Hyun Kyu Ahn

Changes in Clinical Characteristics of Patients with an Initial Diagnosis of Prostate Cancer in Korea: 10-Year Trends Reported by a Tertiary Center

Background The Korea Central Cancer Registry reported that incidence rates of prostate cancer have not increased continuously. We used recent trends in the incidence of prostate cancer to generate a preliminary report of the Korean population with prostate cancer. Methods Patients initially diagnosed with prostate cancer by prostate biopsy from 2006 to 2015 at our tertiary center were selected. All patients were categorized according to age (< 65, 65–75, > 75 years), time period (2006–2010 vs. 2011–2015), and risk classification. Patients with insufficient data were excluded from the analysis. Results Of 675 patients (median prostate-specific antigen [PSA], 9.09 ng/mL), those with a Gleason score (GS) of 6 (32.3%) comprised the largest proportion in our cohort. The proportion with a GS of 8 increased for those aged 65–75 years, despite the lack of increase in PSA. Treatment patterns changed for those with very low to low risk cancer. The overall survival (OS) rate and the cancer-specific survival (CSS) rate for all patients at 5 years were 87% and 90%, respectively. Patients with a low body mass index (BMI; ≤ 23 kg/m2) had worse median OS and CSS rates. Conclusion Significant differences in risk classifications and initial treatments were found between 2006–2010 and 2011–2015. Although PSA did not change, the GS did change. Lower BMI (≤ 23 kg/m2) had worse effects on OS and CSS rates for Korean prostate cancer patients.

The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled Study

Purpose: Excessive bulking force during primary access of the ureteral access sheath may induce ureteral injury. We investigated the efficacy of preoperative &agr;‐blockade to reduce ureteral access sheath insertion force and determine the upper limit required to avoid ureteral injury. Materials and Methods: In this randomized controlled trial 135 patients from a single institution who had ureteropelvic junction or renal pelvis stones and were scheduled to undergo retrograde intrarenal surgery were prospectively enrolled from December 2015 to January 2017. Of the patients 41 and 42 were randomly assigned to the control and experimental groups, respectively. The experimental group received &agr;‐blockade preoperatively. The 21 patients who were pre‐stented were assessed separately. We developed a homemade device to measure maximal ureteral access sheath insertion force. Results: Our ureteral access sheath insertion force measurement device showed excellent reproducibility. Higher insertion velocity resulted in greater maximal sheath insertion force. Maximal insertion force in the &agr;‐blockade group was significantly lower than in the control group at the ureterovesical junction (p = 0.008) and the proximal ureter (p = 0.036). Maximal insertion force in the &agr;‐blockade group was comparable to that in pre‐stented patients. Female patients and patients 70 years old or older showed a lower maximal ureteral access sheath insertion force than their counterparts. The rate of grade 2 or greater ureteral injury was lower in the &agr;‐blockade group than in controls (p = 0.038). No injury occurred in any case in which ureteral access sheath insertion force did not exceed 600 G. Conclusions: Preoperative &agr;‐blockade and slow sheath placement may reduce maximal ureteral access sheath insertion force. If the force exceeds 600 G, a smaller diameter sheath may be an alternative. Alternatively the procedure can be terminated and followed later by pre‐stented retrograde intrarenal surgery.

Development of a Screening Tool to Predict Chronic Kidney Disease Risk in Post-nephrectomy Living Kidney Donors

Few studies have examined the long-term risks of kidney removal to donors despite the increase of frequency in kidney transplantation. This is the 1st study to develop prediction models of chronic kidney disease (CKD) for the 1-year period after donor nephrectomy in living donors. A prospective cohort of patients who underwent donor nephrectomy from March 1, 2006, to December 31, 2016, at the Severance Hospital, Seoul, South Korea, was used. CKD was defined as a glomerular filtration rate (GFR)xa0<60 mL/min/1.73 m2. GFR was estimated with the use of the abbreviated Modification in Diet and Renal Disease Study equation. Patients with a previous CKD history or estimated GFRxa0<60 mL/min/1.73 m2 were excluded, and those with 1-year post-nephrectomy follow-up were included. Among 440 patients who underwent donor nephrectomy, 144 (32.7%) developed a first-time onset of a GFRxa0<60 mL/min/1.73 m2 by 1 year after surgery. Our logistic regression models derived from these 3 variables predicted CKD with an area under the receiver operating characteristic curve of 0.796, an accuracy of 70.9%, and a sensitivity of 66.2% and specificity of 80.6%. This model could assist with decision making about potential donors and for surveillance of those at risk of post-nephrectomy CKD.

MP38-07 THE EFFECT OF BETA-3 ADRENERGIC RECEPTOR AGONIST ON MICROMOTIONS OF MAJOR PELVIC GANGLION DISCONNECTED RAT BLADDER

INTRODUCTION AND OBJECTIVES: Although rapamycin, during stretch, altered matrix, hypoxia and partial outlet obstruction (PBO), improves bladder smooth muscle phenotype and gene expression patterns (Aitken, 2010, Am.J.Path., Schroder, JUrol, 2013, Jiang, PLOSONE, 2015), the effect of rapamycin on gene expression during de-obstruction(dOB) is unknown. We hypothesized that rapamycin-induced changes in gene expression during dOB could uncover new pathways with functional relevance. METHODS: Sprague-Dawley female rats underwent PBO by tying a silk suture around the proximal urethra and a 0.9mm steel rod, leaving only the suture in place. PBO animals were randomized to 6 week PBO or 6 week PBO plus de-obstruction (dOB). dOB were randomized to vehicle (saline) or rapamycin for 6 weeks. Shams were performed over 6 and 12 weeks. High-throughput QPCR was performed to identify genes dysregulated during dOB normalized with rapamycin treatment and were tested by students t-test and Pearsons correlation with non-invasive functional tests which were performed prior to bladder harvest. After identifying significant dOB genes, their gene products were added exogenously to human SMC for 48 hours, fixed and stained immunofluorescently for SMC markers. We used transcription factor binding site programs (DAVID, OPOSSUM) to identify new networks. Circadian/core clock dependency of target genes and SMC markers was queried by applying a circadian modulator, the reverba agonist, SR9009, to BSMC and testing expression of the dOB genes by QPCR over 1 day and SMC markers by immunofluorescence at 18 hours. RESULTS: IGFBP7, BMP2, and SOD3 correlated with functional improvements in rapamycin treated animals. We identified the E-box bound by circadian regulators CLOCK/BMAL or NPAS2/BMAL as a potential common mechanism of transcriptional regulation amongst the three genes. Obstruction and dOB upregulated mRNA expression of CLOCK and NPAS2, above sham levels, while Rapamycin downregulated mRNA of CLOCK, NPAS2, alongside the 3 physiologic genes, p<0.01. BMAL, DEC1/2, and other core clock genes were not significantly altered during rapamycin treatment of dOB vs other groups. Exogenous IGFBP7 increased SMC hypertrophy in vitro. SR9009 had time-specific effects on expression of several core clock genes alongside BMP2 and IGFBP7, p<0.025. CONCLUSIONS: Rapamycin improves core clock and dOB target gene expression, suggesting that circadian E-box binding regulators are under transcriptional control by de-obstruction and rapamycin, coordinate with changes in BSMC phenotype.

Comparison of the delta neutrophil index with procalcitonin, erythrocyte sedimentation rate, and C-reactive protein as predictors of sepsis in patients with acute prostatitis

Background We investigated the usefulness of inflammatory markers including the delta neutrophil index (DNI), erythrocyte sedimentation rate, C-reactive protein, and procalcitonin as early predictors of sepsis in patients with acute prostatitis (AP). In addition, we evaluated the efficacy of intermittent catheterization for the initial management of acute urinary retention (AUR) in patients with AP. Materials and methods All patients who presented to the emergency department and were admitted to the urology department from January 2011 to December 2013 were retrospectively reviewed. The clinical features, prostate-specific antigen levels, inflammatory marker levels, and urine and blood culture results were obtained from medical records. Patients who underwent urethrocystoscopy or prostate biopsy within 7 days were excluded. Results Of 132 patients (mean age, 64.8 years) in this cohort, 17 (12.9%) had sepsis and 22 (16.7%) had positive blood cultures. Escherichia coli was the most common isolate in blood and urine cultures. In multivariate analysis, the DNI and prostate-specific antigen were identified as predictors of sepsis. The DNI was a significant prognostic factor for bacteremia. In patients with AP, procalcitonin was not a significant predictor of sepsis. Of 19 patients with AUR, 10 needed Foley catheterization because of refractory AUR. C-reactive protein was a significant predictor of failure of the initial management of AUR. Conclusions The DNI is useful as a predictive factor for sepsis and bacteremia in patients with AP. Without mandatory cystostomy, intermittent catheterization could be one of the useful management options of AUR in patients with AP.

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

Endoscopic combined intrarenal surgery (ECIRS) with simultaneous retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) has been proposed as a new surgical treatment to overcome the disadvantage of RIRS and PCNL monotherapies in the treatment of renal stone. One of advantages of ECIRS is that it can increase stone-free rates in complex renal stone within single-session. Intermediate-supine position in real-time simultaneous ECIRS can prevent an anesthesiologic problem, and patients burden is small even for long-term operation. Thus, we will share the experience and advantages of real-time simultaneous ECIRS and introduce techniques to increase the stone-free rate.