Jongsoo Lee

Factors Affecting Quality of Life Among Spinal Cord Injury Patients in Korea

Purpose Complaints from spinal cord injury (SCI) patients are typically related to physical disability affecting activities of daily life. However, difficulties with voiding and defecation and/or sexual function can also be major concerns. The general population and even physicians are generally unaware of these complaints; therefore, this study focuses on surveying SCI patients regarding challenges that are faced in daily life. Methods A questionnaire was administered randomly and anonymously to SCI patients who visited the Korea Spinal Cord Injury Association and several rehabilitation hospitals in the Republic of Korea in 2013. All participants gave their consent prior to filling out the questionnaire. Results A total of 299 patients answered the questionnaire; the male to female ratio was 5.8:1 and common vectors for injury were motor vehicle accidents, industrial accidents, and falling down. Of the 169 patients who answered the ‘most troublesome’ and ‘wish would improve’ complaints questionnaire properly, urinary problems were most common, specifically incontinence and urinary tract infection. Among all patients, 67% were using clean intermittent catheterization, 63% were taking voiding-related medications, 83% had sexual desires, and among the 122 patients who did not have offspring, 27% had future plans for children. Conclusions From this questionnaire, we discovered that SCI patients in the South Korea suffer not only from physical disability but also many other quality-of-life-related problems. When managing SCI patients, physicians should show greater concern and educate patients about problems related to voiding and sexual activity, rather than just physical disability.

Is Periurethral Calcification Associated With Urinary Flow Rate and Symptom Severity in Men With Lower Urinary Tract Symptoms-Benign Prostatic Hyperplasia? A Retrospective Review

OBJECTIVE To evaluate the association of periurethral calcification (PUC) with urine flow rate and symptom severity in men with lower urinary tract symptoms-benign prostatic hyperplasia (LUTS-BPH). METHODS The records of 1199 LUTS-BPH patients were obtained from a prospectively maintained database of men on their first visit from April 2010 to April 2013. Patients with incomplete data or comorbidities affecting voiding function were excluded. The degree of PUC was scored by evaluating the ratio of the calcified urethra to the entire prostatic urethra on the midsagittal plane of a transrectal ultrasonogram. The relationships between prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were evaluated. RESULTS A total of 1030 patients were eligible for final analysis. There were 654 patients (63.5%) with no PUC, 233 (22.6%) with mild PUC, and 143 (13.9%) with moderate to severe PUC. The total IPSS was 16.21 ± 7.29, 17.74 ± 7.77, and 17.75 ± 7.60 in no, mild, and moderate to severe PUC groups, respectively (P = .007), whereas peak urinary flow rate (Qmax) was 15.05 ± 7.59, 13.62 ± 6.68, and 12.20 ± 6.39 mL/s, respectively (P <.001). In an age-adjusted partial correlation test, PUC significantly associated with total IPSS, the storage symptom score, and Qmax (P <.05). Multivariate analysis revealed that PUC independently associated with Qmax (P = .012), total IPSS (P = .042), and the storage symptom score (P = .018) but not with postvoid residue, the voiding symptom score, or the postmicturition symptom score. CONCLUSION PUC is independently associated with Qmax and urinary symptoms indirectly advocating for the recent idea that periurethral fibrosis and stiffness could cause LUTS-BPH in men.

Stone heterogeneity index on single-energy noncontrast computed tomography can be a positive predictor of urinary stone composition

The aim of this study was to investigate the correlation between stone composition and single-energy noncontrast computed tomography (NCCT) parameters, including stone heterogeneity index (SHI) and mean stone density (MSD), in patients with urinary calculi. We retrospectively reviewed medical records of 255 patients who underwent operations or procedures for urinary stones or had spontaneous stone passage between December 2014 and October 2015. Among these, 214 patients with urinary calculi who underwent NCCT and stone composition analyses were included in the study. Maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were determined on pretreatment NCCT. The mean MSD (454.68±177.80 HU) and SHI (115.82±96.31 HU) of uric acid stones were lower than those of all other types. Based on post hoc tests, MSD was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001). SHI was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001) Receiver operating characteristic curves of uric acid stones for MSD and SHI demonstrated that SHI (cut-off value: 140.4 HU) was superior to MSD (cut-off value: 572.3 HU) in predicting uric acid stones (P<0.001).

MP84-06 TERTIARY REFERRAL HOSPITAL EXPERIENCES OF MEN PRESENTING WITH PAINLESS POST-COITAL GROSS HEMATURIA AND A SUGGESTION FOR TENTATIVE MANAGEMENT ALGORITHM

to baseline assessment of erectile function. These findings suggest that despite the known association between select comorbid conditions, medications, and ED, the presence of these conditions does not result in a more rapid deterioration in erectile function over time compared to cases with no comorbid conditions. This information provides a significant addition to our current understanding of the natural history of ED progression.

PD64-12 URODYNAMIC FINDINGS OF PATIENTS WITH BRAIN TUMOR CLASSIFIED BY LOCATION OF AFFECTED AREA

improvement of nLUTD within 48 hours. Both neurogenic patients were completely dry two months post-op; UI and nocturia disappeared (bladder diary). Both patients stopped CTNM due to the progression of their comorbidity, though a causal correlation could not be drawn. After 1.5 years the electrode of one patient migrated through the implantation path. In the second group, the male was excluded due to lack of improvement and required an alternative treatment. Five female iOAB patients documented major improvements in their bladder diaries. UUI episodes significantly decreased (base: 2.1/day vs. 2.5/month 6 months post-op) and nocturia vanished. Mean voided volume significantly increased by 70ml, without or increased PVR. In the five iOAB patients, all implants are currently in place and their efficacy confirmed. CONCLUSIONS: CTNM offers a promising treatment option using a novel chronic implantable device using an external charger. The new minimalinvasive technology might revolutionize neuromodulation and offers those patients suffering from refractory OAB an opportunity to perform CTNM over several hours, even while sleeping with low or no stimulation related morbidities.

MP08-06 COMBINATION OF RGB AND NARROW BAND IMAGING FOR DISCRIMINATION OF NON-MUSCLE INVASIVE BLADDER CANCER

METHODS: Nine female participants with OAB underwent an extended urodynamics procedure (Laborie Aquarius XT) while ultrasound images of the bladder were obtained using a 3D 6MHz transabdominal probe (GE Voluson E8). The bladder was filled with saline at a rate of 10% bladder capacity (based on an initial clinical fill) per minute while ultrasound images were captured once per minute. Bladder volume was estimated from 2D cross-sectional images in the sagittal and transverse planes assuming an ellipsoid geometry (Eqn 1, Vspheroid), assuming a shape in between an ellipsoid and a cube (Eqn 2, VBih by Bih et. al. 1998), and from the 3D ultrasound data obtained by tracing the bladder outline in six planes with GE’s 4D View software (V3D, Fig. 1 panel A).

PD42-01 IMPACT OF PREOPERATIVE ALPHA-ADRENERGIC ANTAGONISTS ON URETERAL ACCESS SHEATH INSERTION FORCE AND THE UPPER LIMIT OF FORCE TO AVOID URETERAL MUCOSAL INJURY: A RANDOMIZED-CONTROLLED STUDY

INTRODUCTION AND OBJECTIVES: Primary access of the ureteral access sheath (UAS) is not always possible and often excessive force is exerted, thereby increasing the risk of ureteral injury. A randomized controlled trial was performed to investigate the efficacy of preoperative a-blockade on reducing UAS insertion forces (UASIF) and to appreciate the upper limit of UASIF to avoid ureteral injury. METHODS: From December 2015 to October 2016, 88 patients with ureteropelvic junction or renal pelvis stones planned for retrograde intrarenal surgery (RIRS) were prospectively enrolled. Patients were randomly assigned to a control group (n1⁄437) or to an experimental group who received a-blockade with tamsulosin 0.4 mg q.d. for seven days prior to RIRS (n1⁄439). Pre-stented patients were excluded from randomization (n1⁄412). A homemade UASIF gauge was adapted to measure the maximal UASIF at the ureterovesical junction (UVJ) and the proximal ureter. The degree of mucosal injury was recorded. RESULTS: UASIF of the a-blockade group was significantly lower than controls at the UVJ (260.1 180.2 g vs. 524.2 237.5 g; p1⁄40.017), however, not at the proximal ureter (367.2 175.2 g vs. 647.7 294.3 g; p1⁄40.054). The a-blockade group exhibited comparable UASIF with the pre-stented group at the UVJ (260.1 180.2 g vs. 99.8 19.9 g; p1⁄40.149) and the proximal ureter (367.2 175.2 g vs. 131.4 75.2 g; p1⁄40.081). The rate of mucosal injury was lower in the ablockade group compared to controls (p1⁄40.028). Mucosal injury ( grade 2) did not occur in cases with UASIF <600 g. UASIF was lower in females and patients aged 70 years compared to the counterparts (p1⁄40.008 and p1⁄40.021, respectively). Female gender and preoperative a-blockade were independent predictors of lower risks of ureteral injury. CONCLUSIONS: Preoperative a-blockade mimics the effect of pre-stenting and reduces maximum UASIF and consequent risk of ureteral injury. If the UASIF exceeds 600g, the procedure could be terminated with stent placement and followed later by pre-stented RIRS.

PD42-02 DEVELOPMENT AND VALIDATION OF A HOMEMADE DEVICE FOR THE MEASUREMENT OF URETERAL ACCESS SHEATH INSERTION FORCE

INTRODUCTION AND OBJECTIVES: Primary access of the ureteral access sheath (UAS) is not always possible and often excessive force is exerted, thereby increasing the risk of ureteral injury. A randomized controlled trial was performed to investigate the efficacy of preoperative a-blockade on reducing UAS insertion forces (UASIF) and to appreciate the upper limit of UASIF to avoid ureteral injury. METHODS: From December 2015 to October 2016, 88 patients with ureteropelvic junction or renal pelvis stones planned for retrograde intrarenal surgery (RIRS) were prospectively enrolled. Patients were randomly assigned to a control group (n1⁄437) or to an experimental group who received a-blockade with tamsulosin 0.4 mg q.d. for seven days prior to RIRS (n1⁄439). Pre-stented patients were excluded from randomization (n1⁄412). A homemade UASIF gauge was adapted to measure the maximal UASIF at the ureterovesical junction (UVJ) and the proximal ureter. The degree of mucosal injury was recorded. RESULTS: UASIF of the a-blockade group was significantly lower than controls at the UVJ (260.1 180.2 g vs. 524.2 237.5 g; p1⁄40.017), however, not at the proximal ureter (367.2 175.2 g vs. 647.7 294.3 g; p1⁄40.054). The a-blockade group exhibited comparable UASIF with the pre-stented group at the UVJ (260.1 180.2 g vs. 99.8 19.9 g; p1⁄40.149) and the proximal ureter (367.2 175.2 g vs. 131.4 75.2 g; p1⁄40.081). The rate of mucosal injury was lower in the ablockade group compared to controls (p1⁄40.028). Mucosal injury ( grade 2) did not occur in cases with UASIF <600 g. UASIF was lower in females and patients aged 70 years compared to the counterparts (p1⁄40.008 and p1⁄40.021, respectively). Female gender and preoperative a-blockade were independent predictors of lower risks of ureteral injury. CONCLUSIONS: Preoperative a-blockade mimics the effect of pre-stenting and reduces maximum UASIF and consequent risk of ureteral injury. If the UASIF exceeds 600g, the procedure could be terminated with stent placement and followed later by pre-stented RIRS.

Clinical Significance of Periurethral Calcification According to the Location in Men With Lower Urinary Tract Symptoms and a Small Prostate Volume

Purpose To assess the impact of periurethral calcification (PUC) according to its location on uroflowmetric parameters and urinary symptoms in patients with small prostate volume (PV). Methods Records were obtained from a prospectively maintained database of first-visit men with lower urinary tract symptoms (LUTS). Patients whose PV was >30 mL were excluded to elucidate more clearly the impact of PUC on LUTS. A total of 539 patients were enrolled in the study. The prostatic urethra was examined by transrectal ultrasonography for PUC, and the location of PUC was divided into 3 areas (proximal, mid, and distal). Results The characteristics according to the location of PUC were compared using a 1-way analysis of variance test. The Total International Prostate Symptom Score (IPSS), postmicturition symptoms, and overactive bladder symptom score (OABSS) differed significantly among the groups. In the propensity score matching analysis, the proximal- and distal-PUC groups did not have a significantly different urinary flow rate or symptom score when compared to their matched control groups. However, the mid-PUC group had significantly worse urinary symptoms than its matched control group (total IPSS [P=0.001], voiding symptoms [P=0.002], storage symptoms [P=0.041], and OABSS [P=0.015]). The peak urinary flow rate was also lower in the mid-PUC group with borderline significance (P=0.082). On multivariate linear regression analysis, mid-PUC was independently associated with IPSS and OABSS (P=0.035 and P=0.011, respectively). Conclusions Only mid-PUC was associated with symptom severity in men with LUTS and a small PV. Our findings suggest that mid-PUC could be a potential causal factor of LUTS, and the midportion of the prostatic urethra might play a pivotal role in the process of micturition.