Tae Beom Kim

Second to fourth digit ratio: a predictor of prostate-specific antigen level and the presence of prostate cancer

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b

Second to fourth digit ratio: a predictor of adult penile length.

The second to fourth digit ratio (2D:4D) has been proposed as a putative biomarker for prenatal testosterone and covaries with the sensitivity of the androgen receptor (AR). Both prenatal testosterone and the AR play a central role in penile growth. In this study, we investigated the relationship between digit ratio and penile length. Korean men who were hospitalized for urological surgery at a single tertiary academic centre were examined in this study, and 144 men aged 20 years or older who gave informed consent were prospectively enrolled. Right-hand second- and fourth-digit lengths were measured by a single investigator prior to measurement of penile length. Under anaesthesia, flaccid and stretched penile lengths were measured by another investigator who did not measure nor have any the information regarding the digit lengths. Univariate and multivariate analysis using linear regression models showed that only height was a significant predictive factor for flaccid penile length (univariate analysis: r=0.185, P=0.026; multivariate analysis: r=0.172, P=0.038) and that only digit ratio was a significant predictive factor for stretched penile length (univariate analysis:r=-0.216, P=0.009; multivariate analysis: r=-0.201, P=0.024; stretched penile length=-9.201×digit ratio + 20.577). Based on this evidence, we suggest that the digit ratio can predict adult penile size and that the effects of prenatal testosterone may in part explain the differences in adult penile length.

Second to fourth digit ratio: its relationship with core cancer volume and Gleason score in prostate biopsy

OBJECTIVE To investigate the relationships between 2nd to 4th digit ratio (digit ratio) and prostate cancer detection rate and biopsy findings, including Gleason score. MATERIALS AND METHODS In 770 consecutive men aged 40 years or older that presented with lower urinary tract symptoms (LUTS), right hand 2nd and 4th digit lengths were measured prior to PSA determinations, DRE and transrectal ultrasonography (TRUS). Among these, 166 men with a prostate specific antigen (PSA) level ≥ 3 ng/mL or abnormal digit rectal examination (DRE) prospectively underwent prostate biopsies. The relationship between digit ratio and prostate cancer detection rate and biopsy findings was investigated. RESULTS The study subjects were allocated to two groups by digit ratio (group A: digit ratio < 0.95; n = 420; group B: digit ratio ≥ 0.95; n = 350). Despite similar biopsy rates (22.4% vs. 20.6%, p = 0.544), group A had higher cancer detection rate (46.8% (44/94) vs. 23.6% (17/72), p = 0.002; OR = 2.847, 95% CI = 1.445-5.610). When we analyzed 408 positive biopsy cores (group A: digit ratio < 0.95, n = 282; group B: digit ratio ≥ 0.95, n = 126), group A had higher percentage of core cancer volume (46.7% vs. 37.1%, p = 0.005) and more biopsy cores with high Gleason score (sum of Gleason score ≥ 9: 18/282 (6.4%) vs. 1/126 (0.8%), p = 0.010; primary Gleason score = 5: 12/282 (4.3%) vs. 0/126 (0.0%), p = 0.021). CONCLUSIONS A lower digit ratio is related to an increased detection rate of prostate cancer, a high percentage of core cancer volume and a high Gleason score.

Beneficial Effects of Microsurgical Varicocelectomy on Semen Parameters in Patients Who Underwent Surgery for Causes Other Than Infertility

OBJECTIVES To evaluate whether clinical varicoceles are associated with abnormal semen parameters and whether varicocelectomy could improve the parameters in patients with causes other than infertility. METHODS A total of 268 adult men with clinical varicocele underwent microsurgical varicocelectomy resulting from causes other than infertility. A retrospective analysis of total sperm count, total motile sperm count, sperm concentration, motility, and morphology were performed. RESULTS Of 268 patients, at least 1 abnormal parameter (concentration, motility, or morphology) was found on preoperative semen analysis in 169 (63.1%) patients for whom 121 postoperative analyses were available. Abnormal sperm concentration was observed in 49 (40.5%) patients, motility in 112 (92.6%) patients, and morphology in 82 (67.8%) patients. Total sperm count, total motile sperm count, sperm concentration, and motility showed statistically significant improvement after microsurgical varicocelectomy, however, sperm morphology did not. Subgroup analysis of patients with oligospermia, asthenospermia, or teratospermia showed significant improvement in all semen parameters after varicocelectomy. The highest improvement rate was observed in sperm concentration of patients with oligospermia when a greater than 20% change in preoperative value was defined as improvement or deterioration in semen parameters. Overall, 92 (76.0%) patients showed improvement in at least 1 semen parameter. CONCLUSIONS The majority of varicocele patients with causes other than infertility had abnormal semen parameters, and most semen parameters showed significant improvement after microsurgical varicocelectomy. Therefore, regardless of the chief complaint, semen analysis should be performed in men with clinical varicocele.

The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size.

INTRODUCTION Recently, few studies were reported about the treatment of large, solitary, renal calculi between shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL). We assess the feasibility of SWL for managing solitary, lower calyceal stones over 1 cm by comparing the results of lower pole calculi treatment between patients that underwent SWL or PNL. METHODS We retrospectively reviewed clinical data for patients who had undergone PNL or SWL due to lower calyceal stones over 1 cm. Group 1 consisted of patients who underwent SWL to treat lower pole renal calculi from 2010 to 2011. Group 2 included patients who underwent PNL to manage lower pole renal calculi from 2008 to 2009. We compared patient age, gender, stone size, comorbidities, postoperative complications, additional interventions and anatomical parameters between the two groups. RESULTS A total of 55 patients were enrolled in this study. The mean ages (±SD) of groups 1 (n = 33) and 2 (n = 22) were 55.1 (±13.0) and 50.0 (±10.6) years (p = 0.133) and mean stone sizes were 1.6 (±0.7) and 1.9 (±0.8) cm (p = 0.135), respectively. There were no significant differences in gender distribution, comorbidities or stone laterality between the two groups. No significant differences in various parameters were observed between patients with stones 1 to 2 cm and ones with stones 2 cm or larger. CONCLUSIONS Our results demonstrated that SWL is a safe, feasible treatment for solitary, lower calyceal stones over 1 cm.

Dutasteride, who is it more effective for? Second to fourth digit ratio and the relationship with prostate volume reduction by dutasteride treatment.

Study Type – Prognosis (cohort)

Does the Mother or Father Determine the Offspring Sex Ratio? Investigating the Relationship between Maternal Digit Ratio and Offspring Sex Ratio

Objective In mammals, high parental testosterone levels present around the time of conception are thought to skew offspring sex ratio toward sons. The second to fourth digit ratio (digit ratio) is now widely accepted as a negative correlate of prenatal testosterone. Thus, we investigated the association between digit ratio and offspring sex ratio. Methods A total of 508 Korean patients (257 males and 251 females) less than 60 years old who had one or more offspring were prospectively enrolled. The lengths of the 2nd and 4th digits of the right hand were measured by a single investigator using a digital vernier calliper. Next, the patients’ lifetime offspring birth sex ratios were investigated. Results Maternal (rather than paternal) digit ratio was significantly associated with the number of sons (r = -0.153, p = 0.015), number of daughters (r = 0.130, p = 0.039), and offspring sex ratio (r = -0.171, p = 0.007). And, the maternal digit ratio was a significant factor for predicting offspring sex ratio (B = -1.620, p = 0.008) on multiple linear regression analysis. The female patients with a lower digit ratio (< 0.95) were found to have a higher offspring sex ratio (0.609 versus 0.521, p = 0.046) compared to those with a higher digit ratio (≥ 0.95). Furthermore, females in the low digit ratio group have a probability 1.138 greater of having sons than females in the high digit ratio group. Conclusions Maternal digit ratio was negatively associated with offspring sex ratio. Females with a lower digit ratio were more likely to have more male offspring compared to those with a higher digit ratio. Thus, our results suggest that the sex of offspring might be more influenced by maternal rather than paternal factors.

Intermediate versus low or high prostate-specific antigen density level: Comparison of cancer detection rate between 12- and 18-core prostate biopsy

Abstract Objective. To compare the diagnostic values of 12- and 18-core biopsies with respect to prostate-specific antigen (PSA) levels, prostate volumes (PV) and prostate-specific antigen density (PSAD). Material and methods. Transrectal ultrasound-guided prostate biopsies were performed on 233 patients at a single tertiary academic center. Patients were prospectively randomized to the two protocols (12 or 18 core). The cancer detection rates achieved using these two methods were analyzed at different PSA levels, PVs and PSADs. Results. Considering PSA level and PV simultaneously, patients were stratified into four groups (group A: PSA < 7 ng/ml and PV ≥ 45 cm3; group B: PSA < 7 ng/ml and PV < 45 cm3; group C: PSA ≥ 7 ng/ml and PV ≥ 45 cm3; group D: PSA ≥ 7 ng/ml and PV < 45 cm3). 18-core biopsy had a higher cancer detection rate than 12-core biopsy only in group C (55.2% vs 24.1%, p = 0.015). The 233 patients were also stratified into three groups according to PSAD level: the low PSAD group (PSAD < 0.15 ng/ml/cm3), the intermediate PSAD group (0.15 ng/ml/cm3 ≤ PSAD < 0.25 ng/ml/cm3) and the high PSAD group (PSAD ≥ 0.25 ng/ml/cm3). In the intermediate PSAD group, 18-core biopsy had a higher cancer detection rate than 12-core biopsy (54.2% vs 28.9%, p = 0.048). Conclusion. An 18-core biopsy is more useful than a 12-core biopsy for detecting prostate cancer in patients with high PSA and large PV, that is, with intermediate PSAD level.

Is Tubeless Percutaneous Nephrolithotomy a Feasible Technique for the Treatment of Staghorn Calculi

Purpose Tubeless percutaneous nephrolithotomy (PNL) remains a challenging technique for the surgical treatment of staghorn renal calculi. Our study was designed to compare surgical outcomes between conventional and tubeless PNL. Materials and Methods We retrospectively enrolled consecutive patients who underwent conventional or tubeless PNL under general anesthesia performed by a single surgeon (H.J.) for the treatment of staghorn calculi between 2003 and 2012. All patients were divided into two groups: group 1 included patients who underwent conventional PNL and group 2 included patients who were managed by tubeless PNL for the treatment of staghorn calculi. Preoperative and postoperative parameters were analyzed between the two groups, including age, stone burden, complications, any interventions, and duration of hospital stay. Results A total of 165 patients (group 1, 106; group 2, 59) were enrolled in the study. No significant differences in age, sex, body mass index, or stone laterality were observed between the two groups. The mean stone burdens (±standard deviation) of group 1 and group 2 were 633.6 (±667.4) and 529.9 (±362.8), respectively (p=0.271). The postoperative stone-free clearance rate was higher in group 2 (78.0%) than in group 1 (69.8%); however, the difference was not clinically significant (p=0.127). In addition, no significant differences in postoperative complications, including fever, bleeding, infection, or additional interventions, were observed between the two groups. Conclusions Our results demonstrated that tubeless PNL has the same effectiveness and safety as conventional PNL in the treatment of staghorn calculi. Tubeless PNL may be feasible for managing renal staghorn calculi.

Necrotizing fasciitis following transobturator tape procedure: a case report and literature review

A 51-year-old diabetic woman was referred to our unit with a history of increasing pain in her right thigh and gait disturbance, 10 days following surgery for treatment of stress urinary incontinence with a transobturator tape. Examination elicited a tender right thigh associated with swelling and erythema. Inspection of the vagina revealed an exposed mesh through the vaginal erosion. Plain radiographs and magnetic resonance imaging revealed large thigh abscesses suggestive of gas gangrene from the pelvis to the calf. The mesh was completely removed; extensile incisions, as well as aggressive debridement of all necrotic tissue in the thigh and calf, were performed. A diagnosis of necrotizing fasciitis with gas extending to the lower leg level was confirmed. After mesh removal, abscess drainage and debridement, the patient recovered with antibiotics and daily wound care. Three months after the operation, the patient showed no recurrence of the infection.