Yong Soo Lho

The epidemiology of reno-ureteral stone disease in Koreans: a nationwide population-based study.

The objective of this study was to evaluate the annual incidence of upper tract urolithiasis based on a large population-based study in Korea. This study used a subset of the 2009 Health Insurance and Review and Assessment service-National Patient Sample (HIRA-NPS). The 2009 HIRA-NPS contains data for 1,115,721 patients (711,285 inpatients and 404,436 outpatients) from January 2009 to December 2009. Based on these data, we selected patients who had been diagnosed with urolithiasis using the ICD code and calculated the incidence of urolithiasis. The total number of estimated urolithiasis patients was 219,328. The annual incidence of upper tract urolithiasis was estimated to be 457.02 per 100,000 in the overall population, with 589.09 per 100,000 men and 326.64 per 100,000 women. The male-to-female ratio was about 1.8:1. The annual incidence of urolithiasis in Korea was 457 per 100,000. It is higher than that previously reported in Japan, but lower than that in Western countries.

Erratum to: The effect of climate variability on urinary stone attacks: increased incidence associated with temperature over 18 °C: a population-based study

The aim of this study was to evaluate the effect of seasonal variation and climate parameters on urinary tract stone attack and investigate whether stone attack is increased sharply at a specific point. Nationwide data of total urinary tract stone attack numbers per month between January 2006 and December 2010 were obtained from the Korean Health Insurance Review and Assessment Service. The effects of climatic factors on monthly urinary stone attack were assessed using auto-regressive integrated moving average (ARIMA) regression method. A total of 1,702,913 stone attack cases were identified. Mean monthly and monthly average daily urinary stone attack cases were 28,382 ± 2,760 and 933 ± 85, respectively. The stone attack showed seasonal trends of sharp incline in June, a peak plateau from July to September, and a sharp decline after September. The correlation analysis showed that ambient temperature (r = 0.557, p < 0.001) and relative humidity (r = 0.513, p < 0.001) were significantly associated with urinary stone attack cases. However, after adjustment for trends and seasonality, ambient temperature was the only climate factor associated with the stone attack cases in ARIMA regression test (p = 0.04). Threshold temperature was estimated as 18.4 °C. Risk of urinary stone attack significantly increases 1.71 % (1.02–2.41 %, 95 % confidence intervals) with a 1 °C increase of ambient temperature above the threshold point. In conclusion, monthly urinary stone attack cases were changed according to seasonal variation. Among the climates variables, only temperature had consistent association with stone attack and when the temperature is over 18.4 °C, urinary stone attack would be increased sharply.

Clinical value of acute pyelonephritis grade based on computed tomography in predicting severity and course of acute pyelonephritis.

Purpose This study aimed to evaluate the efficacy of computed tomography (CT)–based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. Materials and Methods This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). Results A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. Conclusions This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Is a 22 cm Ureteric Stent Appropriate for Korean Patients Smaller than 175 cm in Height

Purpose Determining the ideal length of a ureteric stent is important to avoid complications associated with stent placement. Clinically, most urologists usually choose the length of a ureteric stent according to the patients height. On the basis of a Chinese population study, a 22 cm ureteric stent has been recommended for patients smaller than 175 cm. We evaluated the appropriateness of this recommendation in Korean patients. Materials and Methods A total of 70 patients who were smaller than 175 cm and who underwent ureteroscopic lithotripsy and ureteric stent insertion were studied. The appropriateness of the stent length was determined on the basis of plain film findings. Patient discomfort was measured by use of a visual analogue scale (VAS) before the removal of the ureteric stent. Results In 29 patients with a 22 cm ureteric stent, 21 patients (72.4%) had an appropriate ureteric stent length and the mean VAS was 4.1. In 36 patients with a 24 cm ureteric stent, 20 patients (55.6%) had an appropriate ureteric stent length and the mean VAS was 4.0. Among 5 patients with a 26 cm ureteric stent, 1 patient (20%) had an appropriate ureteric stent length and the mean VAS was 5.4. Conclusions In Korean patients smaller than 175 cm in height, a 22 cm ureteric stent was an appropriate length.

Effect of the ratio of resected tissue in comparison with the prostate transitional zone volume on voiding function improvement after transurethral resection of prostate.

OBJECTIVE Few studies exist correlating the extent of tissue resected with symptom improvement after transurethral resection of prostate (TURP). This study evaluated the effect of the ratio of resected tissue in comparison with the transitional zone volume (TZV) on improvement of voiding symptoms and flow rate. METHODS A total of 263 patients who underwent TURP from January 2001 to June 2008 were included in this retrospective study. TURP efficacy was assessed at 6 months using International Prostate Symptom Score (IPSS) and uroflowmetry. Patients were then stratified into 2 subgroups according to resection ratio (volume of resected tissue/TZV); individuals with resection ratio<50% (group A) and ≥50% (group B). The 2 groups were compared with regard to prostate volume, TZV, preoperative and postoperative IPSS, quality of life (QoL), peak flow rate (Qmax), and postvoid residual (PVR). Similar analyses were performed according to prostate volume (small [<40 g] vs large [≥40 g]). RESULTS Of these individuals, 85 (32.3%) met the criteria for group A, and 178 (67.7%) for group B. There were no statistically significant differences in age, prostate volume, TZV, preoperative IPSS, QoL score, Qmax, and PVR. After TURP, there was no significant difference of IPSS, QoL score, Qmax, and PVR between the 2 groups. After stratification according to prostate size, the differences in clinical variables were not significant according to resection ratio. CONCLUSION Resection ratio had no effect on post-TURP clinical improvement. These results suggest that complete prostate adenoma resection may not be essential.

Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location.

Objective: To assess the sensitivity of digital abdominal radiography in the detection of ureteral stones by stone size and location. Materials and Methods: We retrospectively reviewed the digital abdominal radiography of 163 patients for the detection of ureteral stones. Each ureteral stone was confirmed by unenhanced computed tomography (CT) in the emergency department between January and December, 2009. Stone location was defined as proximal or distal by the level where the ureter crossed anterior to iliac vessels, and the stone size was defined as small if smaller than 5 mm and large if larger than 5 mm on unenhanced CT. The interpretation of digital abdominal radiography was classified as visible, invisible, or equivocal. Results: In 163 ureteral stones, 77 stones (47.2%) were in the proximal ureter and 86 stones (52.8%) were in the distal ureter. The mean (SD) size of the ureteral stones was 3.4 (1.7) mm (range, 1-9 mm). Overall sensitivity of digital radiography for ureteral stones was 29.4%. The sensitivity of digital radiography for the proximal ureteral stones was 37.7% and that for the distal ureteral stones was 22.1% (P < 0.05). The sensitivity of digital radiography for small ureteral stones was 23.6% and that for large ureteral stones was 50.0% (P < 0.05). As a group, the sensitivity of digital radiography for large proximal ureteral stones was the highest sensitivity-72.2%-in all groups (P < 0.05). Conclusion: Digital abdominal radiography is useful in detecting large proximal ureteral stones.

Effect of Depression on the Risk and Severity of Lower Urinary Tract Symptoms in Community‐Dwelling Elderly Korean Men

Objectives: To evaluate the association of the risk and severity of lower urinary tract symptoms (LUTS) and depression diagnosed by neuropsychiatrists according to the DSM‐IV diagnostic criteria using an objective questionnaire within community‐dwelling elderly Korean men.

Comparison of Nonspherical Polyvinyl Alcohol Particles and Microspheres for Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia

Purpose To report early results following prostatic artery embolization (PAE) and compare outcomes between nonspherical polyvinyl alcohol (PVA) particles and microspheres to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods PAE was performed in nine patients (mean age: 78.1 years) with symptomatic BPH. Embolization was performed using nonspherical PVA particles (250–355 μm) in four patients and microspheres (300–500 μm) in five patients. Results PAE was technically successful in all nine patients (100%). During a mean follow-up of 10.1 months, improvements in mean International Prostate Symptom Score (IPSS), Quality of Life (QoL), prostatic volume (total volume and transition zone), and peak urinary flow (Qmax) were 9.8 points, 2.3 points, 28.1 mL, 17.8 mL, and 4.5 mL/s, respectively. Clinical success was obtained in seven of nine patients (78%). Patients in the microsphere group showed greater improvement in IPSS, QoL, prostatic volume, and Qmax compared to patients in the nonspherical PVA particle group. However, significant difference was noted only in the prostatic volume. Conclusion PAE is a feasible, effective, and safe treatment option for BPH with LUTS. Use of microspheres showed greater prostatic volume reduction compared to nonspherical PVA particles.

Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy

Purpose We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. Materials and Methods This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores <12, and lack of biopsy location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. Results Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. Conclusions This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.

Induction of contraception by intraepididymal sclerotherapy.

Purpose The objective of the present study was to evaluate the efficacy of a sclerosing solution for inducing epididymal occlusion in male rats. Materials and Methods Male Sprague-Dawley rats were divided into two groups: an injection group (n=20) and control group (n=20). Before injecting the sclerosing agent, seminal vesiculectomy and sperm identification using electrostimulation were performed in all of the rats. In the injection group, 0.2 mL of 0.1% sodium tetradecyl sulfate solution was injected into the epididymis. In the sham group, only the identification of the epididymis was performed. At 4 and 12 weeks after the injection, semen was collected by electrostimulation and evaluated to assess the contraceptive effect. Epididymis was evaluated by hematoxylin and eosin (H&E) staining. Results After 4 and 12 weeks, semen collection was performed in the two groups. Sperms were not observed in the injection group, while there was no change in the sperms in the sham group. H&E staining showed the obstruction of epididymal tubules and an accumulation of inflammatory cells in the injection group. Conclusions This study showed that the sclerosing agent induced sterilization in male rats. This result suggests that the injection method can replace vasectomy as a contraceptive method. However, a further study of large animals and a clinical study are needed. Further, the long-term effectiveness of this method needs to be studied.