Hong Jin Suh

Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder

In a study of patients with BOO and an overactive bladder, authors from Seoul and Pittsburgh compared the use of doxazosin with or without tolterodine. The combination of the two drugs was helpful in most patients, but doxazosin alone was also effective.

Prevalence and Associated Factors of Overactive Bladder in Korean Children 5-13 Years Old: A Nationwide Multicenter Study

OBJECTIVES To estimate the prevalence of overactive bladder (OAB) in Korean children, 5-13 years of age, and to assess the associated factors for OAB. METHODS A randomly selected cross-section study was conducted in 26 kindergartens and 27 elementary schools nationwide in Korea. A total of 19 240 children were included; a parent was asked to complete the questionnaires, which included items about OAB and voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, usually with increased daytime frequency and nocturia (International Childrens Continence Society, 2006). Its prevalence and associated factors were also investigated. RESULTS The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%. The prevalence of OAB decreased with age from 22.99% to 12.16% (P = .0001). The overall incidence of wet and dry OAB was 26.97% and 73.03%, respectively. Compared with normal children, those with OAB had a greater prevalence of nocturnal enuresis, constipation, fecal incontinence, urinary tract infection, delayed bladder control, and poor toilet facilities (P < .05). The incidence of increased daytime frequency and urge incontinence was 3.69% and 2.31% (P = .009) and 26.97% and 14.78% (P = .0001) in OAB and non-OAB children, respectively. The corresponding prevalence decreased with age from 5.04% to 3.06% and from 45.74% to 18.50% in OAB children (P = .0001). CONCLUSIONS The overall prevalence of OAB in Korean children, 5-13 years of age, was 16.59% and decreased with age. Nocturnal enuresis, constipation, fecal incontinence, history of urinary tract infection, delayed bladder control, and poor toilet facilities might be factors associated with the development of OAB.

An Epidemiologic Study of Voiding and Bowel Habits in Korean Children: A Nationwide Multicenter Study

OBJECTIVES To evaluate the prevalence of abnormal voiding and bowel habits in healthy children, and to identify possible relationships between personal and familial factors and voiding and/or bowel habits. METHODS A randomly selected cross-sectional study was conducted in 19,240 children (5-13 years old) nationwide in the Republic of Korea. Parents were asked to complete questionnaires, which included items about nocturnal enuresis, daytime dysfunctional voiding symptoms (DVSs), and abnormal bowel habits (ABHs). Rates and associated factors were investigated. RESULTS The overall rates of DVS, ABH, and of both were 46.4%, 31.3%, and 18.4%, respectively, and nocturnal enuresis was reported in 919 (5.6%). Daytime dysfunctional voiding symptoms were as follows: increased voiding frequency in 419 (2.5%), decreased voiding frequency in 720 (4.4%), urgency in 2740 (16.6%), daytime incontinence in 1854 (11.2%), urge incontinence in 2775 (16.8%), and holding maneuvers or postponed voiding in 3888 (23.5%). ABHs were as follows: constipation by frequency in 1103 (6.7%), constipation by the Bristol scale in 1941 (11.8%), fecal incontinence in 1293 (7.8%), and difficult or painful defecation in 2609 (15.8%). Delayed stool control, history of urinary tract infection, and a double-income family were positively associated with DVS or ABH or both. Furthermore, fathers with a low level of education and a low income were found to be associated with higher risk of ABH or DVS or both. CONCLUSIONS Delayed stool control, a history of urinary tract infection, a low paternal level of education, a double-income family, and a lower family income had a negative effect on voiding or bowel habits in children.

A Nationwide Epidemiological Study of Nocturnal Enuresis in Korean Adolescents and Adults: Population Based Cross Sectional Study

We performed a nationwide epidemiological study to evaluate the prevalence and characteristics of nocturnal enuresis (NE) in Korean adolescents and adults. A questionnaire was sent via e-mail to 51,073 people aged 16-40 yr by stratified sampling according to age, sex, and region among a 200,000 internet survey panel pool. The questionnaire included following information; presence or absence of NE, frequency of NE, possible risk factors for NE, self-esteem scale score and depression score results, and measures for the treatment of NE. Among the 2,117 responders, 54 (2.6%) had NE (≥1 enuretic episode within 6 months). Of 54 bedwetters, 9.3% wet ≥1 night per week and 20.5% wet ≥1 per month. The prevalence rates remained relatively stable with no apparent trend of reduction with age. The presence of sleep disturbance, family history, urgency, or urge incontinence increased the probability of NE episode significantly. The self-esteem score was lower (P=0.053) and the depression scale score was higher (P=0.003) in bedwetters compared with non-bedwetters. Overall 2.6% of Korean aged 16-40 yr have NE. The higher rate of urgency and urge incontinence in adolescent and adult enuretics suggests that bladder function has an important role in adolescent and adult NE.

Double-J stenting: initial management of injured ureters recognized late after gynecological surgery

Introduction and hypothesisTo evaluate the efficacy of double-J stenting as an initial procedure to manage ureteral injuries detected late after gynecological surgery.MethodsEight patients whom the insertion of double-J stent was done primarily were evaluated. Medical records were investigated retrospectively.ResultsUreteral injuries were unilateral in seven and in one patient was bilateral (nine ureters in total). In two patients that double-J stentings were failed underwent open surgery. In six patients (seven ureters), double-J stentings were successful either by cystoscopy or ureteroscopy and four ureters were recovered without sequelae. However, in three ureters, stenosis was remained and managed by ureteral dilation with placement of double-J stent. But, one was lost at follow-up schedule.ConclusionsUreteral double-J stenting, as first-line treatment, could avoid invasive urological surgery in damaged ureter detected after gynecological surgery. More cases are needed for accurate conclusions.

Erratum: Efficacy and Tolerability of Anticholinergics in Korean Children with Overactive Bladder: A Multicenter Retrospective Study

[This corrects the article on p. 1550 in vol. 29, PMID: 25408588.].

Hypofractionated intensity-modulated radiotherapy in patients with localized prostate cancer: a preliminary study

Purpose The aim of this work was to assess the efficacy and tolerability of hypofractionated intensity-modulated radiotherapy (IMRT) in patients with localized prostate cancer. Materials and Methods Thirty-nine patients who received radical hypofractionated IMRT were retrospectively reviewed. Based on a pelvic lymph node involvement risk of 15% as the cutoff value, we decided whether to deliver treatment prostate and seminal vesicle only radiotherapy (PORT) or whole pelvis radiotherapy (WPRT). Sixteen patients (41%) received PORT with prostate receiving 45 Gy in 4.5 Gy per fraction in 2 weeks and the other 23 patients (59%) received WPRT with the prostate receiving 72 Gy in 2.4 Gy per fraction in 6 weeks. The median equivalent dose in 2 Gy fractions to the prostate was 79.9 Gy based on the assumption that the α/β ratio is 1.5 Gy. Results The median follow-up time was 38 months (range, 4 to 101 months). The 3-year biochemical failure-free survival rate was 88.2%. The 3-year clinical failure-free and overall survival rates were 94.5% and 96.3%, respectively. The rates of grade 2 acute genitourinary (GU) and gastrointestinal (GI) toxicities were 20.5% and 12.8%, respectively. None of the patients experienced grade ≥3 acute GU and GI toxicities. The grade 2-3 late GU and GI toxicities were found in 8.1% and 5.4% of patients, respectively. No fatal late toxicity was observed. Conclusion Favorable biochemical control with low rates of toxicity was observed after hypofractionated IMRT, suggesting that our radiotherapy schedule can be an effective treatment option in the treatment of localized prostate cancer.

MP27-01 CHARACTERISTICS OF PATIENTS WITH PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER HOLEP IN BPH

INTRODUCTION AND OBJECTIVES: Holmium laser enucleation of the prostate (HoLEP) in BPH is widely used and the effects are known to be equivalent or better than traditional TUR-P with low incidence of complications. However, some patients who underwent HoLEP still have the lower urinary tract symptoms(LUTS) after surgery. We evaluated the characteristics of patients who visited our clinics due to persistent LUTS and required additional medications after HoLEP in BPH patients. METHODS: The medical records of the patients who underwent HoLEP from March of 2011 to June of 2015 were reviewed retrospectively. The analysis was performed in patients who have been followed for more than 6 months after surgery. The patients were divided into 2 groups. Group A is the patients with persistent obstructive symptoms and group B is with irritation symptoms. Age, prostate specific antigen, International prostate symptom score (IPSS), prostate volume, transition zone volume of prostate, peak flow rate, maximum cystometric capacity, post voided residual volume, resected weights, operation time were analyzed. RESULTS: Among the 482 patients who underwent the HoLEP, the numbers of patients who required the medicine for lower urinary tract symptoms were 138 (28.6%). Among the patients, 53 patients (40.2%) were enrolled in Group A and 85 patients (59.8%) were enrolled in Group B. The mean age, total IPSS, PSA, total prostate volume, peak flow rate, maximum cystometric capacity, post voided residual volume, and operation time between two groups were statistically insignificant. However, transition zone volume and resected weights were significantly different between group A and B. (p1⁄40.017, p1⁄40.010 respectively) CONCLUSIONS: More than 25% of the patients were still taking the medicines for lower urinary tract symptoms after HoLEP. Among the patients who required the medicine, 60% of patients have complained of irritation symptoms. Bigger transition zone with resection weights were correlated with remaining of postoperative irritation symptoms.

The Changes of Psychometric Profiles after Medical Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia.

Objective To investigate the relationship of somatization and depression with the degree of lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and changes in psychometric profiles including somatization and depression after treatment of LUTS/BPH. Methods Subjects were evaluated at baseline and at week 12 following routine treatment for LUTS/BPH using the International Prostate Symptom Score (IPSS) to measure the severity of LUTS/BPH, the Overactive Bladder Symptom Score (OABSS) to measure the severity of OAB, the Patient Health Questionnaire-9 (PHQ-9) to assess depression, and the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatization. The correlation of somatization and depression with the degree of LUTS/BPH symptoms at baseline and changes in somatization and depression after LUTS/BPH treatment were assessed using relevant statistical analyses. Results One hundred and twenty patients agreed to participate in this study, and 101 (84.2%) completed the 12-week trial and responded to the study questionnaires. At baseline, total IPSS score was correlated with PHQ-9 (r=0.475, p=0.005) and PHQ-15 (r=0.596, p<0.001) scores. The results after the 12-week treatment clearly show significant improvement in both PHQ-9 (p <0.001) and PHQ-15 (p=0.019) scores, and the PHQ-9 (r=0.509, p=0.048) and PHQ-15 (r=0.541, p=0.016) scores were positively correlated with total IPSS. Conclusion Our preliminary results indicated that severity of LUTS is correlated with severity of somatization and depression. Further, the improvement of LUTS after treatment may have positive impacts on somatization and depression.

Availability of Cystometrogram as a Predictive Factor of Recurrence of Acute Urinary Retention by Benign Prostatic Hyperplasia.

Purpose: We evaluated the value of cystometrogram (CMG) as a predictive factor of recurrence of acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH). Materials and Methods: 26 patients attending the emergency room or out patients clinic with AUR were assessed. Indwelling catheter was placed in the bladder for 7 days and CMG was performed within 24 hours and 7 days later of AUR. Recurrence was evaluated by medical records or telephone interview after 1 year of AUR. Results: CMG findings performed just after AUR were normal (7), decreased capacity (12), large capacity (4), detrusor overactivity (2) and poor compliance (1). These findings were changed by 7-days-inwelling catheterization. Decreased capacity (12) was changed to normal in 5, unchanged in 7. Large capacity (4) were changed to normal in 3, unchanged in 1, detrusor overactivity (2) and poor compliance (1) were unchanged. AUR was recurred in 5 (33.3%) out of 15 patients who showed normal (7) and turned to normal after 7-days-indwelling catheterization (8), but in 7 (63.6%) out of 11 patients whose CMG was not changed by 7-days-indwelling catheterization. Conclusion: Patients who showed normal at initial CMG and turned to normal CMG after 7-days-indwelling catheter were at low risk of recurrence of AUR. Therefore, CMG performed at the time of AUR may be helpful in the prediction of recurrence of AUR. (J. Korean Continence Society 2003;7:108-111) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ