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.

Influence of Nonregional Lymph Node Metastasis as a Prognostic Factor in Metastatic Prostate Cancer Patients

조석,강성구,태범식,천준 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.10

Purpose: In advanced prostate cancer, malignant cells generally tend to spread into the bone, and metastasis into nonregional lymph nodes (NRLNs) at the time of initial diagnosis is relatively rare. We investigated the prognostic significance of NRLN metastasis in patients receiving hormonal therapy and chemotherapy. Materials and Methods: From February 2005 to August 2011, we identified 105 patients who had metastatic prostate cancer. First, we assessed the prognostic effect of NRLN metastasis on the prostate-specific antigen response through logistic regression and the progression-free time to castration-resistant prostate cancer (CRPC) by using the Cox proportional hazard regression model. Second, we investigated the prognostic influence of NRLN metastasis on the chemotherapy response through logistic regression and on cancer-specific survival of CRPC patients receiving chemotherapy by using Cox proportional analysis. Results: Of these 105 patients, 12 patients (11.4%) had only NRLN metastases without bone metastases. Progression-free time to CRPC was significantly less in patients with NRLN metastases by Cox proportional hazard regression multivariate analysis (p=0.020). However, NRLN metastasis was not an independent factor for predicting the response to chemotherapy in CRPC patients, and NRLN metastasis did not reduce cancer-specific survival in the multivariate analysis. Conclusions: Twelve (11.4%) of 105 patients with NRLN metastases had lymph node metastases without bone metastases. In addition, NRLN metastasis was a significant prognostic factor for predicting reduced progression-free time to CRPC. Thus, although we speculate that prostate cancer with NRLN metastasis exhibits unique tumor biology, additional molecular and genetic studies are needed.

체외충격파쇄석술 도입 후 요석치료에 있어서 관혈적 수술의 적응증

정진원,나군호,이무상 대한비뇨의학회 2002 Investigative and Clinical Urology Vol.43 No.5

Relationship between the Glutathione-S-Transferase P1, M1, and T1 Genotypes and Prostate Cancer Risk in Korean Subjects

권동득,이재환,한동엽,서일영,박승철,정희종,양윤식,채수천,나경숙,모금자,김정중,임정식 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.4

Purpose: The glutathione-S-transferase (GST)P1, GSTM1, and GSTT1 genotypes have been associated with an increased risk of prostate, bladder, and lung cancers. The aim of this study was to investigate the association between the GSTP1, GSTM1, and GSTT1 genotypes and the risk of prostate cancer in Korean men. Materials and Methods: The study group consisted of 166 patients with histologically confirmed prostate cancer. The control group consisted of 327 healthy, cancer-free individuals. The diagnosis of prostate cancer was made by transrectal ultrasound-guided biopsy. Patients with prostatic adenocarcinoma were divided into organ-confined (≤pT2) and non-organ-confined (≥pT3) subgroups. The histological grades were subdivided according to the Gleason score. The GSTP1, GSTM1, and GSTT1 genotypes were determined by using polymerase chain reaction-based methods. The relationship among GSTP1, GSTM1, and GSTT1 polymorphisms and prostate cancer in a case-control study was investigated. Results: The frequency of the GSTM1 null genotype in the prostate cancer group (54.2%) was higher than in the control group (odds ratio=1.53, 95% confidence interval=1.20- 1.96). The comparison of the GSTP1, GSTM1, and GSTT1 genotypes and cancer prognostic factors, such as staging and grading, showed no statistical significance. Conclusions: An increased risk for prostate cancer may be associated with the GSTM1 null genotype in Korean men, but no association was found with the GSTT1 or GSTP1 genotypes.

Prevalence and Correlates of Nocturia in Community-dwelling Older Men: Results from the Korean Longitudinal Study on Health and Aging

이영주,정성진,변석수,이정재,한지원,김기웅 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.4

Purpose: To determine the prevalence and correlates of nocturia in Korean community-dwelling older men. Materials and Methods: A study population of 439 Korean elderly men (≥65 years of age, including 299 men from a randomly sampled population) was sampled from residents of Seongnam, Korea. Standardized face-to-face interviews and questionnaires were performed. In-person interviews solicited sociodemographic information, medical history, Mini-Mental State Examination (MMSE) score, and measurement of body mass index. Transrectal ultrasonography and laboratory tests including urinalysis and measurement of creatinine and prostate-specific antigen were performed. For the analysis of prevalence, 299 randomly sampled men were included. Men who answered the International Prostate Symptom Score questionnaire (n=424) were included in the analysis of the correlates of nocturia. Nocturia was defined as having to get up to urinate two or more times per night (≥2). Results: The overall prevalence of nocturia was 56.0% for community-dwelling older men. There was a significant correlation between age and the prevalence of nocturia (p<0.001). The univariate analysis revealed a significant association between nocturia and MMSE score (odds ratio [OR], 0.88; p<0.001), history of benign prostatic hyperplasia (BPH) (OR, 2.85; p=0.003), alpha-blocker usage (OR, 2.79; p=0.018), alcohol consumption (OR, 0.65; p=0.035), and smoking (OR, 0.58; p=0.025). Age, duration of education, MMSE score, and prostate volume were also significantly associated with nocturia. In the multivariate regression analysis using forward elimination, nocturia was significantly associated with a history of BPH and MMSE score. Conclusions: The prevalence of nocturia was 56.0% in Korean community-dwelling older men. Nocturia was associated with age and a history of BPH. MMSE score was protective. Purpose: To determine the prevalence and correlates of nocturia in Korean community-dwelling older men. Materials and Methods: A study population of 439 Korean elderly men (≥65 years of age, including 299 men from a randomly sampled population) was sampled from residents of Seongnam, Korea. Standardized face-to-face interviews and questionnaires were performed. In-person interviews solicited sociodemographic information, medical history, Mini-Mental State Examination (MMSE) score, and measurement of body mass index. Transrectal ultrasonography and laboratory tests including urinalysis and measurement of creatinine and prostate-specific antigen were performed. For the analysis of prevalence, 299 randomly sampled men were included. Men who answered the International Prostate Symptom Score questionnaire (n=424) were included in the analysis of the correlates of nocturia. Nocturia was defined as having to get up to urinate two or more times per night (≥2). Results: The overall prevalence of nocturia was 56.0% for community-dwelling older men. There was a significant correlation between age and the prevalence of nocturia (p<0.001). The univariate analysis revealed a significant association between nocturia and MMSE score (odds ratio [OR], 0.88; p<0.001), history of benign prostatic hyperplasia (BPH) (OR, 2.85; p=0.003), alpha-blocker usage (OR, 2.79; p=0.018), alcohol consumption (OR, 0.65; p=0.035), and smoking (OR, 0.58; p=0.025). Age, duration of education, MMSE score, and prostate volume were also significantly associated with nocturia. In the multivariate regression analysis using forward elimination, nocturia was significantly associated with a history of BPH and MMSE score. Conclusions: The prevalence of nocturia was 56.0% in Korean community-dwelling older men. Nocturia was associated with age and a history of BPH. MMSE score was protective.

Tricholithobezoar: An Unusual Late Complication of Neourethral Reconstruction in Aphallia

Vishwajeet Singh,Deepak Sharanappa Nagathan,Rahul Janak Sinha,Dheeraj Kumar Gupta 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.5

An 18-year-old man born with aphallia had undergone phallic reconstruction in childhood followed by total urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap urethroplasty at 13 years of age. The patient presented with obstructive voiding symptoms lasting 6 months followed by acute urinary retention. The results of a voiding cystourethrogram showed a filling defect in the distal urethra that had been reconstructed by use of the skin flap. On urethroscopy, a 3 cm×2cm sized tricholithobezoar was seen in the distal urethra. Pneumatic lithotripsy followed by bulbar urethrolithotomy was performed in the same operation to extract the bezoar. The remaining hairs were mechanically epilated. The patient has been doing well for 6 months of follow-up.

The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

연제승,손승준,이영주,차우헌,최원석,정진우,이병기,이상철,정창욱,홍성규,변석수,이상은 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.4

Purpose: Robot-assisted partial nephrectomy (RPN) has emerged as an alternativetreatment for the management of small renal masses. This study was designed to investigateparameters that predict perioperative outcomes during RPN. Materials and Methods: We retrospectively reviewed the medical records of 113 patientswho underwent RPN between September 2008 and May 2012 at the SeoulNational University Bundang Hospital. Clinical parameters, including warm ischemiatime (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluatedto predict perioperative outcomes. Results: Of the 113 patients, 81 were men and 32 were women. The patients’ mean agewas 53.5 years, and their mean body mass index was 22.3 kg/m². Age, gender, and masslaterality had no effect on perioperative complications, WIT, or EBL. Univariate analysisrevealed that a distance between the tumor and the collecting system of ≤4 mmor a renal mass size of >4 cm were associated with adverse profiles of complications,WIT, and EBL. However, multivariate analysis showed no association between the predictiveparameters and tumor complexity as assessed by nephrometry scores. Tumorsize of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidenceinterval [CI], 1.3–9.7; p=0.016). A distance between the tumor and the collectingsystem of ≤4 mm was associated with increased risk of WIT exceeding 20 minutes (OR,2.8; 95% CI, 1.3–6.3; p=0.012). Conclusions: Tumor size and proximity of the mass to the collecting system showed significantassociations with EBL and WIT, respectively, during RPN. The R.E.N.A.L andPADUA nephrometry scoring systems did not predict perioperative outcomes.

Adrenal Cortical Scintigraphy for Lateralization of Bilateral Adrenal Nodules in Primary Aldosteronism

황인상,청아리,김종범,김광호,권동득 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.8

Value and Safety of Midazolam Anesthesia during Transrectal Ultrasound-Guided Prostate Biopsy

송진현,두승환,양원재,송윤섭,김근우,구자현,이창호 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.3

Purpose: Although transrectal ultrasound-guided prostate biopsy is useful for diagnosing prostate cancer, it is a painful procedure. There are many methods for providing pain relief and for treating discomfort during the procedure, but occasionally these are reported to be of limited use. We aimed to evaluate the value and safety of midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy. Materials and Methods: From August 2008 to December 2009, 104 male patients, who were examined with transrectal ultrasound-guided prostate 12-core biopsy, were randomly assigned to two groups. Group 1 (n=51) received ketorolac (TarasynⓇ) 30 mg. Group 2 (n=53) was treated with midazolam (DormicumⓇ) 3 mg, which was increased to 5 mg if necessary. Immediately after the procedure, the patients were asked to rate their comfort level by using a 10-point visual analog self-assessment pain scale. Results: The pain scale in group 2 was significantly lower than that in group 1 (p<0.05). The patients assigned to group 2 experienced no side-effects from midazolam and were more satisfied than the patients in group 1 (p<0.05). Conclusions: Midazolam anesthesia relieves pain effectively, and the patient’s satisfaction is better than with conventional transrectal ultrasound-guided prostate biopsy. Midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy is useful and safe.

Predictive Factors for Premature Discontinuation of Docetaxel- Based Systemic Chemotherapy in Men With Castration-Resistant Prostate Cancer

박승철,이재환,서일영,임정식 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.3

Purpose: The objective was to determine predictive factors for premature discontinuation of docetaxel-based systemic chemotherapy in men with castration-resistant prostate cancer (CRPC). Materials and Methods: We retrospectively reviewed the medical records of men who were treated with docetaxel-based systemic chemotherapy for CRPC in a single institution between May 2005 and April 2010. After being screened, 30 patients fit the eligibility criteria for inclusion in this study. Group 1 included 12 patients who were treated with five or fewer cycles of docetaxel chemotherapy for CRPC, and group 2 included 18 patients who were treated with six or more cycles of docetaxel chemotherapy for CRPC. The treatment consisted of 5 mg prednisolone twice daily and 75 mg/m2 docetaxel once every 3 weeks. Results: The median age was 72 years, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 0. The median baseline prostate-specific antigen (PSA) level was 33.8 ng/mL. The median cycle of docetaxel-based chemotherapy was 5.8. Of 30 patients, 13 patients (48.2%) had a decline in PSA of >50% from baseline;3 of 22 patients (13.6%) with measurable disease had achieved partial response on imaging. No differences in age, ECOG performance status, hemoglobin, serum creatinine,or PSA response were observed between the two groups. Body mass index was significantly lower (p=0.034) in group 1 (21.8 kg/m2) than in group 2 (23.6 kg/m2). Group 1 included more patients with prior systemic chemotherapy (p=0.039), and group 1 had a shorter overall survival rate (p=0.039). Conclusions: Premature discontinuation of docetaxel-based systemic chemotherapy is associated with lower body mass index and prior systemic chemotherapy. Premature discontinuation of docetaxel-based chemotherapy is associated with a shorter overall survival rate.