방광이행세포암으로 근치적 방광적출술을 받은 환자의 생존율에 대한 골반 림프절절제술의 영향

전황균,구자현,정현,곽철,이은식,이종욱,이상은 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.2

Purpose: We assessed the impact of pelvic lymphadenectomy on the survival of patients who had undergone radical cystectomy. Materials and Methods: We retrospectively reviewed 107 patients who underwent radical cystectomy for transitional cell carcinoma of the bladder between January 1991 and December 2000. We preoperatively excluded patients with evidence of pelvic lymphadenopathy and distant metastases from the study. Among 107 patients, 61 patients(Group A) underwent pelvic lymphadenectomy while 46 patients(Group B) did not. The clinicopathological parameters were not significantly different in the two groups. Results: In group A, 12 patients(19.6%) were found to have pelvic node metastases. Five-year overall survival and recurrence-free survival rates were 68% and 75% for Group A, respectively. In group B, 5-year overall survival and recurrence-free survival rates were 36% and 56%, respectively. Multivariate analysis revealed that T stage(p=0.004) and lymphadenectomy(p=0.044) were significant prognostic factors for survival. Conclusions: The overall survival rates between the two groups were significantly different. Our findings suggested that lymphadenectomy may improve the prognosis of patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. (Korean J Urol 2004; 45:103-107)

배뇨장애 환자의 청결간헐적도뇨법 습득에 있어서 병동별 환자교육체계와 비교한 중앙화 집중교육체계의 효과

전황균,손환철,오승준 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.2

Purpose: Our aim was to evaluate the effects of the centralized intensive education system(CIES) compared with an individualized ward education system(IWES) in the degree of acquisition of the proper clean intermittent catheterization(CIC) method as a treatment of patients with voiding dysfunction. Materials and Methods: From March 2002 to March 2003, a prospective questionnaire study was performed on 122 patients(age 55.7±17.0 years; 52 males and 70 females). Patients were randomly divided into two groups (the CIES group versus the IWES group) at the time of the urologic consultation for voiding dysfunction. After the CIC education, the patients were asked to complete a self-administered questionnaire about the CIC education. Under the protocol of CIES or IWES for CIC, patients were instructed by doctors or nurses at their wards and performed self- catheterization under supervision. Results: There were 122 patients with 72 patients in CIES, 50 patients in IWES, respectively. There were no differences between two groups in age, sex, education level, and socioeconomic status(p>0.05). CIES was superior to IWES in terms of the patient's understanding on the need for CIC, cause of their voiding dysfunction, help from pictures and the use of instruments related to CIC, sufficient explanation of questions about CIC, overall satisfaction of education, and confidence for CIC after education (p<0.05). There was a significant difference in the number of acquisitions of confidence for CIC between CIES and IWES, which were 3.1(±2.0) times and 5.9(±5.5) times, respectively(p<0.05). Conclusions: Our result shows that the CIES is superior to the IWES in CIC education. Further efforts are needed to enhance the understanding on the more detailed knowledge of the CIC and to increase the motivation of the patients. (Korean J Urol 2004;45:114-119)

전립선비대증과 전립선암에서 세포고사억제 유전자 Survivin의 발현

전황균,정현,곽철,이상은 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.3

Purpose: Survivin, a novel inhibitor of apoptosis(IAP), is expressed in many human cancers, but its potential role in prostate cancer is unknown. The expressions of survivin in benign prostate hyperplasia, localized prostate cancer and metastatic prostate cancer were investigated. Materials and Methods: Immunohistochemical staining of paraffin sections by a monoclonal antibody for survivin using the standard avidin- biotin-peroxidase technique was performed in 19, 20 and 30 cases with benign prostate hyperplasia, localized prostate cancer and metastatic prostate cancer, respectively. The relationships between the expression of survivin and the clinicopathological characteristics were analyzed. Results: No survivin expression was found in benign prostate hyperplasia, but not in prostate cancer. The expression of survivin was observed in the cytoplasm of the tumor cells, but not in the neighboring normal tissues. The immunoreactivity of survivin increased from localized prostate cancer (60.0%) to metastatic prostate cancer(76.7%), but did not differ significantly. A statistically significant association was observed between the expression of survivin and the Gleason score(p=0.001). Conclusions: Survivin is expressed in the majority of Prostate cancers and is related to the Gleason score. Survivin may be a potential target for apoptosis-based therapy. (Korean J Urol 2004;45:224-228)

방광이행상피암으로 근치적 방광적출술을 받은 환자에서 혈관, 림프관, 신경주위 침범이 예후에 미치는 영향

전황균,이은식,이상은 대한비뇨의학회 2003 Investigative and Clinical Urology Vol.44 No.11

Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

전황균,한웅규,최경화,김광현,나군호,양승철 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.1

Purpose: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. Materials and Methods:We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. Results: Mean follow-up was 47.7±29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location,estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). Conclusion: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.

Diagnostic and Prognostic Significance of Radiologic Nodepositive Renal Cell Carcinoma in the Absence of Distant Metastases: A Retrospective Analysis of Patients Undergoing Nephrectomy and Lymph Node Dissection

이혜원,전황균,정병창,서성일,전성수,최한용,이현무 대한의학회 2015 Journal of Korean medical science Vol.30 No.9

The aim of this study was to evaluate the diagnostic and prognostic value of clinicalpositive nodes at preoperative imaging (cN1) in patients with non-metastatic renal cell carcinoma (RCC) treated with lymph node dissection (LND). We retrospectively reviewed data for a cohort of 440 consecutive patients (cN0, 76.8%; cN1, 23.2%) with cTanyNanyM0 RCC who underwent nephrectomy and LND from 1994 to 2013. Metastasisfree survival (MFS) and cancer-specific survival (CSS) were estimated using the Kaplan- Meier method. Multivariate Cox regression analysis was performed to determine significant predictors of MFS and CSS. The mean number of lymph nodes (LNs) examined for all patients was 8.3, and pN1 disease was identified in 31 (7.0%). LN staging by preoperative imaging had a sensitivity of 65%, a specificity of 80%, and an accuracy of 77%. During a median follow-up of 69 months, 5-yr MFS and CSS were 83.6% and 91.3% in patients with cN0 and 49.2% and 70.1% in patients with cN1, demonstrating a trend toward worse prognosis with radiologic lymphadenopathy (all P < 0.001). Furthermore, differences in MFS and CSS between the cN0pN0 and cN1pN0 groups were significant (all P < 0.001). Clinical nodal involvement is an important determinant of adverse prognosis in patients with non-metastatic RCC who undergo LND.

Comparison of Pathological and Biochemical Outcomes after Radical Prostatectomy in Korean Patients with Serum PSA Ranges

이혜원,전황균,정병창,서성일,전성수,최한용,이현무 대한의학회 2015 Journal of Korean medical science Vol.30 No.3

The aim of this study was to assess surgical outcome at radical prostatectomy (RP) inKorean men with a serum prostate-specific antigen (PSA) level of 2.5 to 3.0 ng/mL andcompared with those of patients who had a PSA level of 3.0-4.0 and 4.0-10.0 ng/mL. Weretrospectively compared clinico-pathological characteristics and biochemical recurrence(BCR) risk in patients with PSA level of 2.5-3.0 (group 1, n = 92, 5.7%), 3.0-4.0 (group 2,n = 283, 17.5%), or 4.0-10.0 ng/mL (group 3, n = 1,242, 76.8%) who underwent RPbetween 1995 and 2013. The pathologic characteristics including Gleason score, pathologicstage, and percentage of significant cancer in group 1 were similar to those in group 2 andgroup 3. Furthermore, pathological upgrading and upstaging were found in 23 (30.7%)and 10 (14.7%) in group 1, 84 (33.9%) and 19 (8.8%) in group 2, and 321 (32.8%) and113 (12.8%) in group 3, respectively, with no significant differences among the threegroups (all P > 0.05). In multivariate analysis, PSA grouping was not an independentpredictor of BCR. Within the population with PSA lower than 10 ng/mL, substratificationof PSA is not a significant predictor for upgrading, upstaging, or adverse prognosis.

근치적후치골전립선절제술 후 발생한 서혜부탈장의 빈도 및 유발 인자

김성한,전황균,정인갑,이은식 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.11

Purpose: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP). Materials and Methods: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model. Results: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p<0.001), prostate volume(p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection(p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time(p=0.039), pelvic lymph node dissection(p=0.002), the presence of transfusion(p=0.012) and the prostate volume(>50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia. Conclusions: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia. Purpose: The aim of this study was to determine the risk factors for developing an inguinal hernia after undergoing radical retropubic prostatectomy(RRP). Materials and Methods: We retrospectively investigated the hospital records of 382 patients who underwent RRP and who were followed over 12 month periods at our institute between January 2000 and December 2006. All the operations were performed by a single surgeon. The clinical and pathological parameters were compared between the patients with and without inguinal hernia, and the risk factors were analyzed using the Cox proportional hazards model. Results: The mean age of the patients was 64.6 years(range, 40 to 83). 32(8.3%) of the 382 patients developed an inguinal hernia at a mean time of 14 months. 8(25.8%) of 32 patients developed an inguinal hernia within 6 months, 23(61.8%) within 1 year, 26(83.9%) within 2 years and 28 (90.3%) developed an inguinal hernia within 3 years. 25(78.1%) developed an inguinal hernia in the right side, 3(9.4%) in left and 4(12.5%) developed an inguinal hernia in both sides. The operative time(p<0.001), prostate volume(p=0.001), the presence of transfusion (p=0.001) and pelvic lymph node dissection(p=0.007) were significantly different between the patients with and without inguinal hernia. Multivariate analysis showed that the operative time(p=0.039), pelvic lymph node dissection(p=0.002), the presence of transfusion(p=0.012) and the prostate volume(>50cc, p=0.012) were independent predictors for post-prostatectomy inguinal hernia. Conclusions: The results of our study show that the duration of surgery, pelvic lymph node dissection, the presence of transfusion and the prostate volume all increase the risk of post-radical retropubic prostatectomy inguinal hernia.

Is Radical Perineal Prostatectomy a Viable Therapeutic Option for Intermediate- and High-risk Prostate Cancer?

이혜원,전황균,정병창,서성일,전성수,이현무,최한용 대한의학회 2015 Journal of Korean medical science Vol.30 No.11

The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and highrisk (HR; PSA >20 ng/mL, bGS ≥8, or ≥cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.

Incidence of kidney, bladder, and prostate cancers in Korea: An update

송완,전황균 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.6

The incidence of cancer is sharply increasing. Cancer is a leading cause of death as well as a significant burden on society. The incidence of urological cancer has shown a higher than average increase and will become an important concern in the future. Therefore, an overall and accurate understanding of the incidence of urological cancer is essential. In this study, which was based on the Korea National Cancer Incidence Database, annual incident cases, age-standardized incidence rates, annual percentage change (APC), and distribution by age group were examined in kidney, bladder, and prostate cancers, respectively. From 1999 to 2011, the total number of each type of urological cancer was as follows: kidney cancer (32,600 cases, 25.5%), bladder cancer (37,950 cases, 29.7%), and prostate cancer (57,332 cases, 44.8%). The age-standardized incidence rates of prostate cancer showed a significant increase with an APC of 12.3% in males. Kidney cancer gradually increased with an APC of 6.0% for both sexes and became the second most frequent urological cancer after 2008. Bladder cancer showed no significant change with an APC of -0.2% for both sexes and has decreased slightly since 2007. The distribution of kidney cancer according to age showed two peaks in the 50- to 54-year-old and 65- to 69-year-old age groups. Bladder and prostate cancers occurred mostly in the 70- to 74-year-old age group. The proportions of male to female were 2.5:1 in kidney cancer and 5.6:1 in bladder cancer. We have summarized the incidence trends of kidney, bladder, and prostate cancers and have provided useful information for screening and management of these cancers in the future.