Efficacy, Tolerability, and Safety of Oxybutynin Chloride in Pediatric Neurogenic Bladder With Spinal Dysraphism: A Retrospective, Multicenter, Observational Study

Lee, Jung Hoon,Kim, Kyoung Rok,Lee, Yong Seung,Han, Sang Won,Kim, Kun Suk,Song, Sang Hoon,Baek, Minki,Park, Kwanjin The Korean Urological Association 2014 Korean Journal of Urology Vol.55 No.12

<P><B>Purpose</B></P><P>Anticholinergics are a key element in treating neurogenic detrusor overactivity, but only limited data are available in the pediatric population, thus limiting the application to children even for oxybutynin chloride (OC), a prototype drug. This retrospective study was designed to provide data regarding the efficacy, tolerability, and safety of OC in the pediatric population (0-15 years old) with spinal dysraphism (SD).</P><P><B>Materials and Methods</B></P><P>Records relevant to OC use for neurogenic bladder were gathered and scrutinized from four specialized clinics for pediatric urology. The primary efficacy outcomes were maximal cystometric capacity (MCC) and end filling pressure (EFP). Data on tolerability, compliance, and adverse events (AEs) were also analyzed.</P><P><B>Results</B></P><P>Of the 121 patient records analyzed, 41 patients (34%) received OC at less than 5 years of age. The range of prescribed doses varied from 3 to 24 mg/d. The median treatment duration was 19 months (range, 0.3-111 months). Significant improvement of both primary efficacy outcomes was noted following OC treatment. MCC increased about 8% even after adjustment for age-related increases in MCC. Likewise, mean EFP was reduced from 33 to 21 cm H<SUB>2</SUB>O. More than 80% of patients showed compliance above 70%, and approximately 50% of patients used OC for more than 1 year. No serious AEs were reported; constipation and facial flushing consisted of the major AEs.</P><P><B>Conclusions</B></P><P>OC is safe and efficacious in treating pediatric neurogenic bladder associated with SD. The drug is also tolerable and the safety profile suggests that adjustment of dosage for age may not be strictly observed.</P>

Treatment of Bladder Dysfunction Using Stem Cell or Tissue Engineering Technique

Kim, Jae Heon,Lee, Hong Jun,Song, Yun Seob The Korean Urological Association 2014 Korean Journal of Urology Vol.55 No.4

<P>Tissue engineering and stem cell transplantation are two important options that may help overcome limitations in the current treatment strategy for bladder dysfunction. Stem cell therapy holds great promise for treating pathophysiology, as well as for urological tissue engineering and regeneration. To date, stem cell therapy in urology has mainly focused on oncology and erectile dysfunction. The therapeutic potency of stem cells (SCs) was originally thought to derive from their ability to differentiate into various cell types including smooth muscle. The main mechanisms of SCs in reconstituting or restoring bladder function are migration, differentiation, and paracrine effects. Nowadays, paracrine effects of stem cells are thought to be more prominent because of their stimulating effects on stem cells and adjacent cells. Studies of stem cell therapy for bladder dysfunction have been limited to experimental models and have been less focused on tissue engineering for bladder regeneration. Bladder outlet obstruction is a representative model. Adipose-derived stem cells, bone marrow stem cells (BMSCs), and skeletal muscle-derived stem cells or muscle precursor cells are used for transplantation to treat bladder dysfunction. The aim of this study is to review stem cell therapy and updated tissue regeneration as treatments for bladder dysfunction and to provide the current status of stem cell therapy and tissue engineering for bladder dysfunction including its mechanisms and limitations.</P>

The Clinical Significance of a Retroaortic Left Renal Vein

Nam, Jong Kil,Park, Sung Woo,Lee, Sang Don,Chung, Moon Kee The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.4

<P><B>Purpose</B></P><P>A retroaortic left renal vein (RLRV) is located between the aorta and the vertebra and drains into the inferior vena cava. Urological symptoms can be caused by increased pressure in the renal vein. To evaluate the clinical importance of RLRV, we reviewed patients' medical records and radiologic findings.</P><P><B>Materials and Methods</B></P><P>Nine patients who were studied with multidetector computed tomography at our institution from January 2003 to December 2009 had urologic symptoms with RLRV. We retrospectively reviewed these patients' medical records and analyzed their clinical characteristics.</P><P><B>Results</B></P><P>The patients' mean age was 46.0±20.1 years (range, 17-65 years) and the male to female ratio was 5 to 4. The urologic symptoms of the initial diagnosis were various (hematuria: 5 of the 9 patients; left flank pain: 4 of the 9 patients; inguinal pain: 1 of the 5 male patients; and gross hematuria: 1 of the 9 patients). The distribution among the type I, II, III, and IV of RLRV was 6, 2, 1, and 0 patients, respectively. The concomitant diseases were ureteropelvic junction obstruction (UPJO; 2 of the 9 patients) and varicocele (2 of the 5 male patients). One patient with UPJO underwent pyeloplasty and the other patient with UPJO underwent nephrectomy due to a nonfunctional atrophied kidney. The microscopic hematuria was not resolved with conservative management for long-term follow-up.</P><P><B>Conclusions</B></P><P>Hematuria and inguinal or flank pain seem to be common in patients with RLRV. The most common type of RLRV was type I. It appeared that the microscopic hematuria continued in the long-term follow-up.</P>

The establishment of KORCC (KOrean Renal Cell Carcinoma) database

Byun, Seok-Soo,Hong, Sung Kyu,Lee, Sangchul,Kook, Ha Rim,Lee, Eunsik,Kim, Hyeon Hoe,Kwak, Cheol,Ku, Ja Hyeon,Jeong, Chang Wook,Lee, Ji Youl,Hong, Sung Hoo,Kim, Yong-June,Hwang, Eu Chang,Kwon, Tae Gyun The Korean Urological Association 2016 Investigative and Clinical Urology Vol.48 No.6

<P><B>Purpose</B></P><P>The purpose of this article is to report establishment of the 1st Web-based database (DB) system to collect renal cell carcinoma (RCC) data in Korea.</P><P><B>Materials and Methods</B></P><P>The new Web-based DB system was established to collect basic demographic and clinicopahtological characteristics of a large cohort of patients with RCC in Korea. Data from a total of 6,849 patients were collected from 8 tertiary care hospitals that agreed to participate in organizing the Korean Renal Cell Carcinoma (KORCC) study group as of 1 July 2015. Basic demographic and clinicopathological characteristics were collected. The data of patients who underwent surgical treatments were analyzed to characterize Korean RCC.</P><P><B>Results</B></P><P>We established the 1st Web-based DB of Korean RCC, a database comprising renal mass management cases from multiple centers in Korea. The data of 5,281 patients who underwent surgical management (mean follow-up, 32 months) were analyzed. The most common symptom was incidentally detected renal mass (76.9%). Clinical T1a was the most common (54.3%) stage and mean tumor size was 4.8±4.2 cm. Radical nephrectomy accounted for 62.7% of cases and an open approach was used in 50.7% and 52.2% of radical and partial nephrectomies, respectively. The 5-year overall, cancer-specific and recurrence-free survival rates were 88.1%, 92.2%, and 88.0%, respectively.</P><P><B>Conclusions</B></P><P>We report the 1st establishment of a Web-based DB system to collect RCC data in Korea. This DB system will provide a solid basis for the characterization of Korean RCC.</P>

Prevalence and Treatment Efficacy of Genitourinary Mycoplasmas in Women with Overactive Bladder Symptoms

Lee, Young-Suk,Kim, Ji-Yoon,Kim, Joon Chul,Park, Won Hee,Choo, Myung-Soo,Lee, Kyu-Sung The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.9

<P><B>Purpose</B></P><P>To evaluate the incidence of genitourinary mycoplasmas and the efficacy of antibiotics in women with overactive bladder (OAB) symptoms.</P><P><B>Materials and Methods</B></P><P>Women with OAB symptoms (micturition ≥8/24 hours and urgency ≥1/24 hours) for ≥3 months were screened for <I>Mycoplasma hominis</I> (<I>M. hominis</I>), <I>Ureaplasma urealyticum</I> (<I>U. urealyticum</I>), and <I>Chlamydia trachomatis</I> (<I>C. trachomatis</I>). Specimens from urethral and cervical vaginal swabs were examined for <I>M. hominis</I> and <I>U. urealyticum</I> by using the Mycoplasma IST2 kit and for <I>C. trachomatis</I> by using PCR. Women with positive results were treated with a 1 g dose of azithromycin. Persistent infection was treated with doxycycline. Changes in a 3-day bladder diary, Patient Perception of Bladder Condition (PPBC), and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) were evaluated 4 weeks after negative conversion. Patient satisfaction was assessed.</P><P><B>Results</B></P><P>Of 84 women screened, 42.8% were positive (<I>U. urealyticum</I>, 40.5%; <I>M. hominis</I>, 7.1%; <I>C. trachomatis</I>, 3.6%; two organisms, 8.3%). After treatment, 82.7% obtained negative conversion, and their median number of micturition episodes decreased from 10.6/24 hours to 8.1/24 hours (p=0.002). PPBC and domain scores of the ICIQ-FLUTS (filling and quality of life) significantly improved. About 87.5% women with negative conversion were satisfied with the treatment.</P><P><B>Conclusions</B></P><P>Considering diagnostic tests and treatment for genitourinary mycoplasmas might be beneficial before invasive workup or treatment in women with OAB symptoms.</P>

Prediction of Perineural Invasion and Its Prognostic Value in Patients with Prostate Cancer

Lee, Jun Taik,Lee, Seungsoo,Yun, Chang Jin,Jeon, Byung Joo,Kim, Jung Man,Ha, Hong Koo,Lee, Wan,Chung, Moon Kee The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.11

<P><B>Purpose</B></P><P>The prognostic significance of perineural invasion by prostate cancer is debated. We investigated the association between perineural invasion and clinicopathological factors and the effect of perineural invasion on survival in patients with prostate cancer.</P><P><B>Materials and Methods</B></P><P>A total of 361 patients with prostate cancer without any neoadjuvant therapies prior to surgery from 1999 to 2010 were analyzed retrospectively. Whole-mount sections of surgical specimens from all patients who underwent radical prostatectomy were evaluated. Positive perineural invasion was defined as infiltration of cancer cells in the perineurium or neural fascicles. The relationship of perineural invasion with clinicopathological features and prognosis of prostate cancer was studied. We also researched preoperative factors that were associated with perineural invasion.</P><P><B>Results</B></P><P>Perineural invasion in a prostatectomy specimen (PNIp) was positive in 188 of 361 patients (52.1%). In the multivariate analysis of the preoperative variables, PNIp was related to the primary Gleason grade (p=0.020), the number of positive cores (p=0.008), and the percentage of tumor cells in positive cores (p=0.021), but not to perineural invasion of a prostate biopsy. In the evaluation between PNIp and pathologic findings of the prostatectomy specimen, PNIp was related to the Gleason score (p=0.010), T-stage (p=0.015), and lymphovascular invasion (p=0.019). However, by multivariate analysis, the PNIp was not an independent prognostic factor of biochemical serum recurrence (p=0.364) or cancer-specific survival (p=0.726).</P><P><B>Conclusions</B></P><P>PNIp was significantly related to biologically aggressive tumor patterns but was not a prognostic factor for biochemical serum PSA recurrence or cancer-specific survival in patients with prostate cancer.</P>

Changes in Aquaporin 1 Expression in Rat Urinary Bladder after Partial Bladder Outlet Obstruction: Preliminary Report

Kim, Sun-Ouck,Song, Seung Hee,Ahn, Kuyoun,Kwon, Dongdeuk,Park, Kwangsung,Ryu, Soo Bang The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.4

<P><B>Purpose</B></P><P>Aquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. AQPs are also called water channels, and they have recently been reported to be expressed in rat and human urothelium. The purposes of this study were to investigate the effect of bladder outlet obstruction (BOO) on the rat urothelium and AQP1 expression in rat urothelium.</P><P><B>Materials and Methods</B></P><P>Female Sprague-Dawley rats (230-240 g each, n=20) were divided into 2 groups: the sham group (the Con group, n=10) and the partial BOO group (the BOO group, n=10). The BOO group underwent a partial BOO. The expression and cellular localization of AQP1 were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder.</P><P><B>Results</B></P><P>AQP1 immunoreactivity in both the control and the BOO groups was localized in the capillaries, arterioles, and venules of the lamina propria of the urinary bladder. The protein expression of AQP1 was significantly increased in the BOO group.</P><P><B>Conclusions</B></P><P>This study showed that BOO causes a significant increase in the expression of AQP1. This may imply that AQP1 has a functional role in the detrusor instability that occurs in association with BOO.</P>

The Establishment of Dendritic Cell-Tumor Fusion Vaccines for Hormone Refractory Prostate Cancer Cell

Kim, Tae-Beom,Park, Ho Ki,Chang, Joo Hyun,Choi, In Ho,Kim, Khae Hawn,Yoon, Sang Jin,Lee, Min Sung,Jung, Han,Kim, Choung-Soo The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.2

<P><B>Purpose</B></P><P>Dendritic cell (DC)-based tumor vaccine is an attractive modality for the treatment of hormone-refractory prostate cancer (HRPC) because it has some efficacy and few side effects in patients with poor general conditions. The aim of this study was to establish which is the most effective DC vaccine for the treatment of HRPC. We compared DC vaccine sensitized with tumor lysate and a fusion vaccine of DCs and tumor cells.</P><P><B>Materials and Methods</B></P><P>The DU145 cancer cell line was purchased from the American Type Culture Collection. DCs were cultured from peripheral blood monocytes. Peripheral blood monocytes were cultured in RPMI 1640 medium supplemented with interleukin-4 (IL-4), granulocyte-macrophage colony-stimulating factor, and 10% fetal calf serum. Tumor necrosis factor-alpha was added on day 7 to support maturation. Functional activity was measured in three groups: the DC single-culture group, the DC culture group with DC vaccine sensitized with tumor lysates, and the DC culture group prepared with tumor fusion vaccine made from irradiated tumor cells and monocyte-derived DCs by the polyethylene glycol method.</P><P><B>Results</B></P><P>By FACS analysis, the rate of DC-tumor fusion vaccine was 20.3±3%. The IL-12 level produced by the DC-tumor fusion vaccine was significantly higher than that of DCs pulsed with tumor lysate (p<0.05). Also, the generation of interferon-γ by tumor-specific T cells in the DC-tumor fusion vaccine group was superior to that of DCs pulsed with tumor lysate (p<0.05). In addition, the T cells of the tumor lysate-pulsed DCs and tumor fusion vaccine had 1.6 and 2.5 times the functional activity, respectively, of the DC single-culture group in killing tumor cells in the cytotoxicity assay.</P><P><B>Conclusions</B></P><P>The DC-tumor fusion vaccine seems to be more effective than DC single-culture or DC-tumor lysate vaccine in the treatment of HRPC.</P>

Reactive Oxygen Species in the Internal Spermatic and Brachial Veins of Patients with Varicocele-Induced Infertility

Yoon, Chang Jin,Park, Hyun Jun,Park, Nam Cheol The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.5

<P><B>Purpose</B></P><P>The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility.</P><P><B>Materials and Methods</B></P><P>Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared.</P><P><B>Results</B></P><P>The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels.</P><P><B>Conclusions</B></P><P>Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.</P>

Preoperative Clinical and Pathological Characteristics of pT0 Prostate Cancer in Radical Prostatectomy

Park, Junsoo,Jeong, In Gab,Bang, Jeong Kyoon,Cho, Young Mee,Ro, Jae Y.,Hong, Jun Hyuk,Ahn, Hanjong,Kim, Choung-Soo The Korean Urological Association 2010 Korean Journal of Urology Vol.51 No.6

<P><B>Purpose</B></P><P>To analyze the preoperative clinical and pathological characteristics of patients with pT0 prostate cancer.</P><P><B>Materials and Methods</B></P><P>We retrospectively reviewed the records of 702 patients who underwent radical prostatectomy (RP) at our institution between January 2004 and July 2008 for clinically localized prostate cancer. If there was no evidence of residual tumor in the pathological specimen of the prostate, a patient was staged as pT0. Patients with pT0 disease were compared with a control group of patients who were operated on during the same period.</P><P><B>Results</B></P><P>Overall, 9 (1.3%) patients were staged as pT0 on the pathologic examination. Significant differences were observed between the pT0 group and the control patients in the biopsy Gleason score (p=0.004), the number of positive cores on biopsy (p=0.018), the tumor length of positive cores (p<0.001), and prostate volume (p=0.015). Cutoff values predictive of pT0 tumor status were defined as a biopsy Gleason score sum ≤6, 2 or fewer positive biopsy cores, tumor length on biopsy ≤2 mm, and prostate volume >30 cm<SUP>3</SUP>. Whereas 8 of the 9 (88.9%) pT0 patients showed all of these characteristics, only 55 of the 693 (7.9%) control patients fulfilled the criteria. The combination suggested above afforded a sensitivity of 88.8% and a specificity of 92.1% for the prediction of pT0 status.</P><P><B>Conclusions</B></P><P>The frequency of pT0 prostate cancer seen on RP was 1.3%. A combination of clinicopathological features, incorporating a biopsy Gleason score, the number of positive biopsy cores, tumor length on biopsy, and prostate volume, was useful to predict pT0 stage on RP.</P>