Kyung Won Kwak

Clinical Inconsistency of Lower Urinary Tract Symptoms Between Questionnaire and Bladder Diary in Children With Nocturnal Enuresis

PURPOSE Classification of pediatric enuresis into monosymptomatic nocturnal enuresis and nonmonosymptomatic nocturnal enuresis is crucial for management because these cases differ in many clinical respects. However, correct classification is frequently confused based on questionnaire and/or bladder diary. We tested the consistency of information obtained on lower urinary tract symptoms between our questionnaire and bladder diary. MATERIALS AND METHODS A total of 108 physically and neurologically normal patients (mean age 7.2 years) with enuresis were included in the study. All patients filled out the questionnaire and 3-day bladder diary completely. Our questionnaire included items on urinary frequency, daytime incontinence and voiding postponement. A total of 93 patients underwent uroflowmetry and residual urine measurements. We analyzed information on lower urinary tract symptoms from the questionnaire and the bladder diary, as well as the uroflowmetry results. RESULTS The percentage of children with nonmonosymptomatic nocturnal enuresis was 89.8% and 68.5% based on the questionnaire and bladder diary, respectively. In comparisons between the questionnaire and bladder diary we did not observe any significant consistency regarding urinary frequency (p = 0.912), daytime incontinence (p = 0.356) or voiding postponement (p = 0.505). Maximum voided volume, average voided volume and percent maximum voided volume/expected bladder capacity of children with monosymptomatic nocturnal enuresis were significantly higher than in those with nonmonosymptomatic nocturnal enuresis based on the bladder diary (p = 0.006, 0.001 and 0.041, respectively). By contrast, no significant difference was found between children with monosymptomatic and nonmonosymptomatic nocturnal enuresis based on the questionnaire (p = 0.559, 0.597 and 0.947, respectively). CONCLUSIONS Significant discrepancies in lower urinary tract symptoms were observed between the questionnaire and bladder diary. Therefore, a detailed history and discussion with the patient and family should be performed to correlate with the questionnaire and bladder diary for the proper treatment of children with enuresis. An updated questionnaire containing a detailed scoring system may be needed.

Association between metabolic syndrome and chronic kidney disease in the Korean population.

Aim:  We performed a retrospective study to examine the association between the metabolic syndrome (MS) and risk for the development of chronic kidney disease (CKD).

Efficacy of Lidocaine Spray as Topical Anesthesia for Outpatient Rigid Cystoscopy in Women: A Prospective, Randomized, Double-Blind Trial

OBJECTIVES To determine the efficacy and feasibility of urethral lidocaine spray for rigid cystoscopy in female outpatients, compared with lidocaine gel for patient tolerance of pain. METHODS A total of 144 consecutive women scheduled to undergo rigid cystoscopy were randomized to receive either 10 mL of lidocaine gel (group 1, n = 48), five metered doses of 10% lidocaine spray (group 2, n = 48), or 10 mL of plain lubricating gel (group 3, n = 48). Patients recorded their level of pain perception during gel instillation or spray and immediately after the procedure using the visual analogue scale (VAS) and a 5-point verbal descriptor scale. RESULTS The perception of pain was significantly decreased when lidocaine spray was used (mean VAS scores 1.9 +/- 1.3 for group 2 versus 3.9 +/- 2.2 for group 3; P <0.001). There was no difference in pain perception when lidocaine spray or gel was used (P = 0.113). Four patients in group 1 and 1 in group 2 but 10 in group 3 requested post-cystoscopic analgesics. There was a slight increase in pain perception on the VAS during the intraurethral application with lidocaine spray (2.2 +/- 1.5) compared with lidocaine gel (0.7 +/- 1.1) or plain gel (1.0 +/- 1.4). CONCLUSIONS Lidocaine spray and lidocaine gel produce similar anesthetic effects in women undergoing rigid cystoscopy. However, concerns about the mild discomfort associated with delivery of the spray need to be resolved through future technical improvement before it gains widespread use.

The Utility of Fluorescence In Situ Hybridization for Detection of Bladder Urothelial Carcinoma in Routine Clinical Practice

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men

The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen (PSA) levels in healthy men with serum PSA level below 4 ng mL(-1). The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment (HOMA [fasting glucose x fasting insulin]/22.5) and quantitative insulin sensitivity check index (QUICKI; 1/[log (fasting insulin) + log (fasting glucose)]). Age-adjusted body mass index (BMI) was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance (ANOVA) test and Duncans multiple comparison test (P < 0.001), but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI (P < 0.001). Age, BMI, insulin resistance by HOMA or QUICKI were significantly independent variables to serum PSA level in a multivariate linear regression analysis (P < 0.001). Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI.

Imaging features of helical computed tomography suggesting advanced urothelial carcinoma arising from the pelvocalyceal system

Background: Urothelial carcinoma is the most common malignant tumor arising from the pelvocalyceal system. Helical computed tomography (CT) is probably the best preoperative-stage modality for the determination of treatment plan and prognosis. Purpose: To obtain helical CT imaging features suggesting advanced pelvocalyceal urothelial carcinoma. Material and Methods: Preoperative CT images in 44 patients with pelvocalyceal urothelial carcinoma were retrospectively reviewed and correlated with the pathological examination to determine imaging features suggesting stage III or IV of the disease. Results: Pathological stages revealed stage I in 16, stage II in three, stage III in 17, and stage IV in eight patients. Seven patients had metastatic lymph nodes. CT imaging showed that renal parenchymal invasion, sinus fat invasion, and lymph node metastasis were highly suggestive of advanced urothelial cell carcinoma (P<0.05). Helical CT sensitivity, specificity, and accuracy for advanced pelvocalyceal urothelial carcinoma were 76% (19/25), 84% (16/19), and 80% (35/44), respectively. Conclusion: Preoperative helical CT may suggest imaging features of advanced urothelial carcinoma, influencing treatment plan and patient prognosis, even though its accuracy is not so high.

ASSOCIATION BETWEEN METABOLIC SYNDROME AND CHRONIC KIDNEY DISEASE IN THE KOREAN POPULATION

AIM We performed a retrospective study to examine the association between the metabolic syndrome (MS)and risk for the development of chronic kidney disease (CKD). METHODS This cohort study included 60 921 healthy adults recruited from two health promotion centres.Anthropometric measures, blood pressure, fasting glucose, lipid profile and serum creatinine were evaluated. The glomerular filtration rate was estimated (eGFR) using the abbreviated equation developed by the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as an eGFR of <60 mL/min per 1.73 m2 or the presence of proteinuria. RESULTS The prevalence of MS and CKD was 19.0% and 7.2% respectively. Those with MS had a higher prevalence of CKD (11.0% vs 6.3%, P < 0.001) than those without MS. As the number of MS components increased, the prevalence of CKD increased and the eGFR decreased. The multiple linear analyses showed that each of the components of the MS was negatively correlated with the eGFR. Unadjusted and multivariate adjusted associations were identified between MS and CKD. Individuals with MS had a multivariate adjusted odds ratio of 1.680 (95% confidence interval, 0.566-1.801) for CKD compared with those without MS. CONCLUSION Our findings, which were obtained from a large Korean cohort, suggest that MS was associated with CKD.