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            • KCI등재

              남성하부요로증상의 병인

              이정구 대한비뇨의학회 2005 Investigative and Clinical Urology Vol.46 No.9

              In the past, older male with frequency, weak stream, hesitancy nocturia has prostatism implying his symptoms are related to benign prostatic hyperplasia(BPH). Recently, it was recognized that such symptoms are not a surrogate for BPH. Lower urinary tract symptoms(LUTS) have many causes, of which BPH is but one. The pathophysiology of LUTS is multifactorial. Bladder outlet obstruction(BOO) is one of the principal causes of LUTS: in addition to BOO, detrusor factors such as detrusor overactivity and detrusor underactivity can contribute to the development of LUTS. Of the men with LUTS, lots of them exhibited non-obstructed causes of LUTS in the urodynamic analysis. Increased awareness that there are multifactorial causes of LUTS became a force in changing the pattern of management. Therefore, relieving BOO such as debulking of the prostate mass may not be crucial for solution of LUTS. Aims of the treatment of LUTS also changed from the reducing obstruction and increasing the flow to the patient quality of life and satisfaction by using medical therapy such as alpha-adrenoceptor blockers. This review summarized the multifactorial causes of LUTS in men based on recent literatures 폐색과 노화 및 노화와 연관된 질환들, 신경계질환, 야간다뇨증, 호르몬변화 및 방광질환 등은 다양한 형태로 방광기능에 영향을 미쳐서 하부요로증상을 유발한다 (Table 1). 폐색과 노화의 연관성은 아직 명확하지 않으며 하부요로증상도 비특이성 증상이므로 폐색만으로 그 원인을 설명하기가 어렵다. 더욱이 배뇨근과활동성이나 수축력 저하 시에 나타나는 증상들은 폐색증상과 유사하다. 따라서 전립선비대증의 올바른 치료를 위해서는 하부요로증상을 유발하는 각각의 요인들을 정확하게 감별하는 일이 중요하다.폐색과 노화에 따른 배뇨근의 변화는 일반 조직검사에서는 큰 차이가 없으나, 전자현미경소견에서는 노화와 폐색, 배뇨근수축력저하, 배뇨근불안정 간에 뚜렷한 차이를 보인다. 최근 전립선비대증에 대한 진단이나 치료는 증상점수분석이나 요속검사 결과 등을 기준으로 하지만 두 가지 모두 하부요로증상의 원인적 진단을 내리는 데에는 부족하다. 현재로서는 폐색을 비롯한 하부요로증상의 정확한 진단은 압력요류검사를 포함한 요역동학검사로서만 가능하지만, 앞으로는 배뇨근조직에 대한 조직검사 소견에 의해 하부요로증상의 원인들을 감별할 수 있으리라 기대한다. 하부요로증상을 유발하는 여러 가지 복합적인 요인들에 대한 새로운 인식은 하부요로증상의 치료형태에 변화를 가져오고 있다. 따라서 하부요로증상을 치료하는 데 더 이상 폐색된 전립선비대를 제거하는 것만으로는 충분하지 않을 수 있다. 하부요로증상의 치료는 페색을 제거하고 요류를 향상시키는 목표로부터 환자의 만족도나 삶의 질을 증진시키는 방향으로 전환이 되고 있으며 이에 부응하는 알파아드레날린수용체차단제를 비롯한 다양한 약물치료들이 시도되고 있다.

            • KCI등재

              여성의 복압성요실금 치료를 위한 변형된 수술법인 Canal Transobturator Tape에 대한 예비보고

              이성훈,김태범,김계환,정한,이민성,윤상진 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.12

              Purpose: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate. Purpose: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate.

            • KCI등재

              줄기세포와 조직공학적 기법을 이용한 회장도관술 대체에 대한 예비연구

              이용석,조수연,김현우,강세희,김희연,이지영,권은비,이지열,홍성갑 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.3

              Purpose: We studied the feasibility and results of a tissue-engineered ileal conduit using a poly (ε-caprolactone) (PCL) nano-sheet seeded with muscle-derived stem cells to replace a conventional ileal conduit in rats. Materials and Methods: Muscle-derived stem cells were isolated from the gastrocnemius muscle of female Sprague-Dawley rats (200-250 g, n=6) by use of a preplate technique and were cultured on a PCL nano-sheet. The PCL nano-sheet was implanted into the omentum of rats and was then made into a conical shaped conduit. Rats were sacrificed 4 and 8 weeks after implantation, and morphologic changes were assessed by H&E and immunofluorescence staining, including DAPI staining and staining for myogenin and myosin heavy chain (MyHC). Results: All rats survived until the end of the experiment. A minimal inflammatory reaction was observed around the PCL nano-sheet in the 4 week specimens but was found to be reduced in the 8 week specimen. Muscle bundles were identified at week 4 as well as week 8 after implantation on H&E staining. Around the PCL sheet, immunostaining for both myogenin and MyHC were positive, indicating skeletal muscle differentiation and ingrowth into the PCL sheet. Conclusions: A PCL nano-sheet seeded with muscle-derived stem cells showed successful skeletal muscle differentiation at 4 and 8 weeks after implantation. This preliminary result supports the feasibility of a tissue-engineered ileal conduit using a PCL nano-sheet (seeded with muscle-derived stem cells) in place of conventional ileal conduits. Purpose: We studied the feasibility and results of a tissue-engineered ileal conduit using a poly (ε-caprolactone) (PCL) nano-sheet seeded with muscle-derived stem cells to replace a conventional ileal conduit in rats. Materials and Methods: Muscle-derived stem cells were isolated from the gastrocnemius muscle of female Sprague-Dawley rats (200-250 g, n=6) by use of a preplate technique and were cultured on a PCL nano-sheet. The PCL nano-sheet was implanted into the omentum of rats and was then made into a conical shaped conduit. Rats were sacrificed 4 and 8 weeks after implantation, and morphologic changes were assessed by H&E and immunofluorescence staining, including DAPI staining and staining for myogenin and myosin heavy chain (MyHC). Results: All rats survived until the end of the experiment. A minimal inflammatory reaction was observed around the PCL nano-sheet in the 4 week specimens but was found to be reduced in the 8 week specimen. Muscle bundles were identified at week 4 as well as week 8 after implantation on H&E staining. Around the PCL sheet, immunostaining for both myogenin and MyHC were positive, indicating skeletal muscle differentiation and ingrowth into the PCL sheet. Conclusions: A PCL nano-sheet seeded with muscle-derived stem cells showed successful skeletal muscle differentiation at 4 and 8 weeks after implantation. This preliminary result supports the feasibility of a tissue-engineered ileal conduit using a PCL nano-sheet (seeded with muscle-derived stem cells) in place of conventional ileal conduits.

            • KCI등재

              전립선비대증 환자에 대한 Doxazosin GITS의 12개월 투여 후 유효성과 안전성 평가

              정병하,김용수,홍성준 대한비뇨의학회 2005 Investigative and Clinical Urology Vol.46 No.5

              Purpose: The aim of this study was to assess the long-term efficacy and safety of doxazosin gastrointestinal therapeutic system(GITS) in Korean patients with benign prostatic hyperplasia(BPH) under usual care conditions. Materials and Methods: In this a 12-month, open-label, multicenter, noncontrolled, flexible-dose study, 475 men(≥40 years), with clinical evidence of BPH, were enrolled from 40 centers. Patients were evaluated at the baseline, and at 1, 2 and 6 months for dose adjustment, based on their treatment response(efficacy), and 12 months to assess the final efficacy. The primary efficacy variable was the Clinician's Global Assessment of Change(CGAC; improved, no change, or worse) and the secondary were the International Prostate Symptom Score(IPSS), quality of life(QoL), maximum flow rate(Qmax) and post void residual(PVR). The adverse events(AEs) and blood pressure(BP) were also recorded. Results: 186 patients completed the study. Most patients(n=155; 83.8%) improved, but 31(16.2%) had no change in symptoms based on the CGAC. The mean changes in the IPSS and QoL from the baseline were -9.0±6.8 and -1.6±1.4, respectively(both p<0.05). The Qmax and PVR were significantly improved compared with the baseline(Qmax 10.5±4.3 vs. 13.7±6.3, PVR 39.1±37.0 vs. 23.2±33.7, p<0.05). The decrease in the systolic and diastolic BP from the baselines in hypertensive patients(n=52) was significantly greater than in normotensive patients(n=134)(SBP/DBP -9.5±18.4/-13.4±10.9 vs. -3.3±12.5/-1.4±9.5, p<0.05). A total of 34 AEs related to the medication were reported(7.1%). The most frequently reported AEs were dizziness(2.7%), impotence(1.1%), dry mouth(0.8%) and postural hypotension(0.4%). Conclusions: Treatment with doxazosin GITS for 12 months resulted in significant improvements in the IPSS, QoL, Qmax and PVR, demonstrating its effectiveness and good tolerability as a long-term therapy for Korean BPH patients.

            • KCI등재
            • KCI등재

              삶의 질 향상에 영향을 미치는 야간뇨 횟수의 최소변화에 대한 연구

              심종백,이성호,김하영 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.3

              PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding <4 times per night, and Group II had severe nocturia with voiding ≥4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia (<4 times/night) and of 2 times in patients with severe nocturia (≥4 times/night) are needed to improve the QoL. PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding <4 times per night, and Group II had severe nocturia with voiding ≥4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia (<4 times/night) and of 2 times in patients with severe nocturia (≥4 times/night) are needed to improve the QoL.

            • KCI등재
            • KCI등재

              전립선비대증 환자에서 교육 후 전립선비대증에 대한 치료 관점의 변화

              강정윤,김선일,이해원,성도환,조진선 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.4

              Purpose: We assessed patients' understanding of benign prostatic hyperplasia (BPH) and their perspectives on the management of BPH through a questionnaire and evaluated changes in perspective after patient education. Materials and Methods: From December 2007 to February 2008, 5 university hospitals participated in the study. A self-administered questionnaire was developed and was completed by patients before and after the patients read the patient's guide. The questionnaire was composed of 22 questions, which were grouped into 4 different categories. The patient's guide was written in everyday words and was based on the American Urological Association patient's guide. Results: A total of 141 patients who visited the urology department for treatment of symptoms suggestive of BPH participated in the survey. Understanding about the statement, "BPH does not progress to become prostate cancer" was increased after reading the patient's guide (35.57%→73.87%, p<0.001). The most preferred treatment option was drug therapy (45.4%→56.7%). Among the desirable effects of drug therapy, the patients' preferences were amelioration of symptoms within a few weeks (51.1%→48.9%), reduction in prostate size (18.4%→24.1%), prevention of acute urinary retention (14.2%→13.5%), and prevention of prostate surgery (7.8%→8.5%). The potential side effect of drug therapy that patients were most concerned about was generalized weakness. Patients' reluctance to undergo surgery was increased after reading the patient guide (9.9%→23.4%, p=0.002). Conclusions: Patients have considerable misunderstanding about BPH. More efforts should be exercised in patient education and in the development of public education programs. Because patients expect not only rapid symptom improvement but also a reduction in prostate size, physicians should consider these points when treating patients with BPH. Purpose: We assessed patients' understanding of benign prostatic hyperplasia (BPH) and their perspectives on the management of BPH through a questionnaire and evaluated changes in perspective after patient education. Materials and Methods: From December 2007 to February 2008, 5 university hospitals participated in the study. A self-administered questionnaire was developed and was completed by patients before and after the patients read the patient's guide. The questionnaire was composed of 22 questions, which were grouped into 4 different categories. The patient's guide was written in everyday words and was based on the American Urological Association patient's guide. Results: A total of 141 patients who visited the urology department for treatment of symptoms suggestive of BPH participated in the survey. Understanding about the statement, "BPH does not progress to become prostate cancer" was increased after reading the patient's guide (35.57%→73.87%, p<0.001). The most preferred treatment option was drug therapy (45.4%→56.7%). Among the desirable effects of drug therapy, the patients' preferences were amelioration of symptoms within a few weeks (51.1%→48.9%), reduction in prostate size (18.4%→24.1%), prevention of acute urinary retention (14.2%→13.5%), and prevention of prostate surgery (7.8%→8.5%). The potential side effect of drug therapy that patients were most concerned about was generalized weakness. Patients' reluctance to undergo surgery was increased after reading the patient guide (9.9%→23.4%, p=0.002). Conclusions: Patients have considerable misunderstanding about BPH. More efforts should be exercised in patient education and in the development of public education programs. Because patients expect not only rapid symptom improvement but also a reduction in prostate size, physicians should consider these points when treating patients with BPH.

            • KCI등재

              사춘기와 성년기 흰쥐에서 고환염전에 의한 대측고환 손상 차이에 대한 연구

              정성진,최우석,하승범,정민수,정재승,백민기,홍성규,최황 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.7

              Purpose: Our study aimed to determine whether the severity of damage to the contralateral testis by ipsilateral testicular torsion/detorsion in pubertal rats, which have an incomplete blood-testis barrier, is different from that in adult rats. Materials and Methods: We divided pubertal (6 weeks, n=17) and adult (10 weeks, n=17) Sprague-Dawley (SD) rats into group S (sham; n=5), group O (orchiectomy; n=6), and group D (detorsion; n=6). After 4 hours' torsion of the ipsilateral testis, we applied orchiectomy (group O) and detorsion (group D) depending on the group and compared the histopathologic changes and germ cell apoptosis of the contralateral testis at the age of 13 weeks. Results: In each age group, increased interstitial area, edema, and germ cell sloughing were observed in group D. The mean seminiferous tubule diameter decreased more in group D than in group S or O in each age group (p<0.05). The mean germ cell layer thickness and number of spermatids per tubule decreased more in group D than in group S or O in each age group; additionally, in group D, values decreased more in pubertal rats than in adult ones (p<0.05, respectively). The mean numbers of terminal deoxyuridine nick-end labeling (TUNEL)-positive cells were less than 1.0 in groups S and O, which was smaller than in group D (p<0.05); additionally, in group D, this value tended to be higher in pubertal rats than in adult ones (p=0.057). Conclusions: SD rats with a detorsioned testis had more severe damage to the contralateral testis than did those undergoing orchiectomy of the torsioned testis. Also, when comparing the severity of damage to the contralateral testis after ipsilateral torsion/detorsion between pubertal and adult rats, rats at a pubertal age, when most testicular torsions occur in clinical situations, had more severe damage than did those at an adult age. Purpose: Our study aimed to determine whether the severity of damage to the contralateral testis by ipsilateral testicular torsion/detorsion in pubertal rats, which have an incomplete blood-testis barrier, is different from that in adult rats. Materials and Methods: We divided pubertal (6 weeks, n=17) and adult (10 weeks, n=17) Sprague-Dawley (SD) rats into group S (sham; n=5), group O (orchiectomy; n=6), and group D (detorsion; n=6). After 4 hours' torsion of the ipsilateral testis, we applied orchiectomy (group O) and detorsion (group D) depending on the group and compared the histopathologic changes and germ cell apoptosis of the contralateral testis at the age of 13 weeks. Results: In each age group, increased interstitial area, edema, and germ cell sloughing were observed in group D. The mean seminiferous tubule diameter decreased more in group D than in group S or O in each age group (p<0.05). The mean germ cell layer thickness and number of spermatids per tubule decreased more in group D than in group S or O in each age group; additionally, in group D, values decreased more in pubertal rats than in adult ones (p<0.05, respectively). The mean numbers of terminal deoxyuridine nick-end labeling (TUNEL)-positive cells were less than 1.0 in groups S and O, which was smaller than in group D (p<0.05); additionally, in group D, this value tended to be higher in pubertal rats than in adult ones (p=0.057). Conclusions: SD rats with a detorsioned testis had more severe damage to the contralateral testis than did those undergoing orchiectomy of the torsioned testis. Also, when comparing the severity of damage to the contralateral testis after ipsilateral torsion/detorsion between pubertal and adult rats, rats at a pubertal age, when most testicular torsions occur in clinical situations, had more severe damage than did those at an adult age.

            • KCI등재

              비뇨기과 복강경 수술 후 발생하는 내과적 합병증 발생에 영향을 미치는 인자에 대한 연구

              이상협,유구한,민경은,이형래,장성구,전승현 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.8

              Purpose: Factors related to nonurologic postoperative complications of laparoscopic surgery in the urologic area were examined. The most significant factors were isolated and analyzed to establish ways to reduce the complication rate. Materials and Methods: The medical records of 154 patients who had undergone laparoscopic surgery between March 2004 and March 2008 were reviewed. Age, anesthetic time, American Society of Anesthesiologists physical status classification, operative difficulty, blood loss (ml), body mass index (BMI), and complications were assessed. Complications were divided into 5 groups based on the modified Clavien classification. Grade 0 to 1 was defined as a no complication group and grades 2 to 5 as a complication group. The Armitage trend test was performed to study the relations between the factors and the complications. Univariate and multivariate analyses were performed to determine the risk ratio of each of the factors and the most significant factors. Results: Complications tended to increase as the anesthetic risk and anesthetic time increased (p=0.011, 0.013, respectively). Operative difficulty and blood loss were related to complications (p=0.018, p<0.001, respectively). The univariate analysis revealed that blood loss of more than 400 ml compared with less than 200 ml had a risk ratio of 18.2. Moderate and hard operative difficulties had a significant risk ratio of around 4, and high anesthetic risk had a high risk rate of around 5. The multivariate analysis showed that blood loss and high anesthetic risk were independent risk factors of complications. Conclusions: Blood loss and high anesthetic risk proved to be independent factors that are associated with complications. Surgeons must keep in mind the patient's anesthetic risk and try to minimize blood loss during the operation to reduce complications after a laparoscopic surgery.

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