Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

이한이,김병원,윤현식,서준교,오승준 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.3

Purpose: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH). Methods: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/ mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the lowand high-PSA groups. Results: The baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized. Conclusions: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

유아기 우식증과 치아 우식 예방에 대한 학령전 어린이 부모의 지식과 태도

이한이,김재곤,이대우,양연미 대한소아치과학회 2018 大韓小兒齒科學會誌 Vol.45 No.4

To investigate knowledge and attitude of parents about early childhood caries and dental caries prevention, a questionnaire survey was conducted on 247 parents of children who had oral screening experience among 3 to 5 years old children in 3 kindergartens in Jeonju city. A total of 220 completed questionnaires were selected for final analysis. The overall perception of the parents about oral health of the children was 82.3 points (10.7 / 13) in terms of 100 points. There were statistically significant correlations between maternal age (p = 0.027), maternal education level (p = 0.002), household monthly income (p = 0.000) and maternal oral health knowledge level. The main source of oral health information was ‘dentist and dental hygienist’(83.6%) followed by ’Web search’(22.3%). Compared with the previous studies, the level of knowledge of parents about oral health of the children was improved. However, in order to raise awareness of the parents about the poorly assessed items in this study, it is necessary to increase the participation rate by advertising the national dental screening program for infants and children and make efforts to improve the quality of oral health education in screening. 유아기 우식증과 이의 예방에 대해 어린이의 부모가 가지는 구강건강 지식 및 태도와 이에 영향을 미치는 요소의 평가를 목적으로, 전주시 소재 유치원 3개소의 만 3 - 5세 어린이 중 최소 1회 이상의 영유아 구강검진 경험이 있는 어린이의 부모 247명을 대상으로 설문조사를 시행하였다. 220명의 보호자의 설문지가 최종 분석을 위해 채택되었다. 어린이 구강건강에 대한 어머니의 전반적 인식은 100점 만점으로 환산하였을 때 82.3점(10.7/13개)으로 비교적 양호하였고, 어머니의 구강건강 지식수준과 어머니의 연령(p = 0.027), 교육수준(p = 0.002), 가계 월수입(p = 0.000)은 통계적으로 유의미한 상관관계가 있었다. 구강건강에 관한 정보의 주된 습득경로는 치과 의료진(83.6%)이었고, 웹 검색(22.3%)이 뒤를 이었다. 결론적으로 과거의 연구에 비해 보호자의 구강건강 지식수준은 향상되었다. 그러나 이 연구에서 미흡하게 평가된 항목에 대한 보호자의 인지도를 개선하기 위해서는, 영유아 구강검진 사업에 대한 홍보를 강화하여 수검률을 높이고, 구강검진 시 행해지는 구강 보건교육의 질을 향상시키기 위한 노력이 필요하다고 판단된다.

초등학교 어린이의 평균 구순폐쇄력과 이에 영향을 미치는 요소

이한이,백경희,김재곤,이대우,양연미 대한소아치과학회 2019 大韓小兒齒科學會誌 Vol.46 No.4

Abnormal orofacial functions such as lip incompetency in the period of growth and development can cause morphological anomalies of the craniofacial complex. Therefore, it is crucial to make an early diagnosis based on the evaluation of the myofunctional conditions, and to make appropriate treatment plans. The objectives of this study were to quantitatively evaluate the standard lip closing force (LCF) of each age in the elementary school children, and to evaluate the relationships between LCF and affecting factors. The sample consisted of 765 children who were 7 - 12 years old in Jeonju city. Clinical examination about occlusal conditions and lip competency, and LCF measurement were performed by a single examiner. LCF was measured three times for each children with the LCF measuring device. The LCF was correlated positively with age in both sexes. The distribution of LCF groups was correlated significantly with Angle’s classes and lip competency (p = 0.016, 0.004). The proportion of children with high LCFs was greater in the “competent lip” group, whereas the proportion of those with low LCFs was greater in the “incompetent lip” group. 성장기 어린이에게서 나타나는 구순폐쇄 부전은 구강기능 및 구강 주위 조직의 구조적 발달 이상을 초래하게 되며, 이는 구강안면근기능 이상으로 발전된다. 이처럼 입술을 다무는 것은 필수적이고 중요한 행동이므로, 입술을 다무는 힘을 측정하는 것은 구강 감각및 운동 이상이 있는 환자를 평가함에 있어서 매우 유용할 수 있다. 이 연구의 목적은 학령기 어린이의 연령, 성별에 따른 평균 구순폐쇄력을 측정하고, 이에 영향을 주는 요인들과의 상관성을 분석하는 것이다. 전주시에 소재한 초등학교 5곳의 7 – 12 세 어린이 765명을 대상으로, 교합상태, 구순폐쇄 여부에 대한 임상 검사와 구순폐쇄력 측정을 시행하였다. 구순폐쇄력은 3회 측정하였고, 측정값의 평균을 대상자의 구순폐쇄력으로 활용하였다. Angle 분류법 및 안정시 구순폐쇄 여부는 구순폐쇄력 고저군 분포와 통계적으로 유의한 상관관계를 나타냈다(p = 0.016, 0.004). 완전 구순폐쇄 군에서는 높은 구순폐쇄력 군의 비율이 높았던 반면, 불완전 구순폐쇄 군에서는 낮은 구순폐쇄력 군의 비율이 더 높게 나타났다.

Translation and Linguistic Validation of the Korean Version of the Dysfunctional Voiding Symptom Score

이한이,Walid Farhat,박관진 대한의학회 2014 Journal of Korean medical science Vol.29 No.3

Although studies on pediatric dysfunctional voiding are increasing, there have not beenenough efforts to validate the Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Therefore, we aimed to translate and validate the DVSS into Korean. The DVSSquestionnaire was validated between January and October, 2013. Two bilingualsindependently translated the English version of the DVSS questionnaire into Korean, andthen reconciled the forward translation of the Korean version. The original DVSS was backtranslatedinto English, then assessed for equivalence to the original. Cognitive debriefinginterviews with 5 patients to test the interpretation of the translation were made, thenmodified and distributed to 48 patients for re-evaluation. A statistical analysis of interscalecorrelation, and test re-test consistency was performed with the Cronbach’s alphacoefficient. The changes from patient interviews were reflected in the final version. In anintra-class correlation, the Cronbach’s alpha was high in all of the questions (0.97,P < 0.001). Test re-test Cronbach’s alpha analysis of reproducibility was higher than 0.8 forall of the 10 questions (P < 0.001). Translation and linguistic validation of Korean versionof the DVSS questionnaire was completed by a proper process, with high reliability andvalidity.

Dental Management in a Patient with Turner Syndrome with Dental Anomalies : A Case Report

이한이,신세영,김재곤,이대우,양연미,Lee, Haney,Shin, Seyoung,Kim, Jaegon,Lee, Daewoo,Yang, Yeonmi Korean Academy of Pediatric Dentistry 2018 大韓小兒齒科學會誌 Vol.45 No.3

터너 증후군이란 한 개의 X 염색체와 전부 혹은 부분이 결여된 X 염색체를 나타내는 염색체 이상 질환이다. 치근 형태 이상이 터너 증후군 환자에서 정상에서보다 호발한다고 보고되었는데, 치근의 이러한 특징은 근관치료를 까다롭게 만들고, 특수한 처치를 요하기도 한다. 또한 터너 증후군 환자들은 종종 심장 또는 신장의 기형과 같은 전신적인 문제를 동반하기도 하므로, 임상의는 터너 증후군의 특징적인 구내 소견을 인지하고, 사전에 구내 합병증을 예방하기 위해 환자들이 정기적으로 치과 검진을 받을 수 있게 해야 한다. 10세 때에 터너증후군 진단을 받은 12세 여자 환자가 하악 양측 소구치 부위의 불편감을 주소로 내원했다. 특징적으로 하악의 모든소구치에서 우상치와 치외치가 관찰되었다. 하악 양측 제1소구치는 세 개의 치근을, 근단부 병소를 보이는 하악 양측 제2소구치는 두 개의 치근을 가지고 있었다. 근관의 복잡한 해부학적 특징 때문에 치과 현미경을 이용한 적절한 시야를 확보하여 근관치료를 마무리 했다. 2년간의 정기적인 관찰 결과 해당치아와 관련된 임상적 징후나 증상, 치근단 병소는 관찰되지 않았다. 본 증례 보고를 통해 터너 증후군 환자의 구강내 특징과 이의 치과적 관리에 대해 보고하고자 하였다. Turner syndrome (TS) is a chromosomal disorder caused by monosomy of the X chromosome, with complete or partial absence of the second sex chromosome. Anomalies of root morphology have been found to occur more often in patients with TS, which make endodontic treatment challenging and requires special handling. The patients with TS may also have systematic problems such as cardiac or renal malformations, so in treating these patients it is important for clinicians not only to be aware of the characteristic intraoral findings, but also to make the patients have regular dental check-ups to prevent oral complications in advance. An 12-year-old girl who had been diagnosed with TS at the age of 10 years was referred due to discomfort in the bilateral mandibular premolar regions. Dens evaginatus and taurodontism were detected in all the mandibular premolars characteristically. The bilateral mandibular first premolars had three roots and the bilateral mandibular second premolars had periapical lesion with two roots. Due to the complexity of the root canal anatomy, root canal treatment were completed with a dental microscope to ensure adequate visualization. After 2 years of regular follow-up examinations, there were no clinical sign or symptom associated with the teeth, and no periapical lesion, was found. This case report describes the characteristic oral features and dental management of TS patients.

Short-term Effects of a Systematized Bladder Training Program for Idiopathic Overactive Bladder: A Prospective Study

이한이,오승준,조성용,이상임,김명 대한배뇨장애요실금학회 2013 International Neurourology Journal Vol.17 No.1

Purpose: This study was to investigate whether a systematized bladder training (BT) program is effective for patients with idiopathic overactive bladder (OAB). Methods: A prospective study was conducted on 105 patients with OAB from March 2009 to November 2011. We developed a 30 minutes BT program, which consisted of first, refraining from going to the bathroom after feeling an urge to void, second, in order to stop thinking about voiding, ceasing action and thought temporarily, and third, performing pelvic floor exercises 5 to 6 times. Before and after BT, the patients filled out voiding diaries as well as the following questionnaires; International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB), International Prostate Symptom Score (IPSS), overactive bladder questionnaire (OAB-q), the short form 36-item health survey (SF-36) questionnaire, the work productivity and activity impairment questionnaire, and a patients’ perception of treatment benefit (PPTB). Results: A final analysis was performed from on 85 patients (38 male, 47 female) with idiopathic OAB. After the first BT, the results of the ICIQ-OAB showed improvement in frequency, nocturia, and urgency (P<0.05), and all domains of IPSS questionnaires showed significant improvement (P<0.05). Among the SF-36 domains, the role-physical domain showed significant improvement after the first BT, and the general health domain showed significant improvement after the second. The voiding diaries showed statistically significant changes in maximal voided volume after the first BT, and nocturia index and nocturnal polyuria index after the second BT. According to the PPTB questionnaire, the perceived usefulness of BT increased after each session, and almost all of the patients replied that BT improved their symptoms. Conclusions: Our results demonstrated that BT was effective in improving many OAB related symptoms and quality of life in patients with idiopathic OAB. More clinical application of BT could be implemented in the future.

Is Concomitant Bladder Neck Reconstruction Necessary in Neurogenic Incontinent Patients Who Undergo Augmentation Cystoplasty?

이한이,배정범,오진규,오승준 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.1

Purpose: In patients with neurogenic bladder due to spinal cord injury or disease who undergo augmentation cystoplasty (AC) for not only bladder dysfunction but also sphincteric incontinence, the need for concomitant bladder neck reconstruction at the time of AC has not yet been established. The aim of this study was to evaluate whether concomitant bladder neck reconstruction is necessary when performing AC. Materials and Methods: We retrospectively investigated 35 patients who underwent AC from January 2006 to September 2010. Medical history, preoperative and postoperative fluoroscopic urodynamic study (FUDS) parameters, and responses to an incontinence questionnaire (ICIQ Korean version) were reviewed. Results: A final analysis was performed on 17 patients (9 male, 8 female) who were diagnosed with sphincteric incontinence. Continence status, the number of pads used, and the bother score were significantly improved postoperatively in this subpopulation. Preoperatively, all patients used pads, and the average daily number was 2.2 (median; range 0 to 6). Postoperatively, the number of pads used decreased significantly to 0.9 (median; range 0 to 3) pads a day (p=0.002). Urodynamic parameters including bladder capacity, compliance, involuntary detrusor contraction, and bladder neck incompetence proven by FUDS were also significantly improved. Conclusions: Our study demonstrated that both objective urodynamic parameters and subjective incontinence symptoms improved significantly after the completion of AC as a single procedure in patients with sphincteric incompetence. This implies that anti-incontinence bladder outlet surgery does not have to be performed simultaneously and can be considered later as a staged operation.

Analysis of Octyl-2-Cyanoacrylate as a Dressing Material after Pediatric Urological Procedures

이한이,민선호,김광명,Lee, Hahn-Ey,Min, Sun Ho,Kim, Kwang Myung Korean Society of Pediatric Nephrology 2012 Childhood kidney diseases Vol.16 No.2

목적: 소아비뇨기과 관혈적 수술 시 피부봉합제로 사용된 Octyl-2-Cyanoacrylate (Dermabond$^{TM}$)의 효용성에 대해 알아보고자 하였다. 방법: 2010년 8월부터 2011년 8월까지 1년 동안 서울대학교 어린이병원 소아비뇨기과에서 단일 술자에 의해 음낭수종절제술, 고환고정술, 음경성형술을 시행받은 환자들을 대상으로 상처 합병증 발생율을 후향적으로 비교분석하였다. 총 128명을 대상으로 210개의 절개 창에서 시행되었으며, 피부 봉합에 Dermabond$^{TM}$을 사용하였다. 모든 절 개창은 Dermabond$^{TM}$을 사용하기 전 흡수사를 이용하여 표피 밑 봉합 혹은 몇 개의 단순 봉합을 시행하였다. Dermabond$^{TM}$는 4 mm 너비로 얇게 두 번 사용되었으며, 건조시키는 과정이 포함되었다. 추가적인 붕대나 드레싱은 적용되지 않았다. 결과: 128명의 환자들을 수술 종류에 따라 세 그룹으로 나누었다(Group 1: 음낭수종 절제술, 55례, 41.3%; Group 2: 고환고정술, 43례, 32.3%; Group 3: 음경성형술, 35례, 26.4%). 수술 후 외래에서 추적 관찰한 210개의 절개창 중에서 총 5개(2.3%)에서 상처 합병증이 발생하였고, 이를 그룹별로 다시 분석해 보면 Group 1에서 0개(0/55, 0%), Group 2에서 1개(1/43, 2.3%), Group 3에서 4개(4/35, 11.4%)가 각각 발생하였다. 상처 부위별로 다시 분석해 보면 서혜부 상처 1개(1/120, 0.83%), 고환 상처 0개(0/55, 0%), 음경 상처 4개(4/35, 11.4%)가 각각 발생하였다. Group 3의 음경 상처에서 다른 군에 비해 통계적으로 의미 있게 증가되었다(P=0.008). Group 2와 3에서 상처 합병증이 발생한 환자들의 평균 나이는 각각 1세, 9.50세 이었고 상처 합병증이 없는 환자들의 평균 나이는 2.34세, 5.61세 였지만 통계적으로 의미는 없었다(P=0.639, 0.122). 5개의 상처 합병증은 모두 가벼운 염증반응이었으며, 항생제 연고만을 적용 후 술 후 평균 13.8일(13-15일) 후 모두 치료되었다. 결론: Dermabond$^{TM}$는 소아비뇨기과에서 음낭수종절제술과 고환고정술 시 피부봉합제로서 기존의 피부 봉합에 대한 대안으로 안전한 방법으로 사료된다. 하지만 음경성형술에서는 향후 더 많은 연구가 필요하다. Purpose: We aimed to evaluate the efficacy of Octyl-2-cyanoacrylate (Dermabond$^{TM}$) as a topical skin adhesive for pediatric urologic open surgery. Methods: From August 2010 to August 2011, we retrospectively evaluated pediatric patients who underwent urologic open surgery at our institution. A total of 128 pediatric patients with 210 incisions used Dermabond$^{TM}$ for skin closure. Results: We divided the 128 patients into 3 groups according to type of surgery. Group 1 underwent hydrocelectomy (55 cases, 41.3%), Group 2 underwent orchiopexy (43 cases, 32.3%), Group 3 underwent penoplasty (35 cases, 26.4%). One hundred and twenty eight patients who underwent 133 surgeries in total, with a total of 210 incisions visited our outpatient department postoperatively, and a total of 5 wound complications (2.3%) occurred, but were simple inflammations and no dehiscence was observed. When analyzed according to groups, no wound problems occurred in Group 1 (0/55, 0%), one occurred in Group 2 (1/43, 2.3%) and four cases occurred in Group 3 (4/35, 11.4%) respectively. When re-analyzed according to wound locations, one occurred in an inguinal wound (1/120, 0.83%), none occurred in scrotal wounds (0/55, 0%), and four occurred in penile wounds (4/35, 11.4%). In Group 3, the incidence of penile wounds was significantly increased compared to other groups (P=0.008). All 5 wound problems were inflammatory and healed at an average of 13.8 days (13-15 days) with antibiotic ointment application only. Conclusion: Dermabond$^{TM}$ is feasible and safe topical skin adhesive alternative to standard skin suture in pediatric urologic surgery. However, further research about its efficacy and safety could be valuable in the future.

한국 남녀 노인의 노쇠에 영향을 미치는 요인

이한이,안지연 한국간호연구학회 2023 한국간호연구학회지 Vol.7 No.3

Purpose : This study is to identify the factors influencing frailty among the elderly population in South Korea by gender. Methods : This study conducted a secondary analysis using data from the 8th National Health and Nutrition Examination Survey to investigate factors affecting frailty in the Korean elderly. A total of 1,467 elderly people aged 65 years and older were included in the study. Frailty was assessed by five items: weight loss, decreased vitality, decreased muscle strength, slow walking speed, and low physical activity. Multivariate logistic regression was used to analyze factors affecting frailty by gender. Result : The prevalence of frailty was 10.9% for male elderly and 13.7% for female elderly. In the logistic regression analysis, age, level of education, perceived health status, and pain were significant factors in both male and female elderly. The only significant factors for male elderly were level of education, employment status, chronic diseases, while the only significant factor for female elderly was habitual exercise behavior and anxiety. Conclusion : Gender-specific interventions to prevent frailty are needed to extend the healthy life span of older adults.

Miniscrew implant를 이용한 상악 구치부 압하와 개방교합 치료의 효과 및 안정성

이한아,박영철 대한치과교정학회 2008 대한치과교정학회지 Vol.38 No.1

최근 절대적인 고정원의 등장으로 다른 부작용 없이 구치부 압하 치료를 가능하게 하였고, 비수술적으로 개방교합의 심미적인 치료를 가능하게 하였다. 그러나, 이러한 치료법의 장기적인 안정성에 대한 연구는 많이 부족한 실정이다. 이에 본 연구에서는 miniscrew implant를 이용하여 상악 구치를 압하시켜 치료한 성인 개방교합 환자 11명 (남자 1명, 여자 10명)을 대상으로 치료 전후, 그리고 유지기의 골격성, 치아 치조성 변화를 측모 두부 방사선사진을 이용하여 평가하였으며 계측치의 치료 전후 변화량간의 상관관계와 치료에 의한 변화량과 재발량과의 상관관계를 규명하여 상악구치의 압하를 통해서 개방교합을 치료할 때의 안정성을 평가하였다. 그 결과로 상악 구치는 2.22mm 압하(P < 0.001)가 일어났고, 평균 17.4개월 유지 후 0.23 mm의 정출(P = 0.359)이 나타났으며, 재발율은 10.36%로 나타났다. 전치부의 수직피개는 평균 5.47 mm의 증가(P < 0.01)가 나타났고 평균 17.4개월 유지 후 0.99 mm의 감소(P < 0.05)가 나타나서, 재발량은 18.10%로 계산되었다. 치료 전후 수치 변화량의 상관분석을 통해 상악구치 압하량과 하악 평면각 변화량이 상관관계(P < 0.05)가 있었다. 치료 전의 개방교합량, 하악 평면각, 전하안면고경과 치료 후의 수직피개 재발량과는 상관관계가 없었다. 상악 구치 압하량과 수직피개 개선량에서 치료에 의한 변화량과 재발량이 통계적으로 유의한 상관관계를 보였고, 이를 토대로 재발량을 예측할 수 있었다. 이상의 결과를 통하여 성인 개방교합 환자에서 miniscrew implant를 이용한 상악구치부의 압하는 비수술, 심미적 접근방법으로 효율적이고 안정적인 치료방법으로 유용하게 사용할 수 있을 것으로 생각된다. Objective: This study investigated the skeletal and dentoalveolar changes after intrusion of maxillary posterior teeth using miniscrew implants during the treatment and posttreatment period. Method: The subjects consisted of 11 adults (1 male, 10 females) whose open bites were treated by posterior teeth intrusion with miniscrew. The lateral cephalometric x-rays of pre-treatment, post-treatment, and the retention period were evaluated. Results: The average intrusion of maxillary posterior teeth at the end of the treatment period was 2.22 mm (P < 0.001) and the average extrusion of maxillary posterior teeth at the end of the 17.4 month retention period was 0.23 mm (P = 0.359). The relapse rate was calculated at 10.36%. A decrease in overbite after the 17.4 month retention period was 0.99 mm (p < 0.05). The relapse rate was calculated at 18.10%. The skeletal changes and vertical height change of maxillary posterior teeth during the retention period was statistically insignificant, but there was a significant decrease in overbite (mean 0.99 mm, P < 0.05). The amount of intrusion and the overbite improvement from treatment significantly correlates to the degree of relapse. Conclusions: The results indicate that intrusion of the maxillary posterior teeth using miniscrews is an effective, non-surgical treatment modality which can reasonably be used to address adult open bite.