Sang Yol Mah

Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage.

Purpose Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment. Materials and Methods Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone. Results Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM. Conclusion Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.

Optimal Timing to Evaluate Prediagnostic Baseline Erectile Function in Patients Undergoing Robot-Assisted Radical Prostatectomy

INTRODUCTION Accurate assessment of prediagnostic baseline erectile function (EF) is crucial when evaluating postoperative changes of EF in patients undergoing bilateral nerve sparing robot-assisted laparoscopic radical prostatectomy (RLRP). Because score domains of the International Index of Erectile Function-5 (IIEF-5) can be affected by factors such as recall intervals and psychological stress or discomfort due to cancer diagnosis and treatment, it is important to assess the prediagnostic baseline EF at appropriate times. AIM To determine optimal timing to evaluate prediagnostic baseline EF in patients undergoing bilateral nerve sparing RLRP. METHODS Between March 2009 and February 2010, 54 patients ranging in age from 48 to 74 years were asked to complete IIEF-5 questionnaires before prostate biopsy, 1 day before RLRP, and 1 month after RLRP to assess preoperative baseline EF. MAIN OUTCOME MEASURES Differences in the mean scores of IIEF-5 were analyzed using paired t-tests. The strengths of the linear relationships among the three IIEF-5 scores were quantified using Pearsons correlation coefficient. An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement among the IIEF-5 scores. RESULTS The mean IIEF-5 score before RLRP was significantly higher than the mean IIEF-5 score before prostate biopsy (P < 0.001). There was no significant difference between the mean IIEF-5 scores before prostate biopsy and 1 month following RLRP (P = 0.931). Scores of the IIEF-5 taken before prostate biopsy and 1 month following RLRP showed substantial agreement (kappa = 0.712), whereas scores of the IIEF-5 taken before prostate biopsy and before RLRP showed lower agreement (kappa = 0.325). CONCLUSION To more accurately assess the prediagnostic baseline EF in patients with localized prostate cancer, the IIEF-5 questionnaire should be administered before prostate biopsy rather than before RLRP as cancer diagnosis-related symptoms and depression can affect IIEF-5 scores.

Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging: A single institute experience with 290 consecutive patients

Objective:  The aim of this study was to determine trends in the incidence of benign lesions in patients undergoing surgery for suspicious renal masses on preoperative computed tomography scan.

Incidentally discovered inverted papilloma of the urinary bladder in patients with lower urinary tract symptoms

BACKGROUND AND PURPOSE Inverted urothelial papilloma (IP) is an uncommon urothelial neoplasm. We aimed to determine the clinicopathologic characteristics of IP of the bladder and its association with prostate volume and lower urinary tract symptoms (LUTS). PATIENTS AND METHODS From 1994 to 2008, 53 patients with urinary IP underwent transurethral resection of the bladder tumor (TURBT) at our institution. We reviewed the clinicopathologic characteristics of IP of the bladder and its association with prostate volume and LUTS. RESULTS The patient population consisted of 46 men and 7 women with a mean age of 56 years (male to female ratio 6.6:1). The most common presenting symptom was LUTS (33 men and 3 women). Of the 33 men with LUTS, the mean prostate volume before TURBT was 48.1 cc (range 21.8-109.3 cc). IP was found incidentally in 14 men on transrectal ultrasonography (TRUS) and in 2 men during transurethral prostate resection. In IP located on the bladder neck of patients with benign prostatic hyperplasia (BPH), significantly higher obstructive symptoms and larger prostate volumes than that of other located IP with BPH were observed. CONCLUSIONS This is the largest series of cases of urinary bladder IP reported from Korea. Despite the absence of agreement of its etiology, its presenting symptoms were related to LUTS and benign prostatic enlargement. TRUS may be helpful, especially in unresponsive patients with LUTS despite medical treatment.

Warm Sitz Bath: Are There Benefits after Transurethral Resection of the Prostate?

Purpose We aimed to evaluate the efficacy of warm water sitz baths in patients who have undergone transurethral resection of the prostate (TURP) owing to lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods We reviewed the records of 1,783 patients who had undergone TURP between 2001 and 2009. In the warm water sitz bath group, patients were instructed to sit in a tub containing lukewarm water at 40-45℃ for 10 minutes each time. Patients were advised to perform the procedure for at least 5 days immediately after the removal of a Foley urethral catheter. The differences in post-TURP complications between the warm water sitz bath group and the no sitz bath group were compared. Results After TURP, 359 of the 1,561 patients performed a warm water sitz bath. Complications after TURP, such as hemorrhage, urinary tract infection, urethral stricture, and acute urinary retention were found in 19 (5.3%) and 75 (6.2%) patients in the sitz bath and no sitz bath groups, respectively (p=0.09). There was a significant difference in postoperative complications such as urethral stricture between the warm sitz bath group and the no sitz bath group (p=0.04). The group that did not undergo warm water sitz bath treatment showed a 1.13-fold increased risk of rehospitalization within 1 month after TURP due to postoperative complications compared with the warm water sitz bath group (odds ratio [OR]=1.134; 95% confidence interval [CI], 1.022 to 1.193; p=0.06). Conclusions Warm water sitz bath treatment reduced postoperative complications such as urethral stricture. These results suggest that large-scale prospective studies are needed to establish an ideal method and optimal duration of sitz baths.

Association between urinary hesitancy symptoms and uroflowmetry measured urinary hesitancy time in men with lower urinary tract symptoms.

In patients with urinary hesitancy, the standard time of urinary hesitancy has not been established. Accordingly, we have analyzed the association between urinary hesitancy and various uroflowmetric finding in the present study.

Prevalence and Management of Lower Urinary Tract Symptoms in Methamphetamine Abusers: An Under-Recognized Clinical Identity

PURPOSE We investigate the prevalence of lower urinary tract symptoms in a cohort of methamphetamine abusers, and assess the therapeutic efficacy of α-blockers and anticholinergics. MATERIALS AND METHODS From May 2011 to March 2013, 78 male methamphetamine abusers diagnosed with methamphetamine addiction were identified at the National Forensic Hospital, Korea. The I-PSS (International Prostate Symptom Score) with consultation was used to investigate the prevalence of lower urinary tract symptoms, defined as total I-PSS 8 or greater and quality of life index score of 2 or greater. These values for methamphetamine abusers were compared to those of 71 age matched controls. α-Blockers and anticholinergics were administered to methamphetamine abusers with lower urinary tract symptoms according to predominant voiding and storage symptoms based on voiding-to-storage subscore ratios. For methamphetamine abusers with no response, defined as a reduction of 4 or less in total I-PSS, an alternative drug or combination was administered. Efficacy was assessed based on a 4-week interval. RESULTS The median periods of methamphetamine abuse and abstinence were 18.1 years and 5.7 months, respectively. Methamphetamine abusers showed a higher prevalence of lower urinary tract symptoms compared to controls (77% vs 15%, p <0.001), with higher I-PSS and quality of life index score (13.3 vs 5.6 and 2.9 vs 0.9, respectively; p <0.001). Anticholinergics showed the greatest effect on I-PSS reduction with overall response rates for α-blockers, anticholinergics and combinations of 13%, 61% and 14%, respectively. Seven (12%) methamphetamine abusers did not respond to any therapy. CONCLUSIONS Lower urinary tract symptoms were highly prevalent among methamphetamine abusers. Our results imply that pathological dopaminergic mechanisms have a role in methamphetamine associated lower urinary tract symptoms. Moreover, first line anticholinergics and prompt combination with α-blockers conferred the most therapeutic benefit to nonresponders.

CHARACTERISTICS AND FACTORS INFLUENCING TREATMENT OUTCOME OF RENAL ABSCESSES MEASURING 4 CM OR LESS

the onset of antibiotics treatment, the CRP level and urine IL-8 level continued to be high, while the serum IL-6 levels decreased significantly (26.1±32.4 vs 9.9±23.5pg/dl, p<0.01). When we divided the patient as mild (CRP<15mg/dl, n=14) and severe (CRP 15mg/dl, n=12) group according to initial CRP levels, serum IL-6 level decreased significantly in mild (14.2±4.0 vs 4.0±1.7pg/dl, p<0.01), and severe (41.1±12.7 vs 22.7±16.4pg/dl, p<0.01) within 24 hours, although CRP and urine IL-8 levels did not decreased significantly in both groups. CONCLUSIONS: Clinically, the level of initial serum IL-6 and urine IL-8 levels were increased according to disease severity. Moreover, serum IL-6 level was decreased rapidly after antibiotic treatment within 24 hours. Serum IL-6 levels were better indicator in determining the severity and the therapeutic effect of empirical parenteral antibiotics use in patients with acute uncomplicated pyelonephritis than either CRP or WBC counts.