Seung-June Oh

Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent

OBJECTIVES To investigate the natural history of bacterial colonization on the stent and in the urine after different periods of indwelling ureteral stent placement. METHODS A total of 57 double-J stents from 52 patients (21 men and 31 women, mean age 52 years, range 20 to 79) were examined. In all patients, short-term (2 to 3 days) antimicrobial therapy was administered at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed by aseptic manipulation, and the proximal and distal tip segments of the stents were obtained. Three culture specimens were acquired from each stent segment (inner surface washing suspension, outer surface washing suspension, and from the stent tip itself). RESULTS Bacterial colonies were found in 44% (25 of 57) of the stents. Of the multiple pathogens identified, Enterococcus species (6 of 25) was the most common, followed by Escherichia coli (5 of 25). After short-term antibiotic prophylaxis, the bacteria did not colonize within the first 2 weeks of stent placement. However, the colonization rate increased as the duration of the stent placement lengthened. Colonization of the stent was followed by colonization of the urine. CONCLUSIONS The results of our study demonstrated that bacterial colonization at the stent began 2 weeks after indwelling stent placement and that stent colonization preceded urine colonization. The rate of colonization increased with longer periods of stenting.

Accuracy of bladder volume determinations by ultrasonography: are they accurate over entire bladder volume range?

OBJECTIVES To investigate the accuracy of a portable three-dimensional hand-held BladderScan (BS) and two-dimensional conventional ultrasonography (CUS) in the estimation of bladder volumes. METHODS The bladder volume of 65 subjects was measured during filling cystometry using two ultrasound modalities. Serial measurements were performed when the infused volume reached 100, 200, 300, and 400 mL; the investigator measured the volumes three times each with BS and CUS. Each corresponding true volume was calculated by interpolation using zero volume and the final catheterized volume at the end of cystometry. The accuracy of the two ultrasound methods was compared using raw scaled values of the volumes and the percentage of differences of volume. RESULTS Bladder volumes determined by CUS and BS were underestimated by 21.8% and 3.3% (mean values), respectively. The percentage of differences of volume of BS was not statistically significant (P >0.05), but that of CUS was statistically significant (P <0.00001). No significant percentage of differences of volume change according to the volume status was observed by either ultrasound measurement method (P >0.05). Linear regression analysis between the true volumes and the raw scaled volumes showed that the slope of the BS was closer to 1.0 than that of the CUS, and the difference was statistically significant (P <0.001). The effects of diagnosis, age, sex, and body mass index were not significant in determining the bladder volume by either method (P >0.05). CONCLUSIONS Our results demonstrated that a three-dimensional hand-held scanner measures the bladder volume in a reproducible and accurate manner for a wide range of bladder volumes and is superior to two-dimensional stationary ultrasonography.

Health-related quality of life and sexual function in women with stress urinary incontinence and overactive bladder

Background:  We evaluated the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on health‐related quality of life (HRQOL) and sexual function.

Spinal Cord/Brain Injury and the Neurogenic Bladder

This article reviews neurogenic bladder related to traumatic injury as well as vascular lesion of brain/spinal cord. Because urological manifestations of traumatic or vascular brain/spinal cord injury are highly diversified and complex, the approaches to achieve accurate diagnosis and administer proper treatment can be complicated. The goal of primary treatment is preservation of renal function and attainment of social continence. Maintaining low intravesical pressure and adequate bladder emptying are central to the treatment strategy. Diagnosis and appropriate urological management of these disease entities should depend on urodynamic studies because of poor correlation between clinical symptoms or somatic neurologic signs and urodynamic findings.

Ethnic differences in the age-related distribution of serum prostate-specific antigen values: a study in a healthy Korean male population.

OBJECTIVES To further improve the use of prostate-specific antigen (PSA) as a screening test for prostate cancer in Asian countries, we sought to establish the normal distribution of serum PSA values in Korean men, because, until recently, studies conducted to establish normal serum PSA values have involved few Asian populations. METHODS Between May 1995 and June 1997, 5805 healthy Korean men 30 to 79 years old who visited our hospital for a routine health checkup were entered into a prospective study of early screening for prostate cancer. All men underwent detailed clinical examinations, including a digital rectal examination and serum PSA determination. All men who were more than 50 years old with abnormal digital rectal examination findings and/or an elevated serum PSA level (greater than 4.0 ng/mL) also underwent transrectal ultrasound-guided sextant biopsy. Four were found to have cancer and were excluded from the analysis. RESULTS The median serum PSA concentration (5th to 95th percentile range) was 0.8 ng/mL (0.2 to 1.8) for patients 30 to 39 years old (n = 1382); 0.8 ng/mL (0.2 to 2.0) for patients 40 to 49 years old (n = 1776); 0.9 ng/mL (0.2 to 2.4) for those 50 to 59 years old (n = 1775); 1.0 ng/mL (0.2 to 3.9) for men 60 to 69 years old (n = 746); and 1.3 ng/mL (0.5 to 6.3) for patients 70 to 79 years old (n = 122). The serum PSA concentration correlated with age (P <0.001), with an increase by approximately 1.2% annually, although the statistical correlation was weak (r = 0.16). Almost no change occurred in the median serum PSA value in patients 50 years old or younger; a gradual increase was observed in patients older than 50. In those 50 years old or older, the median and 95th percentile serum PSA values for Korean men were lower than those for white men. CONCLUSIONS Contrary to earlier observations that the serum PSA level strongly correlates with age, the influence of age on serum PSA was found to be weaker in this study. Moreover, the results also demonstrated that the distribution of the serum PSA level differs along ethnic lines. The cutoff value for serum PSA in mass screening for prostate cancer should be adjusted in nonwhite races.

Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms.

OBJECTIVES To evaluate the association of prostatic urethral angle (PUA) with bladder outlet obstruction (BOO) index in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). METHODS A retrospective analysis was made of 260 men with LUTS and/or BPH aged>50 years (median: 65.9, range: 50-87). Patients underwent an evaluation including the International Prostatic Symptom Score, serum prostate-specific antigen levels, transrectal ultrasonography, frequency-volume chart, uroflowmetry, and measurement of postvoid residual, and multichannel video urodynamic study with a pressure-flow study. RESULTS Patients with higher PUA (PUA>or=35 degrees) had higher prostate-specific antigen levels (P=.043), larger prostate volume (P<.001), higher maximal urethral closure pressure (P=.004), higher detrusor pressure at maximum flow rate (P=.008), and higher BOO index (P=.032), in comparison with those who had lower PUA (PUA<35 degrees). There was no significant difference of PUA values according to the degree of intravesical prostatic protrusion. When we compared BOO index according to PUA, patients with higher PUA had higher BOO index than those with lower PUA (30.6+/-1.8 vs 23.6+/-1.8, P=.006). The area under the curve of PUA was significant for BOO (area, 63.0%; 95% confidence interval, 55.1%-70.9%; P=.002). CONCLUSIONS PUA may be one method to asses the presence of BOO in men with LUTS and/or BPH. Our findings suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.

Urodynamic Findings of the Painful Bladder Syndrome/Interstitial Cystitis: A Comparison With Idiopathic Overactive Bladder

PURPOSE In this study we identify the characteristics of the urodynamic results in patients with painful bladder syndrome/interstitial cystitis and in those with idiopathic overactive bladder. MATERIALS AND METHODS The fluoroscopic urodynamic study results were analyzed retrospectively in 40 consecutive female patients with painful bladder syndrome/interstitial cystitis and 78 female patients with idiopathic overactive bladder between October 2005 and August 2007. Before treatment a symptom assessment, questionnaires, 3-day voiding diary and laboratory tests were performed at the initial outpatient clinic visit. All patients had been diagnosed and grouped according to painful bladder syndrome/interstitial cystitis or overactive bladder based on the clinical features before cystoscopy, potassium chloride sensitivity test and urodynamic investigation. RESULTS Mean (+/-SD) age of patients with painful bladder syndrome/interstitial cystitis and overactive bladder was 57.8 (+/-12.9) and 61.9 (+/-11.9) years, respectively. Maximum flow rate and voided volume based on free uroflowmetry were significantly different between the 2 groups (p <0.05). For the static urethral pressure profile there was a significant difference between the groups in terms of maximal urethral closing pressure and maximal urethral pressure (p <0.05). For filling cystometry the volumes at each interval (first desire, normal desire, strong desire) and the volumes at maximum cystometric capacity were significantly lower (p <0.001) in patients with painful bladder syndrome/interstitial cystitis, as was bladder compliance (p = 0.025). No involuntary detrusor contraction was observed in the painful bladder syndrome/interstitial cystitis group but it was observed in 53 patients (67.9%) with overactive bladder (chi-square p <0.001). There was no significant difference in maximal detrusor pressure on voiding and fluoroscopic results between the 2 groups (p >0.05). Logistic regression analysis after adjusting for age, symptom duration, number of major comorbidities and disease groups showed that all variables in the urethral pressure profile were not significantly different between the painful bladder syndrome/interstitial cystitis and overactive bladder groups. CONCLUSIONS This study showed that the urodynamic results were significantly different between the painful bladder syndrome/interstitial cystitis and overactive bladder groups. Combined with other clinical findings urodynamic studies might provide additional information to confirm a diagnosis of painful bladder syndrome/interstitial cystitis.

The Impact of Overactive Bladder on Health-Related Quality of Life, Sexual Life and Psychological Health in Korea

Purpose We aimed to estimate the prevalence of overactive bladder (OAB) in Korea, to assess the variation in prevalence by sex and age, and to measure the impact of OAB on quality of life. Methods A population-based, cross-sectional telephone survey was conducted between April and June 2010 with a questionnaire regarding the prevalence of OAB, demographics, and the impact of OAB on quality of life. A geographically stratified random sample of men and women aged ≥30 years was selected. Results The overall prevalence of OAB was 22.9% (male, 19%; female, 26.8%). Of a total of 458 participants with OAB, 37.6% and 19.9% reported moderate or severe impact on their daily life and sexual life (5.6% and 3.5%, respectively, in participants without OAB). Anxiety and depression were reported by 22.7% and 39.3% of participants with OAB, respectively (9.7% and 22.8%, respectively, in participants without OAB). Only 19.7% of participants with OAB had consulted a doctor for their voiding symptoms, but 50.7% of respondents with OAB were willing to visit a hospital for the management of their OAB symptoms. Conclusions This study confirmed that OAB symptoms are highly prevalent in Korea, and many sufferers appear to have actively sought medical help. OAB has severe effects on daily and sexual life as well as psychological health.

SUPRANORMAL DIFFERENTIAL RENAL FUNCTION IS REAL BUT MAY BE PATHOLOGICAL: ASSESSMENT BY 99mTECHNETIUM MERCAPTOACETYLTRIGLYCINE RENAL SCAN OF CONGENITAL UNILATERAL HYDRONEPHROSIS

PURPOSE It is unclear whether supranormal differential renal function of the hydronephrotic kidney is real or artifactual. We investigated the effect of clinical and renographic parameters on differential renal function. MATERIALS AND METHODS The study included 34 males and 10 females from 1 to 9 months old (median age 2.6 months) with unilateral congenital hydronephrosis. A 99mtechnetium (Tc) mercaptoacetyltriglycine (MAG3) scan was performed, and regions of interest were drawn on the kidneys, and perirenal and lateral backgrounds. Differential renal function was calculated with and without background subtraction at 30-second intervals from 0.5 to 3 minutes after injection of 99mTc-MAG3. The effects of age, sex, obstruction, site and size of the hydronephrotic kidney were analyzed using the generalized estimating equations method. RESULTS There were 11 right and 33 left hydronephrotic kidneys. An obstructive renographic pattern was present in 33 cases. The trends of differential renal function according to intervals were different between kidneys with and without background subtraction, and differential renal function increased significantly as size increased (p <0.05). Differential renal function of the hydronephrotic kidney with an obstructive renographic pattern increased with time when perirenal or no background subtraction was applied (p <0.05). The effects of age, sex or laterality on differential renal function were not significant. Supranormal function (differential renal function 55% or greater) was present regardless of background subtraction methods and measurement time. CONCLUSIONS Differential renal function is higher in larger hydronephrotic kidney but function of the kidney with an obstructive pattern is overestimated on later phases of 99mTc-MAG3 renal scan. Supranormal differential renal function is real and may be pathologic since it is prone to occur in larger obstructive hydronephrotic kidneys.

Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

Study design:Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).Setting:Three outpatient medical departments in Seoul, Korea.Objectives:To assess depressive symptoms in patients on clean intermittent catheterization after SCI.Methods:In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18–75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).Results:For patients and controls, the average total BDI scores were 20.3±1.0 and 11.4±0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42–10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67–12.81, P=0.003) of depression than those who were able to perform self-catheterization.Conclusions:The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patients ability to perform self-catheterization.