Non-invasive Parameters Predicting Bladder Outlet Obstruction in Korean Men with Lower Urinary Tract Symptoms

강민용,구자현,오승준 대한의학회 2010 Journal of Korean medical science Vol.25 No.2

The goal of this study was to evaluate the clinical and urodynamic features in Korean men with lower urinary tract symptoms (LUTS) and to determine non-invasive parameters for predicting bladder outlet obstruction (BOO). Four hundred twenty nine Korean men with LUTS over 50 yr of age underwent clinical evaluations for LUTS including urodynamic study. The patients were divided into two groups according to the presence of BOO. These two groups were compared with regard to age, the results of the uroflowmetry, serum prostate-specific antigen (PSA) level, prostate volume,International Prostate Symptom Score (I-PSS), and the results of the urodynamic study. Patients with BOO had a lower maximal flow rate (Qmax), lower voided volume,higher serum PSA level and larger prostate volume (P<0.05). BOO group had a significantly higher rate of involuntary detrusor contraction and poor compliance compared to the patients without BOO (P<0.05). The multivariate analysis showed that Qmax and poor compliance were significant factors for predicting BOO. Our results show that Qmax plays a significant role in predicting BOO in Korean men with LUTS. In addition, BOO is significantly associated with detrusor dysfunction, therefore, secondary bladder dysfunction must be emphasized in the management of male patients with LUTS.

방광요관역류 치료를 위한 Dextranomer/Hyaluronic Acid Copolymer 주사 요법에서의 술 후 결과 및 성공 예측 인자

강민용,박동수,이정원,백민기,최황,박용현 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.1

Purpose: We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer(Deflux) injection for vesicoureteral reflux(VUR) and analyze the factors predicting success. Materials and Methods: A total 99 patients(58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve. Results: The overall success rate was 62.3%(96/154) in refluxing ureter units(50.5% in patients). According to grade of VUR, the success rate was 87.5%(8/9), 82.2%(37/45), 67.8%(38/56), 33.3%(13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively(p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors(p<0.05). No significant surgery-related complications developed. Conclusions: Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology.

복강경하 근치적 전립선적출술의 학습 곡선 분석: 후치골 근치적 전립선적출술과의 비교

강민용,구자현,곽철,김현회 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.1

Purpose: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. Materials and Methods: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. Results: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p<0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p<0.05) and the transfusion rate(24.1% vs. 55%, respectively, p<0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p>0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. Conclusions: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naïve for prostate cancer surgery, the learning curve is overcome earlier than expected. (Korean J Urol 2008;49:18-23) Purpose: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. Materials and Methods: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. Results: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p<0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p<0.05) and the transfusion rate(24.1% vs. 55%, respectively, p<0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p>0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. Conclusions: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naïve for prostate cancer surgery, the learning curve is overcome earlier than expected. (Korean J Urol 2008;49:18-23)

경직장초음파 전립선침생검: 시술 전 관장의 유효성

강민용,박주현,곽철,백재승,김현회 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.3

Purpose: There are numerous biopsy protocols that have been described in the clinical literature. We especially assess the role of the use of an enema before a transrectal prostate biopsy by comparing the post biopsy- infectious complications rate. Materials and Methods: From January 2007 to August 2007 we retrospectively evaluated 302 men who underwent transrectal needle biopsy of the prostate according to the inclusion criteria. Patients in group 1(121 patients) did not receive an enema and were given oral ciprofloxacin(500 mg) for 3 days. Those in group 2(181 patients) received an enema before the biopsy and were also administered intravenous ciprofloxacin(400mg) and an additional oral form(500mg) for five days. Only complications related to infection were evaluated, that is, fever and chills with systemic inflammatory symptoms, within two weeks after the biopsy. Results: Patients demographics, such as age and prostate size did not differ between the two groups(p>0.05), but the level of prostate-specific antigen (PSA) in group 2 was significantly higher than in group 1 (12.70ng/ml versus 28.88ng/ml, p<0.05). The cancer detection rate was 36.1%(109/ 302) overall and there was no significant difference between the two groups(32.2% versus 38.7%, p>0.05). The infectious complications rate was 2.6%(8/302) overall and did not differ significantly between the two groups(2.5% versus 2.8%, p>0.05). Especially for group 2 patients, there were two cases of bacteremia and Escherichia coli was reported as the pathogen. Conclusions: Our findings suggest that the use of a pre-biopsy enema shows no significant benefit given the considerations of infectious complications rate, and the patient quality of life. (Korean J Urol 2008;49:248-251) Purpose: There are numerous biopsy protocols that have been described in the clinical literature. We especially assess the role of the use of an enema before a transrectal prostate biopsy by comparing the post biopsy- infectious complications rate. Materials and Methods: From January 2007 to August 2007 we retrospectively evaluated 302 men who underwent transrectal needle biopsy of the prostate according to the inclusion criteria. Patients in group 1(121 patients) did not receive an enema and were given oral ciprofloxacin(500 mg) for 3 days. Those in group 2(181 patients) received an enema before the biopsy and were also administered intravenous ciprofloxacin(400mg) and an additional oral form(500mg) for five days. Only complications related to infection were evaluated, that is, fever and chills with systemic inflammatory symptoms, within two weeks after the biopsy. Results: Patients demographics, such as age and prostate size did not differ between the two groups(p>0.05), but the level of prostate-specific antigen (PSA) in group 2 was significantly higher than in group 1 (12.70ng/ml versus 28.88ng/ml, p<0.05). The cancer detection rate was 36.1%(109/ 302) overall and there was no significant difference between the two groups(32.2% versus 38.7%, p>0.05). The infectious complications rate was 2.6%(8/302) overall and did not differ significantly between the two groups(2.5% versus 2.8%, p>0.05). Especially for group 2 patients, there were two cases of bacteremia and Escherichia coli was reported as the pathogen. Conclusions: Our findings suggest that the use of a pre-biopsy enema shows no significant benefit given the considerations of infectious complications rate, and the patient quality of life. (Korean J Urol 2008;49:248-251)

Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients

강민용,정창욱,곽철,김현회,구자현 대한의학회 2015 Journal of Korean medical science Vol.30 No.8

The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (≥ T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.

Poly (ADP-ribose) polymerase inhibitor: A new horizon in advanced prostate cancer treatment

강민용,전성수 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.5

The Characteristics of Recurrent Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy without Bladder Cuff Excision

강민용,구자현,정창욱,곽철,김현회 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: To investigate oncological outcomes based on bladder cuff excision (BCE) during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma(UTUC) and to provide clinical evidence of tumor recurrence in patients without BCE. Materials and Methods: We retrospectively collected data of 372 consecutive patients who underwent RNU at our institution from May 1989 through October 2010. After excluding some data, we reviewed 336 patients for the analysis. Results: Of the patients who underwent RNU with BCE (n=279, 83.0%) and without BCE (n=57, 17.0%), patients without BCE had poorer cancer-specific and overall survival rates. Among 57 patients without BCE, 35 (61.4%) experienced tumor recurrence. Recurrence at the remnant ureter resulted in poor oncological outcomes compared to those in patients with bladder recurrence,but better outcomes were observed compared to recurrence at other sites. No significant predictors for tumor recurrence at the remnant ureter were identified. In patients without BCE, pathological T stage [hazard ratio (HR), 5.73] and lymphovascular invasion (HR, 3.65) were independent predictors of cancer-specificsurvival, whereas age (HR, 1.04), pathological T stage (HR, 5.11), and positivetumor margin (HR, 6.50) were independent predictors of overall survival. Conclusion: Patients without BCE had poorer overall and cancer-specific survivalafter RNU than those with BCE. Most of these patients experienced tumor recurrenceat the remnant ureter and other sites. Patients with non-organ confined UTUC after RNU without BCE may be considered for adjuvant chemotherapy with careful follow-up.

Preventive Effects of Green Tea (Camellia Sinensis var. Assamica) on Diabetic Nephropathy

강민용,김현회,박용현,김봉섭,서수연,정병창,김정인 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.1

Purpose: This study aimed to evaluate the preventive effects of Camellia sinensis var. assamica (CSVA) on diabetic nephropathy in in vitro and in vivo models. Materials and Methods: MDCK cells were incubated with 1 mM of oxalate with or without different concentrations of CSVA, then MTT and malondialdehyde (MDA) assays were performed to investigate the preventive effects of CSVA on oxalate-induced cytotoxicity and oxidative stress. Thirty male db/db mice were divided into three groups. Group 1 were fed AIN-93G ad libitum; group 2 were fed AIN-93G mixed with 10% fermented CSVA ad libitum; group 3 were fed AIN-93G mixed with 10% non-fermented CSVA ad libitum. The mice were sacrificed 14 weeks later, and the serum glucose level, 24-hour urine chemistry, and morphological changes in the kidneys were examined. Results: As CSVA concentrations increased,viable MDCK cells increased in concentration. MDA production decreased over time in the CSVA treated group. The creatinine clearance of group 3 was lower than those of groups 1 and 2. The amount of urine microalbumin and protein in group 1 were higher than those in groups 2 and 3. Also, more glomerulus basement membrane foot processes were preserved in groups 2 and 3. Conclusion:In conclusion, CSVA has beneficial preventive tendencies towards diabetic nephropathy in both in vitro and in vivo models.

Liquid biopsy? A recent breakthrough in noninvasive bladder cancer surveillance

강민용,구자현 대한비뇨의학회 2016 Investigative and Clinical Urology Vol.57 No.5

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Conditional Survival and Associated Prognostic Factors in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Retrospective Study at a Single Institution

강민용,김형석,정창욱,곽철,김현회,구자현 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Purpose The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. Materials and Methods A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. Results UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. Conclusion Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.