남성하부요로증상의 병인

이정구 대한비뇨의학회 2005 Investigative and Clinical Urology Vol.46 No.9

In the past, older male with frequency, weak stream, hesitancy nocturia has prostatism implying his symptoms are related to benign prostatic hyperplasia(BPH). Recently, it was recognized that such symptoms are not a surrogate for BPH. Lower urinary tract symptoms(LUTS) have many causes, of which BPH is but one. The pathophysiology of LUTS is multifactorial. Bladder outlet obstruction(BOO) is one of the principal causes of LUTS: in addition to BOO, detrusor factors such as detrusor overactivity and detrusor underactivity can contribute to the development of LUTS. Of the men with LUTS, lots of them exhibited non-obstructed causes of LUTS in the urodynamic analysis. Increased awareness that there are multifactorial causes of LUTS became a force in changing the pattern of management. Therefore, relieving BOO such as debulking of the prostate mass may not be crucial for solution of LUTS. Aims of the treatment of LUTS also changed from the reducing obstruction and increasing the flow to the patient quality of life and satisfaction by using medical therapy such as alpha-adrenoceptor blockers. This review summarized the multifactorial causes of LUTS in men based on recent literatures 폐색과 노화 및 노화와 연관된 질환들, 신경계질환, 야간다뇨증, 호르몬변화 및 방광질환 등은 다양한 형태로 방광기능에 영향을 미쳐서 하부요로증상을 유발한다 (Table 1). 폐색과 노화의 연관성은 아직 명확하지 않으며 하부요로증상도 비특이성 증상이므로 폐색만으로 그 원인을 설명하기가 어렵다. 더욱이 배뇨근과활동성이나 수축력 저하 시에 나타나는 증상들은 폐색증상과 유사하다. 따라서 전립선비대증의 올바른 치료를 위해서는 하부요로증상을 유발하는 각각의 요인들을 정확하게 감별하는 일이 중요하다.폐색과 노화에 따른 배뇨근의 변화는 일반 조직검사에서는 큰 차이가 없으나, 전자현미경소견에서는 노화와 폐색, 배뇨근수축력저하, 배뇨근불안정 간에 뚜렷한 차이를 보인다. 최근 전립선비대증에 대한 진단이나 치료는 증상점수분석이나 요속검사 결과 등을 기준으로 하지만 두 가지 모두 하부요로증상의 원인적 진단을 내리는 데에는 부족하다. 현재로서는 폐색을 비롯한 하부요로증상의 정확한 진단은 압력요류검사를 포함한 요역동학검사로서만 가능하지만, 앞으로는 배뇨근조직에 대한 조직검사 소견에 의해 하부요로증상의 원인들을 감별할 수 있으리라 기대한다. 하부요로증상을 유발하는 여러 가지 복합적인 요인들에 대한 새로운 인식은 하부요로증상의 치료형태에 변화를 가져오고 있다. 따라서 하부요로증상을 치료하는 데 더 이상 폐색된 전립선비대를 제거하는 것만으로는 충분하지 않을 수 있다. 하부요로증상의 치료는 페색을 제거하고 요류를 향상시키는 목표로부터 환자의 만족도나 삶의 질을 증진시키는 방향으로 전환이 되고 있으며 이에 부응하는 알파아드레날린수용체차단제를 비롯한 다양한 약물치료들이 시도되고 있다.

사람 방광 수축에 대한 국소마취제의 효과: Organ Bath Study를 통한 연구

백성현,임대정,이은식,이상은,최황,오승준 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.2

Purpose: We investigated the in vitro effects of local anesthetics on the contractility of the human bladder. Materials and Methods: Using human bladder strips obtained from 20 patients undergoing cystectomy, we investigated the effects of tetracaine, bupivacaine, lidocaine, and ropivacaine on the basal spontaneous contractions and contractions induced by various stimuli: KCl, carbachol (CCh), and electrical field stimulation(EFS). The effect of local anesthetic agents on the Ca2+-independent sustained tonic contraction(SuTC) was also investigated. Results: Spontaneous contraction was not observed in 181 out of 187 bladder strips. Local anesthetics inhibited nerve-mediated contractions (EFS, 0.8msec) in a concentration-dependent manner and also inhibited non-nerve mediated contractions induced by KCl, long pulse EFS(direct muscle stimulation, 100msec), and CCh. The rank order of inhibitory potency on nerve-mediated contractions and CCh-induced contractions was ropivacaine, tetracaine, bupivacaine, and lidocaine, while the rank order on KCl-induced contractions was ropivacaine, tetracaine, lidocaine, and bupivacaine, both in decreasing order. Higher concentrations of local anesthetics were needed to inhibit the non-nerve-mediated bladder contraction than the nerve-mediated contraction. SuTC was also suppressed by all local anesthetics in a concentration dependent manner. Conclusions: Our study demonstrates that local anesthetics have inhibitory effects on the contraction of human bladder that is induced by various stimuli. These effects suggest that local anesthetics may be useful as diagnostic and therapeutic agents for bladder dysfunction. (Korean J Urol 2004;45:173-180)

비뇨생식계 암환자에서 화학요법이나 면역요법으로 발생된 호중구감소증에 대한 GM-CSF(Granulocyte-Macrophage Colony Stimulating Factor)의 효과

전승현,장성구 대한비뇨의학회 2002 Investigative and Clinical Urology Vol.43 No.3

요도하열 재수술에 대한 Tubularized Incised Plate 요도성형술의 성적

이완,신동길,이상돈 대한비뇨의학회 2003 Investigative and Clinical Urology Vol.44 No.3

신우신염 백서모델에서 신염증 억제에 대한 젖소 초유와 항생제 병용 투여의 효과

박종규,박흥재,주관중 대한비뇨의학회 2006 Investigative and Clinical Urology Vol.47 No.10

PC3 세포주에서 Docetaxel에 의해 유발된 세포고사에 대한 Sulfated Glycoprotein-2(Clusterin)의 작용에 대한 연구

최종보,김영수,원남희,조재흥 대한비뇨의학회 2002 Investigative and Clinical Urology Vol.43 No.7

광주 지역 초등학생 학부모를 대상으로 한 포경수술에 대한 설문조사

김경한,박성운 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.6

Purpose: Circumcision is widely practiced in Korea, but its implementation is still controversial, especially among younger parents. Using a questionnaire study, we tried to determine the rate of circumcision among elementary school boys and to determine parental concerns about phimosis and circumcision. We then compared our findings with previously published literature. Materials and Methods: Between May and June 2007, we randomly selected five elementary schools and distributed self-administered questionnaires to the parents of 2,712 boys from these schools. Questions were related to children's circumcision status, age at the time of circumcision, and opinions concerning circumcision, such as its necessity and benefits. Completed questionnaires were collected and analyzed. Results: The response rate was 66.2%. The overall circumcision rate of boys in elementary school was 15.4%. Some 40.3% of those boys underwent circumcision in the neonatal period, and 37.3% underwent the procedure between ages 9 and 12 years. The circumcision rate was significantly higher in boys in the higher income bracket group(29.5%) compared to boys in the middle and low income bracket groups(15.4% and 12.8%, respectively). Most boys were circumcised based on the intent of their parents(64.2%). Some 44.5% of parents believed that circumcision was necessary, while 36.3% of parents believed it was not necessary. The most common motive for circumcision was "hygiene benefits"(80.2%). Conclusions: The rates of actual circumcision practice and of approval of circumcision were lower in this report compared to previous reports. It seems that more clinical research on circumcision is needed. Physicians should provide information about circumcision to boys and their parents. (Korean J Urol 2008;49:549-555) Purpose: Circumcision is widely practiced in Korea, but its implementation is still controversial, especially among younger parents. Using a questionnaire study, we tried to determine the rate of circumcision among elementary school boys and to determine parental concerns about phimosis and circumcision. We then compared our findings with previously published literature. Materials and Methods: Between May and June 2007, we randomly selected five elementary schools and distributed self-administered questionnaires to the parents of 2,712 boys from these schools. Questions were related to children's circumcision status, age at the time of circumcision, and opinions concerning circumcision, such as its necessity and benefits. Completed questionnaires were collected and analyzed. Results: The response rate was 66.2%. The overall circumcision rate of boys in elementary school was 15.4%. Some 40.3% of those boys underwent circumcision in the neonatal period, and 37.3% underwent the procedure between ages 9 and 12 years. The circumcision rate was significantly higher in boys in the higher income bracket group(29.5%) compared to boys in the middle and low income bracket groups(15.4% and 12.8%, respectively). Most boys were circumcised based on the intent of their parents(64.2%). Some 44.5% of parents believed that circumcision was necessary, while 36.3% of parents believed it was not necessary. The most common motive for circumcision was "hygiene benefits"(80.2%). Conclusions: The rates of actual circumcision practice and of approval of circumcision were lower in this report compared to previous reports. It seems that more clinical research on circumcision is needed. Physicians should provide information about circumcision to boys and their parents. (Korean J Urol 2008;49:549-555)

원위부 및 근위부 요관 결석에 대한 기대요법에서 Tamsulosin의 효과

김진욱,조대연,이정구 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.7

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.

한국인의 전립선암 발생에 있어서 안드로겐 수용체 유전자 Stu Ⅰ 다형성에 대한 연구

이길호,박정애,김보람,신용우,윤철용,윤덕기 대한비뇨의학회 2005 Investigative and Clinical Urology Vol.46 No.6

Purpose: Single nucleotide polymorphisms(SNPs) are considered very promising genetic markers for a better understanding of the genetic basis for complex diseases. Recently, various mutations have been described in the gene encoding the androgen receptor(AR) in a variety of disease, including male pattern baldness and prostate cancer. Analyzing the SNPs among different population or races shows unpredictable different expression patterns or diseases incidences. Because the incidence and mortality of prostate cancer varies worldwide, the SNPs may explain the differences among races. It has been reported that a synonymous A/G variant in exon I of the AR(NM_000044) at position 1754 showed different expression patterns in male pattern baldness. These observations raise important questions regarding the functional and clinical significances of the AR polymorphism. First, does the A/G variation of the AR have significance in prostate cancer? Second, if not, is the variation ethnogeographically specific in Koreans? To date, no studies have given answers to the above questions. Materials and Methods: A total 120 unrelated subjects were enrolled between May and July 2004. Of the 120 patients, 80 had pathologically confirmed prostate cancer, 20 benign prostate hyperplasia(BPH) and 20 were non-bald men. Genomic DNAs were procured from the blood of the patients. A 416bp fragment in exon I of the AR was amplified, and the polymerase chain reaction(PCR) products digested with Stu I enzyme. Results: All the prostate cancer and BPH patients, and even the controls, showed the Stu I restriction enzyme site at position 1754 in the AR. Conclusions: The Stu I polymorphism in the AR is not related to the occurrence of prostate cancer in Koreans. This suggests that the high incidence of the Stu I polymorphism may be from racial differences in the AR gene.