Min Gu Park

Listening to music during cystoscopy decreases anxiety, pain, and dissatisfaction in patients: A pilot randomized controlled trial

PURPOSE To determine whether listening to music during cystoscopy decreases anxiety, pain, and dissatisfaction among patients and results in a more comfortable and better-tolerated procedure. MATERIALS AND METHODS Seventy male patients who underwent rigid cystoscopy between May 2011 and December 2011 were randomized into the following: no music (Group I, n=35) or classical music during procedure (Group II, n=35). Before cystoscopy, lidocaine gel was instilled in the urethra, and both groups viewed their procedures on a video monitor. Anxiety levels were quantified according to the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for a self-assessment of satisfaction, discomfort, and willingness among patients to repeat the cystoscopy. RESULTS Demographic characteristics, mean age, procedure duration, and procedure indications were statistically similar between the two groups. The mean anxiety level and mean pain score of Group II were significantly lower than those of Group I (p<0.001 for both). Group II also carried a significant greater mean satisfaction score compared with Group I (p<0.001). Statistically significant differences were detected between groups in the postprocedural pulse rate and the systolic blood pressure (p=0.012 and p=0.008, respectively), whereas preprocedure pulse rate and systolic blood pressure were similar. CONCLUSIONS Listening to music during rigid cystoscopy significantly reduces feelings of pain, discomfort, and dissatisfaction. Music can serve as a simple, inexpensive, and effective adjunct to sedation during cystoscopy. We recommend the application of music during rigid cystoscopy for clinical use.

Is There a Correlation Between the Presence of Idiopathic Detrusor Overactivity and the Degree of Bladder Outlet Obstruction

OBJECTIVE To assess the factors associated with the presence of idiopathic detrusor overactivity (IDO) in male patients with clinical benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We prospectively evaluated 193 men who presented with lower urinary tract symptoms. Each patient underwent urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, residual volume check, and transrectal ultrasound for estimation of prostate volume. IDO was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. Patients were divided into groups according to the presence of detrusor overactivity and bladder outlet obstruction index (BOOI) greater than 40. Variables associated with the presence of IDO were analyzed using Students t-test, chi-square test, linear-by-linear association test, and logistic regression analysis. RESULTS Of 193 patients, IDO was present in 49 (25.4%). BOOI and prostate volume showed significant but weak correlation. On univariate analysis, patients with IDO were older and showed smaller maximal bladder capacity (MBC), higher BOOI, higher maximal detrusor pressure at maximal flow rate, and higher irritative IPSS subscores. On logistic regression analysis, MBC and BOOI were the factors affecting the presence of IDO, with odds ratios of 0.981 and 1.046, respectively. Positive linear association was noted between BOOI and prevalence of DO by linear association test with prevalence of DO rising continuously with increasing BOOI. CONCLUSION BOO is responsible for IDO and because the prevalence of IDO is inversely associated with the degree of obstruction, the treatment of BOO is potentially able to reverse the DO.

Impact of metabolic status on the association of serum vitamin D with hypogonadism and lower urinary tract symptoms/benign prostatic hyperplasia

Abstract Objective: The objective of this study is to investigate the impact of metabolic status on associations of serum vitamin D with hypogonadism and lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). Patients and methods: A total of 612 men underwent physical examination, biochemical/hormonal blood testing, and transrectal prostate ultrasound. Moreover, the subjects filled out standard questionnaires for identification and grading of LUTS and hypogonadism symptoms. Parameters were statistically compared with independent t-tests and correlation analyses. Results: Vitamin D levels positively correlated with total testosterone (TT) but not with prostate volume or International Prostate Symptom Score (IPSS). Patients with metabolic syndrome had significantly lower vitamin D levels, which were not correlated with TT, prostate volume, or IPSS. However, vitamin D was positively correlated with TT, and negatively correlated with prostate volume and quality-of-life IPSS in subjects without metabolic syndrome. Conclusion: The clinical usefulness of vitamin D for treatment of hypogonadism or LUTS/BPH varies according to metabolic status.

Combination therapy of testosterone enanthate and tadalafil on PDE5 inhibitor non-reponders with severe and intermediate testosterone deficiency

Several studies have suggested combination therapy with testosterone supplementation in patients not responding to PDE5 inhibitors. Considering the pathophysiological basis for testosterone supplementation, the present study aims to identify whether combination therapy allows persistence of treatment effect after testosterone discontinuation. Furthermore, we evaluated whether the degree of testosterone depletion affects treatment outcome from combination therapy. Hypogonadal patients (<350 ng dl−1) with erectile dysfunction who previously did not respond to PDE5 inhibitors were treated with testosterone enanthate injections and daily tadalafil. Patients were stratified into two groups depending on the level of testosterone deficiency, with 250 ng dl−1 as a reference point. Following testosterone supplementation (12 weeks) and combination therapy (12 weeks), patients with severe testosterone deficiency showed higher IIEF (International Index of Erectile Function) erectile function (EF) domain score (16.47±4.019 vs 12.36±4.051, P=0.001) and more patients responding satisfactorily to treatment by general assessment (57.9 vs 16.0%, P=0.009), despite reaching similar levels of serum total testosterone (602±169 ng dl−1 vs 698±165 ng dl−1, P=0.057). Testosterone supplementation was then discontinued and patients were maintained only on daily tadalafil (12 weeks). The severe depletion group maintained higher EF domain scores than baseline (13.06±3.38 vs 7.20±2.24, P=0.0004), despite testosterone levels returning to baseline. The results suggest that combination therapy was more beneficial to patients with severe testosterone depletion, possibly by improving underlying pathophysiology.

Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique Ⓡ ) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux Ⓡ )

Purpose The aim of this study was to compare cure rates and complications of polydimethylsiloxane (Macroplastique®) and dextranomer/hyaluronic acid copolymer (Deflux®) in the treatment of vesicoureteral reflux (VUR). Materials and Methods From April 2001 to March 2008, 29 boys and 42 girls (total of 115 ureters) with a mean age of 6 years who had undergone endoscopic subureteral transurethral injection for VUR were enrolled. A single subureteral injection of Macroplastique was performed in 31 ureters in 23 children (group I; grade II: 4; grade III: 12; grade IV: 9; grade V: 6), and a single subureteral injection of Deflux was performed in 84 ureters in 48 children (group II; grade II: 24; grade III: 14; grade IV: 25; grade V: 21). Renal ultrasound was done 1 day after injection, and voiding cystourethrography (VCUG) was done at 3 months. Successful reflux correction was defined as absent or grade I reflux on follow-up VCUG. Results No significant difference in success rates was observed between group I and group II [80.6% (25/31) vs. 78.6% (66/84), respectively, p>0.05]. The following postoperative complications developed: ureteral obstruction in 2 ureters of group I and 3 ureters of group II, asymptomatic urinary tract infection in 3 patients of group I and 2 patients of group II, and bladder calcification by erosion or mucosal necrosis in 2 patients of group I. Conclusions Despite differences in material properties, both Macroplastique and Deflux were safe for the treatment of children with VUR. Because of the risk of bladder mucosal necrosis and substantial decreases in volume after implantation, long-term follow-up is required.

Effects of Smoking on Plasma Testosterone Level and Erectile Function in Rats

INTRODUCTION There have been several conflicting reports of the effects of smoking on plasma testosterone levels and erectile function in clinical and animal studies. AIM This study was conducted to determine the actual effects of smoking on plasma testosterone levels and erectile function in rat-smoking models. METHODS For the exposure to cigarette smoke, the rats in a cage had a constant influx of smoke using a specially constructed device. Twenty-four Sprague Dawley (SD) rats for the acute cigarette exposure were allocated randomly into two groups: an experimental group and a control group. Thirty-six SD rats for the chronic cigarette smoke exposure were randomly divided into three groups: a control group and two experimental groups. MAIN OUTCOME MEASURES After exposure to smoking, the rats were subjected to electrical field stimulation of the cavernosal nerve to assess the erectile function, and blood was collected to measure the levels of plasma thiocyanate, testosterone, luteinizing hormone, and follicle-stimulating hormone. The histological changes of testes and corpora cavernosum (CC) were examined. RESULTS In the smoking groups, the thiocyanate levels were significantly higher than in the control group. Also, the mean arterial pressure (MAP) was significantly higher in the smoking groups, but the corpora cavernosal filling rate and maximal intracavernosal pressure/MAP were significantly lower than in the control group. The testosterone levels of experimental groups were significantly lower than those of control group, and the testosterone and thiocyanate levels were significantly correlated with erectile function components in chronic smoking groups. There was no significant histological change in the testes; however, in the CC, there was an increase in collagen fibers and decrease in smooth muscle and sinusoidal space in chronic smoking groups. CONCLUSION The results suggest that both the vasoconstrictor effects of smoking and the decrease in testosterone levels after chronic smoking had some effects on erectile function in rats.

Preoperative erythropoietin administration in patients with prostate cancer undergoing radical prostatectomy without transfusion.

Purpose In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. Materials and Methods We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. Results Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. Conclusions Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.

Cystic Dysplasia of the Rete Testis Accompanying an Inguinal Hernia: A 63-Year-Old Man

Cystic dysplasia of the rete testis (CDT) is a very rare congenital benign testicular tumor that is often associated with ipsilateral genitourinary anomalies. It is usually found in the pediatric population and must be differentially diagnosed from a malignant lesion. Here we report the case of a 63-year-old man with a left inguinal hernia who visited our urologic outpatient clinic. Scrotal ultrasonography showed a left direct inguinal hernia in the inguinal area and a well-circumscribed cystic lesion containing multiple minute cysts with echogenic foci occupying almost one-third of the left testicular parenchyma. Testicular tumor markers were within the normal range and a computed tomography scan of the abdomen showed no genitourinary abnormalities. We presumed that the left testicular lesion was malignant, and the patient underwent radical orchiectomy. However, the pathologic examination revealed a CDT. Here we present this case of a 63-year-old man with an inguinal hernia accompanied by multiple cystic lesions on the left testis.

Bacterial sepsis after extracorporeal shock-wave lithotripsy (ESWL) of calyceal diverticular stone

Most calyceal diverticula are asymptomatic but symptoms occur when there is urinary stasis leading to infection and calculi. Septic shock after ESWL of calyceal stone occurs rarely. A 24-year-old woman had septic shock due to after extracorporeal shock-wave lithotripsy (ESWL) of asymptomatic calyceal diverticular stone.

Testicular Tumor Detected Within 1 Year After Orchiopexy in a 2-Year-Old Boy

The cause of testicular cancer remains controversial and thought to be multifactorial. However, more recent data show that carcinogenic potential of altered testicular environment might induce cancer and that early surgical correction might decrease the chance of cancer development. We report a case of a 20-month-old boy who underwent radical orchiectomy because of testicular cancer detected 9 months after orchiopexy of undescended testis.