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Background: To compare the effects of different alpha-blocker regimes on acute urinary retention (AUR) and the success rate of trial without catheter (TWOC) among patients with AUR secondary to benign prostatic hyperplasia (BPH) to determine the most effective regime., Methods: A comprehensive literature search was performed using PubMed/Medline, Embase, and Cochrane Library up to June 2021. Studies that compared successful TWOC rates between each alpha-blocker regime in patients with AUR secondary to BPH were included. The outcome was the odds ratio of successful TWOC after AUR between groups (each regime of alpha blocker or placebo). To indirectly compare the effect of each alpha-blocker regime on the outcome (successful TWOC rate), a network meta-analysis was conducted using a Bayesian hierarchical random effects model for dichotomous outcomes., Results: In total, 13 randomized controlled trials were included in the present study. There were six nodes (five alpha-blocker regimes and placebo) and eight comparisons in the evidence network plot. Compared to placebo, alfuzosin, silodosin, tamsulosin, and alfuzosin plus tamsulosin resulted in significantly higher TWOC success rates, whereas doxazosin did not show a significant difference in TWOC success rate compared to placebo. Alfuzosin plus tamsulosin was ranked first, followed in order by tamsulosin, silodosin, alfuzosin, and doxazosin. There was no significant inconsistency in the results of this analysis., Conclusions: Alpha blockers may increase the success rate of TWOC. This study evaluated the priority of the effect of several alpha-blocker regimens on AUR related to BPH, which is expected to be helpful in selecting the best medication for patients with AUR., (© 2022 The Asian Pacific Prostate Society. Published by Elsevier B.V.)

Background: Recent studies have shown that donor nephrectomy can induce renal function impairment. However, few meta-analysis studies about this have proceeded. Therefore, the objective of this systematic review and meta-analysis including all data of recent research studies was to determine whether living donor nephrectomy (LDN) could induce renal function impairment., Methods: By November 2020, comprehensive literature searches were performed on PubMed, Embase, and Cochrane databases. Inclusion criteria were: (1) observational studies with data about overall end-stage renal disease (ESRD) or chronic kidney disease (CKD) of living kidney donors, (2) control group consisted of people without donor nephrectomy, and (3) outcomes of studies included long-term end-stage renal disease risks after living kidney donation. Risk of Bias in Non-randomized Studies of interventions (ROBINS-I) assessment tool was used to evaluate our methodological quality., Results: The qualitative review included 11 studies and the meta-analysis included 5 studies. In the meta-analysis, the integrated overall ESRD risk was 5.57 (95% CI: 2.03-15.30). Regarding the overall risk of bias using ROBINS-I assessment tool, 0 studies was rated as "Low", 7 studies were rated as "moderate", 2 studies were rated as "Serious", and two studies were rated as "Critical"., Conclusions: Our study showed that LDN increased ESRD risk in LDN patients. However, in our meta-analysis, variables in included studies were not uniform and the number of included studies was small. To have a definite conclusion, meta-analyses of well-planned and detailed studies need to be conducted in the future., (© 2023. The Author(s).)

Purpose: Cardiovascular disease (CVD) is one of the leading causes of death, accounting for one-third of all deaths worldwide. Patients with CVD are three times more likely to complain of sexual dysfunction than healthy people. Causes of sexual dysfunction in patients with CVD include physical/mental changes and drug side effects. The prevalence of sexual dysfunction in patients with CVD has been estimated to be up to 89%. Ordinary treatments such as pharmacotherapy cannot effectively reduce sexual problems. Therefore, sexual rehabilitation has a broad spectrum, including exercise therapy such as pelvic floor muscle treatment, appropriate counseling, a multidisciplinary approach, and partner rehabilitation. In this study, systematic review and meta-analysis was performed to investigate the effect of sexual rehabilitation on sexual problems in patients with CVD., Materials and Methods: Comprehensive literature searches were conducted using MEDLINE, Cochrane Library electronic database, and EMBASE through June 2022. Questionnaire scores at the end point as outcomes of the study were recorded as were standardized mean difference (SMD) with their 95% confidence intervals (CIs). Meta-regression analysis was conducted for each moderator. We performed a risk of bias evaluation for included studies using the RoB 2 tool., Results: The overall SMD in the meta-analysis for sexual rehabilitation versus no-sexual rehabilitation was 0.430 (95% CI, 0.226-0.633). There was a statistical difference between groups. SMD changes were 0.674 (95% CI, 0.308-1.039) at one month and 0.320 (95% CI, 0.074-0.565) at six months. The regression analysis with all variables (number of patients, study duration, and questionnaire types) revealed no significance., Conclusions: This study indicates that sexual rehabilitation is an effective method with high therapeutic potential for sexual dysfunction of patients with CVD. However, for clinical application, well-designed studies with many patients should be conducted in the future and the standardization of rehabilitation protocols is required., Competing Interests: The authors have nothing to disclose., (Copyright © 2023 Korean Society for Sexual Medicine and Andrology.)

Background: Because of limited differentiation to endothelium from mesenchymal stem cells, it has been strongly recommended to use endothelial progenitor cells for the regeneration of the damaged endothelium of corpora cavernosa. This study was performed to investigate the immortalized human cerebral endothelial cells and their capability for repairing erectile dysfunction in a rat model of cavernous nerve injury. Circulating endothelial progenitor cells were isolated from human fetal brain vasculature at the periventricular region of telencephalic tissues. Over 95% of CD 31-positive cells were sorted and cultured for 10 days. Human cerebral endothelial progenitor cells were injected into the cavernosa of rats with cavernous nerve injury. Erectile response was then assessed. In in vivo assays, rats were divided into three groups: group 1, sham operation: group 2, bilateral cavernous nerve injury: and group 3, treatment with human cerebral endothelial cells after cavernous nerve injury., Results: Established immortalized circulating endothelial progenitor cells showed expression of human telomerase reverse transcriptase transcript by RT-PCR. They also showed the expression of vascular endothelial growth factor, von Willebrand factor, vascular endothelial growth factor receptor, and CD31, cell type-specific markers for endothelial cells by RT-PCR. In in vitro angiogenesis assays, they demonstrated tube formation that suggested morphological properties of endothelial progenitor cells. In in vivo assays, impaired erectile function of rat with cavernous nerve injury recovered at 2, 4, and 12 weeks after transplantation of human cerebral endothelial cells into the cavernosa., Conclusions: Telomerase reverse transcriptase-circulating endothelial progenitor cells from fetal brain vasculature could repair erectile dysfunction of rats with cavernous nerve injury., (© 2022. The Author(s).)

Background: Several cohort studies have explored the relationship between androgen deprivation therapy (ADT) and the severity of coronavirus disease 2019 (COVID-19). This study aimed to characterize the relationship between ADT and the severity of COVID-19 in patients with prostate cancer., Methods: A systematic search was conducted using PubMed, Embase, and Cochrane Library databases from the inception of each database until February 31, 2020. Patients with prostate cancer who were treated with ADT were assigned to treatment group while those patients who were not treated with ADT were assigned to the control group. Outcomes were severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positivity, hospitalization, intensive care unit (ICU) admission, and death. The risk of bias was evaluated using ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) tool., Results: Three studies with qualitative synthesis were included. Finally, two studies with quantitative synthesis having a total of 44,213 patients were included for the present systematic review. There was no significant difference in SARS-CoV-2 positive rate (odds ratio [OR], 0.52; 95% confidence intervals [Cis], 0.13-2.09; P = 0.362), hospitalization (OR, 0.52; 95% CIs, 0.07-3.69; P = 0.514), ICU admission (OR, 0.93; 95% CIs, 0.39-2.23, P = 0.881), or death (OR, 0.88; 95% CIs, 0.06-12.06; P = 0.934) between ADT and non-ADT groups., Conclusion: Qualitative and quantitative analyses of previous studies revealed no significant effect of ADT on COVID-19. However, more studies with higher quality that explore biochemical and immunological factors involved are needed to confirm this finding in the future., Competing Interests: None of the authors has a potential conflict of interest to declare in relation with the manuscript., (© 2022 The Korean Academy of Medical Sciences.)

Purpose: This study aimed to evaluate benign prostatic hyperplasia (BPH) diagnosis rate and the changing landscape of medical and surgical management of BPH over the last decade using national population data of South Korea., Methods: The present study analyzed data of patients diagnosed with BPH (N40) who underwent medical treatment or surgery in 3% of the national patient sample of the Health Insurance and Review Assessment database each year between 2012 and 2018. The primary outcome was the proportion of medical and surgical treatment for BPH. It was evaluated each year between 2012 and 2018. Secondary outcomes included total BPH diagnosis rate in each year of the study period. BPH diagnosis rate by age group was evaluated. The proportion of medical and surgical treatment for BPH according to the type of medical institution was investigated., Results: The proportion of surgical treatment was 1.2% in 2012, 1.0% in 2013, 1.0% in 2014, 0.9% in 2015, 0.8% in 2016, 0.7% 2018, and 0.8% 2018, showing a progressive overall decrease from 2012 to 2018. The rate of surgical treatment for BPH increased with increasing age during the study period, showing a progressive overall increase (from 9,202 per 100,000 men in 2012 to 11,610 per 100 000 men in 2018). The number of patients with BPH was increased steadily from 2012 to 2018 in all age groups. The rate of surgical treatment in tertiary referral hospitals was the highest during the study period, followed by that in general hospitals, hospitals, and clinics., Conclusions: In Korea, the diagnosis rate of BPH was steadily increasing during the study period. Overall surgical treatment gradually decreased compared with an increase in medical treatment among all treatments for BPH. Thus, a comprehensive treatment plan for BPH should be established considering this trend., Competing Interests: The authors declare that no conflicts of interest in relation to this work., (© 2021 Asian Pacific Prostate Society. Published by Elsevier B.V.)

Introduction: Although several studies have been conducted to evaluate the feasibility of Raman spectroscopy (RS) for the diagnosis of bladder cancer (BCa), it is difficult to use RS in real clinical settings based on the current limited evidence. Therefore, we performed a systematic review and meta-analysis to assess the diagnostic accuracy of RS in BCa., Materials and Methods: Comprehensive literature searches were performed in the PubMed/Medline, Embase, and Cochrane Library databases up to March 2019. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this study included reports according to the participant, intervention, comparator, outcomes, and study design approach. The methodological quality of the included studies was evaluated according to questionnaires and criteria suggested by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The quantitative outcomes included diagnostic accuracy (sensitivity and specificity)., Results: Fifteen studies were included for qualitative analysis and four studies (BCa cases, n = 139; control cases n = 107) were included in this analysis by screening the full text of the remaining articles based on the inclusion and exclusion criteria through a systematic review. The pooled sensitivity and specificity of RS were 0.91 (95% confidence interval [CI]: 0.85-0.95) and 0.93 (95% CI: 0.86-0.97), respectively. The among-study heterogeneity was statistically significant in the specificity results (Cochran Q statistic, P = 0.015; I 2 statistic, 71.3%) but not in the sensitivity results (Cochran Q statistic, P = 0.189; I 2 statistic, 37.2%)., Conclusions: RS showed the potential to be an efficient tool with high accuracy for detecting malignant bladder lesions. More studies with in vivo real-time settings are warranted to validate our results., Competing Interests: None

Purpose: To validate a novel arteriogenic erectile dysfunction (ED) model with atherosclerosis (AS) based on molecular and histologic evidence induced by chronic pelvic ischemia (CPI) and determine effect of phosphodiesterase-5 inhibitor treatment., Materials and Methods: Twenty 16-week-old male Sprague-Dawley rats were divided into three experimental groups (Group I, untreated sham-operated rats with regular diet; Group II, CPI with cholesterol diet; Group III, CPI model with cholesterol diet and mirodenafil). Erectile function was accessed using maximum intracavernous pressure (ICP) and ICP/mean arterial pressure (MAP). Molecular changes were examined by western blot analysis using hypoxia inducible factor 1-alpha (HIF-1α), endothelial nitric oxide synthase (eNOS), and transforming growth factor beta-1 (TGF-β1) antibodies. Collagen change was evaluated by Masson's trichrome staining., Results: In vivo measurements of ICP and ICP/MAP in Group II were significantly lower than those in Group I (p<0.01). Smooth muscle/collagen ratio in Group II was significantly lower than that in Group I (p<0.05). After treatment with mirodenafil for four weeks, Group III showed significantly higher levels of ICP and ICP/MAP than Group II (p<0.05). Western blot analysis showed that HIF-1α and TGF-β1 levels were significantly higher in Group II whereas eNOS levels were significantly lower in Group II than those in Group I or III., Conclusions: A novel arteriogenic ED with AS model is successfully induced by CPI and validated based on molecular and histologic evidences., Competing Interests: The authors have nothing to disclose., (Copyright © 2020 Korean Society for Sexual Medicine and Andrology.)

Purpose: Prostate cancer (PCa) incidence is affected by aging phenomenon and performance of screening test. In United States, PCa incidence is affected by period effect of U.S. Preventive Services Task Force (USPSTF) recommendation. However, no study has reported the effect of USPSTF recommendation or aging phenomenon on PCa incidence in South Korea. Thus, the objective of this study was to investigate effects of age, period, and birth cohort on PCa incidence using age-period-cohort analysis., Materials and Methods: Annual report of cancer statistics between 2003 and 2013 from National Health Insurance Service (NHIS) in South Korea for the number of PCa patients and Korean Statistical Information Service (KOSIS) data between 2003 and 2013 from national statistics in South Korea for the number of Korean male population were used. Age-period-cohort models were used to investigate effects of age, period, and birth cohort on PCa incidence., Results: Overall PCa incidence in South Korea was increased 8.8% in annual percentage (95% confidential interval, 6.5 to 11.2; p < 0.001). It showed an increasing pattern from 2003 to 2011 but a decreasing pattern from 2011 to 2013. Age increased the risk of PCa incidence. However, the speed of increase was slower with increasing age. PCa incidence was increased 1.4 times in 2008 compared to that in 2003 or 2013. Regarding cohort effect, the risk of PCa incidence started to increase from 1958 cohort., Conclusion: PCa incidence was affected by period of specific year. There was a positive cohort effect on PCa incidence associated with age structural change.

Purpose: Radical prostatectomy (RP) is one of main treatments for prostate cancer (Pca). The prevalence of Pca has been decreasing in recent reports. However, no study has reported trends in Pca prevalence or RP rate according to age structural changes. The objective of this study was to investigate trends in Pca prevalence and frequency of RP according to age structural change., Materials and Methods: We evaluated trends in Pca prevalence and RP rate using National Health Insurance Data from 2005 to 2015. Relationships for Pca prevalence and RP rate with age structural change were also determined. Primary outcomes included trends in Pca prevalence and RP rates according to age groups, comparing those before and after 2011., Results: Pca prevalence tended to increase before 2011 and decreased after 2011 in persons in the 60-years age group. RP rate increased pattern before 2011 and decreased after 2011 in age groups of 50s, 60s, and over 70s. Pca prevalence and age structural change showed a significantly positive relationship in all age groups, except for the age group under 40 years. RP rate and age structural change also showed a significantly positive relationship in all age groups., Conclusion: Age structural change can affect the decreasing trend in Pca prevalence and RP rate in South Korea. Future studies are needed to validate this result., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2019.)

Background: There is still controversy as to whether initial combination treatment is superior to serial addition of anticholinergics after maintenance or induction of alpha blockers in benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS)., Objective: The objective of this study was to determine the benefits and safety of initial combination treatment of an alpha blocker with anticholinergic medication in BPH/LUTS through a systematic review and meta-analysis., Methods: We conducted a meta-analysis of improvement in LUTS using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL)., Results: In total, 16 studies were included in our analysis, with a total sample size of 3,548 subjects (2,195 experimental subjects and 1,353 controls). The mean change in total IPSS improvement from baseline in the combination group versus the alpha blocker monotherapy group was -0.03 (95% CI: -0.14-0.08). The pooled overall SMD change of storage IPSS improvement from baseline was -0.28 (95% CI: -0.40 - -0.17). The pooled overall SMD changes of QoL, Qmax, and PVR were -0.29 (95% CI: -0.50 - -0.07), 0.00 (95% CI: -0.08-0.08), and 0.56 (95% CI: 0.23-0.89), respectively. There was no significant difference in the number of acute urinary retention (AUR) events or PVR., Conclusions: Initial combination treatment of an alpha blocker with anticholinergic medication is efficacious for in BPH/ LUTS with improved measures such as storage symptoms and QoL without causing significant deterioration of voiding function., Competing Interests: This study was partly supported by Astellas Pharma Korea, Inc. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Background: The aim of this study was to investigate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) of small renal masses in real practice., Methods: Contrast-enhanced CT and MRI were performed between February 2008 and February 2013 on 68 patients who had suspected small (≤4 cm) renal cell carcinoma (RCC) based on ultrasonographic measurements. CT and MRI radiographs were reviewed, and the findings of small renal masses were re-categorized into five dichotomized scales by the same two radiologists who had interpreted the original images. Receiver operating characteristics curve analysis was performed, and sensitivity and specificity were determined., Results: Among the 68 patients, 60 (88.2 %) had RCC and eight had benign disease. The diagnostic accuracy rates of contrast-enhanced CT and MRI were 79.41 and 88.23 %, respectively. Diagnostic accuracy was greater when using contrast-enhanced MRI because too many masses (67.6 %) were characterized as "4 (probably solid cancer) or 5 (definitely solid cancer)." The sensitivity of contrast-enhanced CT and MRI for predicting RCC were 79.7 and 88.1 %, respectively. The specificities of contrast-enhanced CT and MRI for predicting RCC were 44.4 and 33.3 %, respectively. Fourteen diagnoses (20.5 %) were missed or inconsistent compared with the final pathological diagnoses. One appropriate nephroureterectomy and five unnecessary percutaneous biopsies were performed for RCC. Seven unnecessary partial nephrectomies were performed for benign disease., Conclusions: Although contrast-enhanced CT and MRI showed high sensitivity for detecting small renal masses, specificity remained low.

Background: The aim of this study is to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli Escherichia coli (E coli) in female uncomplicated cystitis in Korea using meta-analysis., Methods: A cross-search of the literature was performed with MEDLINE for all relevant data published before October 2015 and EMBASE from 1980 to 2015, the Cochrane Library, KoreaMed, RISS, KISS, and DBPia were also searched. Observational or prospective studies that reported the prevalence of antimicrobial susceptibility and resistance of E coli were selected for inclusion. No language or time restrictions were applied. We performed a meta-analysis using a random effects model to quantify the prevalence of antimicrobial susceptibility and resistance of E coli., Results: Ten studies were eligible for the meta-analysis, which together included a total of 2305 women with uncomplicated cystitis. The overall resistance rate to antibiotics was 0.28 (95% confidence interval [CI]: 0.25, 0.32). The pooled resistance rates were 0.08 (95% CI: 0.06, 0.11) for cephalosporin, 0.22 (95% CI: 0.18, 0.25) for fluoroquinolone (FQ), and 0.43 (95% CI: 0.35, 0.51) for trimethoprim/sulfamethoxazole (TMP/SMX). Regression analysis showed that resistance to FQ is increasing (P = 0.014) and resistance to TMP/SMX is decreasing (P = 0.043) by year. The generation of cephalosporin was not a significant moderator of differences in resistance rate., Conclusion: The resistance rate of FQ in Korea is over 20% and is gradually increasing. Although the resistance rate of TMP/SMX is over 40%, its tendency is in decreasing state. Antibiotic strategies used for the treatment of uncomplicated cystitis in Korea have to be modified., Competing Interests: The authors have no conflicts of interest to disclose.

Introduction: We sought to investigate the impact of fatty liver disease (FLD) on prostate cancer (PCa) screening by estimating the odds of having a prostate-specific antigen (PSA) value over the cutoff used to prompt for the recommendation of prostate biopsy., Methods: Between 2007 and 2013, 18 533 native Korean men eligible to receive a serum PSA test, liver profiles, and abdominal ultrasonography were recruited. Logistic regression was used to estimate the odds of an abnormal PSA (≥2.5 ng/mL) in these men (age 45-75 years, PSA≤10 ng/mL) in relation to FLD. The FLD status was categorized as normal, mild, moderate, and severe grade by abdominal sonography., Results: A total of 16 563 men (89.4%) were included in the study after applying the inclusion criteria. Liver profiles were negatively correlated with the serum PSA level. After controlling for age and obesity, there was a statistically significant trend towards a lower likelihood of having a serum PSA level of ≥2.5 ng/mL with severe FLD, having a 34.7% lower likelihood (odds ratio 0.653, 95% confidence interval 0.477-0.88; p<0.01) compared to men in the normal group., Conclusions: Severe FLD is an independent predictor of a lower likelihood of having abnormal PSA level. Further studies are needed to better define these results in clinical biopsy practice.

Background: Bladder dysfunction induced by spinal cord injury (SCI) can become problematic and severely impair the quality of life. Preclinical studies of spinal cord injury have largely focused on the recovery of limb function while neglecting to investigate bladder recovery., Objective: The present study was performed to investigate and review the effect of stem cell-based cell therapy on bladder recovery in SCI., Methods: We conducted a meta-analysis of urodynamic findings of experimental trials that included studies of stem cell-based cell therapy in SCI. Relevant studies were searched using MEDLINE, EMBASE and Cochrane Library (January 1990 - December 2012). Final inclusion was determined by a urodynamic study involving detailed numerical values. Urodynamic parameters for analysis included voiding pressure, residual urine, bladder capacity and non-voiding contraction (NVC). Meta-analysis of the data, including findings from urodynamic studies, was performed using the Mantel-Haenszel method., Results: A total of eight studies were included with a sample size of 224 subjects. The studies were divided into different subgroups by different models of SCI. After a stem cell-based cell therapy, voiding pressure (-6.35, p <0.00001, I2 = 77%), NVC (-3.58, p <0.00001, I2 = 82%), residual urine (-024, p = 0.004, I2 = 95%) showed overall significant improvement. Bladder capacity showed improvement after treatment only in the transection type (-0.23, p = 0.0002, I2 = 0%)., Conclusion: After stem cell-based cell therapy in SCI, partial bladder recovery including improvement of voiding pressure, NVC, and residual urine was demonstrated. Additional studies are needed to confirm the detailed mechanism and to obtain an ideal treatment strategy for bladder recovery.

Background: Although there is growing evidence of relationship between obesity and some specific stone compositions, results were inconsistent. Due to a greater relationship between metabolic syndrome and some specific stone type, obesity measured by body mass index (BMI) has limitation in determining relationship between obesity and stone compositions. The aim of this study was to determine the relationship among BMI, visceral fat, and stone compositions., Methods: We retrospectively reviewed data of patients with urinary stone removed over a 5 year period (2011-2014). Data on patient age, gender, BMI, urinary pH, stone composition, fat volumes (including visceral fat, subcutaneous fat, total fat, waist circumference), and ratio for visceral to total fat using computed tomography based delineation were collected. To figure out the predicting factor while adjusting other confounding factors, discriminant analysis was used., Results: Among 262 cases, average age was 52.21 years. Average BMI and visceral fat were 25.03 cm(2) and 124.75 cm(2), respectively. By chi square test, there was significant (p < 0.001) difference in stone types according to sex. By ANOVA test, BMI, visceral fat, visceral to subcutaneous fat ratio, the percentage of visceral fat and total fat showed significant association with stone types. By discriminant analysis, visceral fat was proved to be a powerful factor to predict stone composition (structure matrix of visceral fat = -0.735) with 42.0% of predictive value., Conclusion: Visceral fat adiposity strongly related with uric acid stone and has better predictive value than BMI or urinary pH to classify the types of stone.

Background: The efficacy of medical treatment among obese men with lower urinary tract symptoms (LUTS) has been less clear, especially regarding the improvement of QoL. We aimed to investigate the difference in efficacy and consequent satisfaction of life quality after medical treatment of male LUTS according to obesity., Methods: An 8-week prospective study was performed for a total of 140 patients >50 years old with International Prostate Symptom Scores (IPSS) > 12 points and prostate volume > 20 mL. Obesity was determined by either body mass index (BMI) or waist circumference (WC). Patients were divided into 2 groups according to BMI or WC. Patients received tamsulosin at a dose of 0.4 mg daily for 8 weeks. The changes from baseline in the IPSS, maximal urinary flow rate (Qmax), post-void residual volume, questionnaire of quality of life (QoL), and King's Health Questionnaire (KHQ) were analyzed., Results: Of the 150 enrolled patients, 96 completed the study. Seventy-five patients (78.1%) had BMI ≥ 23 kg/m2, and 24 (25.0%) had WC > 90 cm. Overall, the IPSS, IPSS QoL, and total KHQ showed significant improvement. Obese (BMI ≥ 23 kg/m2) and non-obese (BMI < 23 kg/m2) both showed improvement of the IPSS and IPSS QoL scores, but only the obese (BMI ≥ 23 kg/m2) group showed improvement of the total KHQ score (P < 0.001 vs. P = 0.55). Only the obese (WC > 90 cm) group showed improvement of the IPSS and total KHQ scores (P < 0.001)., Conclusions: Our preliminary study showed the different efficacy of an alpha-blocker for improvement of LUTS and life quality according to obesity. Obese patients, defined by BMI or WC, showed the tendency toward a more favorable improvement of LUTS and life quality., Trial Registration: Current Controlled Trials 2010-058. Registered 2 September 2010 in Soonchunhyang University Hospital.

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.

Objective: To determine the association between body mass index (BMI), serum prostate-specific antigen (PSA) level and PSA density (PSAD) in patients with an elevated serum PSA level but a negative prostate biopsy., Methods: This retrospective study enrolled men with a negative prostate biopsy but a serum PSA level of 3.0-10 ng/ml. All men underwent anthropometric measurements, serum PSA determination and transrectal ultrasound examination. BMI was grouped according to the Asia-Pacific obesity criteria: nonobese (<25 kg/m(2)) versus obese (≥ 25 kg/m(2)). Partial correlation and linear regression models between PSA, PSAD and BMI were conducted after adjusting for age., Results: A total of 907 men were enrolled in this study. On multivariate analyses, PSA showed no significant correlation with age or BMI, whereas PSAD had a negative correlation with age and BMI. Similar results were obtained when patients were categorized as having low (3.0 < PSA  ≤ 6.5 ng/ml) or high PSA (6.5 < PSA ≤ 10.0 ng/ml) levels., Conclusion: PSAD, but not PSA, demonstrated a significant negative correlation with BMI. This indicates that a new strategy including PSAD rather than simple PSA levels should be adopted in the study of obesity-adjusted PSA cut-offs., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: The core question of the study was whether adequately achieved HD affected the sexual dysfunction in women on hemodialysis (HD) with chronic renal failure (CRF)., Methods: Thirty-seven female patients on HD, including 18 women with adequate HD and 19 women with non-adequate HD, and 36 healthy controls were included in this study. Demographic and clinical variables, including the sexual hormones estradiol and testosterone, were recorded. Sexual function was assessed according to the Female Sexual Function Index (FSFI) and results were compared between groups. Adequate HD was defined as an average urea clearance of over 1.3 (Kt/V) over three consecutive months., Results: All domains of the FSFI questionnaire, with the exception of satisfaction, were higher in the control group than in the HD group. In comparing the adequate and non-adequate HD groups, there was no difference in any of the six domains of the FSDI questionnaire. Among the clinical variables, the number of menopausal women was higher in the HD group than in the control group (P = 0.023). Estradiol and testosterone levels were higher in the control group than in the HD group (P = 0.003, 0.027, respectively). The number of menopausal women and estradiol and testosterone levels showed no differences between the adequate and non-adequate HD groups. Correlation analysis between Kt/V and FSFI showed no significant relationship, but estrogen did show a significant relationship with FSFI (correlation coefficient = 0.399, P = 0.001)., Conclusions: HD adequacy alone does not have a significant impact on sexual dysfunction. Other treatments options should be considered to treat sexual dysfunction in women with CRF.

Purpose: We analyzed whether any problems existed in terms of the homogeneity of the Korean International Prostate Symptom Score (IPSS) questionnaire used in real practice., Materials and Methods: Between July 2012 and August 2012, 48 Korean IPSS questionnaires used in real practice were collected. All the items on the questionnaire, including the quality of life (QoL) questions, were compared and we then determined the homogeneity of each question in comparison with the originally validated Korean version of the IPSS from 1996., Results: Only 5 of 48 sources (10.4%) of the Korean IPSS totally corresponded with the original Korean version of the IPSS questionnaire. The consistency rate with the originally validated version was generally low for the answer choice items for each question, ranging from 16.6% for "less than half the time" to 35.4% for "almost always," with the exception of the item "not at all" (100.0%). The consistency rate was 60.4% for question 3 (intermittency) and 18.8% for question 6 (straining). No homogeneity was found in any of the QoL-related questions. The average consistency rate with the originally validated version was 42.2% and ranged from 22.9% for "unhappy" to the highest rate of 95.8% for "mostly satisfied.", Conclusions: Compared with the originally validated Korean version of the IPSS, various Korean IPSS questionnaires used in real practice had significant problems in terms of homogeneity for both the questions and the answer choice items. Efforts are needed to ensure the uniform use of the validated Korean version of the IPSS questionnaire.

Renal cell carcinoma is an uncommon source of bladder metastases. Here we report a case of renal cell carcinoma that metastasized to the bladder. A 73-year-old woman complained of gross hematuria. Abdominopelvic computerized tomography showed a bladder mass and a heterogenous enhancing mass in the lower pole of the left kidney with left vein thrombosis. The pathological analysis of the resected bladder specimen revealed metastatic renal cell carcinoma of the clear cell type.

Purpose: Nocturia is a bothersome symptom that impacts sleep quality in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). This study was performed to evaluate the impact of nocturia on sleep quality., Materials and Methods: A total of 58 male patients with LUTS/BPH were enrolled. LUTS/BPH patients without nocturia were included in the control group. The inclusion criteria were eight or more points on the International Prostate System Score (IPSS) including more than one episode of nocturia and a prostate volume larger than 20 ml. IPSS, prostate volume, uroflowmetry, and the Pittsburgh Sleep Quality Index (PSQI) from each patient were recorded., Results: Patients with nocturia showed a higher mean global PSQI (8.5±0.4) than patients without nocturia (4.82±0.4) (p<0.01). Patients with nocturia showed a higher percentage of severe sleep disorders (74.1%) than patients without nocturia (35.3%) (p<0.01). The regression coefficient between the number of episodes of nocturia and mean global PSQI was 0.42 (p<0.01)., Conclusions: Patients with nocturia showed poor sleep quality, and this was related to the number of episodes of nocturia. This suggests that nocturia has a strong impact on sleep quality in patients with LUTS/BPH.

The Bosniak renal cyst classification has been accepted by urologists and radiologists as a way of diagnosing cystic renal masses and determining the management approach. We report two cases of a renal cystic mass that showed a category change from category II on the basis of enhanced computed tomography to category IV after further gadolinium-enhanced magnetic resonance imaging. In both cases, the cysts were later confirmed as kidney cancer by pathology.

We present a case of acute prostatitis with abscess. The patient had undergone intravesical bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. A prostate biopsy demonstrated tuberculous prostatitis with abscess. This case illustrates that when bladder cancer is treated with BCG, a tuberculous prostate abscess can develop.

Myotonic dystrophy 1 (DM1) is a multi-system disorder characterized by endocrine defects that include testicular and tubular atrophy, oligospermia and azoospermia, and increased follicle-stimulating hormone levels. We describe a rare case of DM1 presenting as infertility in a 29-year-old man.

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.

Spontaneously ruptured renal cell carcinoma (RCC) in end-stage kidney disease is very rare. Preoperative diagnosis is difficult because of the relatively small tumor size, associated hematoma, and surrounding acquired cysts. Two middle-aged men who were maintained on hemodialysis (HD) for over 10 years suddenly developed flank pain during HD. Computed tomography scans revealed an enhancing ruptured renal mass in one patient, and no obvious tumor lesion except for a hematoma in the other, both of which were later confirmed as RCCs by pathologic specimens.

Purpose: We analyzed differences in urinary stone composition according to body mass index (BMI)., Materials and Methods: Between January 2007 and December 2010, 505 ureteral or renal stones were collected from 505 patients who underwent surgical intervention. Data on patient age, gender, BMI, urinary pH, and stone composition were collected., Results: The patients' mean age was 49.2 years (range, 20 to 83 years). Of the 505 patients, 196 (38.7%) had calcium oxalate (CO) stones, 172 (33.9%) had mixed calcium oxalate and calcium phosphate (COP) stones, 72 (14.2%) had calcium phosphate (CP) stones, 50 (9.8%) had uric acid (UA) stones, and 15 (2.9%) had struvite stones. We excluded struvite stones in the statistical analysis because of the small number of patients; a total of 490 patients were included in this study. In the multinomial logistic regression analysis, obesity was found to be associated with UA stones compared with COP stones (odds ratio [OR] 3.488; 95% confidence interval [CI] 1.732-7.025; p<0.001) and CP stones (OR 2.765; 95% CI 1.222-6.259; p=0.015). Similar results were observed for CO stones compared with COP stones (OR 2.682; 95% CI 1.727-4.164; p<0.001) and CP stones (OR 2.126; 95% CI 1.176-3.843; p<0.013)., Conclusions: Obesity was associated with UA and CO stones compared with the occurrence of COP and CP stones.

Purpose: Although transrectal ultrasound-guided prostate biopsy is useful for diagnosing prostate cancer, it is a painful procedure. There are many methods for providing pain relief and for treating discomfort during the procedure, but occasionally these are reported to be of limited use. We aimed to evaluate the value and safety of midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy., Materials and Methods: From August 2008 to December 2009, 104 male patients, who were examined with transrectal ultrasound-guided prostate 12-core biopsy, were randomly assigned to two groups. Group 1 (n=51) received ketorolac (Tarasyn®) 30 mg. Group 2 (n=53) was treated with midazolam (Dormicum®) 3 mg, which was increased to 5 mg if necessary. Immediately after the procedure, the patients were asked to rate their comfort level by using a 10-point visual analog self-assessment pain scale., Results: The pain scale in group 2 was significantly lower than that in group 1 (p<0.05). The patients assigned to group 2 experienced no side-effects from midazolam and were more satisfied than the patients in group 1 (p<0.05)., Conclusions: Midazolam anesthesia relieves pain effectively, and the patient's satisfaction is better than with conventional transrectal ultrasound-guided prostate biopsy. Midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy is useful and safe.

Purpose: The most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract., Materials and Methods: From September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site., Results: A total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (≤11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract., Conclusions: When performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus.

Purpose: We investigated the effects of obesity on prostate volume (PV) and lower urinary tract symptoms (LUTS) in Korean men., Materials and Methods: From December 2007 to 2009, a total of 10,383 ostensibly healthy Korean men aged >/=50 years visited our health promotion center for a routine check-up. Among them, 872 men who wanted a prostate evaluation were enrolled in this study. All men underwent detailed clinical evaluations with the International Prostate Symptom Score (IPSS) questionnaire. Anthropometric measurements, including height, weight, and waist and hip circumferences, were determined. A blood sample was obtained for serum prostate-specific antigen (PSA) measurement. Thereafter, a digital rectal examination and transrectal ultrasound were performed., Results: In total, 465 men with moderate to severe LUTS (IPSS>/=8 points) were included in this prospective study. The participants' mean age was 57.2 years. Multivariate analysis demonstrated that only waist circumference was a significant factor in predicting PV besides age and serum PSA. The univariate analysis showed no statistically significant relations between any of the obesity-related parameters and LUTS. The PV was also not correlated with LUTS., Conclusions: Central obesity is the more important predictor of PV than overall obesity. There are no significant relations between obesity-related parameters and LUTS.