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.

브루셀라 고환부고환염: 고환 종물의 드문 원인

차우헌,최영실,김성우,하경임,김기호,서영진,이경섭 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.3

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

복강경 신고정술의 초기 경험

서일영,임정식 대한비뇨의학회 2007 Investigative and Clinical Urology Vol.48 No.11

여성 복압성요실금 환자에서 IRIS 술식의 5년 추적 결과: TVT 술식과의 비교

송필현,현창호,임화수,정희창 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.8

Purpose: We evaluated the long-term efficacy and safety of the innovative replacement of incontinence surgery (IRIS) procedure and compared these with the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence. Materials and Methods: We included 111 consecutively treated women who underwent IRIS (n=51) or TVT (n=60) between January 2002 and December 2003 and followed them up for at least 5 years postoperatively. We analyzed the 5-year success rate and postoperative complications of the IRIS procedure and compared these with the results of the TVT procedure. Results: The 5-year success rate was 92.2% for the IRIS procedure and 93.3% for the TVT procedure, and the satisfaction rates were 90.2% and 85.0%, respectively. Intraoperative complications for the IRIS group included 4 cases of bladder perforation, and there were 5 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 3 patients with de novo urgency, 2 patients with mesh exposure, and 1 patient with temporary urinary retention. Four patients in the TVT group developed de novo urgency, 2 patients had mesh exposure, and 2 patients showed temporary urinary retention. Conclusions: Our results suggest that IRIS may be an effective and safe procedure compared with the TVT procedure for more than 5 years.

방광암세포주의 항암제 반응에 대한 in vivo Hollow Fiber Assay

문기혁,한병규,정성진,홍성규,변석수,이상은 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.5

Purpose: The National Cancer Institute(NCI)'s Hollow Fiber Assay(HFA) is currently used as an in vivo screening model to quantitatively define anticancer activity. To investigate the use of HFA in a bladder cancer model, we conducted in vitro and in vivo experiments with several anticancer drugs in nude mice. Materials and Methods: The human bladder cancer cell lines(CRL2742, 253JP, SW1710, HTB9) were cultured both in vitro and in vivo in polyvinylidene fluoride(PVDF) hollow fibers. The fibers were implanted intraperitoneally(ip) and subcutaneously(sc) into female athymic nude mice(C57BL/6), and the mice were then treated with gemcitabine 120 mg/kg(bolus), cisplatin(3mg/kg), paclitaxel(15mg/kg) or vehicle only (control) for 4-consecutive days. After 6 days, the fibers were retrieved and the viable cell density was analyzed by MTT assay. Results: The difference between in vitro and in vivo growth was not significant for the CRL2742, 253J-P and SW1710 cell lines; the difference between the ip and sc fibers was also not significant in the CRL2742, SW1710 and HTB9 cell lines. After drug treatment, the percent of growth inhibition revealed constant and effective anticancer activities for the 3 individual drugs. Conclusions: This study demonstrates the possibility of measuring and quantifying the anticancer effect with using in vivo hollow fiber assay in a bladder cancer model. (Korean J Urol 2008;49:392-397) Purpose: The National Cancer Institute(NCI)'s Hollow Fiber Assay(HFA) is currently used as an in vivo screening model to quantitatively define anticancer activity. To investigate the use of HFA in a bladder cancer model, we conducted in vitro and in vivo experiments with several anticancer drugs in nude mice. Materials and Methods: The human bladder cancer cell lines(CRL2742, 253JP, SW1710, HTB9) were cultured both in vitro and in vivo in polyvinylidene fluoride(PVDF) hollow fibers. The fibers were implanted intraperitoneally(ip) and subcutaneously(sc) into female athymic nude mice(C57BL/6), and the mice were then treated with gemcitabine 120 mg/kg(bolus), cisplatin(3mg/kg), paclitaxel(15mg/kg) or vehicle only (control) for 4-consecutive days. After 6 days, the fibers were retrieved and the viable cell density was analyzed by MTT assay. Results: The difference between in vitro and in vivo growth was not significant for the CRL2742, 253J-P and SW1710 cell lines; the difference between the ip and sc fibers was also not significant in the CRL2742, SW1710 and HTB9 cell lines. After drug treatment, the percent of growth inhibition revealed constant and effective anticancer activities for the 3 individual drugs. Conclusions: This study demonstrates the possibility of measuring and quantifying the anticancer effect with using in vivo hollow fiber assay in a bladder cancer model. (Korean J Urol 2008;49:392-397)

고등급 방광요관역류에서 변형된 내시경적 주입술기의 효용성

이태원,오미미,진명헌,문두건 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.11

Purpose: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. Materials and Methods: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. Results: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23±0.3ml, while that for the conventional STING was 0.95±0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects. Purpose: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. Materials and Methods: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. Results: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23±0.3ml, while that for the conventional STING was 0.95±0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects.

Effects of α-Lipoic Acid on the Antioxidant System in Prostate Cancer Cells

최성협,민권식,최익준,강동일 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.1

Purpose: Overproduction of lipid peroxidation byproducts and disturbances in the antioxidant defense system have been implicated in the pathogenesis of several diseases, including prostate cancer. Although several studies have investigated the level of lipid peroxidation and antioxidants in prostate cancer, there are no reports on α-lipoic acid(ALA) in prostate cancer. Here we assessed the effects of ALA on the antioxidant system in prostate cancer cells. Materials and Methods: PC-3, LNCaP, and RWPE-2 cell lines were used in this study. Redox factor(Ref)-1 protein was measured by Western blot analysis after treatment with ALA. Real-time polymerase chain reaction (RT-PCR) was performed to detect superoxide dismutase(SOD)-1 and -2, catalase, and glutathione peroxidase(GSH-Px) mRNA expression. Results: Ref-1 was expressed in the PC-3, LNCaP, and RWPE-2 cell lines. The expression of Ref-1 protein was increased after treatment with 125, 250, and 500μM ALA in the PC-3(p<0.05) and LNCaP(p>0.05) cells compared with the RWPE-2 cells at 48 hours. In PC-3 cells, the mRNA expression of SOD-1, SOD-2, catalase, and GSH-Px decreased at 24 and 48 hours dose-dependently compared with that in RWPE-2 cells(p<0.05). The mRNA expression of SOD-2, catalase, and GSH-Px in LNCaP cell decreased at 48 hours dose-dependently(p<0.05). Conclusions: The expression of Ref-1 protein and antioxidant enzymes changed after ALA exposure in prostate cancer cells. Our findings suggest that ALA affects the antioxidant system in prostate cancer cells and may be related to compensatory changes in the antioxidant defense system of the cells. Purpose: Overproduction of lipid peroxidation byproducts and disturbances in the antioxidant defense system have been implicated in the pathogenesis of several diseases, including prostate cancer. Although several studies have investigated the level of lipid peroxidation and antioxidants in prostate cancer, there are no reports on α-lipoic acid(ALA) in prostate cancer. Here we assessed the effects of ALA on the antioxidant system in prostate cancer cells. Materials and Methods: PC-3, LNCaP, and RWPE-2 cell lines were used in this study. Redox factor(Ref)-1 protein was measured by Western blot analysis after treatment with ALA. Real-time polymerase chain reaction (RT-PCR) was performed to detect superoxide dismutase(SOD)-1 and -2, catalase, and glutathione peroxidase(GSH-Px) mRNA expression. Results: Ref-1 was expressed in the PC-3, LNCaP, and RWPE-2 cell lines. The expression of Ref-1 protein was increased after treatment with 125, 250, and 500μM ALA in the PC-3(p<0.05) and LNCaP(p>0.05) cells compared with the RWPE-2 cells at 48 hours. In PC-3 cells, the mRNA expression of SOD-1, SOD-2, catalase, and GSH-Px decreased at 24 and 48 hours dose-dependently compared with that in RWPE-2 cells(p<0.05). The mRNA expression of SOD-2, catalase, and GSH-Px in LNCaP cell decreased at 48 hours dose-dependently(p<0.05). Conclusions: The expression of Ref-1 protein and antioxidant enzymes changed after ALA exposure in prostate cancer cells. Our findings suggest that ALA affects the antioxidant system in prostate cancer cells and may be related to compensatory changes in the antioxidant defense system of the cells.

음경골절 환자에서 시행한 조기 수술 치료의 장기 성적

김민균,유지형,성락희,노충희,정재용 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.2

Purpose: Penile fracture is a rare but serious urological condition. Immediate surgical repair is widely accepted as the treatment of choice in penile fracture. The aim of this study is to investigate the long-term outcome of immediate surgical treatment of penile fracture. Materials and Methods: This is a retrospective study of 12 men with penile fracture who were treated in the Department of Urology, Sanggyepaik Hospital, Seoul, Korea from January 2000 to June 2005. Diagnosis was made clinically and was confirmed by cavernosography in all our patients. All patients underwent immediate surgical repair, within two days after trauma, using a degloving incision. The long term results of the immediate surgical repair were evaluated using questionnaire on outpatient department visiting or telephoning. Results: The median patient age was 43 years (range, 18 to 57 years). The median follow-up was 32 months (range, 14 to 60 months). Of these patients, 8 (66.7%) patients were injured during sexual intercourse, whereas 4 (33.3%) patients were injured during masturbation. All patients were treated by immediate surgery. All patients reported satisfactory, painless erectile function; two developed penile curvature and one had a penile nodule. Conclusions: Immediate surgical repair of penile fracture is effective, restores erectile function, and the incidence of complications is low. Purpose: Penile fracture is a rare but serious urological condition. Immediate surgical repair is widely accepted as the treatment of choice in penile fracture. The aim of this study is to investigate the long-term outcome of immediate surgical treatment of penile fracture. Materials and Methods: This is a retrospective study of 12 men with penile fracture who were treated in the Department of Urology, Sanggyepaik Hospital, Seoul, Korea from January 2000 to June 2005. Diagnosis was made clinically and was confirmed by cavernosography in all our patients. All patients underwent immediate surgical repair, within two days after trauma, using a degloving incision. The long term results of the immediate surgical repair were evaluated using questionnaire on outpatient department visiting or telephoning. Results: The median patient age was 43 years (range, 18 to 57 years). The median follow-up was 32 months (range, 14 to 60 months). Of these patients, 8 (66.7%) patients were injured during sexual intercourse, whereas 4 (33.3%) patients were injured during masturbation. All patients were treated by immediate surgery. All patients reported satisfactory, painless erectile function; two developed penile curvature and one had a penile nodule. Conclusions: Immediate surgical repair of penile fracture is effective, restores erectile function, and the incidence of complications is low.

치료 시작시기에 따른 야뇨증 치료 결과에 대한 고찰

길건,임재성,김홍식 대한비뇨의학회 2006 Investigative and Clinical Urology Vol.47 No.10