전립선비대증에서 KTP 레이저를 이용한 광선택적 전립선 기화술의 치료효과 및 안전성에 대한 결과: 2년 추적관찰

추설호,한덕현,이성원 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Purpose: This study was conducted to evaluate, with using the 2-year follow-up data, the clinical efficacy and safety of performing photoselective vaporization of the prostate(PVP) for the treatment of symptomatic benign prostatic hyperplasia(BPH). Materials and Methods: We analyzed the clinical data of 104 men with symptomatic BPH and who had undergone PVP. The efficacy parameters were the changes from baseline of the International Prostate Symptom Score(IPSS), the quality of life(QoL) score, the maximum urinary flow rate(Qmax) and the postvoid residual volume(PVR). The patients were evaluated preoperatively and then at post-operative 1, 3, 6, 12 and 24 months. Their complications were also evaluated. Results: The mean prostate volume was 45.6ml. The mean lasing time was 44.9 minutes and there was no significant blood loss or fluid absorption during or immediately after PVP. Significant improvements in the IPSS, the QoL score, the Qmax and the PVR were noted as early as 1 month after PVP treatment. After 24-month follow-up, the mean IPSS decreased from 22.4 to 9.9(p<0.0001) and the QoL score decreased from 4.4 to 2.3 (p<0.0001), while the mean Qmax changed from 8.3 to 14.4ml/sec(p< 0.0001). The PVR decreased from 82.0 to 49.9ml(p=0.033). The complications were retrograde ejaculation(26.9%), transient catheterization(6.7%), transient dysuria(2.9%), bladder neck contracture(1.9%), urethral stricture (0.9%) and meatal stenosis(0.9%). 1 patient was diagnosed with prostate cancer 32 months after operation. Conclusions: Significant improvements of the subjective and objective voiding parameters were achieved and these were sustainable for at least 2-year, with minimal complications, after PVP. PVP seems to be a safe and effective treatment for symptomatic BPH. Purpose: This study was conducted to evaluate, with using the 2-year follow-up data, the clinical efficacy and safety of performing photoselective vaporization of the prostate(PVP) for the treatment of symptomatic benign prostatic hyperplasia(BPH). Materials and Methods: We analyzed the clinical data of 104 men with symptomatic BPH and who had undergone PVP. The efficacy parameters were the changes from baseline of the International Prostate Symptom Score(IPSS), the quality of life(QoL) score, the maximum urinary flow rate(Qmax) and the postvoid residual volume(PVR). The patients were evaluated preoperatively and then at post-operative 1, 3, 6, 12 and 24 months. Their complications were also evaluated. Results: The mean prostate volume was 45.6ml. The mean lasing time was 44.9 minutes and there was no significant blood loss or fluid absorption during or immediately after PVP. Significant improvements in the IPSS, the QoL score, the Qmax and the PVR were noted as early as 1 month after PVP treatment. After 24-month follow-up, the mean IPSS decreased from 22.4 to 9.9(p<0.0001) and the QoL score decreased from 4.4 to 2.3 (p<0.0001), while the mean Qmax changed from 8.3 to 14.4ml/sec(p< 0.0001). The PVR decreased from 82.0 to 49.9ml(p=0.033). The complications were retrograde ejaculation(26.9%), transient catheterization(6.7%), transient dysuria(2.9%), bladder neck contracture(1.9%), urethral stricture (0.9%) and meatal stenosis(0.9%). 1 patient was diagnosed with prostate cancer 32 months after operation. Conclusions: Significant improvements of the subjective and objective voiding parameters were achieved and these were sustainable for at least 2-year, with minimal complications, after PVP. PVP seems to be a safe and effective treatment for symptomatic BPH.

4cm 이하 신종물의 병리학적 특성: 양성 종양의 빈도

추설호,정진우,김지영,곽경원,서성일,전성수,최한용,이현무 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Purpose: We examined the clinical and pathologic findings of small renal masses that were suspected to be malignant. We investigated the prevalence and the predictors of benign tumors. Materials and Methods: We retrospectively reviewed the medical records of the patients who underwent surgeries for renal lesions between September 1994 and June 2007. We analyzed the pathologic reports and medical records of 586 patients who had a renal mass that was 4cm or less. The mean patient age was 53 years(age range: 15-82). There were 418 male patients(71.3%) and 168 females(28.7%). Multiple logistic regression analysis was done to determine the clinical factors associated with benign renal masses, including the radiological tumor size, a cystic versus solid appearance, gender, age and the presenting symptoms. Results: Of the 586 renal masses, 62(10.6%) were benign, 520(88.7%) were renal cell carcinoma and 4(0.7%) were other malignancies. The proportion of benign lesions was significantly higher in the females than that in the males(21.4% vs. 6.2%, respectively, p<0.001) and the proportion of benign lesions was significantly higher for the smaller masses(0-2cm) than for the 2.1-4cm sized tumors(14.7% vs. 9.1%, respectively, p=0.048). On multivariate analysis, gender and tumor size were significantly associated with malignant histology with the males having an odds ratio(OR) of 4.16 (95% CI 2.41-7.19, p<0.001) and the tumor size more than 2cm having an OR of 1.93(95% CI 1.08-3.44, p=0.03). Conclusions: A considerable number(10.6%) of benign lesions 4cm or less in the radiological diameter were operated on based on suspicious preoperative imaging. The results of this study seem to help not only for counseling the patients, but also for deciding on a therapeutic modality preoperatively. Purpose: We examined the clinical and pathologic findings of small renal masses that were suspected to be malignant. We investigated the prevalence and the predictors of benign tumors. Materials and Methods: We retrospectively reviewed the medical records of the patients who underwent surgeries for renal lesions between September 1994 and June 2007. We analyzed the pathologic reports and medical records of 586 patients who had a renal mass that was 4cm or less. The mean patient age was 53 years(age range: 15-82). There were 418 male patients(71.3%) and 168 females(28.7%). Multiple logistic regression analysis was done to determine the clinical factors associated with benign renal masses, including the radiological tumor size, a cystic versus solid appearance, gender, age and the presenting symptoms. Results: Of the 586 renal masses, 62(10.6%) were benign, 520(88.7%) were renal cell carcinoma and 4(0.7%) were other malignancies. The proportion of benign lesions was significantly higher in the females than that in the males(21.4% vs. 6.2%, respectively, p<0.001) and the proportion of benign lesions was significantly higher for the smaller masses(0-2cm) than for the 2.1-4cm sized tumors(14.7% vs. 9.1%, respectively, p=0.048). On multivariate analysis, gender and tumor size were significantly associated with malignant histology with the males having an odds ratio(OR) of 4.16 (95% CI 2.41-7.19, p<0.001) and the tumor size more than 2cm having an OR of 1.93(95% CI 1.08-3.44, p=0.03). Conclusions: A considerable number(10.6%) of benign lesions 4cm or less in the radiological diameter were operated on based on suspicious preoperative imaging. The results of this study seem to help not only for counseling the patients, but also for deciding on a therapeutic modality preoperatively.

Interval from Prostate Biopsy to Radical Prostatectomy Does Not Affect Immediate Operative Outcomes for Open or Minimally Invasive Approach

박범수,추설호,전황균,정병창,서성일,전성수,이현무,최한용 대한의학회 2014 Journal of Korean medical science Vol.12 No.12

Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsybefore radical prostatectomy. The aim of our study was to evaluate whether the intervalfrom prostate biopsy to radical prostatectomy affects immediate operative outcomes, witha focus on differences in surgical approach. The study population of 1,848 radicalprostatectomy patients was divided into two groups according to the surgical approach:open or minimally invasive. Open group included perineal and retropubic approach, andminimally invasive group included laparoscopic and robotic approach. The cut-off of thebiopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time andestimated blood loss were evaluated as endpoint parameters. In the open group, therewere significant differences in operative time and estimated blood loss between the< 4-week and ≥ 4-week interval subgroups, but there was no difference in positivemargin rate. In the minimally invasive group, there were no differences in the threeoutcome parameters between the two subgroups. Multivariate analysis revealed that thebiopsy-to-surgery interval was not a significant factor affecting immediate operativeoutcomes in both open and minimally invasive groups, with the exception of the interval< 4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeksof prostate biopsy is feasible for both approaches, and is even beneficial for minimallyinvasive radical prostatectomy to reduce operative time.

Survey on disease insight and prevalence of urinary incontinence in women

심강희,추설호,박성곤,유희재,최종보 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.5

Purpose: With a rapidly aging population in Korea, the number of patients with lower urinary tract symptoms is increasing. Therefore, it is important to determine the current extent of incontinence among Korean women to establish future plans. We attempted to create reference materials for organizing public relations and educational activities by investigating the effect of age on incontinence and quality of life in women. Materials and Methods: The participants comprised women aged 30 years and older who visited a tertiary center for health screening from September 1 to October 31, 2016. The survey included a questionnaire consisting of 12 questions that took approximately 10 minutes to complete. We analyzed the responses and assessed the prevalence of the disease and its rate of recognition. Results: A total of 509 women completed the survey. Irrespective of age, 76.8% of all respondents were aware of urinary incontinence (UI) and 57.4% of the women exhibited lower urinary tract symptoms. The most prevalent symptom was UI (45.8%), and the incidence rates of stress and urge UI were identified as 33.6% and 12.2%, respectively. Only 8.0% of the women had visited a hospital; 38.3% had awaited spontaneous symptom improvement. Many participants (61.2%) answered that a urology clinic is suitable for treating UI, while 58.9% chose a gynecology clinic. Conclusions: Our study showed that more than 75% of women are aware of UI, but their perception of the disease mechanism and treatment options was low. We suggest that continuous education and publicity are necessary.

Negative Delta-Prostate-Specific Antigen Time Ratio as Potential New Marker of Progression-Free Survival in Castration-Resistant Prostate Cancer Patients Treated With First-Line Enzalutamide or Docetaxel

김태환,추설호,심강희,김선일 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.3

Purpose: We propose a new potential marker of progression-free survival (PFS) called negative deltaprostate-specific antigen (PSA) time ratio (NDPSATR) and compare it with conventional PSA response, defined as PSA decline ≥50% at 12 weeks from pretreatment baseline (PSAR50) in metastatic castrationresistant prostate cancer (mCRPC) patients treated with first-line enzalutamide (ENZ) or docetaxel (DTX). Materials and Methods: All patients diagnosed as mCRPC at Ajou University Hospital from 2016 were included. Delta-PSA days is PSA change between 2 consecutive measurements during a regimen multiplied by interval days. A negative delta-PSA days value represents a positive PSA response. NDPSATR is calculated by dividing the sum of days on negative delta-PSA days by total days on the regimen. Student t-test was used to compare mean values and Kaplan-Meier survival curves for PFS were obtained. Results: Of 57 patients identified, 22 and 35 were treated with ENZ and DTX, respectively. Rates of PSAR50 for ENZ and DTX were 72.7% and 20.6%, respectively. Mean NDPSATR for ENZ and DTX were 0.40 and 0.46, respectively and the difference was not statistically significant. For ENZ, median PFS (mPFS) of PSAR50 and non-PSAR50 were 14.3 and 4.8 months, respectively and there was significant difference in PFS (p=0.002). For DTX, mPFS of PSAR50 and non-PSAR50 were 15.0 and 6.5 months, respectively but there was no significant difference in PFS (p=0.055). At cutoff value of 0.4, rate of NDPSATR ≥0.4 for ENZ and DTX were 36.4% and 62.9%, respectively. For ENZ, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were not achieved and 14.1 months, respectively and there was no significant difference in PFS (p=0.895). For DTX, mPFS of NDPSATR ≥0.4 and NDPSATR <0.4 were 9.7 and 6.3 months, respectively and there was a significant difference in PFS (p=0.045). Conclusions: NDPSATR ≥0.4 may be a good marker of PFS in CRPC patients treated with DTX and may replace PSAR50.

The presence of prostate-specific antigen checked more than 1 year before diagnostic biopsy is an independent prognostic factor in patients undergoing radical prostatectomy

박성곤,심강희,추설호,김세중,김선일 대한비뇨의학회 2021 Investigative and Clinical Urology Vol.62 No.4

Purpose: In large scale prospective studies, prostate-specific antigen (PSA)-screening not only decreased prostate cancer mortality, but also reduced biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP). We investigated the independent effect of the presence of PSA checked more than 1 year before diagnostic biopsy on the prognosis of patients undergoing RP in a real world setting without PSA-screening. Materials and Methods: We reviewed the database of patients undergoing RP at Ajou University Hospital from March 1999 to May 2018. Clinicopathological features assessed were age, presence of lower urinary tract symptoms at presentation, presence of PSA checked over 1 year before biopsy, presence of PSA checked within 4 to 1 years of biopsy, last pre-biopsy PSA (pPSA), biopsy grade group (bGG), cT, cN, percentage of positive biopsy cores (PPBC), pathological GG (pGG), pT, pN, surgical margin, and index tumor diameter. The primary endpoint was BCR-free survival (BCRFS). Results: Of 598 patients enrolled, 211 experienced BCR at the mean follow-up of 64±37 months. The 5-year and 10-year BCRFS were 62.8% and 53.9%, respectively. In multivariate analyses including clinical variables only, pPSA, bGG, cT, PPBC, and PSA within 4 to 1 years of biopsy independently affected BCRFS. In multivariate analyses including pathological variables only, pPSA, pGG, pT, pN, PSA checked over 1 year before biopsy and PSA checked within 4 to 1 years of biopsy independently affected BCRFS. Conclusions: Patients who has checked PSA at least once beyond 1 year before diagnosis of prostate cancer show better BCRFS regardless of other factors.

A Case of Giant Hydronephrosis Hidden by Obesity in an 11-year-old Boy

황금빛,황인찬,추설호,김현기,배기수 대한소아신장학회 2017 Childhood kidney diseases Vol.21 No.2

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature.

Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study

강정훈,이신우,문성호,성현환,추설호,한덕현 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.8

Purpose: We evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL. Materials and Methods: We retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups. Results: All patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2±1.0 and 3.1±1.7 for VAS-avg and 2.5±1.8 and 4.7±1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain. Conclusions: Patients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.

Prognostic significance of preoperative and follow-up neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with non-metastatic clear cell renal cell carcinoma

김태우,이정환,심강희,추설호,최종보,안현수,김세중,김선일 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.1

Purpose: To evaluate the significance of preoperative and follow-up neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for recurrence in patients with non-metastatic clear cell renal cell carcinoma (NMCCRCC). Materials and Methods: We retrospectively reviewed the medical records of 309 patients with NMCCRCC who underwent radical or partial nephrectomy. The prognostic significance of various clinicopathological variables, preoperative NLR (pNLR) and PLR (pPLR), and NLR and PLR at recurrence or quasi-recurrence (rNLR and rPLR) for recurrence-free survival (RFS) was analyzed. Results: At mean follow-up of 93 months, 44 patients (14.2%) developed recurrence. In the univariate analysis, clinical presentation, tumor size, pathologic tumor stage, Fuhrman grade, pNLR, pPLR and rNLR were significant prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as continuous variables, tumor size, pathologic tumor stage and pPLR were independent prognostic factors for RFS. In the multivariate analysis using pNLR and pPLR as dichotomous variables, tumor size, pathologic tumor stage, Fuhrman grade and pNLR ≥1.7 were independent prognostic factors for RFS. In multivariate analyses using rNLR and rPLR, only tumor size and pathologic tumor stage were independent prognostic factors for RFS. In a subset of patients with recurrence or at least 42 months follow-up without recurrence, rNLR ≥1.9 was significantly associated with worse RFS, albeit without independent significance. Conclusions: pNLR and pPLR are independent prognostic factors for RFS in patients with NMCCRCC. We propose that postoperative follow-up NLR of 1.9 and higher with one or more adverse clinicopathological factors should prompt radiologic evaluation for possible metastasis.

비신경인성 여성 배뇨장애환자에서 4주간의 Doxazosin GITS의 효용성과 안정성: 단기 추적 결과

이규성,서주태,주명수,김준철,한덕현,김지영,정진우,추설호 대한배뇨장애요실금학회 2008 International Neurourology Journal Vol.12 No.1

Purpose: We administered doxazosin gastrointestinal therapeutic system (GITS) to women with non-neurogenic voiding dysfunction to evaluate its therapeutic effects. Materials and Methods: Women who had voiding dysfunctions for at least 3 mo were included. Inclusion criteria were age ≥18yr, an International Prostate Symptom Score (IPSS) ≥15, and a maximum flow rate (Qmax) <15mL/sec and/or postvoid residual (PVR) ≥150mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram. After 4 weeks, treatment outcomes were evaluated. Results: Sixty-two patients were evaluated of mean age 53.8 (32-78)yr. According to the Blaivas-Groutz nomogram, 24 patients had no or mild obstruction (group A) and 38 had moderate or severe obstruction (group B). After treatment, mean IPSS decreased significantly and by more than 5 points in 42 (67.7%). Mean bother scores, Qmax, and PVR also changed significantly. Thirty-seven (59.7%) showed Qmax increases of more than 50%. No significant difference were observed between the groups in terms of IPSS, bother score, Qmax, PVR, micturition frequencies, or functional bladder capacity changes. Adverse effects related to medication were de novo stress urinary incontinence (SUI) (1 case) and underlying SUI aggravation (1 case). By satisfaction assessments, 16 patients (25.8%) were 'mainly satisfied', 31 (50%) were 'slightly satisfied', and 15 (24.2%) were 'dissatisfied'. Conclusion: Doxazosin GITS was found to be effective in female patients with voiding dysfunction regardless of obstruction grade. The α-adrenoceptor antagonists should be viewed as initial treatment option for women with a non-neurogenic voiding dysfunction. (J Korean Continence Soc 2008;12:19-26)