population, the others were more likely to understand the efficacy, directions, and complications of Viagra. Physicians and medical students(43.1% and 39.0%) gave more preference than general population(26.1%) to using Viagra. There were differences in understanding of Viagra with changes of education level. However, it showed no significant differences about idea of illegal Viagra and combination usage with nitrates. Conclusion: The number of patients using Viagra is increasing but their understanding about Viagra is still poor. Moreover, general populations understand Viagra as 'assistant' for erection poorly. Even some medical students understand more than physicians. The ideas of complications would likely affect to negative thinking about usage for Viagra. Therefore more active and continuous educations for proper use of Viagra are suggested for medical efficacy and less complications.

Symptoms of Bacillus Calmette-Guerin Cystitis in Bladder Cancer Patients according to Tuberculosis Sequelae by Chest Radiography

서원익,강필문,윤장호,최석진,김완석 대한요로생식기감염학회 2017 Urogenital Tract Infection Vol.12 No.1

Purpose: Bacillus Calmette-Guerin (BCG) vaccination has been administered to most infants at birth in Korea; however, tuberculosis (TB) remains extant. TB can leave sequelae on chest radiography according to the immune response of the host. We investigated the symptoms of cystitis after intravesica instillations in bladder cancer, depending on the TB sequelae on chest radiography.Materials and Methods: One hundred forty-two patients with non-muscle invasive bladder cancer (NMIBC) underwent transurethral resection and intravesical BCG therapy for bladder cancer. Patients received a BCG induction course―with or without a maintenance course―and were divided into the two groups: Group A, which included patients with visible sequelae of TB on chest radiography (n=31) and group B, which included patients without visible sequelae of TB (n=111). Cystitis symptoms of BCG intravesical therapy were compared between the two groups. The recurrence and progression rates of bladder cancer were also analyzed.Results: The overall rate of cystitis symptoms was 32.3% (10/31) in group A and 33.3% (37/111) in group B. One patient in group A and three in group B did not complete the treatment course due to severe cystitis symptoms (p=0.876). Pyuria was reported when cystitis symptoms occurred in 80% (8/10) in group A and 56.8% (21/37) in group B. The recurrence and progression rates were not different between the two groups.Conclusions: Our results show that there was no significant difference of cystitis symptoms in accordance with the presence of TB sequelae in chest radiography when BCG instravesical therapy for NMIBC was performed.

Primary Androgen Deprivation Therapy for Prostate Cancer in Koreans: A Retrospective Multicenter Study

서원익,강필문,김태효,문경현,정재민,이동현,Isaac Yi Kim,민권식,정재일,김완석,강동일 대한남성과학회 2014 The World Journal of Men's Health Vol.32 No.3

Purpose: To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. Materials and Methods: Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. Results: The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). Conclusions: Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of ≤0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.

Predictive Value of the Cancer of the Prostate Risk Assessment Score for Recurrence-Free Survival After Radical Prostatectomy in Korea: A Single-Surgeon Series

서원익,강필문,정재일 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.5

Purpose: To evaluate the validity of the cancer of the prostate risk assessment (CAPRA) score, a newly developed nomogram for preoperative prediction of recurrence after radical prostatectomy, in a single institution in Korea. Materials and Methods: We retrospectively studied 115 men who had undergone radical prostatectomy as the first treatment for localized prostate cancer. The validity of the CAPRA score for the prediction of recurrence-free survival (RFS) and pathologic outcome was evaluated by using Kaplan–Meier analysis and a proportional hazards regression model. A seven-group model and a three-group model were used for the results. Results: None of the variables of the CAPRA score was favorable compared with the previously reported data. The three-group model was significantly related with 3- and 5-year RFS (p<0.05), but the seven-group model was not. The concordance indices of the CAPRA score were 0.74 and 0.77. Of four components excluding the clinical T stage, three independently predicted RFS (age, Gleason sum, and percentage of positive biopsies). The CAPRA score was significantly related to the margin status, extracapsular extension, and seminal vesicle invasion in both the seven- and three-group models. In the three-group model, pathologic outcomes were more strongly related, especially a higher risk of seminal vesicle invasion. Conclusions: The CAPRA score showed high accuracy for predicting RFS. In particular, the three-group model was more useful for predicting RFS and pathologic outcomes. Therefore, the CAPRA score may be a useful prediction model for risk stratification and may help clinicians to develop localized prostate cancer treatment.

Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): Ability to Predict Cancer Progression and Decision-Making Regarding Adjuvant Therapy after Radical Prostatectomy

서원익,강필문,강동일,윤장호,김완석,정재일 대한의학회 2014 Journal of Korean medical science Vol.29 No.9

The University of California, San Francisco, announced in 2011 Cancer of the Prostate RiskAssessment Postsurgical (CAPRA-S) score which included pathologic data, but there wereno results for comparing preoperative predictors with the CAPRA-S score. We evaluatedthe validation of the CAPRA-S score in our institution and compare the result with thepreoperative progression predictor, CAPRA score. Data of 130 patients were reviewed whounderwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessedthrough Kaplan Meier analysis and Cox proportional hazards regression test. Additionally,prediction probability was compared with preoperative CAPRA score by logistic regressionanalysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction abilityfor 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk groupstratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for3-yr progression free survival and 5-yr progression free survival (concordance index 0.74vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictorconcerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.

Simultaneous Occurrence of Chromophobe Renal Cell Carcinoma and Urothelial Carcinoma in the Same Kidney

최익준,정성환,서원익,강필문,정수진,정재일 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.5

The simultaneous occurrence of a renal cell carcinoma and a urothelial carcinoma in the same kidney is uncommon. Here we report the case of a 79-year-old woman with ipsilateral synchronous renal cell carcinoma and urothelial carcinoma. She was referred to our hospital for gross hematuria and right flank pain. A computed tomography scan showed a 15x20 mm enhanced lesion on the upper calyx and a 12x15 mm mass on the lateral aspect of the right kidney. We thus suspected a renal pelvis tumor and performed right hand assisted laparoscopic nephroureterectomy with bladder cuff excision (HALSNU). Gross findings were multiple, pale yellowish papillary masses on the upper and lower major calices, of which the largest one measured 16x20 mm. A separated solid mass measuring 12x16 mm was also noted on the anterior midportion of the kidney. The former was a urothelial carcinoma and the latter was a chromophobe renal cell carcinoma. We present a rare case of a chromophobe renal cell carcinoma and a urothelial carcinoma in the same kidney.