Search

The beneficial effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with chronic kidney disease (CKD) with low albuminuria levels have not been established. This study aimed to compare the effects of dapagliflozin on kidney injury biomarkers in patients with CKD stratified by albuminuria level. We prospectively enrolled healthy volunteers (HVs; n = 20) and patients with CKD (n = 54) with and without diabetes mellitus. Patients with CKD were divided into two age-matched and sex-matched subgroups according to urinary albumin-creatinine ratio (uACR) levels (<300 mg/g and ≥300 mg/g). The CKD group received dapagliflozin (10 mg/day). Urine samples were collected before treatment and after 3 and 6 months of dapagliflozin. Urinary kidney injury molecule-1 (KIM-1), interleukin-1β (IL-1β), and mitochondrial DNA nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND1) copy number were measured. The estimated glomerular filtration rate (eGFR) of patients with CKD was lower than that of HVs (P < 0.001). During the study period, eGFR decreased and uACR did not change in the CKD group. Kidney injury markers were significantly elevated in patients with CKD compared with those in HVs. Dapagliflozin reduced urinary KIM-1, IL-1β, and mtDNA copy number in patients with CKD after 6 months of treatment. In further, the levels of urinary KIM-1 and IL-1β, patients with CKD decreased after 6 months of dapagliflozin treatment regardless of albuminuria level. Dapagliflozin reduced urinary kidney injury biomarkers in patients with CKD, regardless of albuminuria level. These findings suggest that SGLT2 inhibitors may also attenuate the progression of low albuminuric CKD., (© 2024 The Authors. Clinical Pharmacology & Therapeutics © 2024 American Society for Clinical Pharmacology and Therapeutics.)

Ni-rich layered oxides have received significant attention as promising cathode materials for Li-ion batteries due to their high reversible capacity. However, intergranular and intragranular cracks form at high state-of-charge (SOC) levels exceeding 4.2 V (vs. Li/Li + ), representing a prominent failure mechanism of Ni-rich layered oxides. The nanoscale crack formation at high SOC levels is attributed to a significant volume change resulting from a phase transition between the H2 and H3 phases. Herein, in contrast to the electrochemical crack formation at high SOC levels, another mechanism of chemical crack and pit formation on a nanoscale is directly evidenced in fully lithiated Ni-rich layered oxides (low SOC levels). This mechanism is associated with intergranular stress corrosion cracking, driven by chemical corrosion at elevated temperatures. The nanoscopic chemical corrosion behavior of Ni-rich layered oxides during aging at elevated temperatures is investigated using high-resolution transmission electron microscopy, revealing that microcracks can develop through two distinct mechanisms: electrochemical cycling and chemical corrosion. Notably, chemical corrosion cracks can occur even in a fully discharged state (low SOC levels), whereas electrochemical cracks are observed only at high SOC levels. This finding provides a comprehensive understanding of the complex failure mechanisms of Ni-rich layered oxides and provides an opportunity to improve their electrochemical performance.

Purpose: To conduct systematic review and meta-analysis to evaluate effects of neoadjuvant chemotherapy (NAC) on survival and histopathological outcomes of variant histology (VH) of urothelial carcinoma (UC) of bladder., Methods: This systematic review was registered in PROSPERO (CRD42023389115). Literature search was conducted in PubMed/Medline, Embase, and Cochrane Library for studies published up to January 2023. Population, intervention, comparator, outcome, and study design were as follows: bladder cancer patients with VH (population), neoadjuvant chemotherapy (intervention), radical cystectomy only (comparators), oncological survival and pathologic response (outcomes), and retrospective or prospective (study design)., Results: Finally, a total of 17 studies were included in the present study (quantitative analysis, n = 17; qualitative analysis, n = 12). Pooled HR was 0.49 (95% CI: 0.31-0.76; P = .002) for OS. Pooled HR was 0.61 (95% CI: 0.38-0.98; P = .04) for CSS. Pooled HR was 0.44 (95% CI: 0.21-0.93; P = .03) in PFS. Pooled OR was 6.61 (95% CI: 4.50-9.73; P < .00001) in complete pathologic response. Pooled OR was 9.59 (95% CI: 3.56-25.85; P < .00001) in any pathologic response. Evidence quality assessments for each 5 comparisons using the GRADE approach were that Certainty was moderate in 1, low in 1, and very low in 3., Conclusions: Administration of NAC before surgery in bladder cancer patients with VH might confer better survival outcomes and higher pathologic down staging rate than no administration of NAC before surgery., Competing Interests: Disclosure The authors report no conflicts of interest in relation to this work., (Copyright © 2023. Published by Elsevier Inc.)

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

Interphase engineering is becoming increasingly important in improving the electrochemical performance of cathode materials for rechargeable batteries, including Li ion, Li metal, and all-solid-state batteries, because irreversible surface reactions, such as electrolyte decomposition, and transition metal dissolution, constitute one of these batteries' failure modes. In this connection, various surface-engineered cathode materials have been investigated to improve interfacial properties. No synthesis methods, however, have considered a plane-selective surface modification of cathode materials. Herein, we introduce the basal-plane-selective coating of Li 2 SnO 3 on layered Li[Ni x Co 1- x ]O 2 ( x = 0 and 0.5) using the concept of the thermal phase segregation of Sn-doped Li[Ni x Co 1- x ]O 2 due to the solubility variation of Sn in Li[Ni x Co 1- x ]O 2 with respect to temperature. The plane-selective surface modification enables the formation of Li 2 SnO 3 nanolayers on only the Li[Ni x Co 1- x ]O 2 basal plane without hindering the charge transfer of Li + ions. As a result, the vertical heterostructure of Li[Ni x Co 1- x ]O 2 -Li 2 SnO 3 core-shells show promising electrochemical performance.

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.

Objectives: To investigate the association between lower urinary tract symptoms (LUTS) and cardiovascular disease (CVD) risk in women, as severe LUTS are known to be associated with CVD risk in men but few studies have focused on this issue in women., Subjects and Methods: A total of 1014 ostensibly healthy women, who participated in a voluntary health check in a health promotion centre from November 2013 to October 2015, were enrolled. LUTS were assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). CVD risk scores were calculated using the Framingham risk score and the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) score. Correlation, partial correlation, and multiple logistic regression analyses were conducted., Results: The mean age and body mass index (BMI) of the women were 51 years and 22.6 kg/m 2 , respectively. The ASCVD score showed significant positive correlations with IPSS items Question 2 (Q2), Q3, Q5, and Q7 (all P < 0.05), total IPSS (P = 0.001), IPSS storage (P = 0.006) and IPSS voiding symptoms scores (P = 0.001) based on partial correlation analysis after adjustment for BMI. For the OABSS, the ASCVD score showed significant positive correlations with OABSS items Q2, Q3, and Q4 (P < 0.001, P = 0.017, and P < 0.001, respectively) and total OABSS (P < 0.001). Multiple logistic regression analysis showed that the moderate-severe risk groups of the OABSS and IPSS were associated with the ASCVD risk score in adjusted models (P < 0.001) compared to the none-mild OABSS and mild IPSS groups. After adjustment for age and BMI, IPSS storage score was significantly related with the ASCVD risk score (B = 0.855, P = 0.016) CONCLUSIONS: LUTS, especially storage symptoms, might be risk factors for predicting future CVD risk in women. Further prospective or cohort studies are needed to validate this possibility., (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)

Objective: To investigate the efficacy and safety of noninvasive intravesical instillation of onabotulinum toxin-A (OBTX-A) through systematic review and meta-analysis. Recently, several studies of noninvasive intravesical instillation of OBTX-A have been published. However, its efficacy is not well validated yet compared to well-known efficacy of minimally invasive intravesical injection of OBTX-A., Method: Systematic review and meta-analysis were performed to evaluate the efficacy of noninvasive intravesical instillation of OBTX-A in patients with overactive bladder and interstitial cystitis/bladder pain syndrome by measuring outcomes such as urgency episode per 72 hours, frequency per 72 hours, urgency urinary incontinence, voided volume (VV), postvoided residual volume, maximum flow rate, and patient perception of bladder condition., Result: Six trials in 4 studies that compared instillation of OBTX-A and placebo involving 248 patients (121 experimental and 127 controls) were included for final data extraction. Instillation of OBTX-A significantly increased VV, with a mean difference of 38.48 (95% confidence interval: 76.05, 0.92) compared to the placebo group. However, other outcomes showed statistically insignificant changes. Major adverse events were not reported in the group receiving intravesical instillation of OBTX-A., Conclusion: Intravesical instillation of OBTX-A showed limited efficacy with improvement of VV for treatment of overactive bladder or interstitial cystitis/bladder pain syndrome. More studies are needed to overcome the efficacy of current noninvasive bladder instillation of OBTX-A regarding effective drug transport., (Copyright © 2018 Elsevier Inc. All rights reserved.)

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.)

Objectives: To date, there is no overall agreement as to risk of ambient temperature for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Thus, we focused on ambient temperature as an environmental factor affecting LUTS and attempted to explain the temperature differences in LUTS severity in cases in real clinical practice., Methods: This was a multicenter, cross-sectional survey. The study involved 1612 men aged 40 years and older who visited 23 university hospitals in 10 major areas in South Korea between September 2010 and December 2011. The participants who had good overall mental and physical health, and complaint of LUTS were included. Korea Meteorological Administration data were used to determine daily average temperatures and daily temperatures on the interview dates at each site., Results: The average age of the 1612 men was 66.57 ± 10.03 years. The mean International Prostate Symptom Score (IPSS) and symptom duration were 18.51 ± 6.77 and 3.79 ± 3.89 years, respectively. Daily average temperature and temperature difference ranged from -13.1 to 28.5 °C and 0 to 20.6 °C, respectively. Age was a significant risk factor for IPSS, symptom duration, prostate volume (PV), maximal urinary flow rate (Qmax), average urinary flow rate (Qave) and total voiding volume (P < 0.001) but not QOL. Logistic regression analysis after adjustment for age and PV revealed that Qave and total voiding volume were increased as the temperature declined. However, IPSS and Qmax did not show a statistically significant difference as the temperature declined., Conclusion: Our findings did not demonstrate an increased clinically significant risk of LUTS severity in connection with ambient temperature in clinical practice., (© 2016 John Wiley & Sons Australia, Ltd.)

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.

Objective: To evaluate the association between the degree of fatty liver disease and severity of lower urinary tract symptoms (LUTS) in healthy middle-aged males., Materials and Methods: A total of 1943 Korean men aged between 40 and 70 years who had participated in the voluntary health checkup program from January 2012 to December 2014 were enrolled. LUTS were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Abdominal ultrasonography was performed to assess nonalcoholic fatty liver disease (NAFLD). Trend test was performed to investigate the association between the degree of fatty liver disease and LUTS severity. Differences between the two groups were analyzed by chi-square test, and we adjusted for confounding factors with analysis of covariance and logistic regression test., Results: The mean age was 51.79 ± 7.03 years, and 1026 (52.8%) subjects were determined to have NAFLD. Differences in categorical variables, between NAFLD grades and IPSS grades, were analyzed by Trend test, and no significant difference was observed (Pearson chi-square, P  =  .155; likelihood ratio, P  =  .151; linear-by-linear association, P  =  .527). After adjustment for age, body mass index, metabolic syndrome, C-reactive protein, prostate-specific antigen, prostate volume with analysis of covariance, and multiple logistic regression test, no significant associations were found between IPSS and NAFLD., Conclusion: No significant associations were found between NAFLD and LUTS in middle-aged men, and the degree of NAFLD was not significantly associated with the severity of LUTS in trend. The role of NAFLD, in comparison with age, might be too small to change the LUTS., (Copyright © 2016 Elsevier Inc. All rights reserved.)

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.

Objective: To investigate the association between high-sensitivity C-reactive protein (hs-CRP) and lower urinary tract symptoms in healthy middle-aged men., Materials and Methods: A total of 4256 ostensibly healthy native Korean men between the ages of 40 and 65 years who voluntarily underwent medical checkup were enrolled. The participants' demographics were collected, including International Prostate Symptom Score, hs-CRP, various metabolic risk factors, and prostate volume (PV). Multivariate regression analyses were performed to investigate the relationship between hs-CRP and lower urinary tract symptoms after adjustment for age, PV, metabolic syndrome, and body mass index (BMI)., Results: Data obtained from 3539 men were analyzed. The mean age was 51.75 ± 7.01 years, and the mean C-reactive protein (CRP) level was 0.137 ± 0.256 mg/L. Correlation analysis after adjustment for age, PV, and BMI revealed that CRP only correlated with storage symptoms (coefficient = 0.044, P value = .007) and not voiding symptoms. Multivariate analysis using the full model revealed that age and CRP were positively correlated with storage symptoms (P <.001 and .008, respectively). Multivariate analysis using a stepwise model revealed that age, CRP, and triglycerides were positively correlated with storage symptoms (P <.001, .007, and .022, respectively) and BMI was negatively correlated with storage symptoms (P = .023)., Conclusion: In healthy men, hs-CRP was independently correlated with storage symptoms after adjustment for age, BMI, PV, and metabolic risk factors. Subclinical inflammation might play a role in the pathophysiology of storage symptoms., (Copyright © 2015 Elsevier Inc. All rights reserved.)

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.

Experiments on spinal cord injury (SCI) have largely focused on the transplantation of stem cells into injured spinal cords for motor recovery while neglecting to investigate bladder dysfunction. The present study was performed to investigate the effect of B10 human mesenchymal stem cells (hMSCs) directly transplanted into the bladder wall of SCI rats and to determine whether they are capable of inhibiting collagen deposition and improving cystometric parameters in SCI rats. Forty 6-week-old female Sprague-Dawley rats were divided into four groups (group 1: control, group 2: sham operated, group 3: SCI, group 4: SCI rats that received B10 cells). B10 cells were labeled with fluorescent magnetic nanoparticles (MNPs). Four weeks after the onset of SCI, MNP-labeled B10 cells were injected to the bladder wall. Serial magnetic resonance (MR) images were taken immediately after MNP-B10 injection and at 4 weeks posttransplantation. Voiding function was assessed at 4 weeks posttransplantation, and the bladder was harvested. Improvements in bladder fibrosis and bladder function were monitored by molecular MR imaging. Transplantation of B10 cells into the SCI rats markedly reduced their weights and collagen deposition. MR images showed a clear hypointense signal induced by the MNP-labeled B10 cells at 4 weeks posttransplantation. Transplanted B10 cells were found to differentiate into smooth muscle cells. The intercontraction interval decreased, and the maximal voiding pressure increased after SCI but recovered after B10 cell transplantation. Survival of B10 cells was found at 4 weeks posttransplantation using anti-human mitochondria antibody staining and MR imaging. The transplanted B10 cells inhibited bladder fibrosis and ameliorated bladder dysfunction in the rat SCI model. MSC-based cell transplantation may be a novel therapeutic strategy for bladder dysfunction in patients with SCI.

Objectives: To evaluate the impact of obesity on the biopsy detection of prostate cancer., Methods: We retrospectively reviewed data of 1182 consecutive Korean patients (≥50 years) with serum prostate-specific antigen levels of 3-10 ng/mL who underwent initial extended 12-cores biopsy from September 2009 to March 2013. Patients who took medications that were likely to influence the prostate-specific antigen level were excluded. Receiver operating characteristic curves were plotted for prostate-specific antigen and prostate-specific antigen density predicting cancer status among non-obese and obese men., Results: A total of 1062 patients (mean age 67.1 years) were enrolled in the analysis. A total of 230 men (21.7%) had a positive biopsy. In the overall study sample, the area under the receiver operator characteristic curve of serum prostate-specific antigen for predicting prostate cancer on biopsy were 0.584 and 0.633 for non-obese and obese men, respectively (P = 0.234). However, the area under the curve for prostate-specific antigen density in predicting cancer status showed a significant difference (non-obese 0.696, obese 0.784; P = 0.017)., Conclusions: There seems to be a significant difference in the ability of prostate-specific antigen density to predict biopsy results between non-obese and obese men. Obesity positively influenced the overall ability of prostate-specific antigen density to predict prostate cancer., (© 2014 The Japanese Urological Association.)

Objective: To investigate the impact of metabolic syndrome (MS) on lower urinary tract symptoms (LUTS) in middle-aged men., Materials and Methods: A total of 4256 ostensibly healthy native Korean men aged between 40 and 65 years who voluntarily underwent medical checkup were enrolled. Participants' demographics were collected including International Prostate Symptom Score, various metabolic risk factors, and prostate volume (PV). All participants were stratified into 2 groups based on the presence or absence of MS. The PV was used for subgroup analysis., Results: Data from 4076 men were retrospectively analyzed. The mean age was 52.2 ± 7.4 years and 18.5% of patients were included in the MS group. The MS group had lower frequency score (P <.01) compared with the non-MS group. In the larger PV group (≥ 28 mL), the age-adjusted odds ratio (OR) for having moderate-to-severe LUTS was significantly lower in subjects with MS having 3 metabolic risk factors (hypertension and hypertriglyceridemia included; OR, 0.666; P <.01) and in subjects with MS having 4 or 5 risk factors (OR, 0.612; P <.05) compared with the non-MS group., Conclusion: We confirmed that MS with increasing number of MS risk factors (especially hypertension and hypertriglyceridemia) had favorable effects on the likelihood of having moderate-to-severe LUTS in middle-aged men with larger PV., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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 relationship between body mass index (BMI), visceral adipose tissue (VAT), and stone components., Methods: A cross-sectional study has been done for urinary stone cohort between 2010 and 2012. Data on patient's age, gender, BMI, urinary pH, stone components, and VAT using computed tomography-based delineation were collected. Obesity was defined as BMI≥25 kg/m2 or as VAT≥100 cm2. To compare the differences between the types of stones, multinomial logistic regression analyses were conducted., Results: Of 203 cases, 49.3% patients were obese based on BMI, and 65.5% were obese using VAT criteria. Multinomial logistic regression analysis revealed that obesity defined by VAT was found to be associated with uric acid stones compared with calcium phosphate stones (odds ratio [OR] 6.544, 95% confidence interval [CI], P=.030) and mixed calcium oxalate phosphate stones (OR 5.582, 95% CI, P=.038). Similar results were observed in calcium oxalate stones over calcium phosphate stones (OR 2.984, 95% CI, P=.032) and calcium oxalate phosphate stones (OR 2.542, 95% CI, P=.041). On the contrary, obesity defined based on BMI has no correlation over all types of urinary stone components., Conclusion: This result implies that VAT has a more important role in uric acid and calcium oxalate stone formation than total body fat, represented by BMI., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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.

Objectives: To compare the treatment outcome of tamsulosin 0.4 mg (TAM) with or without solifenacin 5 mg (SOL) for the most bothersome symptom in male lower urinary tract symptoms (LUTS) with overactive bladder (OAB)., Subjects and Methods: Male LUTS/OAB (≥50 years) patients who had a total International Prostate Symptom Score (I-PSS) of ≥12, I-PSS urgency-related question of ≥2, and quality of life (QoL) of ≥3 points were enrolled. Patients who complained of storage symptoms as the most bothersome were included in the 'storage' group. Patients who complained of voiding symptoms as the most bothersome were included in the 'voiding' group. The change in the I-PSS was compared between the two groups 4 weeks after commencing treatment., Results: In the storage group, 172 were able to finish this study (TAM: 88, TAM + SOL: 84). The improvement of I-PSS and QoL with TAM + SOL was significantly greater than with TAM alone (p < 0.001). In the voiding group, 108 were able to finish the study (TAM: 54, TAM + SOL: 54). The improvement of I-PSS and QoL with TAM alone was significantly greater than with TAM + SOL (p < 0.001)., Conclusions: The most bothersome symptom in male LUTS/OAB should be considered when choosing the appropriate medical treatment., (2014 S. Karger AG, Basel.)

Objectives: The aim of the present study was to determine whether administration of zolpidem, a nonbenzodiazepine sedative-hypnotic agent, at night would improve the nocturia unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms (LUTS)., Methods: This was a prospective observational study comprised of 39 men aged 50 years and older. The study inclusion criteria were age more than 50 years, and nocturia twice or more per night after taking alpha-blockers for more than 8 weeks. A total of 39 patients met the criteria and constituted the study cohort. Pittsburgh Sleep Quality Index (PSQI), International Prostate Symptom Score (IPSS), frequency volume chart (FVCs) and uroflowmetry were recorded. Patients were given 10 mg alfuzosin and 10 mg zolpidem once at night for the 8 weeks., Results: There were no serious side-effects in any patient. Nocturia decreased from a baseline (3.1 ± 0.1) to 8 weeks (1.6 ± 0.2) (P = 0.001). After treatment, global PSQI scores and severe sleep disorders improved. Storage and voiding symptoms including total IPSS scores and quality of life index improved. Nocturnal urine volume and functional bladder capacity improved. Maximum flow rate, voided volume increased and residual urine volume decreased., Conclusion: Combined zolpidem and alpha-blocker therapy resulted in a subjective and objective reduction in nocturia episodes when given to men with nocturia unresponsive to alpha-blocker monotherapy., (© 2012 Wiley Publishing Asia Pty Ltd.)

Aims: The purpose of this study was to develop a new sub-classification system for male lower urinary tract symptoms (LUTS)-mild, moderate and severe-using the conventional International Prostate Symptoms Score (I-PSS)., Methods: From October 2007 to March 2012, a total of 2234 male patients (≥ 50 years old) presenting with LUTS were enrolled in this study. Patients were sorted according to their I-PSS (ranging from 1 to 35 points) and divided into three groups based on their quality of life (QoL) score. A chi-square automatic interaction detection (CHAID) algorithm, based on adjusted significance testing, was used. The Kappa coefficient was calculated for the agreement of original and new categorisation., Results: Mean total I-PSS and QoL scores were 11.0 and 2.9 respectively. According to the original classification, 838 patients (38.6%) had mild, 1053 (48.5%) had moderate and 282 (13.0%) had severe symptoms. After the CHAID algorithm was applied, the scores were re-categorised as 'mild' (1-6 points), 'moderate' (7-21 points) and 'severe' (22-35 points). The overall model was able to correctly predict whether an I-PSS was associated with mild, moderate or severe symptoms, with 70.1% accuracy. According to this new classification, 704 patients (32.4%) were shown to have mild, 1255 (57.8%) to have moderate and 214 (9.8%) to have severe LUTS. The agreement of conventional and new categorisation is very strong (Kappa coefficient = 0.84)., Conclusions: Conventional categorisation of LUTS by I-PSS needs to be updated and the category of moderate LUTS should be broadened., (© 2013 John Wiley & Sons Ltd.)

Prostate cancer is the most common malignancy among men. Prostate cancer-related deaths are largely attributable to the development of hormone resistance in the tumor. No effective chemotherapy has yet been developed for advanced prostate cancer. It is desirable if a drug can be delivered directly and specifically to prostate cancer cells. Stem cells have selective migration ability toward cancer cells and therapeutic genes can be easily transduced into stem cells. In one form of gene therapy for cancer, the stem cells carry a gene encoding an enzyme that transforms an inert prodrug into a toxic product. Cytosine deaminase (CD) transforms the pro-drug 5-fluorocytosine into highly cytotoxic 5-fluorouracil (5-FU). The migration of the genetically modified stem cells was monitored by molecular magnetic resonance imaging, after labeling the stem cells with fluorescent magnetic nanoparticles (MNPs). Human neural stem cells encoding CD (HB1.F3.CD) were prepared and labeled with MNP. In tumor-bearing C57B mice, systemically transplanted HB1.F3.CD stem cells migrated toward the tumor and in combination with prodrug 5-FC, the volume of tumor implant was significantly reduced. These findings may contribute to development of a new selective chemotherapeutic strategy against prostate cancer., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

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.

Objective: To determine whether prostate-specific antigen density (PSAD) has a more significant correlation with obesity than prostate-specific antigen (PSA)., Methods: From October 2007 to March 2012, a total of 2402 Korean men over 40 years old who visited our clinic for prostate examination were enrolled in this study. All men underwent anthropometric measurements, digital rectal examination, serum PSA determination, and transrectal ultrasound examination. Body mass index (BMI) was grouped according to the Asia-Pacific criteria of obesity into the following categories: underweight or normal: less than 23; overweight: 23 to 24.9; obese: 25 kg/m(2) or greater. A partial correlation and linear trend model among PSA, PSAD, and BMI were conducted, after adjusting for age., Results: Finally, data from 2294 men in total were collected. Mean age was 52.3 years and mean PSA was 1.07 ng/mL. Partial correlation revealed a significant negative correlation between BMI and both PSA and PSAD (P = .0017 and <.0001, respectively), and revealed positive correlation between BMI and prostate volume (P <.0001). After adjustment for age, the linear trend model demonstrated that BMI had both a significant trend with PSA and PSAD (P = .0162 and <.0001, respectively), however, PSAD showed a significant linear trend in all BMI groups, whereas PSA showed a significant linear trend only in the group with a BMI ≥ 25 kg/m(2)., Conclusion: PSAD demonstrated a more significant negative correlation with obesity than PSA., (Copyright © 2013 Elsevier Inc. All rights reserved.)

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.

Objectives: To provide insights into the pathogenesis of bladder insult secondary to bladder outlet obstruction., Methods: Six-week-old female Sprague-Dawley rats (n = 80) were divided into eight groups, 10 rats each, according to the duration of bladder outlet obstruction, including 0, 3, 6, 12, 24, 48, 72 h and 1 week. Cystometric parameters were evaluated at 72 h and 1 week after bladder outlet obstruction. Bladder tissues were harvested and Masson's trichrome staining was carried out. Each slide was inspected microscopically and the mean percent collagen area was examined. Changes of collagen deposition and pathological expression of several factors including hypoxia inducible factor-1α, vascular endothelial growth factor, transforming growth factor-β1 and nitric oxide synthase messenger ribonucleic acid of bladders were evaluated., Results: A significant time-dependent increase in the bladder weight after 6 h and the percent of collagen area after 24 h of bladder outlet obstruction were found. Increase in hypoxia inducible factor-1α, transforming growth factor-β1, inducible nitric oxide synthase messenger ribonucleic acid expression, time-dependent increase in vascular endothelial growth factor, neuronal nitric oxide synthase and endothelial nitric oxide synthase messenger ribonucleic acid expression after 6 h of bladder outlet obstruction was found. The intercontraction interval decreased significantly after 72 h of bladder outlet obstruction., Conclusions: Cellular remodeling in the bladder secondary to bladder outlet obstruction starts in the early hours and it includes enhanced angiogenesis and bladder relaxation. Early relief from bladder outlet obstruction is helpful to preserve bladder structure and function., (© 2012 The Japanese Urological Association.)

Unlabelled: Study Type--Prevalence (prospective cohort) Level of Evidence 1b. What's known on the subject? and What does the study add? Managing foreign bodies, including mesh and stones, after anti-incontinence surgery is important because complete removal is necessary to prevent infection and recurrence of stone formation. Traditionally, surgical management of such complications has involved excision using a transurethral approach, with or without a laparoscopic transvesical procedure. The study shows that mesh complications, including exposure and adherent stones, can be successfully treated and a fast recovery can be achieved using transvesical laparoscopic excision and reconstruction. Transvesical laparoscopy is especially suitable for cases that have a restricted visual field with cystoscopy; the technique allows complete removal of mesh/stones and reconstruction with the help of an excellent visual field., Objectives: • To evaluate laparoscopic transvesical excision and reconstruction for the management of vesical mesh or stones around the bladder neck as complications of anti-incontinence intervention. • To compare the techniques, outcomes and recurrence rates of laparoscopic transvesical excision and reconstruction with published results from studies using laparoscopic transvesical procedures., Patients and Methods: • We conducted a retrospective review of three patients who underwent laparoscopic transvesical excision and reconstruction for vesical mesh and stones around the bladder neck. • Patients were identified from operating records including recorded video and electronic data records. • We also conducted a literature review of the available evidence on transvesical laparoscopy for lower urinary tract complications of anti-incontinence procedures., Results: • Between March 2005 and May 2011, three women underwent laparoscopic transvesical excision and reconstruction. All presented with storage symptoms and gross haematuria. The interval between surgery and the diagnosis of presence of a foreign body was 1-3 years. • Two women had previously undergone transobturator tape procedures and one had undergone a retropubic procedure. • Complete excision including the mucosa and muscle layer and reconstruction with intravesical sutures was achieved in all cases. • Storage symptoms were resolved within 3 days and haematuria was not observed. • None of the women had recurrent erosion at follow-up., Conclusions: • Laparoscopic transvesical excision and reconstruction is a technically feasible method. • This procedure offers excellent visualization of mesh materials and stones, especially in cases of location near the anterior bladder neck. • In selected patients, laparoscopic transvesical excision and reconstruction is an acceptable technique for first-line treatment of complications of anti-incontinence procedures., (© 2012 BJU INTERNATIONAL.)

Objective: To highlight the importance of relieving the most bothersome symptom for improving quality of life (QoL) in male patients with lower urinary tract symptoms., Methods: From January 2010 to March 2011, 242 men with lower urinary tract symptoms visited our clinic, and 194 finished this study. At first visit, the most bothersome symptom was selected as the "core symptom." The sum of other symptoms except the core symptom was defined as "peripheral symptoms." All patients underwent empirical medical treatment for male lower urinary tract symptoms during an 8- to 12-week period, thereafter, recorded a follow-up International Prostate Symptom Score (I-PSS) questionnaire. We multivariately analyzed the patients' data after medical treatment to assess the influence of relieving their core symptom on the improvement of QoL., Results: The patients' mean age was 64.7 years and the mean total I-PSS was 19.7 points. Nocturia was the most common core symptom (29.9%), followed by weak stream (16.5%). Multiple logistic regression revealed that relieving the core symptom (odds ratio [OR] = 39.163, 95% confidence interval [CI] = 13.536-113.309) was significantly associated with QoL improvement. Improvement of peripheral symptoms (OR = 4.849, 95% CI = 1.629-14.433) and the inclusion of the moderate symptom group at first visit (OR = 2.622, 95% CI = 1.009-6.811) were also significant factors in predicting QoL improvement., Conclusion: In treating benign prostatic hyperplasia or lower urinary tract symptoms, we should focus more on relieving the individual patient's most bothersome symptom to help improve patient QoL., (Copyright © 2012 Elsevier Inc. All rights reserved.)

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.

Malignant mesothelioma of the tunica vaginalis testis is a rare, but often fatal, malignancy that usually appears during the fourth decade and has a strong relationship with occupational exposure to asbestos and long-lasting hydrocele. We present a case involving a 36-year-old man without a history of hydrocele, trauma, or exposure to asbestos who developed malignant mesothelioma., (Copyright © 2012 Elsevier Inc. All rights reserved.)

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.