Hae Young Park

Bcl-2 and p53 expressions in invasive bladder cancers

We investigated the Bcl-2 and P53 protein expressions in 89 patients with bladder cancers using immunohistochemical analysis. In superficial tumors, the times of tumor recurrence and progression were significantly shorter in the P53-positive group than in the negative group (p < 0.005, p < 0.05, respectively). In invasive tumors, the disease-specific actuarial survivals were significantly lower in the P53 and Bcl-2-positive groups (p <0.05, p < 0.025, respectively). In multivariate analysis, overexpression of p53 and Bcl-2 had independent prognostic value for survivals in invasive tumor, while disease-free survival was related independently to overexpression of p53 in superficial tumor. The results of our assessment for chemoeffectiveness revealed that the patients with Bcl-2-positive tumors had significantly lower response rates than those with Bcl-2-negative tumors (p < 0.05). We conclude that p53 expression is an independent, poor prognostic marker in invasive tumors as well as in superficial tumors and that overexpression of Bcl-2 is independently associated with a reduced-survival in patients with invasive tumors. These prognostic differences related to P53 and Bcl-2 expression in invasive bladder cancers may be partly due to chemo- or radio-sensitivity in relation to apoptotic process.

Effects of tumor necrosis factor-α and interferon-γ on expressions of matrix metalloproteinase-2 and -9 in human bladder cancer cells

Abstract We have investigated the effects of tumor necrosis factor-α (TNF-α) and interferon (INF-γ), the potent Bacillus Calmette–Guerin (BCG)-induced cytokines on the production of MMP-2, MMP-9, TIMP-1, TIMP-2 and MT1-MMP in high grade human bladder cancer cell lines, T-24, J-82 and HT-1376 cell lines. MMP-2 expression and activity were decreased in T-24 cells treated with both cytokines in a dose dependent manner. However, J-82 cells treated with TNF-α and INF-γ revealed dose dependent increases of MMP-9 expression and activity with similar baseline expression and activity of MMP-2. HT-1376 cells after exposure to TNF-α only enhanced the expression and activity of MMP-9. These results indicate that TNF-α and INF-γ could regulate the production of MMP-2 or MMP-9 on bladder cancer cells and their patterns of regulation are cell specific. Furthermore, this diverse response of bladder cancer cells to TNF-α and INF-γ suggests that BCG immunotherapy may enhance the invasiveness of bladder cancer in certain conditions with induction of MMPs.

Initial experience with laparoendoscopic single-site surgery by use of a homemade transumbilical port in urology.

Purpose We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field. Materials and Methods From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis® wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach. Results Mean patient age was 54.8 years. Mean operative time was 171.2±109.1 minutes. Mean estimated blood loss was 265.0±395.5 ml. Mean incision length was 3.2±1.4 cm. Mean length of hospitalization was 5.2±2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively. Conclusions In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery.

Role of early endourologic management of tuberculous ureteral strictures.

BACKGROUND AND PURPOSE Tuberculous ureteral stricture causing progressive obstructive uropathy commonly complicates renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral strictures. PATIENTS AND METHODS Seventy-seven patients (84 renal units) with tuberculous ureteral strictures were analyzed. We evaluated the final outcome of involved kidneys with three different managements: medication only (N = 37), medication plus ureteral stenting (N = 28), or medication plus PCN (N = 19). RESULTS The overall nephrectomy rate was 51%. In patients treated with medication only, the nephrectomy rate was 73%, whereas the nephrectomy rate was 34% in patients treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures also was significantly different for patients treated with medication only (8%) and those receiving medication plus early ureteral stenting or PCN (49%). Spontaneous resolution of the strictures was noted in 6 of the 12 renal units that were managed with early ureteral stenting. CONCLUSIONS Early ureteral stenting or PCN in patients with tuberculous ureteral strictures may increase the opportunity for later reconstructive surgery and decrease the likelihood of renal loss.

Bladder Wall Thickness is Associated with Responsiveness of Storage Symptoms to Alpha-Blockers in Men with Lower Urinary Tract Symptoms

Purpose Bladder wall thickness (BWT) is reported to be related to detrusor overactivity and bladder outlet obstruction. We investigated the relationship between BWT and the responsiveness of storage symptoms to alpha-blockers in men with lower urinary tract symptoms (LUTS). Materials and Methods A total of 74 patients with LUTS were enrolled. International Prostate Symptom Score, uroflowmetry with post-void residual urine volume, and transrectal ultrasonography (TRUS) were investigated. BWT was measured by performing TRUS at the midsagittal plane view, and the average value of BWT at the anterior, dome, and trigone areas was used. After 4 weeks of alpha-blocker medication, patients were reevaluated and divided into two groups. The responder group consisted of patients who reported improvement in the storage symptom subscore of 2 points or more; the non-responder group consisted of patients who reported improvement of less than 2 points. Clinical parameters including BWT were compared between the two groups. Results A total of 52 patients were followed. BWT was positively correlated with intravesical prostate protrusion (IPP) (9.26±4.99, standardized beta=0.393, p=0.002) and storage symptom subscore (0.35±0.43, standardized beta=0.458, p=0.002). Compared with that in the responder group, BWT was thicker in the non-responder group, and improvement in the storage symptom score was correlated with BWT (0.58±0.09 cm vs. 0.65±0.11 cm, p=0.018) and prostate volume (27.08±16.26 ml vs. 36.44±10.1 ml, p=0.018). Conclusions BWT was correlated with IPP, the storage symptom subscore, and the responsiveness of storage symptoms to alpha-blockers in LUTS/benign prostatic hyperplasia (BPH) patients. As BWT increased, the responsiveness of storage symptoms to alpha-blocker decreased in LUTS/BPH patients.

Efficacy and Safety of Tadalafil 5 mg Administered Once Daily in Korean Men with Erectile Dysfunction: A Prospective, Multicenter Study.

Purpose The aim of this study was to evaluate the efficacy of a daily dose of tadalafil 5 mg as well as its safety for the cardiovascular system in men with erectile dysfunction. Materials and Methods This study included a total of 162 men who were administered a daily dose of tadalafil 5 mg between April and December of 2009. A total of 127 men completed the 8-week clinical trial. The International Index of Erectile Function (IIEF)-5, blood pressure, and heart rate were measured before treatment with tadalafil (V1) and 4 (V2) and 8 weeks (V3) after treatment with tadalafil. Adverse effects were assessed at V1, V2, and V3. In cases in which the International Prostate Symptom Score (IPSS) was ≥8 at V1, maximal flow rate (Qmax) and postvoid residual volume (PVR) were measured. Results The IIEF-5 values were 11.25±3.18, 14.56±3.79, and 16.91±3.56 at V1, V2, and V3, respectively, with significant improvement (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). The IPSS values were 10.59±5.56, 9.07±6.06, and 8.15±6.10 at V1, V2, and V3, respectively, and the differences were statistically significant (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). There were no significant differences in blood pressure or heart rate. Adverse effects were observed in 7 men (5.51%) at V2 and in 5 men (3.94%) at V3. Conclusions Tadalafil 5 mg administered once-a-day may be effective in improving erectile function. Adverse effects on the cardiovascular system may be minimal. In addition, it is believed that this may also be effective in improving voiding symptoms.

Initial Experience with Robotic-Assisted Laparoscopic Partial Cystectomy in Urachal Diseases

Purpose In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. Materials and Methods Two men and two women with a mean age of 51.5±9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0° robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. Results The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. Conclusions Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.

Combined Tadalafil and α-Blocker Therapy for Benign Prostatic Hyperplasia in Patients With Erectile Dysfunction: A Multicenter, Prospective Study

This prospective study evaluated the safety of tadalafil 5 mg taken once a day in terms of hypotensive side effects and whether it improves lower urinary tract symptoms (LUTS) and restores sexual function in patients with erectile dysfunction who are receiving concomitant α-blocker (AB) therapy for benign prostatic hyperplasia (BPH). A total of 158 LUTS/BPH patients receiving AB therapy for ≥3 months were given tadalafil 5 mg once a day. Before treatment with tadalafil (V1), and 4 weeks (V2) and 12 weeks (V3) after starting tadalafil, blood pressure, heart rate, International Prostate Symptom Score (IPSS), maximal urine flow rate (Qmax), postvoiding residual urine volume, and International Index of Erectile Function (IIEF-5) score were measured. Of the 158 LUTS/BPH patients, a total of 119 completed the trial. Blood pressure (systolic and diastolic) and heart rate did not change. IPSS and IIEF-5 scores improved significantly, but Qmax and postvoiding residual urine volume did not; however, in the 39 men with a low baseline Qmax (≤10 mL/s), Qmax rose significantly from 7.97 ± 1.44 mL/s (baseline) to 8.91 ± 1.60 mL/s (V3; P = .012). The remaining patients (baseline Qmax >10 mL/s) did not change. At V2 and V3, adverse side effects were observed in 10 men (7.30%) and 6 men (5.04%), respectively. Facial flushing was the most common adverse side effect (6 men at V2 and 4 men at V3), followed by headache (2 men each at V2 and V3) and dizziness (2 men at V2). Two patients dropped out of the study because of adverse side effects. In conclusion, tadalafil 5 mg once a day in combination with AB appeared to have few adverse effects on hypotensive events and can improve LUTS and restore sexual function.

Efficacy of Epididymectomy in Treatment of Chronic Epididymal Pain: A Comparison of Patients With and Without a History of Vasectomy

OBJECTIVES To evaluate the surgical outcome in, and satisfaction with treatment of, patients undergoing epididymectomy for postvasectomy pain syndrome. METHODS A total of 49 patients were included. All participants had undergone epididymectomy for chronic epididymal pain from January 2000 to June 2009. Of the 49 patients, 4 had undergone bilateral epididymectomy, and the total number of procedures was 53: 18 in patients with postvasectomy pain syndrome (group 1, n = 16), 21 in patients with chronic epididymitis and no history of vasectomy (group 2, n = 19), and 14 in patients with an epididymal cyst and no history of vasectomy (group 3, n = 14). The preoperative and postoperative pain scale scores and surgical outcome were analyzed. RESULTS For the total patient sample, the mean age was 52.91 ± 13.51 years, and the mean body mass index was 24.10 ± 3.22 kg/m(2). The mean duration of pain was 1.3 years (range 0.25-20), and the mean duration of postoperative follow-up was 4.2 years (range 0.05-10.25). The mean preoperative pain score was 6.91 ± 0.97. The mean postoperative pain scale score was 1.92 ± 1.54 (P < .01). Statistically significant differences in the preoperative and postoperative pain scores were found for each group: group 1, 5.38 ± 1.47 (range 3-8); group 2, 4.10 ± 1.41 (range 2-6), and group 3, 5.21 ± 1.88 (range 2-8; P = .004). In group 1, excellent surgical outcomes and high patient satisfaction were reported for 94.5% (17 of 18) of the procedures performed. CONCLUSIONS The results of our study have shown that epididymectomy is more effective in patients with a history of vasectomy than in those without.

The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy

Purpose We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. Materials and Methods From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. Results The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5±14.0 ng/ml and 9.1±5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). Conclusions BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.