Efficacy and safety of low power holmium laser enucleation of the prostate: A prospective short- and medium-term single-blind randomized trial

서준교,추민수,오승준 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.5

Purpose: We evaluated the efficacy and safety of mid-term follow-up in low-power (LP) Holmium laser enucleation of the prostate (HoLEP) compared with high-power (HP) surgery for benign prostatic hyperplasia (BPH). Materials and Methods: This prospective, single-blind, randomized controlled study was conducted between September 2020 and April 2021. Ninety male patients >50 years who underwent HoLEP for BPH were randomly assigned to HP (80 W/2 J/40 Hz) and LP (24 W/2 J/12 Hz) groups. The primary endpoint was the total International Prostate Symptom Score (IPSS) six months after surgery. The secondary endpoints were perioperative results and postoperative outcomes at two weeks, three and six months after the surgery, including Clavien–Dindo complication classification. Results: At six months after HoLEP, 41 and 42 patients were followed up in the HP and LP groups, respectively. There was no difference in the preoperative characteristics between the two groups. The prostate volumes were 67.1±23.7 mL for the HP group and 64.3±25.7 mL for the LP group (p=0.592), respectively. Although the total operative time was significantly longer by 13.1 minutes in the LP group (47.8±20.3 min vs. 60.9±23.3 min, p=0.006), the total delivered energy was significantly lower, which was only about 68% of the HP group (58.2±23.9 kJ vs. 39.9±13.2 kJ, p<0.001). Surgical outcomes significantly improved postoperatively in both groups compared to baseline, except for storage symptoms. Improvement in IPSS storage subscore was observed from the immediate postoperative 2 weeks in the LP group (8.1±3.1 to 6.9±3.8, p<0.001), whereas there was no significant recovery in the HP group (8.0±3.2 to 7.7±3.4, p=0.842). In the 6-month follow, there was no significant difference between the two groups in the IPSS total score (5.9±5.6 vs. 7.3±5.3, p=0.260) as well as IPSS storage subscore. In addition, there was no significant difference in postoperative complications, including bleeding or urinary incontinence, between the two groups. Conclusions: The HoLEP procedure performed using an LP laser device resulted in lower total delivered energy, faster recovery, and significantly improved surgical outcomes up to mid-term follow-up. There was no difference in efficiency or safety between the HP device system.

혁신도시, 과거로의 회귀

서준교 한국정부학회 2008 한국정부학회 학술발표논문집 Vol.2008 No.06

mtDNA의 제한효소 절단단편 크기변이를 이용한 한국산 야생마우스와 근교계마우스간의 핵산배열 다양성의 추정

서준교,도선길,성제경,현병화,오양석 한국실험동물학회 1998 한국실험동물학회 학술발표대회 논문집 Vol.1998 No.-

압축적 개발을 통한 도시재생에 대한 논쟁적 접근: 도시생활환경과 사회적 공평을 중심으로

서준교 한국거버넌스학회 2016 한국거버넌스학회보 Vol.23 No.1

The problems associated with urban sprawl have long been recognized. Particularly, as its major characteristics of unlimited outward extension of new development, it has evoked a variety of environmental and socioeconomic problems that have led to a threat to urban sustainability. In response to the problems of urban sprawl, compact urban development has been proposed. The main essence of compact urban development consists of high-dense development including the preservation of undeveloped green-field, the mixture of land uses, the provision of efficient urban transport systems, the proximity of various urban functions to increase social and economic interactions, and etc, which promote environmentally friendly urban development and socioeconomically efficient urban form that encourage urban sustainability. The idea of the compact urban development has increasingly been utilized the core strategies for urban regeneration in many cities of the world in recent years. However, it is doubted that the main characteristics of the compact urban development, such as high-density and the mixture of land uses, would promote sustainable urban development. Particularly, the urban regeneration through the compact development tends to concentrate on the redevelopment of the central city areas, which could produce negative effects on urban living environment and social equity. In spite of economic efficiency, the compactness of development on the central city leads to the bustle of city life as the intensity of various urban functions in the limited space, which negatively affects the overall urban living condition. Moreover, the concentration of development potentials on the central city raises real estate and housing price in there that makes difficulties with access to the revitalized central city for lower-income households. As a result, the central city becomes a place for those affluent upper and middle classes who are able to bear the expanse that leads to the gentrification of the central city. Furthermore, as the concentration of redevelopment on the central city, the socioeconomic aspects of inner-city areas have further been depressed due to a lack of financial investment from both public and private bodies. This leads to the polarization between the central city and the inner-city in terms of development potentials, which divides the city into two cities. Overall, it seems that the urban regeneration through the compact development may not be seen as a way of achieving sustainable urban development. The purpose of this study is to examine the validity of the compact urban development, particularly the urban regeneration through the compact development, in terms of its impact on urban living environment and social equity. 도시의 외연적 확산은 도시규모를 외연적으로 팽창시키는 개발의 특징으로 인해 다양한 환경적 그리고사회경제적 문제를 불려와 도시의 지속가능성을 위협하는 요인으로 지목받고 있다. 최근 도시의 외연적확산으로 비롯된 문제에 대응하기 위한 개발방식으로 압축적 도시개발이 제시되고 있다. 압축적 도시개발의 핵심은 고밀의 혼합토지이용으로 자연녹지로의 개발억제를 통한 보존과 함께 대중교통 중심의 효율적인 도시교통시스템으로 다양한 도시기능 간 접근성 향상에 따른 사회 및 경제적 상호작용을 증진시키는 도시형태로의 개발을 통해 도시의 지속가능성을 촉진시키는 것이다. 이러한 압축적 도시개발은 세계의 여러도시에서 도시재생을 위한 중심전략으로 널리 활용되고 있다. 하지만, 압축적 도시개발의 핵심적 특징인고밀의 혼합토지개발로 도시의 지속가능성을 성취할 수 있는가에 대한 의문을 갖게 한다. 특히, 압축적 개발을 통한 도시재생은 도시중심부에 집중된 재개발을 중심으로 함에 따라 도시생활환경이나 사회적 공평에 부정적인 영향을 줄 수 있을 것으로 보고 있다. 즉, 도시중심부의 압축적 개발은 한정된 공간에 도시기능의 집중으로 도시의 혼잡성을 확대시킴으로써 도시의 전반적인 생활환경에 부정적인 영향을 줄 수밖에없다는 것이다. 여기에, 재개발의 도시중심부 집중은 부동산과 주택가격을 상승시켜 경제적으로 열악한저소득계층의 진입을 어렵게 만드는 원인이 되고 있다. 결과적으로, 도시중심부는 이러한 비용을 부담할수 있는 중상위 계층의 거주지로 탈바꿈하는 고급주택화로 이어지고 있다. 게다가, 도시중심부를 한정한도시재생은 부도심 지역의 사회경제적 낙후를 더욱 심화시킴으로써 도시의 공간적 분리와 양극화에 따른이원적 도시를 낳고 있다. 전체적으로, 압축적 개발의 도시재생은 도시의 지속가능성을 확보하는 지속가능한 개발로서의 한계를 갖고 있음을 지적한다. 본 연구는 압축적 도시개발의 유효성, 특히 압축적 개발의도시재생에 따른 도시생활환경과 사회적 공평에 미칠 영향을 집중적으로 분석하는 것을 목적으로 한다.

지방 국책사업의 갈등에 관한 연구 - 광주 아시아문화중심도시 조성사업의 국립아시아문화전당 건립을 중심으로 -

서준교 한국거버넌스학회 2009 한국거버넌스학회보 Vol.16 No.3

A national policy conducted in a particular local area would face with high possibilities of conflicts and complication as collision with various different interests in the matter. In order to implement the policy, such conflicts and complication should be solved by cooperating in Hub City of Asian Culture Project is an important national as well as local development project designed to make the city of Gwangju as an internationally known cultural city. The success or fail of the project would affect the future of Gwangju's development potential. However, from the beginning of the project, there has been severe conflict and complication between various interest groups in the construction of Asia Culture Complex. The conflict and complication has arisen as the lack of mutual cooperations between the related bodies, which makes difficulties with the establishment of local governance. This study attempts to evaluate the reasons for conflicts and complication in the construction of Asian Culture Complex by using previous studies on policies conducted in various local areas. 국책사업을 특정 지역을 중심으로 추진할 경우 다양한 이해관계의 충돌로 인한 갈등과 대립이 발생할 가능성이 높다. 이러한 잠재적 갈등과 대립을 해소하고 협력으로 나아갈 수 있다면 정책의 성공을 장담할 수 있을 것이다. 아시아문화중심도시 조성사업은 광주시를 국제적인 문화도시로 성장시키려는 야심찬 국책사업이다. 조성사업의 성공은 광주시의 전반적인 변화와 도시구조에 긍정적인 영향을 끼칠 가능성이 높은 중요한 사업임에도 불구하고, 초기단계인 국립아시아문화전당의 건립에서부터 대립과 갈등이 증폭되고 있다. 국립아시아문화전당 건립에서의 대립과 갈등은 정책의 추진에 있어 로컬거버넌스의 구축을 통한 주체간의 협력적 환경이 결여되었기 때문으로 보인다. 본 연구는 아시아문화중심도시 조성사업의 국립아시아문화전당 건립을 둘러싸고 발생하는 갈등과 대립의 원인을 파악하기 위해 선행연구에서 공통적으로 언급되고 있는 성공요인들이 (주체간의 관계성, 주민참여의 수준, 정책전달) 전당의 건립결정과정에서는 어떻게 전개되었는가를 분석하고자 한다.

Critical approaches to the Korean government’s social distancing measures as controversial responses to the COVID-19 pandemic

서준교 한국거버넌스학회 2022 한국거버넌스학회보 Vol.29 No.1

The outbreak of COVID-19 pandemic has caused a health-care emergency, which requires the urgent distribution of effective, affordable and well-timed care to the public. In dealing with the COVID-19 pandemic, some government responses have been more effective in terms of preventing, suppressing and reducing the virus than others. South Korea has regarded as a model for preventing the widespread of the COVID-19 pandemic effectively. South Korea has compressed the sudden increase of the disease by integrating testing, early isolation, the free treatment of infected cases, and also the search for possible infected cases through digital technologies without taking to lockdown measures. The most impressive preventive measure has been social distancing that has effectively mitigated the spread of the COVID-19 pandemic in Korea. However, though the Korean government’s responses to the COVID-19 pandemic and preventive measures, such as social distancing, have seemingly been very effective, they have affected differently among demographic groups in Korea economically as well as socially. The study attempts to illustrate the Korean government’s preventive responses and measures against the COVID-19 pandemic, particularly in terms of social distancing rules and guidelines. It considers not only those governmental actions, but also their effects on demographic groups in Korea.

지역별 임금불균형에 관한 연구

서준교,이성근 한국지역개발학회 2018 한국지역개발학회 학술대회 Vol.2018 No.6

본 연구는 소득양극화와 임금분배 악화현상이 지속적으로 심화되는 가운데, 그간의 연구의 대상이 전국단위이거나 내용이 임금불균형 결정요인에 국한된 것을 지적하며, 지역별 임금불균형 현황을 다양한 분석을 통해 살펴보고자하였다. 지역별 임금불균형을 분석하기 위해 통계청의 지역별고용조사 자료를 2013년부터 2017년까지 활용하였으며, 임금불균형분석은 지니계수, 10분위분배율, 10분위배율을 이용하였다. 분석결과, 모든 지역의 임금불균형이 매우 심각한 것으로 나타났다. 특히 세가지 분석 모두에서 최근 5년간 임금불균형이 증가와 감소를 반속하고 있어, 개선가능성을 발견할 수 없었다. 지역별 임금불균형은 대전이 타지역과 비교해 양호하고, 경북이 가장 심각한 것으로 나타났다. 한편 타지역과 비교해 양호한 것으로 나타난 대전도 임금불균형 수치가 심각한 것으로 나타나 이에 대한 개선이 시급하다.

Long-term oncologic outcomes after radical prostatectomy in clinically localized prostate cancer: 10-year follow-up in Korea

서준교,정재현,정창욱,이상은,이은식,구자현,김현회,곽철 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.3

Purpose: The clinical behavior of prostate cancer differs by race and ethnicity; however, data on the Korean population are scarce. We assessed the long-term oncologic outcomes of clinically localized prostate cancer after radical prostatectomy in Korean men. Materials and Methods: We analyzed 786 clinically localized prostate cancer patients who underwent radical prostatectomy, from June 1993 to June 2008. Kaplan–Meier survival curve analysis and log-rank test were used to assess the oncologic outcomes. Results: The mean age of the patients was 64.9±6.6 years. Pelvic lymph node dissection was performed in 373 patients. Pathologic T and N stage cancer with local advancement and invasion were detected by radical prostatectomy in 307 and 22 patients, respectively. In total, 38 patients who underwent adjuvant therapy were excluded from the analysis of progression after biochemical recurrence (BCR), which occurred in 261 men. In total, 219 patients underwent salvage treatment. Local recurrence and distant metastasis occurred in 109 and 42 patients, respectively; 36 patients experienced metastasis with local recurrence. Castration-resistant prostate cancer developed in 22 patients, and overall and disease-specific mortality was noted in 148 and 23 patients, respectively. The median duration from operation to BCR, BCR to metastasis, and metastasis to disease-specific death was 25, 40, and 22 months, respectively. Conclusions: We demonstrated the long-term prognosis of localized prostate cancer after radical prostatectomy among Koreans. Our results differ from those reported in the Western literature, with a lower prevalence of distant metastasis and shorter time to metastasis after BCR.

Corrigendum: Correction of the Acknowledgment.Prevalence and management status of urologic disease in geriatric hospitals in South Korea: A population-based analysis

서준교,김계환,이상헌,김형석,이영주,이상림,정창욱 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.3

Targeted next-generation sequencing for locally advanced prostate cancer in the Korean population

서준교,정창욱,최성민,구자현,김현회,김광수,곽철 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.2

Purpose: This study aimed to evaluate the feasibility of pan-cancer panel analysis for locally advanced prostate cancer in the Korean population. Materials and Methods: We analyzed 20 patients with locally advanced prostate cancer who underwent radical prostatectomy. A pan-cancer panel (1.9 Mbp) developed by Seoul National University Hospital (SNUH), composed of 183 target genes, 23 fusion genes, and 45 drug target regions was used for this analysis. We compared the SNUH pan-cancer panel results with The Cancer Genome Atlas (TCGA) database to search for different mutations in the Korean population. Clinical data were analyzed with univariate and multivariate analysis, and p-values <0.05 were considered statistically significant. Kaplan–Meier curve and log-rank tests were performed to evaluate survival. Results: The average age of the patients and initial prostate-specific antigen values were 69.3±7.8 years and 66.3±16.9 ng/dL, respectively. Average sequencing depth was 574.5±304.1×. Ninety-nine genetic mutations and 5 fusions were detected. SPOP (25%), KMT2D (20%), and BRAF (15%) were frequently detected. ERG fusions were recurrently detected in 20% of the patients, with SLMAP and SETD4 as novel fusion partners. BRAF mutation was frequently detected in this study, but not in the TCGA database. Multivariate analysis showed BRAF mutation as an independent prognostic factor for biochemical recurrence (hazard ratio, 9.84; p=0.03). Conclusions: The pan-cancer panel comprising genes related to prostate cancer is a useful tool for evaluating genetic alterations in locally advanced prostate cancers. Our results suggest that the BRAF mutation is associated with biochemical recurrence in the Korean population.