Changhee Yoo

Stent Position Is More Important than α-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

Purpose To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. Materials and Methods Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. Results In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. Conclusions Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

Preoperative Clinical Factors for Diagnosis of Incidental Prostate Cancer in the Era of Tissue-Ablative Surgery for Benign Prostatic Hyperplasia: A Korean Multi-Center Review

Purpose To identify potential predictive factors of incidental prostate cancer (IPca) in patients considering tissue-ablation treatment for benign prostatic hyperplasia (BPH). Materials and Methods From the 11 centers, 1,613 men who underwent transurethral resection of the prostate (TURP) or open prostatectomy were included. Before surgery, prostate biopsy was performed in all patients with prostate-specific antigen (PSA) ≥4.0 ng/ml or with abnormal digital rectal examination (DRE) findings. The patients with prostate cancer preoperatively or with PSA >20 ng/ml were excluded. As predictive factors of IPca, age, body mass index, PSA, DRE, and transrectal ultrasonography (TRUS) findings, including total prostate volume (TPV), transition zone volume (TZV), and the presence of hypoechoic lesions, were reviewed. PSA density (PSAD) and PSAD in the transition zone (PSAD-TZV) were calculated. Results IPca was diagnosed in 78 patients (4.8%). DRE findings, PSA, and TZV were independent predictive factors in the multivariate analysis. In the receiver operating characteristic curve analysis of PSA, PSAD, and PSAD-TZV, the area under the curve (AUC) was the largest for PSAD-TZV (AUC, 0.685). Conclusions IPca was detected in 4.8% of the population studied. In addition to DRE findings, the combination of TZV and PSA can be useful predictive factors of IPca in patients considering tissue-ablation treatment as well as TURP.

Feasibility of the Interferon-γ Release Assay for the Diagnosis of Genitourinary Tuberculosis in an Endemic Area

Purpose To evaluate the feasibility of the interferon-gamma release assay (IGRA) as a supplementary diagnostic tool for the diagnosis of genitourinary tuberculosis (GUTB). Materials and Methods Fifty-seven patients who were tested with the IGRA to diagnose GUTB were included. All patients had clinical or radiologic features suspicious for GUTB. Signs and symptoms included chronic dysuria with long-standing sterile pyuria, renal calcification with distorted renal calyces and contracted renal pelvis, and chronic epididymitis. Patients who had a history of tuberculosis in other organs were excluded. Tests including IGRA, urine acid-fast bacilli (AFB) stain and culture, urine tuberculosis polymerase chain reaction (UT-PCR), and radiological examinations were performed to confirm GUTB. The medical records of the patients were reviewed retrospectively. Results The IGRA result was positive in 30 patients (52.6%). The results of the urine AFB stain and culture were positive in 5 patients (8.8%) and 7 patients (12.2%), respectively. The results of UT-PCR were positive in 9 patients (15.8%). The 7 patients who showed positive results in the urine AFB stain and culture also had positive results on the IGRA. A UT-PCR-negative patient was diagnosed with GUTB by positive results on both the IGRA and AFB stain and culture. Conclusions The IGRA might feasibly be used as a supplementary or screening tool for the diagnosis of GUTB in addition to urine AFB stain and culture. Further studies for statistical evaluation of its sensitivity, specificity, and efficacy are needed.

Clinical significance of a large difference (≥ 2 points) between biopsy and post-prostatectomy pathological gleason scores in patients with prostate cancer

We investigated the clinical significance of large difference (≥ 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS ≥ 2, n = 30), B (changed in pGS ≤ 1, n = 1,361; control group), and C (increased in pGS ≥ 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.

PD29-08 PREDICTIVE FACTORS FOR THE DEVELOPMENT OF RENAL INSUFFICIENCY FOLLOWING PARTIAL NEPHRECTOMY AND SUBSEQUENT RENAL FUNCTION RECOVERY

INTRODUCTION AND OBJECTIVES: To evaluate predictors of renal insufficiency and subsequent renal function recovery following partial nephrectomy (PN). METHODS: Data from 6 institutions on 393 patients who underwent PN for solid renal tumors between March 2001 and November 2013 were retrospectively reviewed. Clinicopathological features including age, sex, body mass index, histories of hypertension and diabetes mellitus, ASA score, tumor size, RENAL nephrometry score, operative time, clamp type, ischemic time, blood loss, and serum chemistry were assessed. Renal insufficiency was defined as a new onset eGFR <60 mL/min/1.73m after the operation on the second of two consecutive tests at least 3 months apart. Renal function recovery was defined as eGFR 60 ml/min/1.73m following renal insufficiency. Multivariate models were performed to evaluate predictors of renal insufficiency and subsequent renal function recovery. RESULTS: The median (IQR) age, tumor size, and follow-up period were 53 (45-63) years, 2.6 (1.9-3.8) cm, and 36 (12-48) months, respectively. Tumors were of low complexity in 48.9% of cases. Tumor complexity significantly correlated with ischemic time (p1⁄40.001); however, not with postoperative renal insufficiency. Clavien-Dindo complication GIII occurred in 10.5% patients and were mostly hemorrhagic. Renal insufficiency developed in 53 (13.5%) patients in which age 60 years (HR1⁄43.457, 95% CI 1.947-6.137; p<0.001) and preoperative Cr 1.1 mg/ml (HR1⁄43.533, 95% CI 2.047-6.100; p<0.001) were independent predictors. Among these patients, 20 (37.7%) patients exhibited renal function recovery within a median (IQR) period of 18 (12-36) months of which preoperative Cr <1.1 mg/ml revealed to be an independent predictor (HR1⁄45.937, 95% CI 1.454-24.24; p1⁄40.013). Retrospective nature of the study was a limitation. CONCLUSIONS: Age 60 years and preoperative Cr 1.1 mg/ ml were risk factors for renal insufficiency following PN; however, among patients exhibiting renal insufficiency, those with preoperative Cr <1.1 mg/ml may be expected for renal function recovery.