Changes in uroplakin expression in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome

조강준,이규성,최진봉,고준성,김준철 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.3

Purpose: We evaluated changes in the expression of uroplakin (UP) in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome (IC/BPS). Materials and Methods: Bladder samples were collected from 19 patients with ulcerative IC/BPS who were treated with augmentation ileocystoplasty and from 5 control patients. Frequency-volume charts, the pain visual analogue scale (VAS), and the O'Leary-Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate the patients' symptoms preoperatively. The expression levels of UP-Ib and UP-III in the urothelium were compared between the IC/BPS patients and control patients. Results: Sixteen women and three men with IC/BPS were evaluated. Their values for preoperative mean voiding frequency, number of nocturia episodes, and functional bladder capacity as recorded in frequency-volume charts were 21.1±12.8, 5.9±4.2, and 151.1±62.7 mL, respectively. The mean pain VAS, ICSI, and ICPI scores were 8.4±1.3, 17.7±2.2, and 14.7±1.8, respectively. Immunofluorescence staining showed that UP-Ib and UP-III were localized in the urothelium. Upon Western blot analysis, the expression of UP-III was significantly increased in the IC/BPS group compared with the control group. However, expression of UP-Ib did not differ significantly between the IC/BPS and control groups. Conclusions: UP-III was significantly upregulated in patients with ulcerative IC/BPS. UP-III is a potential biomarker for the diagnosis of ulcerative IC/BPS.

Factors Associated With Early Recovery of Stress Urinary Incontinence Following Holmium Laser Enucleation of the Prostate in Patients With Benign Prostatic Enlargement

조강준,고준성,최진봉,김준철 대한배뇨장애요실금학회 2018 International Neurourology Journal Vol.22 No.3

Purpose: To investigate factors associated with early recovery of stress urinary incontinence (SUI) following holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic enlargement (BPE). Methods: The medical records of 393 patients who underwent HoLEP for BPE were retrospectively reviewed. Patients with SUI following HoLEP were selected and divided into 2 groups: those who experienced early recovery of SUI and those who experienced persistent SUI. Recovery of SUI within 1 month after HoLEP was defined as early, and SUI that remained present after 1 month was defined as persistent. Preoperative clinical and urodynamic factors, as well as perioperative factors, were compared between groups. Results: SUI following HoLEP was detected in 86 patients. Thirty-three patients exhibited recovery of SUI within 1 month, and SUI remained present in 53 patients after 1 month. Multivariate analysis showed that the transition zone prostate volume (odds ratio [OR], 5.354; 95% confidence interval [CI], 1.911–14.999; P=0.001) and the enucleation ratio (OR, 8.253; 95% CI, 1.786–38.126; P=0.007) were significantly associated with early recovery of SUI. Conclusions: Early recovery of SUI within 1 month following HoLEP was associated with transition zone prostate volume and the enucleation ratio.

근치적 방광적출술 후 정위성 회결장 방광대치술과 회장 방광대치술의 합병증 및 요역동학적 검사의 비교

조강준,손동완,김세웅 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.5

Sen2Cor 대기보정 프로세서 평가를 위한 항공 초분광영상 기반 Sentinel-2 모의영상 생성 및 TOA와 BOA 반사율 자료와의 비교: 농업지역을 중심으로

조강준,김용일 대한원격탐사학회 2019 大韓遠隔探査學會誌 Vol.35 No.2

Sentinel-2 Multi Spectral Instrument(MSI) launched by the European Space Agency (ESA) offered high spatial resolution optical products, enhanced temporal revisit of five days, and 13 spectral bands in the visible, near infrared and shortwave infrared wavelengths similar to Landsat mission. Landsat satellite imagery has been applied to various previous studies, but Sentinel-2 optical satellite imagery has not been widely used. Currently, for global coverage, Sentinel-2 products are systematically processed and distributed to Level-1C (L1C) products which contain the Top-of-Atmosphere (TOA) reflectance. Furthermore, ESA plans a systematic global production of Level-2A(L2A) product including the atmospheric corrected Bottom-of-Atmosphere (BOA) reflectance considered the aerosol optical thickness and the water vapor content. Therefore, the Sentinel-2 L2A products are expected to enhance the reliability of image quality for overall coverage in the Sentinel-2 mission with enhanced spatial, spectral, and temporal resolution. The purpose of this work is a quantitative comparison Sentinel-2 L2A products and fully simulated image to evaluate the applicability of the Sentinel-2 dataset in cultivated land growing various kinds of crops in Korea. Reference image of Sentinel-2 L2A data was simulated by airborne hyperspectral data acquired from AISA Fenix sensor. The simulation imagery was compared with the reflectance of L1C TOA and that of L2A BOA data. The result of quantitative comparison shows that, for the atmospherically corrected L2A reflectance, the decrease in RMSE and the increase in correlation coefficient were found at the visible band and vegetation indices to be significant. Sentinel-2 위성은 기존 Landsat 시리즈보다 높은 공간해상도, 시간해상도 및 13개의 가시광, Red-edge, 적외, 단파적외 영역을 포함하는 다중분광 영상을 제공하고 있다. 이는 Landsat 시리즈와의 비슷한 파장대역 구성으로 향후 Landsat 시리즈와 융합분석이 가능하다는 이점이 있다. 그 동안 Landsat 위성영상은 국내의 다양한 연구에 적용되고 있으나 Sentinel-2 광학 위성영상은 많은 활용 사례가 보고되지 않았다. Sentinel-2 광학 위성은 기존 Landsat 위성이 제공하는 Top-of-Atmosphere(TOA) 반사율 영상을 Level-1C(L1C)에서 제공하고 있으며, Level-2A(L2A)영상을 통해 Landsat 시리즈보다 한 단계 더 대기보정이 수행된 Bottom-of-Atmosphere(BOA) 반사율 영상을 제공할 예정에 있다. BOA 반사율 영상은 에어로졸 광학 두께(AOT: Aerosol optical thickness)와 대기 중 수증기(WV: Water Vapor) 자료를 Sentinel-2 영상으로부터 얻고 이를 보정하여 TOA 반사율 영상을 BOA 반사율 영상으로 변환을 가능하게 한다. 현재, 유럽 전역지역에서 L2A 자료를 무료로 다운로드 가능하며 이외지역의 경우 L2A 자료의 실시간 제공이 예정되어 있다. 따라서, Sentinel-2 L2A 자료의 활용가능성이 국내에서점점 커질 것으로 기대되는 바이며 농업지역에서 Sentinel-2 L2A 영상이 제공하는 BOA 반사율 자료의 활용가능성을 확인하기 위해 경상남도 합천군에서 촬영된 항공 초분광영상을 활용하여 Sentinel-2 L2A 자료를 모의해보고 정량적인 분석을 통해 모의영상과 실제 촬영된 영상을 비교해보았다. 본 연구에서는 Sentinel-2 L2A 자료와 항공기 기반의 초분광 영상을 통해 모의된 Sentinel-2 영상에 대한 정량적인 비교를 수행하였으며, 가시광 영역대의 밴드와 식생지수에 대하여 참조 영상인 모의영상과 대기보정이 수행된 L2A 자료의 RMSE의 감소 및상관관계의 증가 경향이 뚜렷하게 나타나는 것으로 확인되었다.

Management of Urinary Incontinence With Underactive Bladder: A Review

조강준,김준철 대한배뇨장애요실금학회 2020 International Neurourology Journal Vol.24 No.2

Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.

혈청 PSA 4-10ng/ml이고 반복적 경직장전립선생검이 음성인 하부요로증상을 호소하는 환자에서 전립선암 진단을 위한 경요도적 전립선절제술의 역할

조강준,하유신,이충범 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.10

Effect of 5-alpha Reductase Inhibitor on Storage Symptoms in Patients with Benign Prostatic Hyperplasia

조강준,강세희,김효신,고준성,김준철 대한배뇨장애요실금학회 2011 International Neurourology Journal Vol.15 No.3

Purpose: Many patients with benign prostatic hyperplasia (BPH) have storage symptoms. The aim of this study was to evaluate the effects of treatment with a 5-alpha reductase inhibitor (5ARI) on storage symptoms in patients with BPH. Methods: This study was conducted in 738 patients with lower urinary tract symptoms secondary to BPH. Patients with a prostate volume of higher than 30 mL on the transrectal ultrasound were classified into two groups: group A, in which an alpha blocker was solely administered for at least 12 months, and group B, in which a combination treatment regimen of an alpha blocker plus 5ARI was used. This was followed by an analysis of the changes in parameters such as the total International Prostate Symptom Score (IPSS), voiding symptom subscore, and storage symptom subscore between the two groups. In addition, we examined whether there was a significant difference between the two groups in the degree of change in storage symptoms between before and after the pharmacological treatment. Results: Of the 738 men, 331 had a prostate volume ≥30 mL, including 150 patients in group A and 181 patients in group B. Total IPSS, the voiding symptom subscore, and the storage symptom subscore were significantly lower after treatment than before treatment in both groups (P<0.05). A comparison of the degree of change between before and after treatment, however, showed no significant differences in the storage symptom subscore between the two groups (P>0.05). Conclusions: Alpha blocker and 5ARI combination treatment is effective for patients with BPH including storage symptoms. However, 5ARI does not exert a significant effect on storage symptoms in BPH patients.

Preoperative Factors Affecting Postoperative Early Quality of Life During the Learning Curve of Holmium Laser Enucleation of the Prostate

조강준,김준철,고준성,한승범,김상훈,김현우,조수연,김효신 대한배뇨장애요실금학회 2013 International Neurourology Journal Vol.17 No.2

Purpose: The aim of this study was to investigate the preoperative factors related to early quality of life (QoL) in patients with benign prostatic hyperplasia after holmium laser enucleation of the prostate (HoLEP) during the surgeon’s learning curve. Methods: The medical records of 82 patients with a follow-up period of at least 3 months who were treated with HoLEP during the time of a surgeon’s learning curve were analyzed retrospectively. We divided the patients into two groups on the basis of the QoL component of the International Prostate Symptom Score (IPSS) 3 months after HoLEP: the high QoL group (IPSS/QoL≤3) and the low QoL group (IPSS/QoL≥4). Preoperative factors in each group were compared, including prostate volume, prostatespecific antigen, history of acute urinary retention (AUR), urgency incontinence, IPSS, and urodynamic parameters. Detrusor underactivity was defined as a bladder contractility index less than 100 on urodynamic study. Results: A total of 61 patients (74.3%) had a high QoL, whereas 21 (25.7%) had a low QoL. A history of AUR, detrusor pressure on maximal flow (PdetQmax), bladder outlet obstruction grade, bladder contractility index, and detrusor underactivity were associated with postoperative QoL in the univariate analysis. In the multivariate analysis, a history of AUR and PdetQmax were independent factors affecting postoperative QoL. Conclusions: A history of AUR and bladder contractility affect early QoL, and preoperative urodynamic study plays an important role in the proper selection of patients during the HoLEP learning curve.

Changes in transient receptor potential vanilloid 1 and transient receptor potential vanilloid 4 in patients with lower urinary tract dysfunction

조강준,고준성,최진봉,박상희,이원선,김준철 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.3

Purpose: We investigated the association between transient receptor potential vanilloid (TRPV) expression in human urothelium tissue and lower urinary tract dysfunction (LUTD). Materials and Methods: We prospectively enrolled men who planned to undergo surgical treatment for benign prostatic obstruction to analyze TRPV1 and TRPV4 expression in the urothelium using enzyme-linked immunosorbent assay and immunofluorescence staining. Patients were divided into two groups based on urodynamics: the detrusor underactivity (DU) group and the non-DU group. Levels of TRPV1 and TRPV4 were compared between the two groups. We also divided patients into two groups according to degree of subjective urinary urgency symptoms using a 5-point urinary sensation scale and compared the differences in TRPV1 and TRPV4 levels between the two groups. The correlations between urodynamic parameters with TRPV1 or TRPV 4 in all patients were also analyzed. Results: The levels of TRPV1 and TRPV 4 were not significantly different between the DU group (n=10) and the non-DU group (n=11). When we divided the patients according to degree of subjective urgency, the level of TRPV1 was not significantly different between the urgency group (n=10) and the non-urgency group (n =11), but the level of TRPV4 was significantly increased in the urgency group (p=0.029). There was no significant correlation between the level of TRPV1 or TRPV4 and urodynamic parameters in any patients. Conclusions: TRPV4 could be a useful diagnostic biomarker for patients with LUTD.

노인의 하부요로기능 변화와 배뇨장애 기전

조강준,김준철 대한의사협회 2015 대한의사협회지 Vol.58 No.10

Understanding the pathophysiology of lower urinary tract dysfunction in the elderly is necessary for the adequate management of lower urinary tract dysfunction, as aging causes anatomical and functional changes in the lower urinary tract. While epithelium atrophy of genitourinary organs and detrusor muscle changes occur in elderly women, due to estrogen decline, prostate enlargement may lead to bladder outlet obstruction and wall thickening in elderly men. Urodynamic changes that occur with aging include bladder outlet obstruction, detrusor overactivity and underactivity, decreased bladder compliance, and detrusor hyperactivity with impaired contractility. Moreover, impaired mobility, central nervous system diseases, non-genitourinary comorbidities, and various medications can also influence lower urinary tract function. Among these age-associated multifactorial conditions, adequate differentiation and management of the factors responsible for lower urinary tract dysfunction is of paramount importance in elderly patients.