Hyun Jun Park

Pusan National University, Tsau-liang-hai, Busan, South Korea

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Publications (61)90.9 Total impact

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    ABSTRACT: The aim of this study was to investigate the efficacy of mirodenafil in middle-aged male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Eighty-eight males with CP/CPPS were randomized to receive either levofloxacin (500 mg/d) (group L, 40 patients) or levofloxacin (500 mg/d) and mirodenafil (50 mg/d) (group ML, 48 patients) for six weeks. The International Prostate Symptom Score (IPSS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and erectile function (EF) domain scores of the International Index of Erectile Function (IIEF) questionnaire were used to grade symptoms at baseline and 6 weeks after treatment. The mean change in total IPSS from baseline was higher in group ML than that in group L (group L, -1.1 vs. group ML, -4.3; p<0.05). Significant improvements were also seen in the IPSS voiding subscore (group L, -0.7 vs. group ML, -3.0; p<0.05). Changes observed in the NIH-CPSI of group ML at six weeks were greater than those at baseline (group L, -3.2 vs. group ML, -7.2; p<0.05). Significant improvements were seen in the NIH-CPSI voiding (group L, -0.5 vs. group ML, -1.7; p<0.05) and quality of life domains (group L, -1.0 vs. group ML, -1.8; p<0.05). Group ML showed a significantly greater increase in the IIEF-EF score than did group ML (group L, +0.2 vs. group ML, +7.8; p<0.05). Mirodenafil (50 mg once daily) was well tolerated and resulted in significant symptomatic improvement in middle-aged males with CP/CPPS.
    12/2014; 32(3):145-50. DOI:10.5534/wjmh.2014.32.3.145
  • Kwang Baek Kim, Hyun Jun Park, Doo Heon Song
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    ABSTRACT: A sequence alignment algorithm is a basic building block for protein analysis and nucleic acid analysis in bioinformatics. Such alignment represents the similarities and differences of two or more compared sequences. Thus, there have been many algorithms and tools studied and developed. In this paper, we focus on the PHRED based sequence alignment algorithm using Needleman-Wunsch dynamic programming. Although it is well known and proven to be reliable to some extent, it suffers from the heavy computation of producing scoring matrix based on dynamic programming whose time complexity is O(mn). We propose a method applying quadrant method in that process to reduce the computational loads. Also, PHRED based algorithms suffer from the environment when low quality bases are frequently in tips of DNA fragments. Thus, we designed a fuzzy logic system to control the gap cost dynamically to improve the quality of the alignment. In the experiment using real genome data from NCBI (National Center for Biotechnology Information), we verify that the proposed method reduces the computational loads by half in producing scoring matrix and thus the alignment quality is also improved by our fuzzy inference system.
    Current Bioinformatics 11/2014; 9(5). DOI:10.2174/1574893609666140523000227 · 1.73 Impact Factor
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    ABSTRACT: Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma may be focal/unilateral or diffuse/bilateral, and in the latter case, it is referred to as lymphangiomatosis. Here, we report a case of a 38-year-old man with perirenal lymphangiomatosis. The patient's chief complaint was left flank pain, and left pleural effusion was found on radiological examination. After radical nephrectomy, the pathological examinations revealed that the kidney was enclosed by a multicystic mass with intrarenal cystic dilatations. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.
    08/2014; 32(2):116-9. DOI:10.5534/wjmh.2014.32.2.116
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    ABSTRACT: In this paper, we propose a method to extract sternocleidomastoid and longus capitis/colli automatically and measure the thickness of those muscles from cervical vertebrae ultrasound images. Extracting sternocleidomastoid is relatively easy but for longus capitis/colli case, due to the brightness sensitivity, it requires much more computationally burdensome procedures. In the binarization process, instead of simple and cheap thresholding method, we apply fuzzy sigma binarization to mitigate the sensitivity. Since that binarization procedure is computationally expensive we keep thresholding method for sternocleidomastoid case. With considerate image processing processes such as 4-directional contour analysis and Cubic Spline interpolation, we can successfully analyze features like muscle thickness. In experiment, the efficacy of the proposed method is verified as having 73 ~ 87% of real world cervical vertebrae images successfully analyzed meaning that only a small magnitude of errors in measuring thickness from medical expert's own measurement (less than 0.1 cm for sternocleidomastoid and less than 0.3 cm for longus capitis/colli). We hope such result encourages the use of automatic ultrasound analysis system for cervical vertebrae in rehabilitation practices.
    Current Medical Imaging Reviews 07/2014; 10(2). DOI:10.2174/157340561002140715101740 · 1.06 Impact Factor
  • Kwang Baek Kim, Hyun Jun Park, Gwang Ha Kim
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    ABSTRACT: In this paper, we propose a new fully computerized image analysis method for measuring the thickness of muscles from ultrasound image obtained by muscle endurance test using morphological information of fascia and thoracic vertebra. Firstly, we divide the image into lumbar region and thoracolumbar region by the difference of density in image for measuring the thickness of muscles. In lumbar region, we notice that the intensity of fascia is relatively higher than other parts. Thus, we measure the thickness of muscles surrounding the fascia area. In the process, we apply median filter to candidate fascia areas for extracting candidate muscle layers between fascias. Then, the thickness of muscles we measure is that of the third layer. In thoracolumbar region, we apply region expansion method for classifying the region into subcutaneous fat part and part including thoracic vertebra. Then, we apply counting method and evolutionary computation search model to find the measuring location that is in between subcutaneous fat area and thoracic vertebra. In experiment, the proposed method is effective in measuring the thickness of muscles and avoids failures of previous studies. The performance of this approach is sufficiently comparable to that of medical experts.
    Multimedia Tools and Applications 07/2014; 71(2). DOI:10.1007/s11042-013-1773-5 · 1.06 Impact Factor
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    ABSTRACT: OBJECTIVE To investigate the reasons for prescription change of alpha 1-blockers in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. METHODS The ratio and interval of prescription change were assessed in 3200 patients who were eligible for the study and took 1 of 4 different alpha 1-blockers (doxazosin, alfuzosin, tamsulosin, or silodosin). The reasons for prescription change and evaluation of efficacy were analyzed in 444 patients whose medical records were complete. RESULTS Prescription change to another alpha 1-blocker occurred in 694 of 3200 patients (21.7%), and the mean duration of taking their first alpha 1-blocker was 10.8 +/- 8.2 weeks. Lack of efficacy (52.7%) was the main reason for changing alpha 1-blockers, followed by adverse events (33.1%), relatively high cost compared with other alpha 1-blockers (7.0%), inconvenience of taking drugs (4.1%), and cardiovascular comorbidity (3.2%). The mean duration of treatment according to each reason is as follows: increased adverse events: 6.3 +/- 5.2 weeks, relatively high cost compared with other alpha 1-blockers: 8.7 +/- 4.5 weeks, cardiovascular comorbidity: 10.5 +/- 6.8 weeks, inconvenience of taking drugs: 10.8 +/- 3.9 weeks, and lack of efficacy: 14.8 +/- 6.8 weeks. The proportion of prescription change (16.3%) and prescription change because of hemodynamic adverse events (2.4%) in the silodosin group were low compared with those in the other groups (P <.05 and P <.006, respectively), but prescription change because of a ejaculation disorder was high in the silodosin group (30.1%, P <.001). CONCLUSION Major reasons for prescription change in patients taking a1-blockers were lack of efficacy and adverse events. In the silodosin group, the proportion of prescription change was significantly low compared with that in the other 3 groups. (C) 2014 Elsevier Inc.
    Urology 06/2014; 84(2). DOI:10.1016/j.urology.2014.02.068 · 2.13 Impact Factor
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    ABSTRACT: Phosphodiesterase type 5 (PDE5) inhibitors are the most commonly used treatment for erectile dysfunction (ED). Since the launch of sildenafil, several drugs-including mirodenafil, sildenafil citrate (sildenafil), tadalafil, vardenafil HCL (vardenafil), udenafil, and avanafil-have become available. Mirodenafil is a newly developed pyrrolopyrimidinone compound, which is a potent, reversible, and selective oral PDE5 inhibitor. Mirodenafil was launched in Korea in 2007, and an orally disintegrating film of mirodenafil was developed in 2011 for benefitting patients having difficulty in swallowing tablets. This study aimed to review the pharmacokinetic characteristic profile of mirodenafil and report evidence on its efficacy in the case of ED. In addition, we reviewed randomized controlled studies of mirodenafil's daily administration and efficacy for lower urinary tract symptoms.
    04/2014; 32(1):18-27. DOI:10.5534/wjmh.2014.32.1.18
  • Hyun Jun Park, Nam Cheol Park
    The Journal of Urology 04/2014; 191(4):e728-e729. DOI:10.1016/j.juro.2014.02.1987 · 3.75 Impact Factor
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    ABSTRACT: Purpose This post hoc integrated analysis assessed the efficacy and safety of tadalafil 5 mg once daily in a large Korean population with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH-LUTS). Materials and Methods Individual Korean participant data were integrated from three 12-week, randomized, double-blind, placebo-controlled studies in Asian men with BPH-LUTS, wherein 177 Korean men received placebo and 177 received tadalafil 5 mg once daily. The primary objective was to compare the change from baseline to week 12 in total International Prostate Symptom Score (IPSS) after treatment with tadalafil versus placebo. Results A significantly greater improvement (p<0.001) in total IPSS from baseline to week 12 was observed for tadalafil compared to placebo (least squares mean: tadalafil=-5.97; placebo=-3.94 ). Total IPSS at weeks 4 and 12, IPSS voiding and storage subscores at weeks 4, 8, and 12, and IPSS quality of life index at weeks 8 and 12 were also significantly improved (p<0.05) for tadalafil compared to placebo. There was significant improvement (p<0.001) in the patient global Impression of improvement responses and numerical improvement in the clinician global impression of improvement responses with tadalafil compared to placebo. There were no significant treatment differences for peak urine flow rate or postvoid residual volume. Few participants had treatment-emergent adverse events and there were no unexpected safety findings. Conclusions This integrated analysis of three randomized, placebo-controlled Asian studies confirmed tadalafil 5 mg once daily as an efficacious and well-tolerated treatment for Korean men with BPH-LUTS.
    04/2014; 32(1):28-35. DOI:10.5534/wjmh.2014.32.1.28
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    ABSTRACT: In rehabilitation, ultrasonography is a popular diagnostic tool. However, it could be subjective to the medical expert's experience. Thus, it is necessary to develop an objective automatic procedure for ultrasonographic image analysis. A disadvantage of the existing automatic analytic procedure in musculoskeletal systems is the designation of an incorrect muscle area when the figure of fascia is vague. In this study, we propose a new procedure to more accurately extract muscle area in abdominal ultrasonographic images. After removing unnecessary noise from the input image, we apply the End-in search algorithm to enhance the contrast between the fascia and muscle area. Then after extracting the initial muscle area using an up-down search, we trace the fascia area with a mask based on morphological and directional information. By this tracing of mask movements, we can emphasize the fascia area to extract more accurate muscle area as a result. This new procedure is proven to be more effective than existing methods based on experiments using convex ultrasound images which are used in the practical diagnostic field of rehabilitation.
    Journal of Medical Imaging and Health Informatics 03/2014; 4(1):8-13. DOI:10.1166/jmihi.2014.1218 · 0.62 Impact Factor
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    ABSTRACT: Infertile couples interested in nonspouse artificial insemination by donor (AID) not only require a thorough understanding of the medical procedure but also must scrutinize the effects it will have on family relationships, including those on the infant to be born. We conducted a series of surveys in couples with male infertility to collect information necessary for AID counseling. A total of 384 cases with noncurable male infertility were enrolled in this inquiry survey. The questionnaire consisted of 18 items that assessed demographic characteristics, background information concerning the choice to use AID, subjective experiences, long-term effects, and an overall evaluation. A total of 126 surveys were returned (32.8%). AID was first suggested by the husband in about half of the cases. The major reason for considering the procedure was to form a complete family. Two-thirds of the couples were anxious about the procedure, most often about possible congenital or acquired deformities in the infant. After the birth of the child, most couples were positive about their decision to have used AID. About half of the couples felt that the child was their own and expected not to tell the child about AID. Overall, about 50% of the couples were satisfied with the procedure. Those who underwent AID experienced various psychological effects, including anxiety about the child to be born. To overcome these problems, sufficient medical information and consultation about the process of selecting the donor and about AID procedures should be provided before the procedure is used.
    Korean journal of urology 02/2014; 55(2):134-9. DOI:10.4111/kju.2014.55.2.134
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    ABSTRACT: A nationwide survey was conducted of Korean urologists to illustrate physicians' perceptions and real practical patterns regarding Peyronie disease (PD). A specially designed questionnaire exploring practice characteristics and attitudes regarding PD, as well as patient satisfaction with each treatment modality, was e-mailed to 2,421 randomly selected urologists. Responses were received from 385 practicing urologists (15.9%) with a median time after certification as an urologist of 12 years. Regarding the natural course, 87% of respondents believed that PD is a progressive disease, and 82% replied that spontaneous healing in PD occurred in fewer than 20% of patients. Regarding diagnosis of PD, the methods used were, in order, history taking with physical examination (98%), International Index of Erectile Function questionnaires (40%), intracavernous injection and stimulation (35%), and duplex sonography (28%). Vitamin E was most preferred as an initial medical management (80.2%), followed by phosphodiesterase-5 inhibitors (27.4%) and Potaba (aminobenzoate potassium, 20.1%). For urologists who administered intralesional injection, the injected agent was, in order, corticosteroid (72.2%), verapamil (45.1%), and interferon (3.2%). The most frequently performed surgical procedure was plication (84.1%), followed by excision and graft (42.9%) and penile prosthesis implantation (14.2%). Among the most popular treatments in each modality, the urologists' perceptions regarding the suitability of treatment and patient satisfaction were significantly different, favoring plication surgery. The practice pattern of urologists depicted in this survey is in line with currently available Western guidelines, which indicates the need for development of further local guidelines based on solid clinical data.
    Korean journal of urology 01/2014; 55(1):57-63. DOI:10.4111/kju.2014.55.1.57
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    Jung Woo Lee, Hyun Jun Park, Nam Cheol Park
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    ABSTRACT: We studied the relative importance of high-sensitivity C-reactive protein (hs-CRP) concentrations in patients with erectile dysfunction (ED) and diabetes and determined whether the hs-CRP level predicts the response to treatment with 5 mg tadalafil once daily. We enrolled 102 men (aged 40-60 years) with diabetes and ED. All patients completed the International Index of Erectile Function (IIEF) questionnaire and were given 5 mg tadalafil daily. The IIEF and serum hs-CRP levels in patients and healthy controls and in patient responders and nonresponders to 5 mg tadalafil once daily were compared. Median age was 53.2 years (range, 45 to 62 years) in patients and 55.6 years (range, 47 to 64 years) in healthy controls (p=0.158). The median duration of diabetes was 54.3 months (range, 34 to 70 months). The median IIEF and hs-CRP level were 12.1 (range, 5 to 20) and 0.21 mg/dL (range, 0.05 to 0.6 mg/dL) in patients and 28.2 (range, 13 to 31) and 0.09 mg/dL (range, 0.04 to 0.2 mg/dL) in the controls, respectively (pIIEF=0.000, pCRP=0.031). After tadalafil treatment, 71 patients (69.6%) achieved an erection sufficient for sexual intercourse, whereas 31 (30.4%) did not. The median age of the tadalafil nonresponders was 56.2 years (range, 45 to 64 years) and that of the responders was 51.3 years (range, 42 to 62 years; p=0.065). Median hs-CRP levels were 0.31 mg/dL (range, 0.18 to 0.62 mg/dL) in nonresponders and 0.14 mg/dL (range, 0.09 to 0.4 mg/dL) in responders, respectively (p=0.028). Serum hs-CRP was significantly higher in patients with ED and diabetes mellitus than in patients without ED. A significant correlation was observed between serum hs-CRP levels, the degree of ED, and responsiveness to tadalafil.
    Korean journal of urology 12/2013; 54(12):858-64. DOI:10.4111/kju.2013.54.12.858
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    ABSTRACT: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE. The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. UROLOGISTS IN KOREA DIAGNOSED PE USING VARIOUS CRITERIA: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN). A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.
    12/2013; 31(3):226-31. DOI:10.5534/wjmh.2013.31.3.226
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    ABSTRACT: This review assesses lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with or without erectile dysfunction (ED) and related therapies focusing on tadalafil. A literature search was obtained and reviewed for the epidemiology, treatment therapies, pathophysiology, and efficacy and safety of phosphodiesterase type 5 inhibitor (PDE5i) tadalafil in patients with LUTS/BPH. Approximately 42% of men aged 51 to 60 years have BPH. Approximately 90% of men aged 45 to 80 years have LUTS. Occurrence of LUTS increases with age for almost all racial/ethnic groups (range, 32% to 56%) with prevalence of LUTS highest among Hispanic men, then Blacks, Caucasians, and Asians. There is an independent relationship with LUTS/BPH and ED, with approximately 70% of men with LUTS/BPH having ED with severity of one disease often correlating with the other. The European Urological Association guidelines include the use of the PDE5i tadalafil. Tadalafil is the only therapy recommended for treatment of co-existing BPH and ED, while other therapies have unwanted ED side effects. The mode of action of tadalafil may involve different areas of the lower urinary tract such as smooth muscle cell relaxation in the bladder neck, prostate, and urethra, but there may also be resulting modulation of the afferent nerve activity. Tadalafil (5 mg) in Asian men with LUTS/BPH, similar to global studies, is efficacious and safe. Tadalafil (5 mg) improves co-existing LUTS/BPH and ED, independently. Men with LUTS/BPH likely also have ED. Asian men with LUTS/BPH have similar incidence rates, co-existing ED, comorbid diseases, and risks as non-Asian men. Tadalafil can improve co-existing LUTS/BPH and ED.
    12/2013; 31(3):193-207. DOI:10.5534/wjmh.2013.31.3.193
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    ABSTRACT: To investigate the intraocular pharmacokinetics of triamcinolone acetonide (TA) injected into the posterior subtenon of vitrectomized rabbit eyes. Vitrectomy was performed on the right eyes of 35 rabbits. Triamcinolone acetonide (40 mg/mL) was injected into the posterior subtenon space of both eyes. Five rabbits each were killed at days 1, 3, 7, 14, 28, 56, and 84. Both eyes were enucleated. The vitreous was isolated, and TA concentration was measured. In vitrectomized eyes, the intravitreal concentrations of TA were 1763, 822.9, 321.5, 113.3, 35.5, 14.4, and 6.7 ng/mL, respectively, at the time points indicated above; the concentrations in nonvitrectomized eyes were 397.8, 360.4, 154.4, 48.5, 30.7, 15.2, and 8.0 ng/mL, respectively. Triamcinolone acetonide concentrations were significantly higher in the vitrectomized eyes at days 1, 3, 7, and 14. The terminal half-life of intravitreal TA was 23.3 days in the vitrectomized eyes and 28.9 days in the nonvitrectomized eyes. Intravitreal absorption and excretion of TA in the posterior subtenon space are increased after vitrectomy. Although the terminal half-life of TA was shorter, higher early concentration and similar effective duration were achieved in the vitrectomized eyes.
    Retina (Philadelphia, Pa.) 09/2013; DOI:10.1097/IAE.0000000000000000 · 3.18 Impact Factor
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    Sungmin Kang, Hyun Jun Park, Nam Cheol Park
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    ABSTRACT: Late-onset hypogonadism (LOH) in aging males is a clinical and biochemical syndrome characterized by a decline in serum testosterone levels. LOH results in various physical and mental disabilities. We evaluated the relationship between serum testosterone levels and symptoms of LOH. During an andropause screening program, we examined responses to the Saint Louis university androgen deficiency in aging males (ADAM) questionnaire and results on the International Index of Erectile Function (IIEF-5) in terms of clinical symptoms and evaluated serum total testosterone levels for a biochemical diagnosis of LOH in healthy community-living volunteers aged over 40 years. The mean age of the 534 men was 59.1 years (range, 40 to 79 years), and their mean serum testosterone level was 464.1±171.9 ng/dL. The serum testosterone level decreased significantly with age. There was a 92.5% positive response rate to the ADAM questionnaire. The percentage of patients whose serum testosterone level was <350 ng/dL among those with a positive response to the ADAM questionnaire was 25.6% (137 patients). The mean serum testosterone level among patients with a positive or negative ADAM questionnaire was 472.4±198.5 ng/dL and 487.3±165.7 ng/dL, respectively (p>0.05). There was no significant correlation between IIEF-5 scores and serum testosterone levels. Among men over 40 years of age, 25.6% met the clinical and biochemical diagnostic criteria for LOH. There was no relationship between serum testosterone levels and symptoms of LOH.
    Korean journal of urology 09/2013; 54(9):619-23. DOI:10.4111/kju.2013.54.9.619
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    ABSTRACT: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06±2.56 and 11.81±2.87 mm, and prostatic urethral lengths were 36.39±6.15 and 37.45±7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25±0.06 and 0.24±0.06, and prostatic-posterior urethral length ratios were 0.75±0.06 and 0.76±0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.
    08/2013; 31(2):163-9. DOI:10.5534/wjmh.2013.31.2.163
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    Nam Cheol Park, Tae Nam Kim, Hyun Jun Park
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    ABSTRACT: Currently, phosphodiesterase type 5 (PDE5) inhibitors are the initial treatment option for erectile dysfunction. The reported efficacy of PDE5 inhibitors is about 70%, although it is significantly lower in difficult-to-treat subpopulations. Treatment failures might be due to the severity of the underlying pathophysiology, improper use of medication, unrealistic patient expectations, difficult relationship dynamics, severe performance anxiety, and other psychological problems. Physicians must address these issues to identify true treatment failures attributable to the drugs. This article discusses factors that might affect the response to PDE5 inhibitors and develops a strategy to maximize the overall efficacy of PDE5 inhibitors in initial non-responders to PDE5 inhibitors.
    04/2013; 31(1):31-5. DOI:10.5534/wjmh.2013.31.1.31
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    ABSTRACT: Intratesticular cysts, once thought to be a rarity, are now being reported with an increasing prevalence as a result of the wider use of scrotal ultrasound scanning. Despite greater understanding of intratesticular cysts, their management remains unclear. Treatment has included enucleation and even radical orchiectomy over fear of the possibility of an associated malignancy. A more conservative approach with serial ultrasound scanning has been advocated if a clear distinction can be made between neoplastic and non-neoplastic testicular cysts. However, in view of the benign nature of such cysts, even repeated ultrasound scanning may not be necessary and may be considered over-treatment. In this study we present clinical and morphological characteristics of multiple cysts in the right testicle in a 62-year-old patient, where a slightly nodular lesion in the right testicle was detected.
    04/2013; 31(1):79-82. DOI:10.5534/wjmh.2013.31.1.79