Feasibility study of a novel rectal cooling system for hypothermic radical prostatectomy in a swine model

송원훈,선인영,장관,이정훈,정재현,이정찬,김희찬,정창욱 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.4

Thermal damage and inflammatory responses of the sphincter and neurovascular bundles (NVBs) are responsible for post-prostatectomy incontinence and erectile dysfunction. Intraoperative hypothermia in the pelvic cavity may reduce the occurrence of these complications. We evaluated the feasibility of a novel rectal cooling system using an animal model. A novel rectal cooling system consisting of a cooling console and a multi-lumen rectal balloon was developed. We conducted animal tests on male pigs to evaluate the efficacy and safety of the system. The primary endpoint was to maintain the temperature of the NVBs at 25℃ (±5℃) during and after the electrocauterization of the bladder neck for 10 seconds. The safety endpoint was device-related complications or significant changes in the core body temperature of the pigs. The NVB temperature was below 30℃ within 3 minutes of activation of the rectal balloon. The temperature of the proximal NVB was consistently maintained below 25℃ in all cases. The temperature 1 cm from the bladder neck did not rise above 38°C and dropped to the initial level within 1 minute after electrocauterization. During cooling, the minimum temperature at the apex of the prostate was reduced to 10.1℃. There were no device-related complications or significant changes in core body temperature throughout the experiment. Animal tests suggest the feasibility and safety of this novel rectal cooling system. A first-in-human trial to assess the safety and efficacy of this system during radical prostatectomy is warranted.

Animal model evaluation of a novel renal denervation system for future laparoscopic treatment of resistant hypertension

송원훈,백진환,양선철,최의근,박성민,정창욱 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.1

Purpose: Although percutaneous catheter-based ablation of renal sympathetic nerve fibers has been used in the treatment of patients with resistant hypertension, a recent phase III study did not confirm its efficacy. In this study, we developed a novel laparoscopic renal denervation system and evaluated its safety and initial feasibility using an animal model. Materials and Methods: A novel surgical instrument that uses a smart algorithm with temperature-monitoring feedback was developed. We used 4 male pigs (6 weeks old, weighing approximately 45 kg each) to evaluate the safety and efficacy of the laparoscopic renal denervation system. We performed immunohistochemical staining analysis after renal denervation using various tip temperatures and over various durations through an open approach. Results: When the temperature of the outer wall of the renal artery was maintained at 90℃ for 180 seconds, the artery was completely denervated without damaging its inner layer, as evaluated using Masson's trichrome staining. When the temperature ranged from 70℃ to 90℃ and the duration ranged from 90 to 420 seconds, partial or complete denervation without significant vessel injury was confirmed with anti- growth-associated protein 43 and anti-S100 staining. Conclusions: This animal study confirmed the safety and feasibility of the novel laparoscopic renal denervation system. A safe and effective protocol was developed with ablation at a constant tissue temperature of 70℃ to 90℃ within 180 seconds. However, further developments are necessary before its clinical use.

Prostate Cancer in a Patient with a Family History of BRCA Mutation: a Case Report and Literature Review

송원훈,김성한,정재영,박원서,서호경,정진수,이강현 대한의학회 2017 Journal of Korean medical science Vol.32 No.2

One of the most significant risk factors for prostate cancer (PC) is a family history of the disease, with germ-line mutations in the breast cancer predisposition gene (BRCA) 2 conferring the highest risk. We here report a 56-year-old man presented with painful gait disturbance and diagnosed PC with multiple disseminated bone metastases. The patient had a strong family history of breast cancer with his 2 nieces affected. Furthermore, his aunts and uncles from both sides were diagnosed with stomach, ovarian, and colorectal cancers. His genomic sequencing analysis of the BRCA genes revealed the same BRCA2 deleterious mutation that his breast cancer-affected nieces carried. Previous studies have suggested that BRCA2-mutated PC is associated with a more aggressive phenotype and poor prognosis. Our experience in the present case also indicated the urgent needs for novel treatment modality and PC screening in this high-risk group of patients.

Changes in the Prevalence and Risk Factors of Erectile Dysfunction during a Decade: The Korean Internet Sexuality Survey (KISS), a 10-Year-Interval Web-Based Survey

송원훈,Juhyun Park,Sangjun Yoo,Sohee Oh,Sung Yong Cho,Min Chul Cho,Hyeon Jeong,Hwancheol Son 대한남성과학회 2019 The World Journal of Men's Health Vol.37 No.2

Purpose: Although the prevalence of erectile dysfunction (ED) can be affected by social changes, this association has not been well evaluated. We aimed to evaluate the prevalence and risk factors of ED through a 10-year-interval web-based sur-vey using the previous database of same group of panels, with same methodology. Materials and Methods: We sent e-mails and surveyed the panels registered in the Internet survey agency. Results: In total, 900 participants were recruited in 2016. The age-adjusted overall prevalences of self-reported ED (self-ED) and International Index of Erectile Function-5-assessed ED (IIEF-5-ED; score ≤21) in the 2016 study were 3.2% and 44.8%, respectively, which were lower than the prevalences of 8.1% (p=0.036) and 51.4% (p=0.323), respectively, in the 2006 study. The risk factors of IIEF-5-ED in their 20s and 30s in 2016 were psycho-social factors such as depression, low frequency of conversation about sex with sexual partner. The risk factors of IIEF-5-ED in their 40s to 60s in 2016 were organic factors, such as hypertension, diabetes mellitus, smoking, alcohol use, and self-reported premature ejaculation. Conclusions: Although the age-adjusted overall prevalence of self-ED has decreased during a decade, there was no differ-ence in the age-adjusted overall prevalence of IIEF-5-ED. Psycho-social support may be important for young men with ED and overall healthcare can be helpful for elderly men with ED.

신장암 표준임상빅데이터 구축 및 머신러닝 기반 치료결정지원시스템 개발

송원훈,박미영 한국산업융합학회 2022 한국산업융합학회 논문집 Vol.25 No.6

Since renal cell carcinoma(RCC) has various examination and treatment methods according to clinical stage and histopathological characteristics, it is required to determine accurate and efficient treatment methods in the clinical field. However, the process of collecting and processing RCC medical data is difficult and complex, so there is currently no AI-based clinical decision support sy stem for RCC treatments worldwide. In this study, we propose a clinical decision support system that helps clinicians decide on a precision treatment to each patient. RCC standard big database is built by collecting structured and unstructured data from the standard common data model and electronic medical information system. Based on this, various machine learning classification algorithms are applied to support a better clinical decision making.

머신러닝을 활용한 신장암의 임상적치료결정지원시스템 개발

박미영,송원훈 한국지능시스템학회 2023 한국지능시스템학회논문지 Vol.33 No.2

There are various treatment methods for kidney cancer depending on the clinicalstage and histopathological characteristics. Therefore, accurate and efficient treatmentdecisions are urgently needed in the clinical field. In this study, we propose asystem that supports clinicians to determine personalized treatments for kidneycancer patients. To develop the system, data from patients diagnosed with kidneycancer who visited Pusan National University Yangsan Hospital from 2008 to 2021were collected and Decision Tree machine learning algorithm is applied. In addition,feature selection is applied to find out the effect of the number of features onclassification among the entire feature set. Among the feature sets, 50 features fromfeature selection and 50 features from prior knowledge were compared. As a result,the performance tended to increase as the number of features increased, and using50 features based on prior knowledge showed slightly better performance than theresult of selecting 50 items through feature selection. Therefore, it would beconsidered that the system developed in this study is reliable. 신장암은 임상 병기 및 조직병리학적 특성에 따라 다양한 치료법이 존재하므로 임상 현장에서 정확하고 효율적인 치료 결정이 시급한 상황이다. 본 연구에서는 임상의들이 환자별 맞춤형 치료 방법을 결정하도록 지원하는 시스템을 제안한다. 시스템 개발을 위해 2008년부터2021년까지 양산부산대학교병원을 내원한 신장암 진단 환자들의 데이터를 수집하고, DecisionTree 머신러닝 알고리즘을 적용한다. 또한 전체 특징(feature) 집합 중 특징집합의 수가 분류에미치는 영향을 알아보기 위해 feature selection을 적용한다. Feature selection으로 선택한50개의 특징과 임상의가 직접 추출한 50개의 특징에 대한 머신러닝 성능을 비교한 결과, 특징의 수가 증가할수록 성능이 높아지는 경향을 보였고, 사전 지식을 바탕으로 특징을 사용할경우 feature selection을 적용한 결과보다 조금 더 나은 성능을 보였다. 따라서, 본 연구에서개발한 시스템의 성능은 신뢰할 만하다고 판단되며, 추후 개발 시스템을 활용하여 의료현장에서 임상의와 환자의 시간과 경제적 비용이 절감될 것을 기대할 수 있다.

External validation of European Association of Urology NMIBC risk scores to predict progression after transurethral resection of bladder tumor in Korean patients with non-muscle-invasive bladder cancer

김재연,이단비,송원훈,이승수,박성우,남종길 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.5

Purpose: This study aimed to validate the newly proposed risk model in Korean patients diagnosed with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods: A retrospective review was performed with 1,238 patients who underwent transurethral resection of bladder tumor from 2009 to 2020. We included 973 patients and categorized them into four risk groups according to the European Association of Urology (EAU) NMIBC risk stratification standards, which incorporate the World Health Organization 2004/2016 grading classification. Kaplan–Meyer survival analysis and multivariable analysis of time to progression were performed to calculate the probability of progression for all risk groups. Results: A total of 973 patients were followed for 54.85 months. Patients were classified according to the risk factors proposed by the new NMIBC risk table and stratified into low, intermediate, high, and very high-risk groups based on the table. Cancer progression into muscle-invasive bladder cancer (MIBC) in each risk group was observed in 7 (4.4%), 24 (15.2%), 76 (48.1%), and 51 (32.3%) individuals, respectively. The progression rate was distinguishable between risk groups in the Kaplan–Meier progression-free survival analysis, and higher risk was associated with a higher rate of progression. The new NMIBC risk variables were demonstrated to have prognostic value in the multivariate analysis. The very high-risk group was associated with progression to muscle-invasive disease. Conclusions: This study demonstrates that the new EAU NMIBC risk group categorization is feasible in predicting the progression of NMIBC into MIBC in the Korean population and thus should be applied to clinical practice in Korea.

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

김태언,백승룡,송원훈,남종길,이현정,박성우 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.6

Purpose: To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). Materials and Methods: Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI. Results: PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases. Conclusions: Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.

Corrigendum: Correction of the Affiliation. Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

김태언,백승룡,송원훈,남종길,이현정,박성우 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.6

Clinical Outcomes of Patients With Variant Histology of Urothelial Carcinoma After Radical Cystectomy

이단비,김재연,이윤하,송원훈,이승수,박성우,남종길 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.3

Purpose: The efficacy of standard chemotherapy or radical cystectomy in patients who have urothelial tumors with variant histology (VH) is very limited in terms of their prognosis. This study aimed to investigate the prognosis of bladder cancer (BC) patients with VH who underwent radical cystectomy (RC). Materials and Methods: We retrospectively evaluated 327 BC patients who underwent RC at Pusan National University Yangsan Hospital between February 2010 and June 2021. VH was categorized into less and more aggressive types according to the patient’s mortality risk relative to pure urothelial carcinoma (PUC). More aggressive types included micropapillary, plasmacytoid, and sarcomatoid variants. Less aggressive types comprised other variant types, including squamous differentiation, glandular differentiation, lipoid, and nested. Small cell carcinoma, pure adenocarcinoma, pure squamous cell carcinoma, and lymphoma BC were excluded from analysis. The progression-free survival (PFS) and overall survival (OS) rates were evaluated using Kaplan-Meier analysis and Cox regression. Results: After the exclusion of nonurothelial tumors, data from 299 patients were available for analysis. We identified 244 (74.6%) and 55 patients (16.8%) with PUC and urothelial carcinoma with VH, respectively. VH patients were categorized as having less aggressive (n=35) and more aggressive (n=20) types. Univariate analysis identified significant differences in PFS (p=0.031) between patients with PUC (n=244) and more aggressive VH (n=20). Multivariate analysis showed that more aggressive VH was significantly associated with OS and PFS. In the Kaplan-Meier analysis, a statistically significant difference was observed between PUC and more aggressive VH in OS and PFS. Conclusions: VH patients with more aggressive types showed more advanced TNM stages at presentation than PUC patients. Pathological upstaging after RC was more common in VH patients. Among VH patients, the presence of a more aggressive VH type can be an independent predictor of progression after RC, with a worse prognosis than that of PUC patients.