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.

p21 유전자의 발현이 방광암에 미치는 영향

정원일,조인창,하윤석,조성환,박문선,이영숙,윤석중,김원재 대한비뇨의학회 2006 Investigative and Clinical Urology Vol.47 No.11

4cm 미만 크기의 신세포암에서 시행한 복강경 신보존수술

이용성,이승훈,한웅규,이영훈,양승철,나군호 대한비뇨의학회 2006 Investigative and Clinical Urology Vol.47 No.10

재발성 완전 후부요도협착에서 박근판을 보강한 회음부 요도성형술의 치료효과

이진하,이영태 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.8

A Functioning Adrenocortical Oncocytoma

오우석,정재욱,권준범,권태균,김정식,윤길숙 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.4

Adrenocortical oncocytomas are exceptionally rare and most are benign and nonfunctioning. Only 3 cases of adrenal oncocytomas have been reported in the Korean literature and all of them were nonfunctioning. Herein, we report a case of a functioning adrenocortical oncocytoma in a 49-year-old man who presented with Cushing syndrome.

80g 이상 크기 거대 전립선비대증에서 양극성 경요도전립선절제술의 유용성 및 절제량에 따른 수술 결과의 분석

백민기,백성현,이병기,강명범,노용수,정성일,김형곤 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.12

Purpose: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. Materials and Methods: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). Results: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. Conclusions: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result. Purpose: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. Materials and Methods: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). Results: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. Conclusions: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result.

요관 Access Sheath를 이용한 요관경하배석술의 유용성

현창호,송필현,김현태,정희창 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.4

Purpose: The ureteral access sheath (UAS) was developed to facilitate difficult ureteroscopic procedures. However, some have questioned the safety of the UAS and its likelihood of causing significant ureteral traumas. We evaluated the efficacy and safety of a UAS for managing ureteral calculi. Materials and Methods: From July 2005 to June 2008, a total of 122 patients underwent ureteroscopic removal of stones (67 patients with UAS, 55 patients without UAS). Under local, spinal, or general anesthesia, all patients were treated by using a semirigid ureteroscope with or without UAS. The operative results of the patients were assessed with KUB, and excretory urography or ultrasonography were assessed postoperatively after 2 to 4 weeks. We also analyzed the success rates of stone removal and the complication rates for each procedure. Results: Mean stone size and mean operation time were 9.3 mm and 38.8 minutes, respectively, with UAS and 8.9 mm and 40.4 minutes, respectively, without UAS. Overall stone-free rates were 89.6% and 76.4%. Mean hospital stay was 2.0 days and 2.2 days. The time for operation was significantly decreased for upper ureteral stones treated with UAS (p= 0.022). The stone-free rates were higher for upper ureteral stones treated with UAS (28/32, 87.5%, p=0.027), especially for stones greater than 10 mm in size (p=0.048). Conclusions: The use of UAS is effective and safe. The stone-free rates of ureteroscopic removal of stones with UAS were significantly higher than the rates without UAS for large (≥10 mm) upper ureteral calculi.

상부요관석의 치료에서 Stone Cone의 유용성-초기경험

정한수,박종연,김한권,박창면 대한비뇨의학회 2006 Investigative and Clinical Urology Vol.47 No.4

전립선비대증으로 인한 하부요로증상을 호소하는 환자에서 전립선 조직 내 염증의 의미

정원호,최미선,장혁수,박철희,김천일 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.8

Purpose: Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. Materials and Methods: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. Results: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). Conclusions: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients. Purpose: Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. Materials and Methods: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. Results: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). Conclusions: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients.

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