Eun Sang Yoo

Comparison of pelvic phased-array versus endorectal coil magnetic resonance imaging at 3 Tesla for local staging of prostate cancer.

Purpose Several studies have demonstrated the superiority of endorectal coil magnetic resonance imaging (MRI) over pelvic phased-array coil MRI at 1.5 Tesla for local staging of prostate cancer. However, few have studied which evaluation is more accurate at 3 Tesla MRI. In this study, we compared the accuracy of local staging of prostate cancer using pelvic phased-array coil or endorectal coil MRI at 3 Tesla. Materials and Methods Between January 2005 and May 2010, 151 patients underwent radical prostatectomy. All patients were evaluated with either pelvic phased-array coil or endorectal coil prostate MRI prior to surgery (63 endorectal coils and 88 pelvic phased-array coils). Tumor stage based on MRI was compared with pathologic stage. We calculated the specificity, sensitivity and accuracy of each group in the evaluation of extracapsular extension and seminal vesicle invasion. Results Both endorectal coil and pelvic phased-array coil MRI achieved high specificity, low sensitivity and moderate accuracy for the detection of extracapsular extension and seminal vesicle invasion. There were statistically no differences in specificity, sensitivity and accuracy between the two groups. Conclusion Overall staging accuracy, sensitivity and specificity were not significantly different between endorectal coil and pelvic phased-array coil MRI.

The 7-year outcome of the tension-free vaginal tape procedure for treating female stress urinary incontinence.

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

The Impact of Overactive Bladder on Health-Related Quality of Life, Sexual Life and Psychological Health in Korea

Purpose We aimed to estimate the prevalence of overactive bladder (OAB) in Korea, to assess the variation in prevalence by sex and age, and to measure the impact of OAB on quality of life. Methods A population-based, cross-sectional telephone survey was conducted between April and June 2010 with a questionnaire regarding the prevalence of OAB, demographics, and the impact of OAB on quality of life. A geographically stratified random sample of men and women aged ≥30 years was selected. Results The overall prevalence of OAB was 22.9% (male, 19%; female, 26.8%). Of a total of 458 participants with OAB, 37.6% and 19.9% reported moderate or severe impact on their daily life and sexual life (5.6% and 3.5%, respectively, in participants without OAB). Anxiety and depression were reported by 22.7% and 39.3% of participants with OAB, respectively (9.7% and 22.8%, respectively, in participants without OAB). Only 19.7% of participants with OAB had consulted a doctor for their voiding symptoms, but 50.7% of respondents with OAB were willing to visit a hospital for the management of their OAB symptoms. Conclusions This study confirmed that OAB symptoms are highly prevalent in Korea, and many sufferers appear to have actively sought medical help. OAB has severe effects on daily and sexual life as well as psychological health.

Efficacy and Safety of Low-Dose Propiverine in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia with Storage Symptoms: A Prospective, Randomized, Single-Blinded and Multicenter Clinical Trial

Purpose The aim of this study was to evaluate whether low-dose anticholinergics combined with an α1-receptor antagonist would continue the effect of an alpha-blocker, decrease the side effects of anticholinergics, and improve the symptoms of lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). Materials and Methods Two hundred nine men with LUTS/BPH with storage symptoms (International Prostate Symptom Score [IPSS] ≥12; storage symptoms ≥4) were randomly assigned in a prospective, multicentered, and single-blind fashion to either the control group (alfuzosin 10 mg, once daily) or the combined group (alfuzosin 10 mg, once daily, and propiverine 10 mg, once daily) for 2 months. IPSS, maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were used to grade symptoms, side effects, and the impact on quality of life (QoL) at the start of the study and after 1 and 2 months. Results There were no significant differences in patient background, including age, prostate size, Qmax, and PVR, between the control group and the combined group. In the combined group, the IPSS total score and the IPSS storage symptom score were significantly improved compared with the control group. The IPSS voiding symptom score, QoL, Qmax, and PVR did not differ significantly. There were no serious side effects in either group. Conclusions Management with an α1-receptor antagonist combined with a low-dose anticholinergic improved the total score and storage symptom score of the IPSS compared with α1-receptor antagonist only group without causing serious side effects. This initial combination medication can be considered an effective and safe treatment modality for LUTS/BPH patients with storage symptoms.

Chylous ascites as a complication of laparoscopic nephrectomy.

PURPOSE Chylous ascites is a rare complication after major retroperitoneal surgery. Recently chylous ascites has developed more often after laparoscopic nephrectomy since that is increasingly done for various indications at many centers. We reviewed our cases of chylous ascites after laparoscopic nephrectomy. MATERIALS AND METHODS Between January 2002 and December 2008 we performed 622 transperitoneal laparoscopic nephrectomies. We retrospectively analyzed factors related to chylous ascites as a complication of laparoscopic nephrectomy. RESULTS The overall incidence of chylous ascites was 5.1% (32 of 622 cases), including 4 severe refractory cases (0.6%). The difference in incidence by operation type was not statistically different (p = 0.251). Chylous ascites developed more often after left than right nephrectomy (7.3% or 25 of 343 cases vs 2.5% or 7 of 279, p = 0.010). In patients with radical nephrectomy and nephroureterectomy the incidence was higher in those who did vs did not undergo lymphadenectomy (13.9% or 10 of 72 vs 4.0% or 11 of 275, p = 0.027). Only 1 patient underwent explorative laparotomy due to persistent severe chylous ascites despite 8-week conservative management. The other cases were successfully managed conservatively by total parenteral nutrition and a low fat diet. CONCLUSIONS Chylous ascites is not a rare complication after laparoscopic nephrectomy and most cases can be managed conservatively. To prospectively prevent this complication we recommend meticulous clipping of all perihilar and retroperitoneal fibrous fatty tissue during major vessel dissection, especially for left nephrectomy or extensive lymphadenectomy.

Differentiation of Human Dental Pulp Stem Cells into Dopaminergic Neuron-like Cells in Vitro

We investigated the potential of human dental pulp stem cells (hDPSCs) to differentiate into dopaminergic neurons in vitro as an autologous stem cell source for Parkinson’s disease treatment. The hDPSCs were expanded in knockout-embryonic stem cell (KO-ES) medium containing leukemia inhibitory factor (LIF) on gelatin-coated plates for 3–4 days. Then, the medium was replaced with KO-ES medium without LIF to allow the formation of the neurosphere for 4 days. The neurosphere was transferred into ITS medium, containing ITS (human insulin-transferrin-sodium) and fibronectin, to select for Nestin-positive cells for 6–8 days. The cells were then cultured in N-2 medium containing basic fibroblast growth factor (FGF), FGF-8b, sonic hedgehog-N, and ascorbic acid on poly-l-ornithine/fibronectin-coated plates to expand the Nestin-positive cells for up to 2 weeks. Finally, the cells were transferred into N-2/ascorbic acid medium to allow for their differentiation into dopaminergic neurons for 10–15 days. The differentiation stages were confirmed by morphological, immunocytochemical, flow cytometric, real-time PCR, and ELISA analyses. The expressions of mesenchymal stem cell markers were observed at the early stages. The expressions of early neuronal markers were maintained throughout the differentiation stages. The mature neural markers showed increased expression from stage 3 onwards. The percentage of cells positive for tyrosine hydroxylase was 14.49%, and the amount was 0.526 ± 0.033 ng/mL at the last stage. hDPSCs can differentiate into dopaminergic neural cells under experimental cell differentiation conditions, showing potential as an autologous cell source for the treatment of Parkinson’s disease.

Complications of Transperitoneal Laparoscopic Nephrectomy: A Single-center Experience

OBJECTIVES To present the incidence of complications of transperitoneal laparoscopic nephrectomy performed for various indications during a 6-year period. METHODS From 2002 to 2007, 505 transperitoneal laparoscopic nephrectomies were performed, consisting of 125 live donor, 212 radical, 80 simple, and 28 partial nephrectomies and 60 nephroureterectomies. We retrospectively analyzed the factors related to perioperative complications, including the type of operation, body mass index, history of abdominal surgery, and American Society of Anesthesiologists score. RESULTS The overall complication rate was 13.7% (69/505). Major complications requiring open conversion or reoperation occurred in 15 patients (3.0%). The remaining 54 patients experienced minor surgical or postoperative medical problems. The mortality rate in our series was 0%. The complication rates by the type of operation were not significantly different. Patients with a history of abdominal surgery demonstrated slightly greater complication rates (19.2% vs 12.6%, P = .069). When stratified by a body mass index of <25 kg/m(2) and <25 kg/m(2), no statistically significant difference was found in the complication rates (13.1% vs 15.6%, respectively, P = .067). Patients with greater American Society of Anesthesiologists scores had greater complication rates (P = .038). The intraoperative complication rates decreased as our experience with laparoscopic surgery increased (P = .042); however, the total complication rates remained constant throughout the study period. CONCLUSIONS In consideration of the contributing factors, the complication rates of transperitoneal laparoscopic nephrectomy were not related to the type of operation, body mass index, or history of abdominal operation but to the American Society for Anesthesiologists score. Complications unique to laparoscopic nephrectomy exist but they decrease with experience.

Combined injection of three different lineages of early-differentiating human amniotic fluid-derived cells restores urethral sphincter function in urinary incontinence

To investigate whether a triple combination of early‐differentiated cells derived from human amniotic fluid stem cells (hAFSCs) would show synergistic effects in urethral sphincter regeneration.

Correlation between Radiologic and Pathologic Tumor Size in Localized Renal Cell Carcinoma

Purpose To evaluate the accuracy of radiologic tumor size for making decisions regarding nephron-sparing surgery of localized renal cell carcinomas (RCCs), we compared tumor size measured by a preoperative radiologic modality with that measured in the pathologic specimen. Materials and Methods Between January 2003 and December 2007, a total of 186 patients with pT1 or pT2 RCC underwent radical or partial nephrectomy at our institute. We excluded 11 patients who had preoperative arterial embolization (n=9) or positive surgical margins (n=2), and a total of 175 patients were included in this study. Radiologic size was defined as the largest diameter on computed tomography (CT), and pathologic size was defined as the largest diameter of the surgical specimen of the tumor. We retrospectively analyzed the difference between radiologic and pathologic tumor size. Results The radiologic and pathologic tumor sizes did not significantly differ (4.98±2.82 cm vs. 4.55±2.70 cm, respectively, p=0.152). In the subgroup analysis, the size difference was statistically significant only for tumor sizes of less than 6 cm. The size difference was largest in tumors of 3 to 4 cm, for which mean the radiologic size was 0.63±1.19 cm larger than the mean pathologic size (p=0.002). Histologic type had no significant influence on the difference between radiologic and pathologic size. Conclusions The tumor size of RCCs in preoperative CT seems to correlate well with pathologic tumor size. However, CT imaging may overestimate the size of a tumor in the small mass group (less than 6 cm). These results should be considered when making decisions about nephron-sparing surgery.

Pre-Clinical Efficacy and Safety Evaluation of Human Amniotic Fluid-Derived Stem Cell Injection in a Mouse Model of Urinary Incontinence

Purpose Stem cell-based therapies represent new promises for the treatment of urinary incontinence. This study was performed to assess optimized cell passage number, cell dose, therapeutic efficacy, feasibility, toxicity, and cell trafficking for the first step of the pre-clinical evaluation of human amniotic fluid stem cell (hAFSC) therapy in a urinary incontinence animal model. Materials and Methods The proper cell passage number was analyzed with hAFSCs at passages 4, 6, and 8 at week 2. The cell dose optimization included 1×104, 1×105, and 1×106 cells at week 2. The in vivo cell toxicity was performed with 0.25×106, 0.5×106, and 1×106 cells at weeks 2 and 4. Cell tracking was performed with 1×106 cells at weeks 2 and 4. Results The selected optimal cell passage number was smaller than 6, and the optimal cell dose was 1×106 for the mouse model. In our pre-clinical study, hAFSC-injected animals showed normal values for several parameters. Moreover, the injected cells were found to be non-toxic and non-tumorigenic. Furthermore, the injected hAFSCs were rarely identified by in vivo cell trafficking in the target organs at week 2. Conclusion This study demonstrates for the first time the pre-clinical efficacy and safety of hAFSC injection in the urinary incontinence animal model and provides a basis for future clinical applications.