Jang Ho Bae

Desmopressin Add-On Therapy for Refractory Nocturia in Men Receiving α-Blockers for Lower Urinary Tract Symptoms

PURPOSE Alpha-blockers improve lower urinary tract symptoms associated with benign prostatic obstruction. Nocturia, a storage symptom, is a common complaint in men. However, it does not fully respond to α-blocker therapy, likely due to its multifactorial pathophysiology. We evaluated the efficacy and safety of desmopressin as add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms. MATERIALS AND METHODS Eligible patients were men 50 years old or older with lower urinary tract symptoms and persistent nocturia despite α-blocker treatment for a minimum of 4 weeks. The optimum dose of oral desmopressin was determined during a 4-week dose titration period and this dose was maintained for 24 weeks. Flow volume charts, International Prostate Symptom Score total and subscores, uroflowmetry and post-void residual urine volume were assessed. RESULTS A total of 216 patients were enrolled in the study. Of these patients there were 158 (76%) with nocturnal polyuria, 15 (7.2%) with decreased nocturnal bladder capacity and 35 (16.8%) with nocturia due to both causes. The number of nocturnal voids significantly decreased from a baseline mean of 7.0 to 5.7 episodes for 3 days at the 24-week visit. The average International Prostate Symptom Score total and subscore significantly decreased by 4 weeks and were maintained at 24 weeks. In patients younger than 65 years, International Prostate Symptom Score voiding subscores were significantly improved at 24 weeks compared to those age 65 years or older. CONCLUSIONS Desmopressin add-on therapy for refractory nocturia in men previously treated with an α-blocker for lower urinary tract symptoms improved voiding symptoms as well as nocturia, storage symptoms.

Comparison Between Subcutaneous Injection of Basic Fibroblast Growth Factor-Hydrogel and Intracavernous Injection of Adipose-derived Stem Cells in a Rat Model of Cavernous Nerve Injury

OBJECTIVE To compare the effects of subcutaneous penile injection of basic fibroblast growth factor (bFGF)-hydrogel and intracavernous injection of human adipose-derived stem cells (h-ADSCs) on improving erectile function in a rat model of cavernous nerve injury. MATERIALS AND METHODS Adult male Sprague-Dawley rats were randomly divided into 5 groups (n = 10 per group): age-matched control (normal group), bilateral cavernous nerve injury (BCNI group), penile subcutaneous injection of hydrogel after BCNI (hydrogel group), penile subcutaneous injection of bFGF-hydrogel after BCNI (bFGF-hydrogel group) and intracavernous injection of h-ADSCs after BCNI (ADSC group). Four weeks after the treatment, all rats underwent an erectile function test. Then, penile tissue was harvested for immunohistological analysis of bFGF, phalloidin, and cluster of differentiation (CD) 31. The cyclic guanosine monophosphate (cGMP) level of the corpus cavernosum was quantified by cGMP assay. RESULTS From the functional test and immunohistological result, we observed that bFGF-hydrogel and h-ADSCs injection significantly elevated intracavernous pressure. The evaluation of filamentous actin content, CD31 expression, and cGMP concentration in the corpus cavernosum were meaningfully increased in the bFGF-hydrogel and ADSC groups compared with BCNI group. The bFGF released from bFGF-hydrogel prevented smooth muscle atrophy. Moreover, bFGF expression was significantly increased in bFGF-hydrogel group. CONCLUSION The subcutaneous injection of bFGF-hydrogel prevented smooth muscle atrophy, increased the intracavernous pressure, and improved erectile function like an intracavernous injection of h-ADSCs.

Another Option for Laparoscopic Living Donor Nephrectomy: A Single Center Experience Comparing Two-Port Versus Hand-Assisted Technique

PURPOSE To compare the clinical outcomes of two-port laparoscopic donor nephrectomy (TPLDN) vs hand-assisted laparoscopic donor nephrectomy (HALDN). PATIENTS AND METHODS Between November 2010 and March 2012, 100 kidney donors scheduled for left nephrectomy were alternatively assigned to HALDN or TPLDN in a 1:1 fashion. All procedures were performed by the same laparoscopic surgeon. Demographic data and intraoperative and early postoperative data were collected prospectively and analyzed. RESULTS There was no difference in the operating time (133±12 vs 142±17 min, P=0.07), blood loss (55±46 vs 58±52 mL, P=0.84), complication rate (10% vs 12%, P=0.74), and length of hospital stay (3.8±0.8 vs 4.1±2.8 days, P=0.5) between the HALDN and TPLDN groups. The warm ischemia time was longer in the TPLDN group (2.2±0.7 vs 3.5±0.9 min, P<0.001). No statistically significant differences were found in the analgesic requirement and the visual analog pain scores. There was a trend toward quicker return to 100% recovery in the TPLDN group (60±46 vs 39±15 days, P=0.05). The TPLDN group had a significantly smaller surgical incision (8.2±0.6 vs 5.5±0.4 cm, P<0.001) and higher scar satisfaction score (7.8±1.5 vs 8.6±1.3, P=0.02) than the HALDN group. No differences were found in the recipient serum creatinine values or in the incidence of delayed graft function. CONCLUSIONS In comparing TPLDN and HALDN, there was no significant difference in a majority of the operative and postoperative parameters. TPLDN might be associated with smaller surgical incision, improved cosmetic satisfaction, and equivalent recipient graft function.

Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia

Purpose To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). Materials and Methods The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. Results Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. Conclusions It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

A simple technique for the retraction of the liver in laparoscopic right renal surgery.

The retraction of the liver is essential to obtain a better laparoscopic view in right nephrectomy. A simple technique for liver retraction during laparoscopic right renal surgery using surgical cotton is presented. The advantage of the presented method is that this technique is simple, does not require special equipments, and eliminates the need for any additional ports.