비뇨기과적 관점에서 분석한 배설강존속증을 가진 환아들의 임상적 특징

방우진,이혜영,한상원 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.1

Purpose: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. Materials and Methods: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. Results: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. Conclusions: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory. (Korean J Urol 2008;49:77-81) Purpose: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. Materials and Methods: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. Results: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. Conclusions: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatory. (Korean J Urol 2008;49:77-81)

근치적 전립선절제술 후 요실금 발생 환자에서의 항콜린제 처방에 대한 비뇨기과 의사의 실태조사

방우진(Woo Jin Bang),주관중(Kwan Joong Joo),조진선(Jin Seon Cho),전성수(Seong Soo Jeon),백성현(Sung Hyun Paick),성도환(Do Hwan Seong),김홍섭(Hong Sup Kim),함원식(Won Sik Ham),홍성준(Sung Joon Hong) 대한비뇨기종양학회 2012 대한비뇨기종양학회지 Vol.10 No.2

Purpose: We surveyed the actual use of anticholinergics for urinary incontinence after radical prostatectomy among the practicing urologists. Materials and Methods: 142 urologist members of the Korean Urological Oncology Society were given surveys through conventional mail and e-mail with 76 members returning responses. Answering for the number of radical prostatectomy performed each year, 21 urologists responded more than 50 cases, 37 responded 10 to 50 cases, 11 responded 5 to 10 cases, and 7 said 1 to 5 cases. Concerning primary approach, retropubic approach surgery, laparoscopic surgery, robotic surgery and perineal approach surgery each had 39, 19, 17, and 1, respectively. Results: Among 76 participants, 64 (84%) acknowledged prescribing anticholinergics after prostatectomy depending on symptoms. For post-op indication of anticholinergics, 43 members responded significant incontinence symptoms, while 19 answered frequent urination. Concerning the initiation of medication, 52 answered when symptoms arise after catheter removal. For duration of anticholinergics, less than 30 days, 31-60 days, 61-90 days, more than 90 days each received 8, 17, 24, and 15 votes from participants, respectively. Finally, 57 members thought the use of anticholinergics were beneficial in treating urinary incontinence after radical prostatectomy. Conclusions: Over 80% of survey participants acknowledged prescribing anticholinergics to urinary incontinence patients according to symptoms, and 75% concurred with their usefulness. But, there is no specified protocol of anticholinergics use for urinary incontinence after radical prostatectomy.

Bacillus Calmette Guerin 주입요법 이후 생긴 가종양에 대한 경구 Prednisolone의 효과

박경기,방우진,서주완,김영식,이석영,고우진 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.4

Effect of desmopressin lyophilisate (MELT) plus anticholinergics combination on functional bladder capacity and therapeutic outcome as the first-line treatment for primary monosymptomatic nocturnal enuresis: A randomized clinical trial

심명선,방우진,오철영,강민재,조진선 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.3

Purpose: To assess the efficacy of desmopressin plus anticholinergic combination therapy as first-line treatment for children with primary monosymptomatic nocturnal enuresis (PMNE) and to analyze this combination's effect on functional bladder capacity (FBC). Materials and Methods: A total of 99 children with PMNE were prospectively enrolled from 2015 to 2019 and randomly allocated to a monotherapy group (n=49), with oral desmopressin lyophilisate (MELT) only; and a combination group (n=50), with desmopressin plus an anticholinergic (propiverine 5 mg). Efficacy and FBC were evaluated at 1 and 3 months after treatment initiation; the relapse rate was assessed at 6 months after treatment cessation. Results: The combination therapy group showed a higher rate of complete response than the monotherapy group after 3 months of treatment (44.0% vs. 22.4%, p=0.002). A significant increase in mean FBC was observed only in the combination group, from 88.72±26.34 mL at baseline to 115.52±42.23 mL at 3 months of treatment (p=0.024). Combination therapy was significantly associated with treatment success at 3 months after treatment initiation (odds ratio [OR], 3.527; 95% confidence interval [CI], 1.203–6.983; p=0.011) and decreased risk of relapse at 6 months after treatment cessation (OR, 0.306; 95% CI, 0.213–0.894; p=0.021), by multivariable analysis. Conclusions: This study represents the first prospective, randomized controlled trial showing higher response rates and lower relapse rates with desmopressin plus anticholinergic combination therapy compared with desmopressin monotherapy as first-line treatment for children with PMNE.

신장 길이 측정에서 초음파와 Dimercaptosuccinic Acid(DMSA) 신주사 간의 차이

김성수,방우진,서주완,조강수,한상원 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.1

Feasibility of the Interferon-γ Release Assay for the Diagnosis of Genitourinary Tuberculosis in an Endemic Area

김종근,방우진,오철영,유창희,조진선 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.2

Purpose: To evaluate the feasibility of the interferon-gamma release assay (IGRA) as a supplementary diagnostic tool for the diagnosis of genitourinary tuberculosis (GUTB). Materials and Methods: Fifty-seven patients who were tested with the IGRA to diagnose GUTB were included. All patients had clinical or radiologic features suspicious for GUTB. Signs and symptoms included chronic dysuria with long-standing sterile pyuria, renal calcification with distorted renal calyces and contracted renal pelvis, and chronic epididymitis. Patients who had a history of tuberculosis in other organs were excluded. Tests including IGRA, urine acid-fast bacilli (AFB) stain and culture, urine tuberculosis polymerase chain reaction (UT-PCR), and radiological examinations were performed to confirm GUTB. The medical records of the patients were reviewed retrospectively. Results: The IGRA result was positive in 30 patients (52.6%). The results of the urine AFB stain and culture were positive in 5 patients (8.8%) and 7 patients (12.2%),respectively. The results of UT-PCR were positive in 9 patients (15.8%). The 7 patients who showed positive results in the urine AFB stain and culture also had positive results on the IGRA. A UT-PCR-negative patient was diagnosed with GUTB by positive results on both the IGRA and AFB stain and culture. Conclusions: The IGRA might feasibly be used as a supplementary or screening tool for the diagnosis of GUTB in addition to urine AFB stain and culture. Further studies for statistical evaluation of its sensitivity, specificity, and efficacy are needed.

Effectiveness of three different luteinizing hormone-releasing hormone agonists in the chemical castration of patients with prostate cancer: Goserelin versus triptorelin versus leuprolide

심명선,방우진,오철영,이용성,조진선 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.4

Purpose: To investigate the changes in testosterone levels and rates of chemical castration following androgen-deprivation therapy (ADT) with goserelin, triptorelin, and leuprolide. Materials and Methods: We retrospectively reviewed the medical records of 125 patients with prostate cancer treated with luteinizing hormone-releasing hormone (LHRH) agonists between January 2009 and December 2015. Changes in testosterone concentration during 9 months of ADT with goserelin 11.34 mg, triptorelin 11.25 mg, and leuprolide 11.25 mg were analyzed using a mixed model. The number of patients with serum testosterone below castration levels defined as various values (<50 ng/dL, <20 ng/dL, or <10 ng/dL) at 3, 6, and 9 months were also evaluated. Results: Of the 125 patients, 59 received goserelin, 44 received triptorelin, and 22 received leuprolide, respectively. The lowest mean testosterone levels during 9 months of treatment were achieved in patients treated with triptorelin, followed by those treated with leuprolide, and then by those treated with goserelin (p=0.001). Significant differences in chemical castration levels were observed only at <10 ng/dL, with 54.2% of goserelin, 93.2% of triptorelin, and 86.4% of leuprolide treated patients (p<0.001). Conclusions: Three LHRH agonists showed comparable efficacy for achieving castration when the castration threshold was 50 or 20 ng/dL. However, triptorelin was the most potent LHRH agonist, achieving the lowest mean testosterone levels and the highest rate of chemical castration at <10 ng/dL testosterone.

Factors Influencing the Acceptance of Transrectal Ultrasound-Guided Prostate Biopsies

황지원,방우진,오철영,유창희,조진선 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.7

Purpose: This study aimed to improve prostate biopsy compliance by analyzing the factorsthat influence the acceptance of prostate biopsy by patients to whom transrectalultrasound (TRUS)-guided prostate biopsy is recommended for suspected prostatecancer. Materials and Methods: The subjects of this study were 268 patients to whomTRUS-guided prostate biopsy was recommended from January to June 2011 and whocompleted a questionnaire. Patients who showed a prostate-specific antigen (PSA) increaseto more than 4.0 ng/mL or abnormal findings on a digital rectal examinationand TRUS were recommended to undergo prostate biopsy. The questionnaire consistedof 9 questions about the subjects’ demographic characteristics and 15 questions thatassessed their knowledge of prostate disease. Fisher exact probability test was conductedto assess the influence of the demographic characteristics and levels of knowledgeof prostate disease on acceptance of prostate biopsy. Results: The mean age of the subjects was 66.2 years (range, 43–83 years). Of the cohort,188 patients (70.7%) agreed to the prostate biopsy and 78 patients (29.3%) refused. Interms of demographic characteristics, the patients’ acceptance of prostate biopsy wasassociated only with education level. Patients with relatively lower education levelshad a higher acceptance rate for prostate biopsy (80.0% vs. 65.9%, p=0.018). Other demographicfactors, as well as the degree of knowledge of prostate disease, had no significanteffect on the acceptance rate. Conclusions: The patients’ acceptance of prostate biopsy can be influenced by demographiccharacteristics, especially education level. Therefore, when prostate biopsy isrecommended to patients, their demographic characteristics should be taken intoconsideration.

Effect of Diabetes Mellitus on Symptomatic Improvement After Surgery for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptom and its Relations With Prostatic Urethral Angulation

조정기,김환익,방우진,오철영,조진선,심명선 대한배뇨장애요실금학회 2023 International Neurourology Journal Vol.27 No.2

Purpose: To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP). Methods: The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA; <50° vs. ≥50°). Medication-free survival after surgery was also investigated. Results: No significant differences were noted between the DM and non-DM groups in baseline characteristics except for comorbidities (i.e., hypertension, cerebrovascular disease, and ischemic heart disease, P=0.021, P=0.002, and P=0.017, respectively) and postvoid residual urine volume (115±98 mL vs. 76±105 mL, P=0.028). Non-DM patients showed significant symptomatic improvement regardless of PUA, while DM patients demonstrated improvement in obstructive symptoms only in those with large PUA (≥51°). Among patients with small PUA, DM patients had worse medication-free survival after surgery compared to controls (P=0.044) and DM was an independent predictor of medication reuse (hazard ratio, 1.422; 95% confidence interval, 1.285–2.373; P=0.038). Conclusions: DM patients experienced symptomatic improvement after surgery only in those with large PUA. Among patients with small PUA, DM patients were more likely to reuse medication after surgery.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

Myungsun Shim,방우진,Cheol Young Oh,이용성,Seong Soo Jeon,Hanjong Ahn,Young-Su Ju,Jin Seon Cho 대한의학회 2020 Journal of Korean medical science Vol.35 No.4

Background: The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population. Methods: Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD). Results: GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant. Conclusion: Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.