Cheol Young Oh

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.

Effects of obesity on lower urinary tract symptoms in Korean BPH patients

We analyzed the effects of obesity on lower urinary tract symptoms (LUTSs) in Korean benign prostatic hyperplasia (BPH) patients. This is a multicenter, cross-sectional, prospective study conducted in four centers in Korea. A total of 602 men with LUTSs secondary to BPH were included. BPH/LUTSs cases were men aged >/= 40 years with international prostate symptom scores (IPSS) > or = 8 points. Height, weight and waist circumference were measured. Among the 602 patients, 156 patients had a waist circumference above 90 cm, representing central obesity, and 215 patients had a body mass index above 25 kg m(-2). Waist circumference was positively correlated with prostate volume (P = 0.034). Men with waist circumference > 90 cm experienced a 1.36-fold increased risk of severe LUTSs (95% CI 0.82-2.41) compared with men with waist circumference < or = 90 cm. Prostate volume was positively correlated with urgency and nocturia in men with central obesity. In this population of Korean men diagnosed with BPH, central obesity rather than overall obesity seems to be the more important predictor of LUTSs correlated with BPH.

Safety and Efficacy of Once Daily Administration of 50 mg Mirodenafil in Patients with Erectile Dysfunction: a Multicenter, Double-Blind, Placebo Controlled Trial

PURPOSE We evaluated the improvement in erectile dysfunction and lower urinary tract symptoms as well as the safety of once daily administration of 50 mg mirodenafil in men with erectile dysfunction. MATERIALS AND METHODS A total of 226 patients visited for treatment of erectile dysfunction and were recruited for the study. Of these men 180 met the study inclusion criteria after completing a 2-week screening period (visit [V]1). The patients were randomly allocated into 2 groups. Group 1 (90 patients) received 50 mg mirodenafil once daily and group 2 (90 patients) received a placebo daily. Blood pressure, heart rate, IIEF-5 (5-item version of the International Index of Erectile Function), and SEP (Sexual Encounter Profile) questions 2 and 3 were assessed at 4 (V2), 8 (V3) and 12 weeks after the start of treatment (V4). I-PSS (International Prostate Symptom Score), maximal flow rate and post-void residual volume were also assessed for the evaluation of lower urinary tract symptoms. RESULTS Of the 180 patients 71 in group 1 and 63 in group 2 completed the 12-week clinical trial. IIEF-5 and I-PSS significantly improved in group 1 (p <0.001 for both). Facial flushing was the most common adverse effect, followed by headaches. Notably there were no statistically significant differences in either of the variables related to the cardiovascular system. CONCLUSIONS Once daily administration of 50 mg mirodenafil was efficacious and safe for the treatment of erectile dysfunction and lower urinary tract symptoms.

Korean Urologist's View of Practice Patterns in Diagnosis and Management of Benign Prostatic Hyperplasia: A Nationwide Survey

Purpose In Korea, there was no specific guidelines for the management of benign prostatic hyperplasia (BPH). We reviewed the practice patterns of Korean urologists in the management of BPH and aimed to describe the need to develop specific guidelines. Materials and Methods A probability sample was taken from the Korean Urological Association Registry of Physicians, and a structured questionnaire, that explored practice patterns in the management of BPH, was mailed to a random sample of 251 Korean urologists. Results For the initial evaluation of BPH, most urologists routinely performed prostatic specific antigen (PSA) (96.4%), digital rectal exam (94.4%), international prostate symptom score (IPSS) (83.2%) and transrectal ultrasound (79.2%). Symptom assessment (36.4%) followed by transrectal ultrasound of prostate (TRUS) (20.0%) was considered as the most important diagnostic examination affecting the decision about individual treatment options. Almost all urologists (92.2%) chose medical treatment as the first-line treatment option for uncomplicated BPH with moderate symptoms. Of the respondents, 57.2% had prescribed alpha blocker and 41.6% alpha blocker plus 5-alpha reductase inhibitors as the medical treatment option for BPH. The prescription of 5-ARIs was dependent on the size of the prostate and the severity of symptoms. Conclusion The results of our current survey provide useful insight into variations in the clinical practice of Korean urologists. They also indicate the need to develop further practical guidelines based on solid clinical data and to ensure that these guidelines are widely promoted and accepted by the urological community.

Comparison of the clinical efficacy of medical treatment of symptomatic benign prostatic hyperplasia between normal and obese patients

We aimed to investigate the difference in efficacy of medical treatment of symptomatic benign prostatic hyperplasia (BPH) between normal and obese patients with BPH; obesity was determined by either body mass index (BMI) or waist circumference (WC). In this 12-week prospective observational study, a total of 175 patients aged ≥40 years with International Prostate Symptom Scores (IPSS) ≥12 points and prostate volume ≥20 ml were prospectively enrolled. The patients were divided into two groups according to BMI or WC. Patients received the doxazosin gastrointestinal therapeutic system (GITS) at a dose of 4 mg once per day for 12 weeks. The changes from baseline in the IPSS, maximal urinary flow rate (Q(max)), post-void residual volume, quality of life (QoL) scores and adverse events (AEs) were analysed. Of the 175 enrolled patients, 132 completed the study. Sixty-seven patients had BMI >23 kg m⁻², and 43 had WC >90 cm. Obese patients represented by WC >90 cm or BMI ≥23 kg m⁻² had a significantly greater prostate volume compared with non-obese patients at baseline. Total IPSS was significantly higher in the WC >90 cm group compared to the WC ≤90 cm group. Total IPSS was positively correlated with prostate volume (P=0.031) and WC (P=0.045). All groups showed significant improvements in total IPSS and QoL at 12 weeks. However, the improvement of total IPSS was greater in the high-BMI and high-WC groups. The most frequent AE was dizziness (n=13), and it was significantly lower in the obese BPH patients. Obesity was associated with increased prostate volume and lower urinary tract symptoms. Alpha-blockers appear to be efficacious for controlling symptoms, especially in obese men.

Effects of Components of Metabolic Syndrome on Sexual Function in Korean BPH/LUTS Patients

INTRODUCTION There are limited data concerning the association between components of metabolic syndrome and sexual function in men aged 40 years and older in Korean benign prostatic hyperplasia (BPH) patients. AIM To examine the effects of metabolic markers on sexual function in Korean BPH patients and to evaluate obesity as a causal factor for the development of BPH and sexual dysfunction in a large population of Korean men. METHODS This is a multicenter, cross-sectional, prospective study conducted at four centers in Korea. A total 602 men with LUTS secondary to BPH were included. BPH/LUTS cases were men with international prostate symptom scores (IPSS) >or=8 points and prostate volume >or=20 cc by transrectal ultrasound of the prostate. Height, weight, and waist circumference were measured. Trained interviewers using the structured Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-15) collected information on sexual function. MAIN OUTCOME MEASURES Sexual function using IIEF-15 and MSHQ was assessed according to presence of diabetes mellitus (DM) or hypertension, waist circumference and BMI. RESULTS BPH patients with DM or hypertension had significantly lower sexual function, and satisfaction scores on the MSHQ were significantly lower in BPH patients with hypertension. In the central obesity group, prostate volume was significantly greater compared to the normal waist group (P = 0.01). Moreover, in Korean BPH/LUTS patients, central obesity was significantly related to sexual function. BPH/LUTS represented by IPSS was significantly correlated with prostate volume and MSHQ and IIEF-15 scores. In addition, severe LUTS was significantly related to all domains of the MSHQ. CONCLUSIONS This study provides evidence that in the Korean population, sexual function is more closely associated to central obesity than general obesity. The relationship of comorbidities such as diabetes, hypertension, and sexual dysfunction determined by the MSHQ correlated with that determined by the IIEF-15.

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.

PD69-03 COMPARISON OF EFFICAY AND SAFETY FOR ERECTILE DYSFUNCTION OF MIRODENALFIL 50MG ONCE DAILY AND 100MG ON-DEMAND IN PATIENTS WITH RADICAL PROSTATECTOMY : MULTICENTER, RANDOMIZED TRIAL.

including global rating of distress, medication assessment, and Index of Premature Ejaculation (IPE). Wilcoxon rank-sum test was used for comparison of all outcomes. RESULTS: An interim analysis was conducted in 21 men who were randomized (15 treatment, 6 placebo) and had complete follow-up data. Baseline mean standard deviation IELT was 74.3 31.8 vs 84.9 29.8 seconds among the treatment and placebo groups, respectively (p1⁄40.39). After 2 months, men in the treatment group had significant improvement in IELT with a mean increase of 231.5 166.9 seconds (95% confidence interval of 139-323 seconds) which was significantly greater than men on placebo (94.2 67.1 seconds, p1⁄4 0.043). A greater proportion of men in the treatment group after one and two months achieved IELT of at least 2 minutes vs placebo (60%, 80.0% vs 33.3% respectively). Compared to placebo, men in the treatment group reported greater improvement in distress relating to intercourse, control of ejaculation, and satisfaction with sexual intercourse over the study period (p<0.01, p1⁄40.01, and p<0.01, respectively). Treatment was well tolerated and no transference was reported. CONCLUSIONS: Topical 4% benzocaine wipes improved both objective and subjective symptoms of PE compared to placebo.