Skeletal Muscle Metastases from Urothelial Cell Carcinoma

두승환,김웅빈,김봉기,양원재,윤종현,송윤섭,최인호 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.1

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.

A Case of Tuberculous Prostatitis with Abscess

두승환,송윤섭,김재헌,양원재,김순임,이동화,홍성숙 대한남성과학회 2012 The World Journal of Men's Health Vol.30 No.2

We present a case of acute prostatitis with abscess. The patient had undergone intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. A prostate biopsy demonstrated tuberculous prostatitis with abscess. This case illustrates that when bladder cancer is treated with BCG, a tuberculous prostate abscess can develop.

Strong Impact of Nocturia on Sleep Quality in Patients with Lower Urinary Tract Symptoms

두승환,송윤섭,이홍준,Jin Ahn,김재헌,윤종현,양원재 대한남성과학회 2012 The World Journal of Men's Health Vol.30 No.2

Purpose: Nocturia is a bothersome symptom that impacts sleep quality in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). This study was performed to evaluate the impact of nocturia on sleep quality. Materials and Methods: A total of 58 male patients with LUTS/BPH were enrolled. LUTS/BPH patients without nocturia were included in the control group. The inclusion criteria were eight or more points on the International Prostate System Score (IPSS) including more than one episode of nocturia and a prostate volume larger than 20 ml. IPSS, prostate volume, uroflowmetry, and the Pittsburgh Sleep Quality Index (PSQI) from each patient were recorded. Results: Patients with nocturia showed a higher mean global PSQI (8.5±0.4) than patients without nocturia (4.82±0.4) (p<0.01). Patients with nocturia showed a higher percentage of severe sleep disorders (74.1%) than patients without nocturia (35.3%) (p<0.01). The regression coefficient between the number of episodes of nocturia and mean global PSQI was 0.42 (p<0.01). Conclusions: Patients with nocturia showed poor sleep quality, and this was related to the number of episodes of nocturia. This suggests that nocturia has a strong impact on sleep quality in patients with LUTS/BPH.

체외충격파쇄석술 시 환자와 시술자에게 가해지는 방사선량

두승환,양원재,송윤섭,박영호,이경화 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.2

Purpose: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). Materials and Methods: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. Results: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. Conclusions: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL. (Korean J Urol 2008;49:155-159) Purpose: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). Materials and Methods: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. Results: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. Conclusions: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL. (Korean J Urol 2008;49:155-159)

Impact of Nocturia on Abnormal Daytime Sleepiness in Men with Lower Urinary Tract Symptoms/Benign Prostate Hyperplasia

두승환,송윤섭,Hong Jun Lee,양원재,Hong Cheol Ahn,Jung Hoon Kim,Si Jung Park,Jin Ahn 대한남성과학회 2012 The World Journal of Men's Health Vol.30 No.1

Purpose: Nocturia is one of the most bothersome lower urinary tract symptoms (LUTS). The aim of the present study is to determine whether severe-nocturia have impact on the abnormal daytime sleepiness in men with LUTS/benign prostate hyperplasia (BPH). Materials and Methods: Severe-nocturia was classified as twice or more per night. A total of 85 men met the criteria and constituted the study cohort. The patients had a detailed clinical evaluation, including a complete history, physical examination, urine analysis, urine culture, a digital rectal examination, serum prostate-specific antigen (PSA) level, prostate volume by transrectal ultrasonography, uroflowmetry and postvoid residual urine volume. LUTS and symptom-specific quality of life (QoL) were assessed using the IPSS. Patients were asked to complete an Epworth Sleepiness Scale questionnaire for daytime sleepiness. Results: 43 patients had less than one, 42 patients had more than two episodes of nocturia. There was no significant difference of age, total prostate volume, PSA levels between patients with mild-nocturia and severe-nocturia. There was no significant difference of maximum flow rate (Qmax), voided volume and postvoid residual urine volume (PVR) between patients with mild-nocturia and severe-nocturia. There was significant decrease of total International Prostate Symptom Score (IPSS) scores and QoL index in patients with severe-nocturia compared in patients with mild-nocturia. The number of patients with abnormal daytime sleepiness in mild-nocturia and severe-nocturia were 4.7% (2/43), 16.7% (7/42), respectively (p<0.05). Regression coefficiency between percent of nocturia and total score of daytime sleepiness was significant (p<0.05) and regression coefficient (R) was 0.29. Conclusions: Our results indicate that severe-nocturia had impact on the abnormal daytime sleepiness in patients with LUTS.

Metastasis of Renal Cell Carcinoma to the Bladder

두승환,김웅빈,김봉기,양원재,윤종현,진소영,송윤섭 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.1

Renal cell carcinoma is an uncommon source of bladder metastases. Here we report a case of renal cell carcinoma that metastasized to the bladder. A 73-year-old woman complained of gross hematuria. Abdominopelvic computerized tomography showed a bladder mass and a heterogenous enhancing mass in the lower pole of the left kidney with left vein thrombosis. The pathological analysis of the resected bladder specimen revealed metastatic renal cell carcinoma of the clear cell type.

Suprapubic Cystostomy: Risk Analysis of Possible Bowel Interposition Through the Percutaneous Tract by Computed Tomography

조규형,두승환,양원재,송윤섭,이경화 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.10

Purpose: The most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract. Materials and Methods: From September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site. Results: A total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (≤11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract. Conclusions: When performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus. Purpose: The most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract. Materials and Methods: From September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site. Results: A total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (≤11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract. Conclusions: When performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus.

Effects of Obesity on Prostate Volume and Lower Urinary Tract Symptoms in Korean Men

김근우,두승환,양원재,송윤섭 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.5

Purpose: We investigated the effects of obesity on prostate volume (PV) and lower urinary tract symptoms (LUTS) in Korean men. Materials and Methods: From December 2007 to 2009, a total of 10,383 ostensibly healthy Korean men aged ≥50 years visited our health promotion center for a routine check-up. Among them, 872 men who wanted a prostate evaluation were enrolled in this study. All men underwent detailed clinical evaluations with the International Prostate Symptom Score (IPSS) questionnaire. Anthropometric measurements, including height, weight, and waist and hip circumferences, were determined. A blood sample was obtained for serum prostate-specific antigen (PSA) measurement. Thereafter, a digital rectal examination and transrectal ultrasound were performed. Results: In total, 465 men with moderate to severe LUTS (IPSS≥8 points) were included in this prospective study. The participants’ mean age was 57.2 years. Multivariate analysis demonstrated that only waist circumference was a significant factor in predicting PV besides age and serum PSA. The univariate analysis showed no statistically significant relations between any of the obesity-related parameters and LUTS. The PV was also not correlated with LUTS. Conclusions: Central obesity is the more important predictor of PV than overall obesity. There are no significant relations between obesity-related parameters and LUTS.

와파린 복용 중단과 연관된 음경지속발기증

송미호,두승환,양원재,송윤섭 대한남성과학회 2010 The World Journal of Men's Health Vol.28 No.2

Priapism attributable to an anticoagulant drug has rarely been reported. Although the pathophysiology of this type of priapism is not well understood, most investigators contend that thromboembolic phenomena play either a causative or supportive role. We describe a case of priapism associated with the discontinuation of oral warfarin.

Value and Safety of Midazolam Anesthesia during Transrectal Ultrasound-Guided Prostate Biopsy

송진현,두승환,양원재,송윤섭,김근우,구자현,이창호 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.3

Purpose: Although transrectal ultrasound-guided prostate biopsy is useful for diagnosing prostate cancer, it is a painful procedure. There are many methods for providing pain relief and for treating discomfort during the procedure, but occasionally these are reported to be of limited use. We aimed to evaluate the value and safety of midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy. Materials and Methods: From August 2008 to December 2009, 104 male patients, who were examined with transrectal ultrasound-guided prostate 12-core biopsy, were randomly assigned to two groups. Group 1 (n=51) received ketorolac (TarasynⓇ) 30 mg. Group 2 (n=53) was treated with midazolam (DormicumⓇ) 3 mg, which was increased to 5 mg if necessary. Immediately after the procedure, the patients were asked to rate their comfort level by using a 10-point visual analog self-assessment pain scale. Results: The pain scale in group 2 was significantly lower than that in group 1 (p<0.05). The patients assigned to group 2 experienced no side-effects from midazolam and were more satisfied than the patients in group 1 (p<0.05). Conclusions: Midazolam anesthesia relieves pain effectively, and the patient’s satisfaction is better than with conventional transrectal ultrasound-guided prostate biopsy. Midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy is useful and safe.