Kyu Shik Kim

Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients

LESS‐NU may be an alternative minimally‐invasive treatment option for patients eligible to undergo laparoscopic surgery for upper urinary tract urothelial carcinoma. The true benefits of LESS‐NU remain to be determined and require randomized control trials in the future. Despite encouraging early findings, clinical trials still are warranted before this procedure is adopted widely, and longer follow‐up is needed to determine its oncological durability.

A Quality Analysis of Randomized Controlled Trials about Erectile Dysfunction

Purpose A low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed. Materials and Methods We selected randomized controlled trials (RCTs) about erectile dysfunction (ED) conducted in Korea using Medline and KoreaMed. Quality assessment of selected RCTs was performed using three assessment tools (Jadad scales, van Tulder scale, Cochrane Collaboration Risk of Bias Tool [CCRBT]). Results The first RCT about ED conducted in Korea was published in 2002. Since 2002, a total of 20 RCTs have been published in medical journals. Among the 20 articles, only 1 article was found to have a low risk of bias according to the CCRBT. On the Jadad scale, there were 17 high quality articles, while 19 articles were assessed as high quality by the VTS. Only 2 RCTs described the randomization method adequately. Only 1 RCT presented allocation concealment. Conclusions A low quality clinical trial could produce errors, and these errors could, in turn, distort the results of the clinical trial. To avoid applying distorted results of trials clinically, a quality analysis of clinical trials is needed. The quality of RCTs was found to be high because almost all of the selected RCTs were double blinded studies. However, the quality of RCTs was inadequate with regard to the lack of randomization and absence of allocation concealment. Therefore, performing adequate randomization and adding a description of the appropriate concealment of allocation may improve the quality of RCTs.

Men With Severe Lower Urinary Tract Symptoms Are at Increased Risk of Depression.

Purpose: Lower urinary tract symptoms (LUTS) comprise a set of common, bothersome symptoms in middle-aged and elderly men. Recent research suggests that depressive symptoms may influence the symptoms of benign prostatic hyperplasia (BPH). We performed a community-based cross-sectional study to evaluate the correlation between LUTS and depression. Methods: The survey was conducted in a rural community during four periods in August 2009, 2010, 2011, and 2012. Two validated questionnaires were used to examine LUTS and depressive symptoms. These included the International Prostate Symptom Score/quality of life (IPSS/QoL) and the Korean version of the Center for Epidemiological Studies-Depression scale (CES-D-K). Patients were categorized in the depressive symptom group if their CES-D-K score was >16 points. Results: A total of 711 men were included in this study. Thirty-five participants (4.92%) were found to have depressive symptoms. There was a positive correlation between depressive symptoms and LUTS severity (P<0.001). As compared to the mild LUTS group, the odds ratio (OR) of depression was 2.868 (95% confidence interval [CI], 1.293–6.362; P for trend<0.001) in the moderate LUTS group, and 4.133 (95% CI, 1.510–11.313; P for trend<0.001) in the severe LUTS group. In a model considering multiple variables such as age, education level, smoking, and exercise, the OR in the moderate LUTS group was 2.534 (1.125–5.708, 95% CI, P for trend=0.005), while that in the severe LUTS group was 3.910 (95% CI, 5.708–11.154; P for trend=0.005). In addition, depression was related to voiding symptoms. Conclusions: Men with severe LUTS are at higher risk of depression than those with less severe urinary symptoms. The severity of voiding symptoms worsens depression. More aggressive urological diagnosis and treatment is needed in patients with severe LUTS, due to the impact on depressive symptoms and QoL.

Randomized Controlled Trials In Endourology: A Quality Assessment

PURPOSE To analyze the quality of studies reporting randomized clinical trials (RCTs) in the field of endourology. MATERIALS AND METHODS RCTs published in the Journal of Endourology from 1993 until 2011 were identified. The Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT) were used to assess the quality of the studies. The review period was divided into early (1993-1999), mid (2000-2005), and late (2006-2011) terms. Studies were categorized by country of origin, subject matter, single- vs multicenter setting, Institutional Review Board (IRB) approval and funding support, and blinding vs nonblinding. RESULTS In total, 3339 articles had been published during the defined review period, of which 165 articles were reporting a RCT. There was a significant increase in the number of RCTs published over time, with 18 (2.81%), 43 (4.88%), and 104 (5.72%) studies identified in the early, mid, and late term, respectively (P=0.009). Nevertheless, there was no difference in terms of quality of reporting, as assessed with the Jadad scale, van Tulder scale, or CCRBT, between the three study terms. On the other hand, significant differences were found in both the number of high qualitative RCTs that used blinding methodology and those that had IRB review, when comparing the early, mid, and late terms. CONCLUSION There has been a growing number of Journal of Endourology publications reporting on RTC over the last two decades. The quality of reporting for these studies remains suboptimal, however. Researchers should focus on a more appropriate description of key features of any given RCT, such as randomization and allocation methods, as well as disclosure of IRB review and financial support.

The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate

Purpose Dutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP). Materials and Methods Eighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization. Results Lower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group. Conclusions Preoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.

Tamsulosin Treatment Affecting Patient-reported Outcomes in Benign Prostatic Hyperplasia-associated Depressive Symptoms

OBJECTIVE To investigate the effect of tamsulosin on LUTS and depressive symptoms among depressed and nondepressed individuals previously diagnosed with benign prostatic hyperplasia. MATERIALS AND METHODS The study conducted from July 2013 to June 2014 included outpatient participants with benign prostatic hyperplasia presenting with lower urinary tract symptoms (LUTS). One tablet of tamsulosin (0.2 mg) was administered to patients daily. We divided participants with geriatric depression scale (GDS) scores of 0-17 into the nondepressive symptom group (group 1) and those with GDS scores of 18-30 into the depressive symptom group (group 2). At the first visit (V1), 4th week (V2), and 12th week (V3), the International Prostate Symptom Score (IPSS), quality of life (QoL), patient perception of bladder condition, overactive bladder syndrome symptom score, and GDS questionnaires were administered. RESULTS IPSS (17.35 ± 7.11 vs 14.61 ± 6.04, P = .10) as well as GDS scores (20.97 ± 3.07 vs 8.84 ± 4.50, P  <  .01) were higher among those with depressive symptoms than those without, and difference between the two groups was not represented. After taking tamsulosin, on the V2 and V3, both groups had improved overactive bladder syndrome symptom scores, patient perception of bladder condition, IPSS, QoL, and GDS. Comparing the first visit with the V2 and V3, group 2 showed significant changes in GDS, but group 1 did not. CONCLUSION Treatment with tamsulosin is associated with improved LUTS and decreased depressive symptoms, which could enhance QoL.

The Effect of Terpene Combination on Ureter Calculus Expulsion After Extracorporeal Shock Wave Lithotripsy

Purpose Terpene combination (Rowatinex) is known to help with the expulsion of urinary stones. The aim of this study was to determine how Rowatinex affects the expulsion of remnant stones after shock wave lithotripsy (SWL). Materials and Methods Clinical data were collected retrospectively from 499 patients with a diagnosis of ureteral stones who underwent SWL from January 2009 to August 2012. Ureteral stones were diagnosed in all patients by kidney, ureter, and bladder x-ray and abdominal computed tomography (CT). The progress of patients was documented every 2 weeks to confirm remnant stones after SWL. The patients with remnant stones underwent SWL again. Group 1 consisted of patients who were prescribed an analgesic, Tamsulosin 0.2 mg, and Rowatinex. Group 2 consisted of patients who were prescribed only an analgesic and Tamsulosin 0.2 mg. The expulsion rate of urinary stones was compared between groups. Results The expulsion rate of urinary stones was not significantly different between the two groups after 2 weeks. However, after 4 weeks, group 1 had a significantly higher expulsion rate (72.2% compared with 61.1%, p=0.022). Fifteen patients (10.2%) in group 1 and 40 (11.4%) in group 2 had to undergo ureteroscopic removal of the stone (p=0.756). Acute pyelonephritis occurred in one patient (0.7%) in group 1 and in one patient (0.3%) in group 2 (p=0.503). Conclusions The long-term administration of Rowatinex for 4 weeks increased the expulsion rate of urinary stones after SWL.

PD69-03 COMPARISON OF EFFICAY AND SAFETY FOR ERECTILE DYSFUNCTION OF MIRODENALFIL 50MG ONCE DAILY AND 100MG ON-DEMAND IN PATIENTS WITH RADICAL PROSTATECTOMY : MULTICENTER, RANDOMIZED TRIAL.

including global rating of distress, medication assessment, and Index of Premature Ejaculation (IPE). Wilcoxon rank-sum test was used for comparison of all outcomes. RESULTS: An interim analysis was conducted in 21 men who were randomized (15 treatment, 6 placebo) and had complete follow-up data. Baseline mean standard deviation IELT was 74.3 31.8 vs 84.9 29.8 seconds among the treatment and placebo groups, respectively (p1⁄40.39). After 2 months, men in the treatment group had significant improvement in IELT with a mean increase of 231.5 166.9 seconds (95% confidence interval of 139-323 seconds) which was significantly greater than men on placebo (94.2 67.1 seconds, p1⁄4 0.043). A greater proportion of men in the treatment group after one and two months achieved IELT of at least 2 minutes vs placebo (60%, 80.0% vs 33.3% respectively). Compared to placebo, men in the treatment group reported greater improvement in distress relating to intercourse, control of ejaculation, and satisfaction with sexual intercourse over the study period (p<0.01, p1⁄40.01, and p<0.01, respectively). Treatment was well tolerated and no transference was reported. CONCLUSIONS: Topical 4% benzocaine wipes improved both objective and subjective symptoms of PE compared to placebo.

Reporting of randomized controlled trials in andrology journals: a quality assessment.

INTRODUCTION Quality assessment of randomized controlled trials (RCTs) is important to prevent the adoption of findings of low-quality trials into clinical practice. AIM The aim of this study was to analyze the quality of studies reporting RCTs in andrology journals (The Journal of Sexual Medicine [JSM], the Asian Journal of Andrology [AJA], the Journal of Andrology [JOA], the International Journal of Andrology [IJA]). METHODS A quality assessment was conducted on all studies identified as RCTs published in andrology journals (JSM, AJA, JOA, IJA) until 2011. The review period was divided into three terms: early, mid, and late each journal. MAIN OUTCOME MEASURES The Jadad scale, van Tulder scale, and the Cochrane Collaboration Risk of Bias Tool (CCRBT) were employed. The RCTs were also categorized by country of origin, the inclusion of institutional review board (IRB) approval, funding, and blindness. RESULTS There were1,954 original articles published in the JSM, 893 articles in the AJA, 2,527 articles in the JOA, and 2,086 articles in the IJA for the review period. There were 172 studies reporting on RCTs in the JSM, 33 RCTs in the AJA, 63 RCTs in the JOA, and 29 RCTs in the IJA. No significant increase in Jadad or van Tulder scale scores were found over time, nor were there any significant changes in the number of high-quality articles as assessed by CCRBT. However, significant differences in quality analysis were found according to blinding, funding, and IRB approval. CONCLUSION The number of original articles and RCTs in andrology increased over time. However, the ratio of RCTs to original articles as well as RCT quality was statistically insignificant. It would be required for the researchers to focus efforts in performing high-quality studies to ensure appropriate randomization, reviews by IRB, financial support, and inclusion of allocation concealment during study performance.

MP45-20 THE EFFECT ON BLOOD FLOW RATE OF PROSTATE IN DAILY ADMINISTRATION OF MIRODENAFIL 50MG FOR BENIGN PROSTATIC HYPERPLASIA PATIENTS: RANDOMIZED CONTROLLED STUDY

INTRODUCTION AND OBJECTIVES: Chronic ischemia in the pelvis induces benign prostatic enlargement (BPE) in animal studies. However, whether local atherosclerosis induces BPE in humans has not yet been elucidated. To elucidate the mechanism of occurrence of BPH/BPE induced by the local atherosclerosis in humans, the association between local atherosclerosis and clinical background was investigated, and the molecular biological analyses was performed by using human surgical specimens. METHODS: A total of 69 consecutive patients who underwent robot-assisted radical prostatectomy (RARP) participated in this prospective study. To evaluate actual local atherosclerosis, prostatic arteries were removed during RARP. Microscopic assessment of local atherosclerosis was classified as one of three degrees of narrowing (minimal, moderate, and severe) according to the degree of obstruction of the inner cavity of the prostatic artery. The expression of the several biomarkers related to the chronic ischemia and cell proliferation of the prostate was investigated by immunohistochemistry. RESULTS: Local atherosclerosis of the prostatic artery was analyzed in 576 specimens (8.3 5.0 specimens per patient). Local atherosclerosis was significantly more severe in patients who had a history of treatment for benign prostatic hyperplasia (P1⁄40.02). Prostate size wassignificantly lager in thesevere local atherosclerosis group than in the minimal and moderate local atherosclerosis groups (P<0.001 and P1⁄40.03, respectively). There was a significantly negative correlation between prostate size and patency of the prostatic artery (r1⁄4-0.30, P1⁄40.01). Multivariate analyses showed that prostate size was significantly correlated with local atherosclerosis (P1⁄40.04). In the immunohistochemical analyses, the positive expression rate of malondialdehyde (MDA), Hypoxia-inducible Factor (HIF)-1a, transforming growth factor (TGF)-b1and basic fibroblast growth factor(bFGF) in the prostate were significantly higher in the patients with local atherosclerosis than in the patients without local atherosclerosis (all P<0.01, respectively). CONCLUSIONS: In human surgical specimens, local atherosclerosis of the prostatic artery induced prostatic enlargement. The increase in the obstruction in the prostatic artery was proportional to the increase of prostate size. Chronic ischemia due to local atherosclerosis led to the upregulation of oxidative stress and HIF-1a levels. Increase of TGFb1and bFGF induced by oxidative stress and HIF-1a in the prostate might induce the enlargement of the prostate by the stromal proliferation, transdifferentiation, and extracellular matrix production.