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추민수,최우석,조성용,구자현,김현회,곽철 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.1
Purpose: We compared the impact of prostate volume on oncological and functional outcomes 2 years after robot-assisted laparoscopic prostatectomy (RALP) and open radical retropubic prostatectomy (ORP). Materials and Methods: Between 2003 and 2010, 253 consecutive patients who had undergone prostatectomy by a single surgeon were serially followed over 2 years postoperatively. RALP was performed on 77 patients and ORP on 176. The patients were divided into two subgroups according to prostate volume as measured by transrectal ultrasound: less than 40 g and 40 g or larger. Recoveries of potency and continence were checked serially by interview 1, 3, 6, 9, 12, and 24 months postoperatively. Results: RALP was associated with less blood loss (ORP vs. RALP: 910 mL vs. 640 mL, p<0.001) but a longer operation time (150 minutes vs. 220 minutes, p<0.001) than was ORP. No statistically significant differences were found between the two groups for oncological outcomes, such as positive surgical margin (40% vs. 39%, p=0.911) or biochemical recurrence (12% vs. 7%, p=0.155). The overall functional outcomes showed no statistically significant differences at 2 years of follow-up (continence: 97% vs. 94%,p=0.103; potency: 51% vs. 56%, p=0.614). In the results of an inter-subgroup analysis, potency recovery was more rapid in patients who underwent RALP in a small-volume prostate than in those who underwent ORP in a small-volume prostate (3 months: 24% vs. 0%, p=0.005; 6 months: 36% vs. 10%, p=0.024). However, patients who underwent RALP in a large-volume prostate were less likely to recover continence than were patients who underwent ORP in a large-volume prostate (97% vs. 88%, p=0.025). Conclusions: Patients can be expected to recover erectile function more quickly after RALP than after ORP, especially in cases of a small prostate volume.
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추민수,손환철 대한의사협회 2020 대한의사협회지 Vol.63 No.2
The prevalence of benign prostatic hyperplasia (BPH) is rising with Korea becoming an aging society. As patients age, their comorbidities and the risks associated with anesthesia increase. Recently, there has been an increasing concern regarding sexual function after surgery. As a result, interest in minimally invasive surgery for BPH that does not require anesthesia or affect sexual function has grown. This review article introduces newly developed minimally invasive surgeries for BPH divided into four categories based on the strategy—mechanical, anatomical, atrophic, and laparoscopic. Here, the mechanisms for each surgical method have been introduced. Furthermore, recent representative studies of these procedures with a focus on randomized controlled trials and meta-analyses have also been reviewed. Side effects related to sexual function have also been mentioned briefly along with the efficacy and indication for robotic BPH surgery, which has recently been attracting attention. However, these newer, minimally invasive procedures require additional comparative randomized controlled trials and long-term results to produce more robust evidence for their use.
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추민수,류호영,이상철 대한배뇨장애요실금학회 2022 International Neurourology Journal Vol.26 No.1
Purpose: To develop an automatic interpretation system for uroflowmetry (UFM) results using machine learning (ML), a form of artificial intelligence (AI). Methods: A prospectively collected 1,574 UFM results (1,031 males, 543 females) with voided volume>150 mL was labelled as normal, borderline, or abnormal by 3 urologists. If the 3 experts disagreed, the majority decision was accepted. Abnormality was defined as a condition in which a urologist judges from the UFM results that further evaluation is required and that the patient should visit a urology clinic. To develop the optimal automatic interpretation system, we applied 4 ML algorithms and 2 deep learning (DL) algorithms. ML models were trained with all UFM parameters. DL models were trained to digitally analyze 2-dimensional images of UFM curves. Results: The automatic interpretation algorithm achieved a maximum accuracy of 88.9% in males and 90.8% in females when using 6 parameters: voided volume, maximum flow rate, time to maximal flow rate, average flow rate, flow time, and voiding time. In females, the DL models showed a dramatic improvement in accuracy over the other models, reaching 95.4% accuracy in the convolutional neural network model. The performance of the DL models in clinical discrimination was outstanding in both genders, with an area under the curve of up to 0.957 in males and 0.974 in females. Conclusions: We developed an automatic interpretation algorithm for UFM results by training AI models using 6 key parameters and the shape of the curve; this algorithm agreed closely with the decisions of urology specialists.
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추민수,유창원,조성용,정성진,정창욱,구자현,오승준 대한배뇨장애요실금학회 2017 International Neurourology Journal Vol.21 No.S1
Purpose: As the elderly population increases, a growing number of patients have lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH). The aim of this study was to develop decision support formulas and nomograms for the prediction of bladder outlet obstruction (BOO) and for BOO-related surgical decision-making, and to validate them in patients with LUTS/BPH. Methods: Patient with LUTS/BPH between October 2004 and May 2014 were enrolled as a development cohort. The available variables included age, International Prostate Symptom Score, free uroflowmetry, postvoid residual volume, total prostate volume, and the results of a pressure-flow study. A causal Bayesian network analysis was used to identify relevant parameters. Using multivariate logistic regression analysis, formulas were developed to calculate the probabilities of having BOO and requiring prostatic surgery. Patients between June 2014 and December 2015 were prospectively enrolled for internal validation. Receiver operating characteristic curve analysis, calibration plots, and decision curve analysis were performed. Results: A total of 1,179 male patients with LUTS/BPH, with a mean age of 66.1 years, were included as a development cohort. Another 253 patients were enrolled as an internal validation cohort. Using multivariate logistic regression analysis, 2 and 4 formulas were established to estimate the probabilities of having BOO and requiring prostatic surgery, respectively. Our analysis of the predictive accuracy of the model revealed area under the curve values of 0.82 for BOO and 0.87 for prostatic surgery. The sensitivity and specificity were 53.6% and 87.0% for BOO, and 91.6% and 50.0% for prostatic surgery, respectively. The calibration plot indicated that these prediction models showed a good correspondence. In addition, the decision curve analysis showed a high net benefit across the entire spectrum of probability thresholds. Conclusions: We established nomograms for the prediction of BOO and BOO-related prostatic surgery in patients with LUTS/BPH. Internal validation of the nomograms demonstrated that they predicted both having BOO and requiring prostatic surgery very well.
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추민수,이한이,배정범,조성용,오승준 대한배뇨장애요실금학회 2014 International Neurourology Journal Vol.18 No.3
Purpose: To identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding. Methods: We identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding). Results: The mean prostate volume was 65.1±31.5 mL, and the mean prostate-specific antigen (PSA) level was 3.69±3.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2–5 and 7–10 o’clock positions in the proximal prostate. The average number of bleeding arteries was 12.1±7.9 per procedure, and 1.93±1.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels. Conclusions: During the HoLEP procedure, the most common locations of significant bleeders were the 2–5 and 7–10 o’clock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.
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추민수,한준현,신태영,고경태,이원기,조성태,이상곤,이성호 대한배뇨장애요실금학회 2015 International Neurourology Journal Vol.19 No.3
Purpose: To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a communitybased, prospective longitudinal cohort study. Methods: In a suburban area in Korea, 1,514 subjects aged ≥45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of ≥8 points during the 3-year follow-up period. Results: LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of ≥50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration. Conclusions: The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration.
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추민수,정성진,조성용,유창원,정창욱,구자현,오승준 대한배뇨장애요실금학회 2017 International Neurourology Journal Vol.21 No.S1
Purpose: We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. Methods: Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. Results: A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. Conclusions: External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.
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