[Show abstract][Hide abstract] ABSTRACT: Purpose: We aimed to analyze the relationship between prostate volume and Gleason score (GS) upgrading [higher GS category in the radical prostatectomy (RP) specimen than in the prostate biopsy] in Korean men. Materials and Methods: We retrospectively analyzed the medical records of 247 men who underwent RP between May 2006 and April 2011 at our institution. Transrectal ultrasound (TRUS) volume was categorized as 25 cm³ or less (n=61), 25 to 40 cm³ (n=121) and greater than 40 cm³ (n=65). GS was examined as a categorical variable of 6 or less, 3+4 and 4+3 or greater. The relationship between TRUS volume and upgrading of GS was analyzed using multivariate logistic regression. Results: Overall, 87 patients (35.2%) were upgraded, 20 (8.1%) were downgraded, and 140 (56.7%) had identical biopsy and pathological Gleason sum groups. Smaller TRUS volume was significantly associated with increased likelihood of upgrading (p trend=0.022). Men with prostates 25 cm³ or less had more than 2.7 times the risk of disease being upgraded relative to men with TRUS volumes more than 40 cm³ (OR 2.718, 95% CI 1.403-8.126). Conclusion: In our study, smaller prostate volumes were at increased risk for GS upgrading after RP. This finding should be kept in mind when making treatment decisions for men with prostate cancer that appears to be of a low grade on biopsy, especially in Asian urologic fields.
Yonsei medical journal 07/2013; 54(4):902-906. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. Materials and Methods: Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. Results: Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. Conclusion: Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.
Yonsei medical journal 03/2013; 54(2):464-8. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To evaluate the effectiveness of digital rectal-compression immediately after transrectal prostate biopsy (P-bx) for improving the accuracy of prostate cancer (PCa) staging. Materials and Methods: Between July 2008 and June 2010, 94 consecutive patients who had a radical prostatectomy were included in our retrospective analysis. The exclusion criteria included a history of previous P-bx and surgery, a biopsy performed in another hospital, a number of biopsy cores different from 12, or a condition interfering with bleeding assessment. The subjects were divided into two groups, compression and non-compression. All enrolled patients took magnetic resonance imaging (MRI) for PCa staging. Results: The compression and non-compression groups were comparable with respect to several baseline characteristics. However, the total hemorrhage score of intraprostatic bleeding was significantly different between the groups, even with adjustment for the time from biopsy to MRI (compression:15.4±2.32, non-compression: 24.9±2.43, p<0.001). The intra-prostatic cancer location matching rate was higher in the compression group (78.0%) than in the non-compression group (70.2%) (p=0.011). Overall accuracy of staging in compression and non-compression groups was 84.7% and 77.3%, respectively. Conclusion: Our results demonstrate that digital rectal compression performed immediately after prostate biopsy to reduce intraprostatic hemorrhage improves the accuracy for detection of PCa using MRI.
Yonsei medical journal 01/2013; 54(1):81-6. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: We analyzed changes to the trends of prostate cancer management and patient characteristics at a single institute during 5 years due to the significant increase of the prostate cancer incidence and the robotic equipment in Korea. Materials and Methods: Prostate cancer patient data from a single institute recorded from 2006 to 2010 were analyzed. Cancer stage, initial treatment modalities, and the pattern of outpatient clinical management were reviewed. Results: Between 2006 and 2010, 386 prostate cancers were newly diagnosed at the institute. The proportion of localized and locally advanced cancer cases increased from 67% in 2006 to 79% in 2010 respectively. Among the treatment choices during follow-up in the out-patients clinic, the proportion of radical prostatectomies increased from 43% in 2006 to 62% in 2010. In contrast, the proportion of hormone therapies decreased from 58% to 37%. For initial treatment choice, radical prostatectomy was chosen for 59% of the patients who were newly diagnosed with cancer during the study period. However, hormone therapy alone was administrated as a primary therapy to 26%. Analysis of the radical prostatectomy subgroup showed that a robot- assisted technique was used in 83% of the patients, and the remaining 17% underwent an open radical prostatectomy. Conclusion: As the prostate cancer incidence increased in Korea, the proportion of localized and locally advanced cancer also increased. In addition, the main treatment modality changed from non-surgical treatment to radical prostatectomy.
Yonsei medical journal 01/2013; 54(1):87-91. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To assess the validity of the 7th edition of the American Joint Committee on Cancer TNM staging system for prostate cancer, paying special attention to bladder neck invasion, in an Asian population. METHODS: Clinicopathologic data of 368 men who underwent radical prostatectomy between 2003 and 2011 at our institution were reviewed. The main interest of this study was to confirm that both isolated positive bladder neck margin and positive bladder neck margin associated with other surgical margin have more favorable biochemical outcomes than seminal vesicle invasion (pT3b). RESULTS: The 3-year biochemical recurrence-free survival for men with organ confined disease, extraprostatic extension, isolated positive bladder neck margin, positive bladder neck margin with other surgical margin and seminal vesicle invasion was 88.9, 74.8, 51.2, 19.4 and 18.8%, respectively. On multivariate analysis, the increased risk of progression associated with an isolated positive bladder neck margin (hazard ratio 4.34, 95% confidence interval 1.40-13.46, P = 0.011) was less than that of seminal vesicle invasion (hazard ratio 9.67, 95% confidence interval 3.70-25.25, P < 0.001). As for the positive bladder neck margin with other surgical margin, the increased risk of progression (hazard ratio 9.32, 95% confidence interval 3.50-24.82, P < 0.001) was similar to that of men with seminal vesicle invasion. CONCLUSIONS: In our study, men with isolated positive bladder neck margin and positive bladder neck margin plus other surgical margin had no worse biochemical outcomes than those with seminal vesicle invasion (pT3b). It is reasonable to classify prostate cancer with bladder neck invasion (the 6th American Joint Committee on Cancer edition pT4 category) into the 7th edition pT3 category.
Japanese Journal of Clinical Oncology 12/2012; · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: There are still debates on the benefit of mass screening for prostate cancer (PCA) by prostate specific antigen (PSA) testing, and on systemized surveillance protocols according to PSA level. Furthermore, there is a paucity of literature on current practice patterns according to PSA level in the Korean urologic field. Here, we report the results of a nationwide, multicenter, retrospective chart-review study. Materials and Methods: Overall 2122 Korean men (>40 years old, PSA >2.5 ng/mL) were included in our study (from 122 centers, in 2008). The primary endpoint was to analyze the rate of prostate biopsy according to PSA level. Secondary aims were to analyze the detection rate of PCA, the clinical features of patients, and the status of surveillance for PCA according to PSA level. Results: The rate of prostate biopsy was 7.1%, 26.3%, 54.2%, and 64.3% according to PSA levels of 2.5-3.0, 3.0-4.0, 4.0-10.0, and >10.0 ng/mL, respectively, and the PCA detection rate was 16.0%, 22.2%, 20.2%, and 59.6%, respectively. At a PSA level >4.0 ng/mL, we found a lower incidence of prostate biopsy in local clinics than in general hospitals (21.6% vs. 66.2%, respectively). A significant proportion (16.6%) of patients exhibited high Gleason scores (≥8) even in the group with low PSA values (2.5-4.0 ng/mL). Conclusion: We believe that the results from this nationwide study might provide an important database for the establishment of practical guidelines for the screening and management of PCA in Korean populations.
Yonsei medical journal 11/2012; 53(6):1136-41. · 0.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate the risk for postoperative inguinal hernia according to the presence of patent processus vaginalis in an adult population. Methods: Medical records of 205 patients who underwent robot-assisted laparoscopic radical prostatectomy from May 2007 to November 2011 were reviewed. Age, prostate-specific antigen, prostate volume, body mass index, operative time and history of previous abdominal surgery were evaluated. The existence of patent processus vaginalis was also evaluated for the development of postoperative inguinal hernia. Results: Postoperative inguinal hernia occurred in 20 out of 410 (4.9%) groins (17/205 patients; 8.3%), and patent processus vaginalis was observed in 49 out of 410 (11.9%) groins. In the normal groin group, inguinal hernia occurred in seven out of 361 (1.9%) groins. However, in the patent processus vaginalis group, it occurred in 13 out of 49 (26.5%) groins. On univariate analysis using Cox proportional hazards model, age, body mass index, history of previous abdominal surgery and patent processus vaginalis were significant risk factors. Among them, patent processus vaginalis significantly increased the risk of postoperative inguinal hernia in multivariate analysis (hazard ratio 22.37). In the patent processus vaginalis group, inguinal hernia developed at 12.9 ± 9.2 months after robot-assisted laparoscopic radical prostatectomy and 15 ± 7.4 months in the normal groin group. Inguinal hernia-free ratios were significantly lower in the patent processus vaginalis group than the normal groin group (P < 0.001). Conclusions: The existence of patent processus vaginalis represents an important risk factor for postoperative inguinal hernia in adults. Urologists should consider the possibility of postoperative inguinal hernia when patent processus vaginalis is observed during surgery.
International Journal of Urology 08/2012; · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report our initial experience with transvesicoscopic cross-trigonal ureteral reimplantation (TVUR), describing stepwise the surgical procedure and determining critical aspects of this surgery in the actual surgical field.
Between September 2008 and April 2010, 48 patients with bilateral vesicoureteral reflux (VUR) underwent TVUR. To identify the critical aspects affecting the surgical difficulty, we divided our TVUR procedure into four steps: TVUR set-up, mobilization of ureters, creation of submucosal tunnels, and ureterovesical anastomosis. To evaluate the evolution of our TVUR, we analyzed changes in the operative time and complications versus increase in surgeon experience (dividing our cases into three groups: the first third, the second third, and the last third). Changes in operative time for all four steps of TVUR were analyzed separately, as well as change in overall operative time.
Of a total of 48 cases, 45 patients underwent TVUR successfully except for 3 cases of open conversion. Among the 45 cases, the mean overall operative time was 155.6 min. In 1 patient, proximal migration of the ureteral catheter occurred. No other perioperative complications were observed. The mean postoperative hospital stay was 1.6 days. The VUR resolution rate was 96.4%. Upon analysis of our results by step, Step 4 (ureterovesical anastomosis) required the largest portion of the overall operative time in most cases. During the early period of our TVUR, we encountered several technical difficulties. However, the operative times for all four steps were stabilized with increasing number of cases, without deteriorating surgical outcomes.
Our report demonstrates that TVUR might potentially be a safe and effective alternative to open ureteral reimplantation in children with VUR, with a shorter learning curve than expected.
[Show abstract][Hide abstract] ABSTRACT: We aimed to determine whether prediagnostic lower urinary tract symptoms (LUTS) are associated with the aggressiveness of nonmetastatic prostate cancer (PCa) and compared the clinicopathologic features of PCa patients with and without preexisting LUTS.
We retrospectively reviewed the medical records of 295 prostate cancer patients who underwent a radical prostatectomy (RP) by a single surgeon from 2006 to 2010. A total of 205 patients were assigned to two groups according to whether they showed preoperative LUTS (International Prostate Symptom Score [IPSS]≥8). Clinical, operative, pathologic, and postoperative functional data were collected.
The mean age at RP was 62.7 years in the no LUTS group (group A, n=108) and 64.7 in the LUTS group (group B, n=97). The baseline mean IPSS score was 6.1 in group A and 14.6 in group B (p=0.029). The incidence of pathologic T3a stage or above was significantly higher in group B than in group A (p=0.036). The mean postoperative follow-up period was 16.8 months (range, 4 to 38 months). The mean time to biochemical recurrence was 16.9 and 18.2 months in groups A and B, respectively (p=0.148). The median time to recovery of urinary incontinence was 3.6 and 3.3 months in groups A and B, respectively.
PCa patients without baseline LUTS had a favorable result of pathologic T stage even though there were no significant differences in biochemical recurrence or recovery of postoperative incontinence compared with patients with baseline LUTS.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of targeted prostate biopsy using magnetic resonance imaging (MRI) and to characterize clinicopathologic features of tumors detected with targeted prostate biopsy in men with previous negative prostate biopsy results.
We prospectively studied 87 patients with a persistently increasing level of serum prostate-specific antigen (PSA), at least one previous set of negative 12-core prostate biopsies, and normal digital rectal examination. All patients were examined with combined T2-weighted and diffusion-weighted MRI before undergoing the prostate biopsy. Prostate biopsy was performed using transrectal ultrasonography-guided standard 12 cores plus targeted biopsy to suspicious region(s) as identified on T2 images on their MRI.
Of a total of 87 cases, 82 (94.2%) patients had suspicious lesion(s) on their MRI. Of these 82 patients, 46 (56.0%) patients had prostate cancer (PCA) as determined by the biopsy. The patients with PCA showed a significantly higher incidence of having suspicious lesion(s) (the anterior or apex) on MRI than the patients without PCA (P<0.05). On analysis by dividing all biopsy cores into the targeted cores and standard cores, PCA was found in 149/518 (28.8%) MRI-targeted cores and in 32/903 (3.6%) standard cores (P=0.012) Of 43 patients who underwent radical prostatectomy, 37 (86.0%) patients were detected with PCA located at the anterior or apex portion of the prostate. For tumor characteristics according to tumor locations, there was no significant correlation between tumor location and Gleason scores or pathologic stage.
Our data suggest that a MRI-targeted prostate biopsy after prostate MRI might be considered for the identification of cancer foci and the detection of PCA, for patients with a previous negative standard prostate biopsy result despite a persistently elevated PSA value.
Journal of endourology / Endourological Society 11/2011; 26(7):787-91. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the impact of a retrotrigonal layer backup stitch (RTBS) during robot-assisted laparoscopic radical prostatectomy (RALP) on post-prostatectomy incontinence.
We compared the difference in continence recovery between 94 patients (group 1, as historical controls) and 57 patients (group 2). The only technical difference between our two groups was the incorporation of the retrotrigonal layer into the posterior aspect of the vesicourethral anastomosis (group 1: without RTBS; group 2: with RTBS). Postoperative continence recovery was defined as the use of no absorbent pads.
In group 1, the continence rate at 3, 6, and 12 months postoperatively was 40.4%, 70.2%, and 90.4%, respectively;in group 2, the continence rate was 42.1%, 70.1%, and 89.7%, respectively. The median (95% confidence interval) time to continence recovery was four months (range, 1 to 12 months) in group 1 and four months (range, 1 to 9 months) in group 2. Kaplan-Meier curves showed no significant difference in the recovery of continence between the two groups (log rank test, p=0.629).
A RTBS does not appear to improve urinary incontinence after RALP. Further anatomical study and prospective randomized studies will be needed to confirm this.
[Show abstract][Hide abstract] ABSTRACT: 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.
To determine optimal timing to evaluate prediagnostic baseline EF in patients undergoing bilateral nerve sparing RLRP.
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.
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 Pearson's 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.
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).
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.
Journal of Sexual Medicine 09/2011; 9(2):602-7. · 3.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-specific antigen (PSA) concentration.
This retrospective study included 579 consecutive patients with newly diagnosed prostate cancer (Pca) who underwent a bone scan study at our institution between 2002 and 2010. We used receiver operating characteristics curves to evaluate accuracy of bone metastasis between serum PSA 10 and 20 ng/mL.
A positive bone scan result was found in 83 men (14.3%) with PCa. However, 27 men (4.6%) with serum PSA between 10 and 20 ng/mL, 29/579 men (5.0%) with GS ≤ 7, and 21/83 (25.3%) with serum PSA ≤ 20 ng/mL and Gleason score (GS) ≤ 7 had positive bone scans. In the logistic regression analyses, clinical T stage (odds ratio [OR] = 3.26; 95% CI, 2.29-4.33; P = 0.021), GS (OR = 3.41; 95% CI, 2.91-4.63; P = 0.019), and serum PSA (OR = 8.37; 95% CI, 3.91-19.21; P < 0.001) were predictive factors of detecting the BM. When the serum PSA concentration ≤20 ng/mL and GS ≤ 7, AUC value of bone scans for the detection of BM was 0.640 (P = 0.020; 95% CI, 0.563-0.717). With serum PSA at 10 ng/mL and GS ≤ 7, the AUC values of bone scans were 0.828 (P < 0.001; 95% CI, 0.773-0.883).
Bone scans might be necessary in men with serum PSA between 10 and 20 ng/mL. New guidelines for eliminating bone scans in patients with newly diagnosed Pca are needed, especially in Asians.
World Journal of Urology 07/2011; 30(2):265-9. · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the difference in efficacy of medical treatment of symptomatic benign prostatic hyperplasia (BPH) between normal and obese patients with BPH; obesity was determined by either body mass index (BMI) or waist circumference (WC). In this 12-week prospective observational study, a total of 175 patients aged ≥40 years with International Prostate Symptom Scores (IPSS) ≥12 points and prostate volume ≥20 ml were prospectively enrolled. The patients were divided into two groups according to BMI or WC. Patients received the doxazosin gastrointestinal therapeutic system (GITS) at a dose of 4 mg once per day for 12 weeks. The changes from baseline in the IPSS, maximal urinary flow rate (Q(max)), post-void residual volume, quality of life (QoL) scores and adverse events (AEs) were analysed. Of the 175 enrolled patients, 132 completed the study. Sixty-seven patients had BMI >23 kg m⁻², and 43 had WC >90 cm. Obese patients represented by WC >90 cm or BMI ≥23 kg m⁻² had a significantly greater prostate volume compared with non-obese patients at baseline. Total IPSS was significantly higher in the WC >90 cm group compared to the WC ≤90 cm group. Total IPSS was positively correlated with prostate volume (P=0.031) and WC (P=0.045). All groups showed significant improvements in total IPSS and QoL at 12 weeks. However, the improvement of total IPSS was greater in the high-BMI and high-WC groups. The most frequent AE was dizziness (n=13), and it was significantly lower in the obese BPH patients. Obesity was associated with increased prostate volume and lower urinary tract symptoms. Alpha-blockers appear to be efficacious for controlling symptoms, especially in obese men.
Asian Journal of Andrology 04/2011; 13(5):728-31. · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The bladder is involved in less than 4% of inguinal hernias. Inguinoscrotal bladder hernias are difficult to diagnose, and less than 7% are diagnosed preoperatively. Inguinoscrotal bladder hernias are usually asymptomatic. However, they can result in significant complications, such as bladder necrosis or acute renal failure. Accurate diagnosis is crucial to avoid bladder injury during surgery and other complications. Here we report the case of a 64-year-old man who presented with a scrotal mass. Ultrasonography of the scrotal mass showed a nonspecific cystic mass. During surgery, the mass was revealed to be a herniated bladder.
[Show abstract][Hide abstract] ABSTRACT: There are few data regarding the epidemiology of hereditary or familial prostate cancer (PCa) in East Asians, especially in Korean men. Therefore, we evaluated the incidence of familial and hereditary PCa and the relation between socioeconomic status and the incidence of nonsporadic prostate cancer (NSPC).
We collected data from all patients who were treated for PCa at our center between November 2009 and January 2010. All patients were either newly diagnosed or had been diagnosed with PCa and seen as outpatients during the study period.
In a sample of 218 patients with PCa; 25 (11.5%) were NSPC patients, and 193 (88.6%) were sporadic PCa sporadic prostate cancer (SPC) patients. Overall, 11.5% of the patients had a positive family history. There was one hereditary PCa family (three patients, 1.4%) and 11 familial PCa families (22 patients, 10.1%). Patients were divided into three different age groups. Of these, 18 (9.3%) SPC patients and 6 (24%) NSPC patients were diagnosed with the disease at the age of 55 years or younger (p=0.02). Prostate-specific antigen (PSA) levels in the NSPC group were significantly higher than in the SPC group (7.2±3.2 versus 6.3±4.9 ng/ml, p=0.042). SPC patients had larger waist circumferences than did NSPC patients (p=0.041). There were no significant differences between the SPC and NSPC groups in terms of socioeconomic status, Gleason score, pathological stage, or pathologic Gleason grade.
East Asian NSPC patients are diagnosed at earlier ages than are SPC patients, even though the incidence of NSPC in the East Asian population is lower than in Western men.