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Overactive bladder (OAB) is clinically defined as urinary urgency with or without urinary incontinence. It is associated with daytime frequency or constipation and has a prevalence of approximately 5%–12% among 5- to 10-year-olds. The appropriate functional exchange between the pontine micturition center, periaqueductal gray matter, and prefrontal cortex is important for proper micturition control. Several studies on pediatric cases observed a link between OAB and neuropsychiatric problems, such as anxiety, depression, and attention deficit, and treatment of these comorbidities improved patient symptoms. In this review, we present the pathophysiology of OAB, its associated conditions, and aspects related to updates in OAB treatment, and we propose a step-by-step treatment approach following this sequence: behavioral therapy, medical treatment, and invasive treatment. Although anticholinergic drugs are the mainstay of OAB medical treatment, beta-3 agonists and alpha-blockers are now recommended as a result of significant advancements in pharmacologic treatment in the last 10 years. Electrical stimulation techniques and botulinum toxin are also effective and can be used, especially in conventional treatment-refractory cases.

Purpose Treatment options for urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms are limited other than carbapenem. Accordingly, clinicians should investigate alternative antimicrobial options for limited infection. This study was performed to assess the efficacy of single-dose amikacin and a 7-day oral regimen of amoxicillin/clavulanate for the treatment of acute cystitis caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae. Materials and methods A single-dose amikacin and 7-day oral amoxicillin/clavulanate regimen was given to all patients with acute cystitis or recurrent cystitis between May 2016 and October 2018. We conducted a retrospective cohort study assessing the efficacy of this regimen for the treatment of UTI due to ESBL-producing organisms. Both clinical and laboratory efficacy were assessed a minimum of 7 days and a maximum of 14 days after the completion of treatment. Results A total of 47 patients were enrolled in this study. E. coli and K. pneumoniae were isolated in 44 patients (93.6%) and 3 patients (6.4%), respectively. Of the 47 enrolled, 39 patients (83.0%) showed sterile culture results on follow-up. Thirty-seven patients (78.7%) showed improvement of symptoms. Of 8 patients who showed bacterial persistence, 4 patients showed ESBL-producing E. coli, whereas 4 patients showed non-ESBL E. coli on follow-up cultures. During follow-up, 12 patients experienced the recurrence of acute cystitis with a median recurrence period of 2.5 months. Conclusions The combination of amoxicillin/clavulanate and amikacin may be an alternative to carbapenem treatment in patients with acute cystitis caused by ESBL-producing Enterobacteriaceae.

Background Larger middle molecules are important substances associated with cardiovascular complications in end- stage renal disease. Unfortunately, larger middle molecules are not reliably removed by a high -flux dialyzer. A medium cut-off (MCO) membrane could effectively remove larger middle molecules. This study aimed to identify the long-term effect of the MCO membrane for changes of larger middle molecules. Methods Thirty-four patients were prospectively analyzed for 12 months. The enrolled patients were divided into control and MCO groups. We measured the plasma levels of growth differentiation factor 15, sclerostin, and fibroblast growth factor 23 in larger middle molecules and those of biomarkers including small solutes. Single-pool Kt/V (spKt/V) and reduction ratios also were evaluated. Results Plasma sclerostin did not increase significantly in patients using the MCO dialyzer (135.294 [–637.726 to 908.314], p = 0.715). And there was a significant difference in change of plasma sclerostin level between the two groups (–1,646.916 [–3,015.150 to –278.682], p = 0.033). Furthermore, a negative association between calcium and sclerostin was not observed in the MCO group (r = –0.142, p = 0.587). Solute clearance of larger middle molecules in the MCO group was significantly higher. Moreover, spKt/V values for patients in the MCO group were significantly increased without albumin loss. Values are presented as mean (95% confidence interval [CI]) or adjusted mean (95% CI). Conclusion The MCO dialyzer can increase dialytic adequacy and suppress the increase in plasma sclerostin level without significant albumin loss in patients with end-stage renal disease.

Purpose To explore the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer in this systematic review and meta-analysis. Patients and Methods A systematic literature search of Medline, Embase, and Cochrane Library databases up to October 2019 was performed. The sensitivity, specificity, and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated. The summary receiver operator characteristic graph came from individual studies. We also conducted metaregression analysis to identify the moderated factors. Results Across 54 studies (17,575 patients), the pooled sensitivity, specificity, and diagnostic odds ratio of PCA3 were 0.71 (95% CI, 0.67-0.74), 0.68 (95% CI, 0.63-0.74), and 5.28 (95% CI, 4.28-6.51), respectively. The area under the summary receiver operator characteristic curve was 0.75 (95% CI, 0.71-0.79). Conclusion Pooled data indicated that the PCA3 test had moderate sensitivity and specificity in the diagnosis of prostate cancer. PCA3 could be used as a noninvasive method for the diagnosis of prostate cancer.

AIMS Although generally well tolerated, a urodynamic study is an unpleasant and stressful procedure for some patients. This study evaluated the effects of a heating pad on anxiety, pain, and distress during urodynamic studies in female patients with stress urinary incontinence. METHODS A total of 74 female patients with stress urinary incontinence who underwent a urodynamic study between May 2015 and October 2015 were randomized to either the experimental group using a heating pad (n = 37) or control group (n = 37). In the experimental group, a heating pad was applied on the patient's sacrum during the urodynamic study. All patients completed the State-Trait Anxiety Inventory (20-80) before and after the procedure and assessed their degree of pain and distress after the procedure by the visual analog scale (0-10). Systolic and diastolic blood pressure and pulse rate were also checked before and after the procedure. RESULTS Demographic characteristics, mean age, procedure duration, pre and post-procedural systolic, and diastolic blood pressures, and pulse rate were statistically similar between the experimental and control groups. The mean State-Trait Anxiety Inventory was significantly lower in the experimental group than in the control group (30.9 ± 7.5 vs 42.5 ± 10.1, P

Purpose Differences in the severity of subjective symptoms have been noted depending on whether a Hunner lesion is present in women with interstitial cystitis/bladder pain syndrome (IC/BPS). In this study, we aimed to identify differences in objective urodynamic parameters in women with IC/BPS according to the presence of a Hunner lesion. Methods This cross-sectional study included a total of 55 patients with IC/BPS. IC/BPS and the presence of a Hunner lesion on cystoscopy were diagnosed according to American Urological Association guidelines. The patients were categorized into a Hunner IC/BPS group and a non-Hunner IC/BPS group according to the presence of a Hunner lesion on cystoscopy. At the initial visit, a medical history was taken from all patients with IC/BPS, and they underwent symptom assessment using a 3-day voiding diary and laboratory tests. A urodynamic study was then performed before any treatment was performed. Baseline characteristics and urodynamic parameters were compared between the 2 groups. Results Of the 55 patients, 23 (41.8%) had a Hunner lesion on cystoscopy. As documented in the voiding diaries, the Hunner IC/BPS group had more frequent voids and a smaller maximal voided volume (P=0.045, P

Objective To identify differences in urodynamic parameters between female outpatients with interstitial cystitis (IC) and/or bladder pain syndrome (BPS) and severe overactive bladder (OAB). Materials and Methods This cross-sectional study included 24 and 28 consecutive IC/BPS and severe OAB female patients, respectively. IC/BPS was defined based on the American Urological Association guideline, and severe OAB was defined based on baseline symptoms recorded in a voiding diary. Before treatment, symptom assessment using questionnaires and a 3-day voiding diary, as well as laboratory tests, were performed at the initial visit. The patients' baseline characteristics and urodynamic parameters were compared between the IC/BPS and severe OAB groups. Results The IC/BPS group showed fewer episodes of urge incontinence and shorter duration of symptoms than the severe OAB group ( P = .019, P = .017, respectively). Volumes at first sense, normal desire, strong desire, and maximal capacity during filling cystometry (MBC) were significantly higher in the severe OAB group than in the IC/BPS group ( P .001, P .001, P = .006, P .001, respectively). The IC/BPS and severe OAB groups showed significant differences in urodynamic parameters in terms of MBC and the volume discrepancy between MBC and maximal voided volume ( P .001, both). The receiver operating characteristic curve also showed an area under the curve of 0.760 and 0.783 for MBC and volume discrepancy, respectively (both P .001). Conclusion Data from our study suggest that combined with other clinical findings, urodynamic studies could provide useful information to differentiate between a diagnosis of IC/BPS or severe OAB.

Purpose: To evaluate the postoperative outcome of the multiple slit on plaque plication technique for the treatment of Peyronie’s disease. Materials and Methods: We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for the surgical treatment of Peyronie’s disease, who had failed medical treatment between 2009 and 2014. Patients were grouped by preoperative degree of penile curvature into Group I: mild (n=5, 22.7%), Group II: moderate (n=11, 50.0%), and Group III: severe (n=6, 27.3%). After a thorough review of the medical records, we evaluated (a) the correction of the curvature; (b) sexual function; and (c) any penile shortening or other complications. Results: The mean postoperative follow-up period was 39 months. Complete correction of the curvature was attained in 21 patients (95.5%). As an inevitable complication, minimal penile shortening (＜1.5 cm) was reported by 14 patients (82.4%) but did not adversely affect sexual intercourse (0%), and all patients found the extent of penile shortening to be acceptable. Nineteen patients had good erectile function (International Index of Erectile Function ＞21). The most frequent complication was subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months following surgery. Conclusions: As a modified technique, multiple slit on plaque with plication is a simple, minimally-invasive and effective technique for correcting penile curvature regardless of curvature severity. The degree of penile curvature does not significantly predict the amount of penile length loss.

INTRODUCTION AND OBJECTIVE:We aimed to explore the role of the diagnostic accuracy of prostate cancer antigen 3 (PCA3) test for the diagnosis of prostate cancer through systematic review and meta-a...

INTRODUCTION AND OBJECTIVE:Soft tissue augmentation using hyaluronic acid (HA) filler has grown rapidly in recent years, while clinical studies, especially randomized control trial, in penile augme...

Purpose The primary aim of this study was to assess treatment persistence with a fixed-dose combination (FDC) of tadalafil (5 mg) and tamsulosin (0.4 mg). This study also evaluated the reasons for early treatment discontinuation. Materials and methods This retrospective observational study included patients with benign prostatic hyperplasia and erectile dysfunction who started an FDC treatment of tadalafil (5 mg) and tamsulosin (0.4 mg) between July 2017 and February 2018. Treatment persistence and reasons for early discontinuation were evaluated during the first 6 months. The cumulative discontinuation rate and differences in various parameters were assessed using Kaplan-Meier analysis and the log-rank test, respectively. Factors related to persistence were analyzed using a Cox proportional hazard model. Results Overall, 97 patients were included in the study. The cumulative persistence rate at 30, 90, and 180 days was 88.7%, 66.0%, and 54.6%, respectively. The cumulative persistence over 6 months differed significantly according to the administration of FDC therapy (log-rank p=0.005) and age (log-rank p=0.024). Younger patients (odds ratio, 2.049; p=0.021) and treatment-naive patients (odds ratio, 2.461; p=0.006) were more likely to discontinue therapy within 6 months. The common reasons for discontinuing therapy were side effects (63.6%) and perceived poor efficacy (22.7%). Conclusions Side effects were reported to be the main reason for treatment discontinuation. Thus, to improve compliance for a once-daily FDC of tadalafil (5 mg) and tamsulosin (0.4 mg), it is recommended to select patients who show adaptation to a combination of α-blockers and phosphodiesterase type 5 inhibitors prior to FDC treatment.

This study evaluated the effects of using a heating pad during cystoscopy on anxiety, pain, and distress in female patients. Seventy-four female patients who underwent rigid cystoscopy between January 2017 and August 2017 were randomized to either the experimental group using a heating pad (n = 37) or the control group using a pad without heat (n = 37). In the experimental group, a heating pad was applied to the patient’s sacrum during cystoscopy. All patients completed the State-Trait Anxiety Inventory-S (STAI-S, 20-80) before and after the procedure and assessed their degree of pain and distress after the procedure using a visual analog scale (0–10). Systolic and diastolic blood pressure and pulse rate were also measured before and after the procedure. Demographic characteristics, mean age, procedure duration, and pre- and post-procedural systolic and diastolic blood pressures and pulse rate were statistically similar between the experimental and control groups. The mean STAI-S score of the experimental group was significantly lower than that in the control group (33.1 ± 10.1 vs 48.2 ± 11.1, p

Objective To predict actual performance in real surgery when vesicourethral anastomosis (VUA) is performed in patients after Tube 3 module training of robot-naive surgeons. Methods Forty-five patients were enrolled and divided into 3 groups according to chronological trends (each containing 15 patients). Three robot-naive surgeons in a single center completed VUA in robot-assisted radical prostatectomy (RARP) following robotic virtual reality simulator (RVRS) training. The practicing tool used in robotic virtual reality simulator was Tube 3, which was invented for the dV-Trainer that imitates a VUA in RARP. The effects of performance were investigated by analyzing the number of repetitions and the time required to complete the task until achieving the predetermined proficiency level. Results The targeted time (predetermined proficiency level) for completing tasks of Tube 3 and the number of required task repetitions to achieve the proficiency level were 283.1 s and 36 times, respectively, whereas in actual VUA procedures, the number of required attempts was 24, with an average time of 14.9 minutes. The mean time for completing VUA in real surgery significantly decreased with serial cases among all surgeons (1-15 vs 16-30 vs 31-45 cases, P Conclusion The Tube 3 module can represent a valuable educational tool for procedure-specific robotic training by bridging the gap between safe acquisition of surgical skills and effective performance during actual VUA in RARP.

Purpose: To evaluate disease insight, personal distress, and healthcare-seeking behavior of women with urinary incontinence (UI) to improve women’s health in Korea. Methods: In October 2012, 500 Korean women residing around Seoul, Incheon, and Gyeonggi-do were selected by random sampling for a population-based cross-sectional survey conducted by computer-aided telephone interview. Sixteen questions, which included information on demographic characteristics, information sources, disease insights, and general health-seeking behavior, were used for data collection. Results: Among the responders, 23.8% experienced UI, the prevalence of which increased with increasing age; 83.3% knew about UI through the mass media out of 98.2% apprehended people. Regarding general awareness of UI, 77.2% understood that UI is caused by aging. A total of 48.7% of subjects experienced societal restrictions because of UI. Most women in their 30s (25.6%) acquired UI information from the Internet, while those in their 50s and 60s (50–59 years, 51.1%; 60–64 years, 42.4%) learned about UI through friends. Among subjects who did not have UI, 89.37% intended to see a doctor or consult a professional if they developed UI (83.2%). Among those with UI, however, only 59.0% had talked about UI; 79.7% had talked with friends or associates, whereas only 23.2% had consulted a professional. Conclusions: Most respondents tended to obtain information on UI through the mass media. Subjects who did not have UI expressed their intention to consult a professional if they developed UI, while the percentage of subjects with UI who had consulted a professional was very low. Many women are ashamed of UI in Korea, which may be changed by providing efficient advertising with the right information and establishing a new perception of UI.

Objective To assess the risk factor that influences bladder stone formation in patients with benign prostatic hyperplasia (BPH). Materials and Methods We reviewed the data of 271 consecutive patients with BPH who underwent transurethral resection of the prostate between January 2008 and December 2012. Patients were classified into 2 groups based on the presence of a bladder stone: Group 1 had a bladder stone and group 2 did not. Univariate analysis was performed to determine the association between the presence of bladder stone and the patients' age, body mass index, International Prostate Symptom Score, total prostate volume (TPV), transitional zone volume, intravesical prostatic protrusion (IPP), uroflow parameters, and urodynamic parameters. Results The overall rate of bladder stone in patients with BPH was 9.9%. The patients' body mass index, International Prostate Symptom Score, and urodynamic parameters did not significantly differ between the 2 groups. The patients' age, TPV, transitional zone volume, and IPP were all significantly higher and the Qmax was significantly lower in group 1 than that in group 2. Multivariate analysis revealed that age (hazard ratio [HR] = 1.089; P = .020), IPP (HR = 1.145; P P = .019) significantly affected the presence of bladder stone in patients with BPH. A predictive model using logistic regression for bladder stone in BPH patients was defined as follows: probability = 1/[1 + exp (−8.499 + 0.085 (age) + 0.009 (TPV) + 0.136 (IPP) − 0.143 (Qmax))] with area under the curve of 0.850 obtained from the receiver operating characteristic curve analysis. Conclusion This study demonstrated that older age, longer IPP, and lower Qmax are independent factors that associated with the presence of bladder stone in patients with BPH.

Purpose: This study was performed to investigate the discomfort reported by patients taking phosphodiesterase type 5 inhibitors (PDE5Is) in clinical practice. Materials and Methods: From September 2011 to March 2012, we surveyed patients who were prescribed PDE5Is for erectile dysfunction (ED). The questionnaire elicited information concerning: patient characteristics, medication counseling received and inconveniences experienced in hospitals and at pharmacies, effects of PDE5Is, and the separation of the prescribing and the dispensing of PDE5Is. Results: A total of 237 patients completed the questionnaire (mean age: 58.81±9.14 years). Among the 62 patients (26.0%) who reported having encountered some inconveniences in hospitals, the most frequently expressed concerns ’assistant staff,’ including nurses (38.7%), ‘testing procedures’ (27.4%), and ‘the issuing of prescriptions’ (22.6%). Of the 137 patients (57.8%) who noted inconveniences in obtaining medications from pharmacies, 60.6% cited ‘self-consciousness’ as the most common reason, followed by ‘insufficient medication counseling’ (22.6%), and ‘absence of consultation’ (11.6%). In contrast, 82% of the patients were satisfied with the medication counseling that they had received in hospitals, covering drug usage, side effects, and precautions regarding PDE5Is; this proportion was only 30% for pharmacies. Further, most patients (89%) indicated that they preferred to obtain their prescriptions and medications for ED from the hospital at the same time. Conclusions: Treatment of ED is a highly private matter. According to the survey, ED patients more often felt that obtaining medication from pharmacies was inconvenient. The sociocultural aspects of ED necessitate that exceptions to separating the prescribing and the dispensing of medication be considered.

To assess the effect of desmopressin on serum testosterone level in men with nocturia and late onset hypogonadism.We prospectively enrolled men with nocturia and symptoms of late onset hypogonadism. Desmopressin (0.1 mg) was administered once daily to patients for 12 weeks, and we then compared serum testosterone levels, electrolytes, frequency volume chart indices, and changes in the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Aging Male's Symptom scales before and after treatment. Patients with a history of cardiovascular disease or hyponatremia, those using hypnotics, and those who had primary hypogonadism or hypogonadotrophic hypogonadism were excluded from the study.Sixty-two men (mean age, 68.4 years) completed pre- and post-treatment questionnaires and underwent laboratory testing. At the end of the study, the testosterone levels in men with low testosterone levels (3.5 ng/mL) increased after the 12-week desmopressin treatment (2.85 ± 0.58 to 3.97 ± 1.44 ng/mL; P = .001). Mean scores had decreased from 17.7 to 13.9 (IPSS), 3.8 to 3.2 (IPSS-Quality of Life), and 33.7 to 31.1 (Aging Male's Symptom). On the frequency volume chart, nocturnal urine volume, nocturnal polyuria index, actual number of nocturia events, nocturia index, and nocturnal bladder capacity index were significantly decreased.Desmopressin improved nocturia and other urinary symptoms. Moreover, serum testosterone levels increased significantly in men with low testosterone levels after 12-week desmopressin treatment.

Objective It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Rarely, different compartments of the vagina have been examined closely for VD. This study attempts to further elucidate the correlation between POP and VD by using the standardized Pelvic Organ Prolapse Quantification (POP-Q) staging system. Study design The clinical records of 66 women who underwent cystocele (≥POP-Q stage III) repair with concomitant midurethral sling were reviewed. Urodynamic study and POP-Q examination were performed preoperatively. The subjects were divided into two groups according to the presence of VD, which was defined as the presence of at least one of the following criteria: maximal flow rate below 15 mL/s or postvoid residual urine volume (PVR) above 50 mL on preoperative uroflowmetry. Age, parity, uroflowmetry and urodynamic parameters were compared between the two groups. Results Of 66 women, 36 had VD preoperatively. In the VD group, failure in the postoperative voiding trial was more frequent ( p = 0.040), with lower maximal flow rate ( p = 0.007) and higher PVR ( p = 0.034). POP-Q stage was significantly higher ( p = 0.018), and points Aa and Ba were significantly longer ( p = 0.005 and p = 0.006, respectively) in the VD group. POP-Q stage with points Aa and Ba were significantly correlated with the presence of preoperative VD, and moderately correlated with PVR. Conclusion The prevalence of VD in patients with cystocele is high (55%). Points Aa and Ba of POP-Q stage had positive correlations with VD in patients with cystocele.

Objective To assess the reliability and negative predictive value of voiding cystourethrogram (VCUG) performed within 24 hours postoperatively. Methods Forty patients (56 ureters) who underwent first injection of dextranomer/hyaluronic acid (Dx/HA) because of vesicoureteral reflux (VUR) were enrolled. Patients with previous reflux operation or neurogenic disorders were excluded. All patients underwent the hydrodistention implantation technique (HIT). Patients underwent VCUG within 24 hours postoperatively and after 6 months. Grade 0 and grade 1 were considered to be cured. Negative predictive values of VCUG performed within 24 hours postoperatively were assessed. Results The mean age of the patient was 98 ± 45.8 months. Twenty-seven patients were male and 13 patients were female. The number of refluxing ureters was 4, 12, 14, 12, and 14 in ascending order of VUR grade. Overall success rate of single injection therapy was 66.07%. Only 2 ureters with grade IV and 1 patient with grade V VUR showed failure on 24-hour VCUG. The success rates on 6 months VCUG were 100%, 83.3%, 78.57%, 50%, and 42.85% according to ascending order of VUR grade.The negative predictive value of 24-hour VCUG were 100%, 83.3%, 78.57%, 60.0%, and 46.15% according to ascending order of VUR grade. VUR grade was the only factor associated with the discrepancy. Positive but weak correlation was noted between the preoperative grade of VUR and the rate of discrepancy on Spearman correlation analysis (Spearman correlation coefficient = 0.303, P value = .018). Conclusion Twenty-four hour VCUG cannot replace follow-up VCUG usually performed beyond 3 months postoperatively. Further studies are needed for confirmation of cure.

To evaluate the effect of listening to music on pain, anxiety, or stress during a urodynamic study (UDS).A total of 74 female and 74 male patients who underwent UDS between March 2013 and October 2013 were prospectively randomized. The patients were divided into 2 groups according to gender (female, n = 74 vs male, n = 74) and into 2 subgroups according to whether they listened to music or not. Music group subjects played their preferred music during UDS. Before and after UDS, all subjects completed the State-Trait Anxiety Inventory (STAI) form and their degree of pain, anxiety, and satisfaction during examination were assessed by the visual analog scale (VAS, 0-10). Basic vital signs were also checked before and after the procedure.In the analysis of anxiety, pain, and stress scores, the mean shame, discomfort, and satisfaction scores (VAS) were significantly higher in female patients, whereas the mean score of willingness to retry the procedure was higher in male patients whether listening to music or not (P .001). In the analysis of differences of STAI total, state anxiety, and trait anxiety, there were no statistical significances between the music group and the no-music group in either gender.In our study, music during UDS did not reduce anxiety, pain, and stress in either gender. In the analysis focusing on gender difference, female patients showed statistically higher levels of pain, anxiety, and stress scores than male patients whether listening to music or not.

The purpose of this study was to evaluate whether computed tomography (CT) parameters can predict the success of ureteroscopic lithotripsy (URSL) and establish a model for predicting the success rates of a single URSL procedure for the treatment of a single ureteral stone. We retrospectively reviewed the records of 237 patients who underwent URSL for ureteral stones diagnosed by CT between January 2009 and June 2012. Stone-free status was defined as the absence of stones or residual stone fragments

Objective To analyze whether strains positive for extended-spectrum β-lactamase (ESBL) affected the clinical course and progression to chronic prostatitis in patients with postbiopsy acute prostatitis. Methods From 2002 to 2011, 3657 patients underwent transrectal ultrasound-guided biopsy of the prostate, and 33 patients with acute prostatitis were enrolled. Acute prostatitis was defined as a fever greater than 38°C, pyuria, and tenderness on digital rectal examination. Urine and blood cultures were tested for antibiotic susceptibility. Laboratory and clinical variables according to the presence of ESBL were analyzed. Results Blood or urine culture was positive in 23 patients. The most common strain was Escherichia coli . Sixteen patients showed ESBL-positive and 18 patients were quinolone-resistant. Thirteen of 16 patients with ESBL-positive strains showed quinolone resistance, and 13 of 18 patients with quinolone resistance were ESBL-positive ( P = .621). Besides imipenem, all ESBL-positive patients were susceptible to amikacin and were highly susceptible to cefoxitin and amoxicillin/clavulanic acid. The prevalence of ESBL-positive strains has tended to increase since 2006. Patients with ESBL had higher peak fever, white blood cell count, absolute neutrophil count, and longer duration of fever and hospitalization. The progression rate to chronic prostatitis was significantly higher in ESBL-positive patients (4/16 vs 0/17, P = .044). Conclusion Since 2006, ESBL strains have been increasing, and the presence of ESBL showed more detrimental effects on the clinical course of the patients, resulting in a higher rate of progression to chronic prostatitis.

Purpose: The present study was done to define the degree of intravesical prostatic protrusion (IPP) causing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms. Materials and Methods: We retrospectively evaluated 239 patients with BPH, analyzing age, IPP, prostate volume, International Prostate Symptom Score (IPSS), and the results from a pressure-flow study. Urethral resistance was quantified by using the BOO index (BOOI), according to the formula BOOI=PdetQmax-2×Qmax (where Pdet is detrusor pressure at the peak flow rate and Qmax is peak flow rate). BOO was defined by a BOOI above 40. Patients with a BOOI below 20 were excluded. Patients were classified into two groups (obstructed and unobstructed groups) by the BOOI. Correlations were determined by logistic regression analysis, and receiver operating characteristic curves were plotted to estimate the optimal cutoff for IPP. Results: There were significant differences in total prostate volume, postvoiding residual urine (PVR), IPP, and Qmax (p＜0.001, p＜0.001, p＜0.001, and p=0.026, respectively) between the obstructed and unobstructed groups, but there were no significant differences in age (p=0.653), IPSS total score (p=0.624), or quality of life score (p=0.138). IPP had a significant prognosis (p＜0.001) but was weakly correlated with prostate volume (p=0.026). The correlation coefficients between IPP and Qmax, PVR, prostate volume, and BOO were 0.551, -0.159, 0.225, and 0.391, respectively. For IPP, the area under the curve was 0.759 (95% confidence interval, 0.657 to 0.861) and the cutoff to indicate BOO was 5.5 mm with 66.7% sensitivity and 80.5% specificity. Conclusions: An IPP exceeding 5.5 mm was significantly associated with BOO.

Objective To identify the incidence and potential risk factors affecting postoperative transient urinary retention (TR) with transobturator tape (TOT) mid-urethral sling surgery for female patients with stress urinary incontinence (SUI). Study design We reviewed the medical records of 305 patients with SUI who underwent the TOT procedure. Postoperative TR was defined as follows: (1) patients had still voiding difficulty after removing the Foley catheter postoperatively and (2) straining pattern of postoperative voiding with the post-void residual urine volume (PVR) larger than 100 mL during 1st or 2nd trial of self-voiding and (3) these voiding problems are resolved within 48 h without any special treatment. The Foley catheter was removed routinely on the first postoperative day. Age, previous pelvic surgery history, co-existence of cystocele, number of vaginal deliveries and all urodynamic parameters were analyzed and compared between the TR group and control group. Results The incidence of TR was 9.5%. Comparative analysis revealed concomitant prolapse surgery including anterior and posterior repair, Valsalva leak point pressure and preoperative PVR. In multivariate analysis, preoperative PVR proved to be a potential risk factor for TR. Conclusion TR was not a rare postoperative complication after TOT procedures. Potential risk factors for transient retention include preoperative PVR.

To determine whether listening to music during cystoscopy decreases anxiety, pain, and dissatisfaction among patients and results in a more comfortable and better-tolerated procedure.Seventy male patients who underwent rigid cystoscopy between May 2011 and December 2011 were randomized into the following: no music (Group I, n=35) or classical music during procedure (Group II, n=35). Before cystoscopy, lidocaine gel was instilled in the urethra, and both groups viewed their procedures on a video monitor. Anxiety levels were quantified according to the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for a self-assessment of satisfaction, discomfort, and willingness among patients to repeat the cystoscopy.Demographic characteristics, mean age, procedure duration, and procedure indications were statistically similar between the two groups. The mean anxiety level and mean pain score of Group II were significantly lower than those of Group I (p0.001 for both). Group II also carried a significant greater mean satisfaction score compared with Group I (p0.001). Statistically significant differences were detected between groups in the postprocedural pulse rate and the systolic blood pressure (p=0.012 and p=0.008, respectively), whereas preprocedure pulse rate and systolic blood pressure were similar.Listening to music during rigid cystoscopy significantly reduces feelings of pain, discomfort, and dissatisfaction. Music can serve as a simple, inexpensive, and effective adjunct to sedation during cystoscopy. We recommend the application of music during rigid cystoscopy for clinical use.

Uric acid stones are the most readily dissolvable of all types of urinary stones. The present paper describes two patients with uric acid stones in kidney and ureter, whom we have treated successfully only by a combination of increased fluid intake and adequate dietary modification.

Summary Aims: To evaluate the efficacy and treatment satisfaction with low-dose (0.2 mg) tamsulosin in patients with symptomatic benign prostatic hyperplasia (BPH), and to investigate individual lower urinary tract symptoms according to treatment satisfaction. Methods: A cross-sectional study was conducted in a total sample of 2574 patients from multiple centres. International Prostate Symptom Score (IPSS), prostate volume, uroflowmetry and combined medications were reviewed. Detailed questionnaires were used to assess treatment satisfaction and IPSS 8 weeks after treatment with low-dose tamsulosin. Results: After 8 weeks of treatment with low-dose tamsulosin, IPSS improved significantly. Among the 2574 patients, 1,630 (63.42%) were satisfied and 940 patients (36.50%) were dissatisfied with low-dose tamsulosin. The reasons for dissatisfaction included efficacy problems (84.66%) and side effects (3.72%). Treatment satisfaction was affected by symptom duration, baseline IPSS, and prostate size (p = 0.0441

This study was performed in order to determine the value of plasma osteopontin (OPN) levels as a predictive factor of disease stage and recurrence in patients with bladder urothelial carcinoma (UC). Data from 50 patients diagnosed to have bladder UC after transurethral resection of bladder tumor (TURBT) from 2009 to 2010 were evaluated prospectively. Blood tests were performed before and after TURBT, and plasma OPN levels were measured using enzyme-linked immunosorbent assay. Differences in OPN levels according to clinicopathologic variables were analyzed statistically. Significant differences in plasma OPN levels were observed between groups with and without muscle invasion (89.16 vs. 67.08ng/mL, p=0.041). Comparison according to tumor grade found no significant difference between high and low grade groups (p=0.115). Mean plasma OPN levels decreased after TURBT without statistical significance (p=0.571). Between groups with recurrence and those without recurrence, OPN levels of the group with recurrence were higher without statistical significance (p=0.161). Comparison of plasma OPN levels according to performance of radical cystectomy (RC) showed significant differences; patients who underwent RC showed higher levels of plasma OPN (95.58 vs. 70.37ng/mL, p=0.030). Comparison according to T stage after RC showed significant differences in OPN levels (T1: 67.45, T2: 86.60 and T3: 95.23ng/mL, respectively, p=0.006). The group with lymph node invasion showed significantly higher levels of OPN, compared to the group without invasion (153.24 vs. 68.03ng/mL, p=0.017). Preoperative plasma OPN levels correlated to muscle invasion of bladder UC and pathological stage after RC.

INTRODUCTION AND OBJECTIVES: There are no established evidence of comparing efficacy and safety between surgical methods of benign prostatic hyperplasia (BPH). This study investigated the present status related BPH surgery in Korea during five years. METHODS: County level data from the National Health Insurance Service and National Statistical Office was analyzed in this ecological study. The trend of number of BPH related surgery was analyzed and age, geographic distribution and assortclassification of hospital were also reviewed. RESULTS: There are not much change of total number of BPH related surgery during five years. Although, there is not much alteration in the number of conventional transurethral resection of prostate (TURP), the number of holmium laser prostate surgery (HOLEP) is dramatically increased. The number of HOLEP overtake the number of KTP laser after 2011 and it is anticipated that the gap will be arise. In the analysis of age, BPH related surgery is increased according to years in seventy while it is decreased in fifty and sixty. Meanwhile, after 2012, the number of BPH related surgery is decreased in local clinics, but it is increased in large hospital in metropolitan and it may be related with the increased number of HOLEP. In the analysis of geographical distribution, an uneven distribution according to country characteristics (metropolitan cities vs. nonmetropolitan cities) was showed. CONCLUSIONS: Through the data of the National Health Insurance Service, we could apprehend the present status of BPH related surgery in Korea. Then, we could know about the trend according to several factors and we think it is valuable results as academic references as well. Source of Funding: none

Objective It is generally assumed that there is a negative linear association between androgen receptor (AR) sensitivity and the CAG repeat length. However, correlation between CAG repeat length and clinical factors of metabolic syndrome (MS), late onset hypogonadism is unclear. In this study we explored the relationship between AR CAG repeat length polymorphism and MS, late onset hypogonadism (LOH) in a Korean male population. Methods The association between AR CAG repeat length polymorphism and MS was analyzed in 241 Korean men (20–90 years old). MS was diagnosed according to the NCEP criteria (any three or more of the following components were present: abdominal obesity [waist circumference (WC) >102 cm], triglycerides >150 mg/dL, HDL cholesterol 110 mg/dL, or blood pressure of >130/85 mmHg). LOH was diagnosed by serum testosterone level of

Objective To compare short-term outcomes of 180W-XPS GreenLight photoselective vaporization of the prostate (XPS PVP) to transurethral resection of prostate (TURP) on uroflowmetry and IPSS at two months in patients with benign prostatic hyperplasia (BPH) Methods A retrospective chart review was performed of 40 patients with BPH who underwent XPS PVP. Controls were configured with 40 patients who underwent TURP with similar prostate size of XPS PVP group. All parameters were collected retrospectively including maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate specific antigen, IPSS, and complication. Results XPS PVP and TURP were similar in preoperative parameters such as mean age, prostate volume, Qmax, PVR, IPSS and QoL score respectively. The median operative time for XPS PVP was significantly longer than TURP (49.1±19.5 min TURP and 69.9±38.6 min XPS PVP, P=0.001). XPS PVP showed significantly shorter hospital stay (4.5±1.0 vs. 3.0±1.4, P

Objective To evaluate the postoperative outcome of multiple slit on plaque plication technique for the treatment of Peyronie Je Jong Ki. Methods We retrospectively evaluated 22 patients who underwent plaque incision with penile plication for surgical treatment of Peyronieu Geon Moon of tamoxifen, L-l treatment between 2009 and 2014. Patients were grouped by pre-operative degree of penile curvature such as Group I: mild [n=5 (22%)], Group II: moderate [n=11 (50%)], and Group III: severe [n=6 (27%)]. On the thorough review of medical records, we evaluated (I) correction of the curvature; (II) sexual function; and (III) any penile shortening or other complications. Results The mean postoperative follow-up period was 39 months. Complete correction of the curvature was obtained in 21 patients (95%). As inevitable complication, minimal penile shortening (21]. The most frequent complication was the subcutaneous penile edema in three patients (13.6%), which was resolved within about 3 months after surgery. Conclusions As modified technique, multiple slit on plaque with plication is a simple, non-invasive and effective technique for correcting penile curvature regardless of curvature severity. And the degree of penile curvature does not significantly predict the amount of penile length loss.

Objective This study was designed to evaluate the efficacy of combination therapy of Tamoxifen, L-carnitine and daily PDE5 inhibitors and to compare with Potassium para-aminobenzoate (Potaba) monotherapy in the medical treatment of Peyronie’s disease. Methods From January 2011 to December 2014, a total of 104 patients with Peyronie’s disease enrolled in this study. Sixty-eight patients were treated with Tamoxifen 20 mg and Acetyl L-carnitine 330 mg twice a daily in addition to daily PDE5 inhibitors (Tadalafil 5 mg once daily) combination therapy (Group 1), while thirty-four patients were treated with Potassium para-aminobenzoate 12 g daily (Group 2), Pain on erection, impossibility of intercourse, plaque size, penile curvature and IIEF-5 were assessed. Plaque volume was assessed by penile ultrasonography. Results Both groups showed resolution of pain and intercourse satisfaction after treatment. The pre-treatment plaque sizes of both groups were 17.1±7.2, 17.0±5.0 mm, respectively. After treatment, those parameters significantly reduced to 13.2±5.6, 16.2±5.3 mm. In group 1, combination therapy significantly improved the angle of penile curvature, plaque size, and IIEF (P value

Several studies have suggested combination therapy with testosterone supplementation in patients not responding to PDE5 inhibitors. Considering the pathophysiological basis for testosterone supplementation, the present study aims to identify whether combination therapy allows persistence of treatment effect after testosterone discontinuation. Furthermore, we evaluated whether the degree of testosterone depletion affects treatment outcome from combination therapy. Hypogonadal patients (

Purpose Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disabling disease of the urinary bladder, and its etiology and treatment are not yet established. Current medications used in the treatment of PBS/IC have shown limited efficacy. This prospective study investigated the efficacy of intravesical resiniferatoxin (RTX) in PBS/IC refractory to medical treatment. Methods Patients with proven PBS/IC refractory to traditional medical treatment were enrolled. By randomized trial, a total of 18 consecutive patients were divided into two groups: treatment with hydrodistention and intravesical RTX (group 1) or treatment with hydrodistension only (group 2). We assessed bladder pain by use of a visual analogue pain scale, the maximal urine flow rate, post-void residual urine volume, and a voiding diary before and 3 months after treatment. Results The median age of the 18 patients was 55.8±6.9 years, and the median duration of symptoms before diagnosis was 3.6±1.6 years. Frequency, functional bladder capacity, and score on a 5-point pain scale were significantly improved at 3-month after treatment in both groups. Intravesical RTX instillation plus hydrodistention, compared with hydrodistention only, did not have a significant effect on the voiding symptoms or uroflowmetry of the patients but significantly improved scores on the pain scale. Conclusions Intravesical RTX instillation plus hydrodistention was effective in relieving pain but was not effective in improving lower urinary tract symptoms. Further larger studies are needed to clarify the efficacy of combination treatment of intravesical RTX instillation and hydrodistention.

Objectives: The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Methods: Patients were treated with low-dose tamsulosin for an initial run-in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. Results: One hundred and seventy-four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty-five patients completed the 36-week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Conclusion: Both low- and intermediate-dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.

Bladder capacity is an important factor in the diagnosis and treatment of children with voiding dysfunction. The purpose of this study was to define the normal maximal voided volume formula in Korean children younger than 2 years.We measured the bladder capacities of 151 Korean children between 0 and 24 months of age (83 boys and 68 girls) who did not have clinical voiding dysfunction. The maximal voided volume was determined in all subjects using a 2-day frequency volume chart with a four-hour voiding observation. The largest voided volume for each patient was considered to be the maximal voided volume. Statistical analyses were carried out using linear regression analysis.The maximal voided volume increased with age and weight (P = 0.0001). There was no significant difference between males and females (P = 0.771). A formula that approximates bladder capacity with respect to age is the following: bladder capacity (ml) = [1.6 × age (months)] + 45 (t = 8.757, P = 0.0001). A formula that approximates bladder capacity with respect to weight is the following: bladder capacity (ml) = [4.1 × weight (kg)] + 28 (t = 10.152, P = 0.0001).These formulas may be useful for the diagnosis of abnormal bladder capacity and the evaluation of voiding dysfunction in Korean children younger than 24 months.

Despites the debates on penile girth enhancement (PGE), demands for enhancement are increasing. Recently, various fillers have been widely used for soft tissue augmentation with proven efficacy and safety.To identify the feasibility and efficacy of PGE by injection of filler.Fifty patients with subjective small penis who visited Korea University Guro outpatient clinic were enrolled and prospectively followed. Restylane Sub-Q (Q-med, Upssala, Sweden) was injected into the fascial layer of penile body via 21G cannula with "BackForth Technique" and homogenized with a roller.From April 2006 to February 2008, 50 patients were enrolled and 41 patients were followed until 18 months after PGE. Changes in penile girth at midshaft were measured by tapeline at 1 and 18 months. Patient's visual estimation of residual volume (Gr 0-4), patient's satisfaction (Gr 0-4), and any adverse reactions were also evaluated.Mean injected volume was 20.56 cc (18-22). Compared with basal girth of 7.48 ± 0.35 cm, maximal circumference was significantly increased to 11.41 ± 0.34 cm at 1 month (P0.0001) and maintained as 11.26 ± 0.33 cm until 18 months. In patient's visual estimation, two patients complained the decrease as Gr 3 with focal depression at 1 month. At 18 months, all patients answered as Gr 4 without asymmetry. Patient's and partner's satisfaction score was 3.71 ± 0.46 and 3.65 ± 0.48 at 1 month and 3.34 ± 0.53 and 3.38 ± 0.49 at 18 months. There were no inflammatory signs or serious adverse reactions in all cases.Considering the property of material, methods, and follow-up results of 18 months, PGE using filler is a very effective and safe technique for penile augmentation.

Purpose To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. Materials and Methods From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. Results The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. Conclusions PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.

Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition.

Purpose: This study was conducted to investigate the relationship between serum total testosterone levels and scores on the Aging Male’s Symptom (AMS) scale and the International Index of Erectile Function (IIEF) in men with erectile dysfunction with testosterone deficiency syndrome (TDS). Materials and Methods: From January 2005 to July 2008, 134 patients who complained of sexual dysfunction such as erectile dysfunction or decreased libido as the main symptoms of TDS with serum total testosterone levels less than 3.5 ng/ml were evaluated by independent t-test and linear regression analysis, respectively. Patients with treated hypogonadism within 6 months, with a history of taking a PDE5 inhibitor or an antidepressant for a depressive disorder, or who had metabolic syndrome were excluded from this study. Results: The AMS scale and its 3 subdomain scores were not significantly correlated with the total testosterone level. By contrast, the total IIEF score and the score of each IIEF domain except sexual desire showed a weakly significantly positive correlation with serum total testosterone. Conclusions: In TDS patients with erectile dysfunction, there was a low relationship between serum total testosterone levels and the AMS scale and a weakly positive correlation between total testosterone levels and all IIEF domains except sexual desire. There was a low relationship between the AMS scale, the sexual desire domain score of the IIEF, and total testosterone. We should understand these limitations when evaluating patients with erectile dysfunction with TDS. New scales should be developed for the evaluation of erectile dysfunction in these patients.