Effects of pelvic bone fracture on recurrence-free rate after bulbomembranous anastomotic urethroplasty in men with posterior urethral injuries

최돈경,김성진,오종진 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.1

Purpose: To determine the impact of pelvic bone fracture on the recurrence of urethral stenosis after bulbomembranous anastomotic urethroplasty. Materials and Methods: A total of 197 patients with complete posterior urethral injuries underwent bulbomembranous anastomotic urethroplasty. These patients were divided into two groups according to the presence of pelvic bone fracture. Recurrence of urethral stenosis was defined as the need for any postoperative surgical intervention. The surgical outcomes and postoperative recurrence rate of urethral stenosis were compared between the two groups, and significant predictors for posterior urethral restenosis, including pelvic bone fracture, were analyzed via multivariate analysis. Results: Of the patients, 92 had pelvic bone fractures and the other 105 patients did not. The patients with pelvic bone fracture had increased involvement of the prostatic urethra compared to the group without pelvic bone fracture (3.8% vs. 17.4%, p=0.002). Recurrence of urethral stenosis was more common in the pelvic bone fracture group (42/92, 45.7%) than the group without pelvic fracture (27/105, 25.7%). In a Kaplan—Meier analysis, the recurrence rate at 5 years was significantly lower in the pelvic bone fracture group (59.1% vs. 72.6%, p=0.003). A Cox proportional hazard analysis showed that the presence of pelvic bone injury was a significant predictor of posterior urethral re-stenosis. Conclusions: Patients with posterior urethral injuries associated with pelvic bone fracture had a higher recurrence rate of urethral stenosis after bulbomembranous anastomotic urethroplasty than those without pelvic bone fracture.

Detection of Y Chromosome Microdeletion is Valuable in the Treatment of Patients With Nonobstructive Azoospermia and Oligoasthenoteratozoospermia: Sperm Retrieval Rate and Birth Rate

최돈경,공인혁,황진호,오종진,홍재엽 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.2

Purpose: We evaluated clinical characteristics, sperm retrieval rates, and birth rates in a relatively large number of infertile patients with Y chromosome microdeletions. Materials and Methods: We retrospectively reviewed clinical data from 213 patients with nonobstructive azoospermia (NOA) and 76 patients with oligoasthenoteratozoospermia (OATS) who were tested for Y chromosome microdeletion from March 2004 to June 2011. Results: Of the 289 patients, 110 patients presented with Y chromosome microdeletion and 179 patients presented with no microdeletion. Among the patients with Y chromosome microdeletions, 83/110 (75.4%) were NOA patients and 27/110 (24.5%) were OATS patients. After subdividing the patients with Y chromosome microdeletion, 29 had azoospermia factor (AZF)b-c microdeletion and 81 had AZFc microdeletion. The sperm retrieval rate was similar between patients with Y chromosome microdeletion and those with no microdeletion (26.6% vs. 25.6%, p=0.298) after multiple testicular sperm extraction (TESE). Excluding 53 patients who did not undergo TESE, 30 patients were analyzed. All of the 9 men with AZFb-c microdeletion had a complete absence of sperm despite multiple TESE. However, multiple TESE was successful for 9 of 21 patients with only AZFc microdeletion (p=0.041). Twenty patients with Y chromosome microdeletion gave birth. Conclusions: In NOA and OATS patients, no significant difference in the sperm retrieval rate was shown between patients with Y chromosome microdeletion and those with no microdeletion. Patients with short Y chromosome microdeletion such as AZFc microdeletion have better prognoses for sperm retrieval and an increased chance of conception than do patients with larger microdeletions such as AZFb-c microdeletion.

전립선암의 수술적 치료

최돈경,서성일 대한의사협회 2015 대한의사협회지 Vol.58 No.1

With the recent increase in the elderly population, and the Westernization of the diet and increased consumption of meat products, a significant rise in the incidence of prostate cancer has been noted in the Republic of Korea. In cases with localized prostate cancer and sufficiently long life expectancy, the standard treatment is surgical resection of the prostate. Such surgical treatment is so far the only modality demonstrated through randomized prospective studies to be beneficial in terms of disease-specific survival; this procedure involves not only surgical removal of the prostate but also pelvic lymphadenectomy for accurate staging and neurovascular bundle preservation to aid in postoperative functional recovery. Prostatectomy can be carried out either with an open technique, laparoscopically, or under robot assistance. Reviews of the literature and meta-analyses have shown that laparoscopic and robot-assisted procedures offer significant reductions in blood loss and transfusion rates and advantages in terms of recovery from postoperative complications such as incontinence and impotence over open prostatectomy. However, no long-term oncologic outcomes are available for laparoscopic or robot-assisted procedures, and the long-term prevalence of incontinence and impotence for these two methods doesnot differ significantly from those for open prostatectomy, despite the laparoscopic and robot-assisted procedures being far more costly. Therefore, surgical treatment of prostate cancer should be carefully decided on following ample deliberation of various factors including the stage, age, comorbidities, and economic status of the patient and provision of sufficient information to the patient.

고속 슬롯링에서 개선된 DMCSL 프로토콜과 성능 분석

최돈경(Don-Kyoung Choi),송화선(Hwa-Sun Song),정영준(Young-Jun Chung) 한국정보과학회 1994 한국정보과학회 학술발표논문집 Vol.21 No.1

고속 슬롯 링 LAN상에서 실시간 동기 트래픽의 전송을 보장하면서 적은 동기 지연 변동을 제공하는 DMCSL[1] 프로토콜이 제안되었다. 그러나 DMCSL은 전송 속도 또는 링 길이의 증가, 즉 전송거리가 증가함에 따라 전송 모드 전환(동기/비동기 전송 모드)으로 인한 오버헤드가 증가하여 링크의 효율이 저하된다. 본 논문은 이러한 문제점을 개선한 EMCSL(Enhanced Mode Change Slotted Ring LAN) 프로토콜을 제안한다. 그리고 트래픽이 증가함에 따라 발생하는 스테이션의 기아현상을 예방하는 우선순위 제어 메카니즘을 제시한다. 또한 시뮬레이션을 통하여 ATMR, DMCSL 및 EMCSL의 처리율, 메세지 지연, 동기 트래픽 지연 변화를 비교하였다. 그 결과 EMCSL은 처리율, 메세지 지연, 동기 트래픽 지연 변동에서 우수한 성능을 보여 주었다.

전이성 신세포암에서 장기적 예후를 가질 수 있는 적절한 치료 방안

최돈경(Don-Kyoung Choi),서성일(Seong Il Seo) 대한비뇨기종양학회 2013 대한비뇨기종양학회지 Vol.11 No.2

Recent developments in the treatment of metastatic renal cell carcinoma (mRCC) will be discussed, with emphasis on data published over the past year. With recent improvements in the prognosis for patients with metastatic renal cell carcinoma (mRCC), focus is now shifting towards maximizing clinical benefit from targeted therapies. To achieve this goal, a number of factors which impact on treatment selection and outcomes need to be considered when treating patients with mRCC, such as the optimal sequence of targeted therapies. Futhermore, despite the absence of data from Phase III trials, available evidence suggests that some patients may benefit substantially from cytoreductive nephrectomy (CRN) in the era of targeted therapy. Results of ongoing and planned clinical trials, coupled with advances in the understanding of the underlying biology of RCC, are likely to contribute towards even greater improvements in the prognosis for patients with mRCC in the near future. The purpose of this review is to analyze and weigh the efficacy data available for the drugs approved for metastatic renal cell carcinoma and to suggest the best therapy based on the multiplicity of features of each patient in relation to the main characteristics of each agent.

B-ISDN 네트워크 트래픽 관리 기능 설계 ( The design of Network Traffic Management Functions in B-ISDN )

송화선,최돈경,정영준 한국통신학회 1995 한국통신학회 학술대회논문집 Vol.- No.-

Predictive factors of prolonged warm ischemic time (≥30 minutes) during partial nephrectomy under pneumoperitoneum

고광진,최돈경,신승제,유현수,김태선,송완,전황균,정병창,서성일 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.11

Purpose: Current clinical data support a safe warm ischemia time (WIT) limit of 30 minutes during laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). We evaluated independent factors predicting prolonged WIT (more than 30 minutes) after LPN or RPN. Materials and Methods: A retrospective data review was performed for 317 consecutive patients who underwent LPN or RPN performed by the same surgeon from October 2007 to May 2013. Patients were divided into two groups: group A was defined as prolonged WIT (≥30 minutes) and group B as short WIT (<30 minutes). We compared clinical factors between the two groups to evaluate predictors of prolonged WIT. Results: Among 317 consecutive patients, 80 were in the prolonged WIT group. Baseline characteristics were not significantly different between the groups. In the univariable analysis, PADUA (preoperative aspects and dimensions used for an anatomical) score (p=0.001), approach method (transperitoneal or retroperitoneal approach; p<0.001), and surgeon experience (p<0.001) were significantly associated with prolonged WIT. In the multivariable analysis, PADUA score (p=0.032), tumor size (≥25 mm; odds ratio, 2.98; 95% confidence interval, 1.48-5.96; p=0.002), and surgeon experience (p<0.001) were independent predictors of prolonged WIT. Conclusions: Surgeon experience, tumor size, and PADUA score predicted prolonged WIT after RPN or LPN. Among these factors, increasing surgical experience with LPN or RPN is the most important factor for preventing prolonged WIT.

Comparison of Immediate Primary Repair and Delayed Urethroplasty in Men with Bulbous Urethral Disruption after Blunt Straddle Injury

공인혁,오종진,최돈경,황진호,강문형,이영태 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.8

Purpose: The aim of this study was to analyze the outcomes of immediate primary repair (IPR) compared with delayed repair (DR) after initial suprapubic cystostomy. Materials and Methods: We reviewed the records of 60 patients with bulbous urethral disruption after blunt trauma from February 2001 to March 2011. Seventeen patients who presented in an acute injury state underwent IPR; 43 patients underwent DR after the initial suprapubic cystostomy. None of the patients had undergone previous urethral manipulation. We compared the outcomes, including stricture, impotence, and incontinence, between the two management approaches. We also measured the time to spontaneous voiding, the duration of suprapubic diversion, and the number of days spent in the hospital. Results: The median follow-up was 20.5 months (range, 13 to 59 months; mean, 23.3 months). Among 17 patients in the IPR group, strictures developed in 2 patients (11.7%), and among 53 patients in the DR group, strictures developed in 8 patients (18.6%, p=0.709). The incidences of impotence and incontinence were similar in both groups (17.6% and 0% in the IPR group vs. 27.9% and 4.6% in the DR group, p=0.520 and 1.000, respectively). The time to spontaneous voiding and the duration of suprapubic diversion were significantly shorter in the IPR group (average 27.3 and 33.4 days, respectively) than in the DR group (average 191.6 and 198.1 days, respectively; p<0.001 and <0.001). Conclusions: IPR may provide comparable outcomes to DR and allow for shorter times to spontaneous voiding and reduce the duration of suprapubic diversion. Purpose: The aim of this study was to analyze the outcomes of immediate primary repair (IPR) compared with delayed repair (DR) after initial suprapubic cystostomy. Materials and Methods: We reviewed the records of 60 patients with bulbous urethral disruption after blunt trauma from February 2001 to March 2011. Seventeen patients who presented in an acute injury state underwent IPR; 43 patients underwent DR after the initial suprapubic cystostomy. None of the patients had undergone previous urethral manipulation. We compared the outcomes, including stricture, impotence, and incontinence, between the two management approaches. We also measured the time to spontaneous voiding, the duration of suprapubic diversion, and the number of days spent in the hospital. Results: The median follow-up was 20.5 months (range, 13 to 59 months; mean, 23.3 months). Among 17 patients in the IPR group, strictures developed in 2 patients (11.7%), and among 53 patients in the DR group, strictures developed in 8 patients (18.6%, p=0.709). The incidences of impotence and incontinence were similar in both groups (17.6% and 0% in the IPR group vs. 27.9% and 4.6% in the DR group, p=0.520 and 1.000, respectively). The time to spontaneous voiding and the duration of suprapubic diversion were significantly shorter in the IPR group (average 27.3 and 33.4 days, respectively) than in the DR group (average 191.6 and 198.1 days, respectively; p<0.001 and <0.001). Conclusions: IPR may provide comparable outcomes to DR and allow for shorter times to spontaneous voiding and reduce the duration of suprapubic diversion.

Outcomes of Gleason Score ≤8 among High Risk Prostate Cancer Treated with 125I Low Dose Rate Brachytherapy Based Multimodal Therapy

박동수,공인혁,최돈경,황진호,신현수,오종진 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.5

Purpose: To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications. Materials and Methods: We reviewed the records of 50 high-risk PCa patients [clinical stage ≥T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score ≥8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period <3 years. Biochemical recurrence (BCR) followed the Phoenix definition. BCR-free survival rates were compared between the patients with Gleason score ≥9 and Gleason score ≤8. Results: The mean initial PSA was 22.1 ng/mL, and mean D90 was 244.3 Gy. During a median follow-up of 39.2 months, biochemical control was obtained in 72% (36/50) of the total patients; The estimated 3-year BCR-free survival was 92% for the patients with biopsy Gleason scores ≤8, and 40% for those with Gleason scores ≥9 (p<0.001). In Cox multivariate analysis, only Gleason score ≥9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade ≥3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively. Conclusion: Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score ≤8. Despite small number of subjects, biopsy Gleason score ≥9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.

Does Methylphenidate Affect Cystometric Parameters in Spontaneously Hypertensive Rats?

김계환,정하범,최돈경,박근호,조성태 대한배뇨장애요실금학회 2015 International Neurourology Journal Vol.19 No.2

. Purpose: Methylphenidate (MPH) is one of the most commonly prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract function. This study investigated changes in cystometric parameters after intragastric administration of MPH in conscious spontaneously hypertensive rats (SHRs), an animal model of ADHD. Methods: Fourteen- to 16-week-old male SHRs (n=10), weighing between 280 and 315 g, were used. Three micturition cycles were recorded before administering MPH. One hour after each intragastric MPH injection, three cycles of cystometrogram were obtained in the awake condition. Various cystometric parameters were evaluated, including basal pressure (BP), maximal pressure (MP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), micturition interval (MI), and residual volume (RV). The data were analyzed using paired Student t -tests. Results: Five SHRs were each administered a dose of 3-mg/kg MPH, and the other five received a dose of 6-mg/kg MPH. BP and MP increased significantly in the rats that received the 3-mg/kg MPH injection, but not in those that received the 6-mg/ kg injection. BC, MV, and MI significantly increased in the rats that received the 6-mg/kg MPH injection, but not in those that received the 3-mg/kg injection. There were no significant changes in TP after either injection. Conclusions: Significant increases in BC, MV, and MI after the 6-mg/kg MPH injection suggest that the peripheral and the central nervous systems may play important roles in bladder function in those receiving MPH for ADHD.