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PURPOSE To investigate whether hospitalization influences serum prostate-specific antigen (PSA) values. MATERIALS AND METHODS Transrectal ultrasound-guided prostate biopsies were performed for detecting prostate cancer in 2,017 patients between February 2001 and April 2011 at Ajou University Hospital. Of those patients, 416 patients who were hospitalized for prostate biopsies, whose serum PSA values were measured at the outpatient department within 1 month of admission and also just after admission, and who had negative prostate biopsy results were included in the present study. We retrospectively reviewed the data of the 416 patients and compared the serum PSA values measured in the outpatient department with those measured during hospitalization. RESULTS Among all 416 patients, the interval between the two PSA measurements was 22.2 days (range, 3 to 30 days) and the prostate size measured by transrectal ultrasonography was 53.63 mL (range, 12.8 to 197.9 mL). Among all patients, mean serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department (6.69 ng/mL vs. 8.01 ng/mL, p

Purpose Testicular microlithiasis (TM) is an uncommon pathologic condition that is commonly diagnosed by scrotal ultrasonography. Indirect evidence suggests that this syndrome may be associated with an increased risk of testicular malignancy and infertility. Materials and methods A total of 1,439 patients undergoing scrotal ultrasound during a 6-year, 5-month period (January 2003 to May 2009) were retrospectively reviewed. Any possible association of TM with pathologic findings was assessed. Among patients with TM, further grading of TM with testicular cancer and semen analysis of the infertile group with TM were also performed. Results TM was diagnosed in 87 patients (6.0%) out of a total of 1,439. Of all established pathologic entities, only testicular malignancy and infertility were meaningfully associated with TM. There was no significant difference in the prevalence of testicular cancer between each grade. Seminal profiles (sperm count, motility, morphology, and white blood cell count) were not found to be statistically different between infertile men with and without TM. Conclusions The prevalence of TM in symptomatic men was found to be 6.0% with significant co-occurrence of TM, testicular cancer, and infertility. Further grading of TM does not seem to be essential with regard to the detection of patients with testicular cancer and TM. TM showed no significant effect on the seminal profiles of infertile men.

Purpose: To investigate the incidence, clinical features, pathogenic bacteria, and risk factors associated with acute prostatitis after transrectal prostate biopsy. Materials and Methods: We retrospectively reviewed the medical records of 923 transrectal ultrasound-guided needle biopsies of the prostate in 878 patients performed at our institution from June 2004 to May 2009. The indications for biopsy were generally serum prostate-specific antigen (PSA) elevation, abnormal findings on a digital rectal examination, or both. All biopsies were performed with the patient hospitalized except for 10 patients who refused to be hospitalized, and ciprofloxacin was administered as an antibiotic prophylaxis. The incidence, clinical features, pathogenic bacteria, and potential risk factors associated with acute prostatitis after prostate biopsy were evaluated. Results: Acute prostatitis developed in 18 (2.0%) cases after prostate biopsy. Among them, 9 (1.0%) had bacteremia and 2 (0.2%) showed clinical features of sepsis. Of the total 50 urine or blood specimens sent for culture study, 27 (54.0%) specimens showed positive cultures, including E. coli in 25. Among the 27 culture-positive specimens, 26 (96.3%) were resistant to ciprofloxacin. Among the potential risk factors for acute prostatitis after prostate biopsy, biopsy performed as an outpatient procedure without a cleansing enema (p=0.001) and past history of cerebrovascular accident (p=0.048) were statistically significant. Conclusions: Fluoroquinolone is effective as an antibiotic prophylaxis for transrectal prostate biopsy in most cases. The incidence of acute prostatitis after transrectal prostate biopsy was 2.0%, and almost all cases were caused by fluoroquinolone-resistant E. coli. A cleansing enema is recommended before transrectal prostate biopsy.

Purpose: The aim of this study was to investigate the association of preoperative C-reactive protein (CRP) elevation and thrombocytosis with the prognosis of patients with non-metastatic renal cell carcinoma (RCC). Materials and Methods: This was a retrospective review of the medical records of 177 patients (130 men and 47 women) with non-metastatic RCC who underwent a radical nephrectomy between March 2000 and May 2008 and for whom preoperative CRP and platelet data were available for analysis. Preoperative CRP elevation and thrombocytosis were compared with clinical and pathological variables. Results: There were 38 patients with CRP elevation and 11 patients with thrombocytosis. The mean follow-up time was 48.3 months (median, 48.0; range, 13-111 months). Twenty-three patients (13.0%) developed metastases and six patients died during the follow-up period. CRP elevation was significantly correlated with anemia (p=0.001), T stage (p=0.004), grade (p=0.025), and metastasis (p＜0.001). Thrombocytosis was significantly correlated with anemia (p=0.003), T stage (p=0.002), and metastasis (p=0.001). The univariate analysis identified anemia, CRP elevation, thrombocytosis, tumor histology subtype, tumor size, T stage, and grade as significant prognostic factors associated with recurrence-free survival, whereas the multivariate analyses showed that CRP elevation (p=0.033) and tumor size (p=0.007) were independent prognostic factors. Conclusions: Preoperative CRP elevation and thrombocytosis were associated with a poorer prognosis and a higher recurrence rate in patients with non-metastatic RCC. Moreover, preoperative CRP elevation appeared to be an independent predictor of tumor recurrence and prognosis. Preoperative thrombocytosis, however, was not an independent prognostic factor for tumor recurrence and prognosis.

Purpose: We investigated whether a short-term follow-up prostate-specific antigen (PSA) measurement before prostate biopsy is useful in predicting the presence of prostate cancer. Materials and Methods: From January 2004 to May 2008, 670 patients underwent transrectal ultrasound-guided prostate biopsy. The initial PSA (PSA1) was measured at the first outpatient visit. The second PSA (PSA2) was measured the evening before prostate biopsy. Only the patients with a PSA1 between 2.5 and 20 ng/ml and an interval between PSA1 and PSA2 of between 7 and 90 days were included in this study. The short-term PSA velocity (PSAVm) was defined as {(PSA2−PSA1/interval (days)}x30. Prostate volume (PV), PSA1, PSA2, and PSAVm were compared between the patients with prostate cancer and those with benign histology. Results: Of the 362 patients who fulfilled the entry criteria, 365 prostate biopsies were performed. The PSAVm differed significantly between patients with prostate cancer and those with benign histology (p=0.021). In patients with a PSA1 of 10-20 ng/ml, age, PV, PSA1, PSA2, and PSAVm were significantly different between patients with prostate cancer and those with benign histology, whereas in patients with a PSA1 of 2.5-10 ng/ml, only PV was significantly different. In multivariate logistic regression analysis excluding PSA1 and PSA2, PSAVm was a significant predictor of prostate cancer overall and in patients with a PSA1 of 10-20 ng/ml, but not in patients with a PSA1 of 2.5-10 ng/ml. Conclusions: PSAVm was significantly different between the benign group and the prostate cancer group. But, this difference was mainly the result of a falsely elevated PSA, and PSAVm was not a significant predictor of prostate cancer when the PSA1 was 2.5-10 ng/ml. (Korean J Urol 2009;50: 553-559) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: A study was conducted to evaluate the clinical characteristics of patients with postcoital hematuria without bloody ejaculate. Materials and Methods: The records of 21 men(mean age 48.6 years, range 27-64 years) with isolated postcoital hematuria without bloody ejaculate were retrospectively reviewed. Patients underwent routine laboratory testing including coagulation studies and urological evaluation which included urinalysis, urine cytology, abdominal and transrectal ultrasonography, and cystourethroscopy. Results: Among total 21 patients, there were no detectable abnormalities in 11(52.4%) patients. Lesions were found in 10(47.6%) patients, which included 1 pathologically proven prostatic urethral hemangioma, 5 benign prostatic hyperplasia, 1 bladder neck obstruction, and 3 ultrasonographically identified seminal vesicle dilatation. In 19(90.5%) patients, symptom subsided after treatment or simple observation without recurrences. In the remaining two patients, postcoital hematuria has still persisted intermittently. Conclusions: Thorough evaluations are necessary in the case of postcoital hematuria as treatable lesions could be identified. In cases without identifiable causes, the patients could be reassured that the condition is benign and self-limiting. (Korean J Urol 2008;49:264-267)

Soo Hyung Lee, Jung Hwan Lee, Jong Tak Park, Il Han Kim, Hyun Wook Im, Young Soo Kim, Se Joong Kim From the Department of Urology, Ajou University School of Medicine, Suwon, Korea Secondary polycythemia is a condition for which the red blood cell count is increased due to the physiologic response to hypoxia, autonomous erythropoietin production or deliberate erythropoietin administration. Hydronephrosis and postrenal obstruction have rarely been reported as the causes of secondary polycythemia. We report here on a case of a 30-yearold man with secondary polycythemia that was caused by giant hydronephrosis due to ureteropelvic junction obstruction, and this patient was successfully treated by nephrectomy. (Korean J Urol 2007;48:984-985)

Purpose: For the measurement of testicular volume, we tried to evaluate the differences between the 1) ultrasonographic and intraoperative ruler measurements, 2) the performances by a radiologist and urologic residents and also 3) the difference among the various formulas for volume calculation. Materials and Methods: The sizes of 108 testes of 96 children (mean age: 4) were measured preoperatively for the length (L) and width (W) with using ultrasonography by a radiologist. These testes were also measured intraoperatively for the L, W and thickness (T) with using a ruler. Of the 108 testes, 57 testes were also scanned with using ultrasonography by urologic residents to measure the L, W and T. The testicular volumes were calculated with three different formulas: LxWx0.52 (F1), LxWxTx0.52 (F2) and LxWxTx0.71 (F3). Results: The mean volumes of the 108 testes measured with ultrasonography by the radiologist and with a ruler were 0.27±0.2ml vs. 0.87± 0.56ml, respectively (p

Purpose: This study aimed to evaluate the tumor biologic behavior and prognostic value of inverted papilloma (IP) of the urinary tract. Materials and Methods: Thirty-one cases (27 males and 4 females, mean age 55.2 years) of urinary IP that were treated at a single center were retrospectively reviewed. There were 21 cases with bladder IP only (group 1), 8 cases with bladder IP and transitional cell carcinoma (TCC) within a single neoplasm (group 2), and 2 cases with IP and TCC in a different location (group 3). The patient and tumor characteristics were analyzed. Results: There was a male predominance with hematuria being the main presenting symptom in all groups. The most common macroscopic feature of IP was a polypoid lesion in group 1. The most common location of IP was bladder neck (57.1%) in group 1 and lateral bladder wall (75%) in group 2. The most common associated urologic disease was benign prostatic hyperplasia in group 1. Transurethral resection was performed in 30 cases (96.8%). There were no recurrences at a mean follow-up of 19.4 (3-68) months after surgery in 27 cases followed for 3 months or longer. Conclusions: One-third of urinary IP were associated with TCC within a single neoplasm or in a different location, and this suggests that IP has a malignant potential. However, because there was no recurrence in IP of the urinary tract, a surveillance protocol as frequent as the one suggested for urothelial cancer does not seem to be necessary. (Korean J Urol 2006;47:1103-1106) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: This study was performed to evaluate the impact of microvessel density (MVD), a reflection of tumor angiogenesis, and microvascular invasion (MVI) on the prognosis of patients with renal cell carcinoma (RCC). Materials and Methods: Formalin-fixed, paraffin-embedded tissue sections of RCC from 81 patients who had undergone radical nephrectomy were stained immunohistochemically for CD34, which decorate endothelial cells, in order to assess MVD and MVI. The immunostaining results of MVD and MVI were compared with the clinicopathological variables. Results: Twenty-two patients had either synchronous or metachronous metastases and fourteen patients died during the follow-up. MVD was significantly correlated with only metastasis (synchronous or metachronous; p=0.020). MVI was significantly correlated with tumor size (p=0.005), TNM stage (p