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Chronic Low Dosing of Phosphodiesterase Type 5 Inhibitor for Erectile Dysfunction
성현환,이성원 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.6
Oral phosphodiesterase type 5 (PDE5) inhibitors have provided non-invasive, effective, and well-tolerated treatments for patients with erectile dysfunction (ED). However, many patients with ED are unresponsive to ‘on-demand’ PDE5 inhibitors. In addition, the lack of spontaneity and naturalness of the on-demand regimen could be a reason for decreased compliance with PDE5 inhibitors. Recently, tadalafil and udenafil were approved for low-dose daily administration for the treatment of ED. Since the introduction of the concept of daily administration of PDE5 inhibitors, several reports have supported the potential benefits of this therapy for disease modification, improvement of the treatment response in difficult-to-treat populations, spontaneity, and safety, although further research is needed to better address these hypotheses. In this article, we reviewed the daily administration of PDE5 inhibitors in terms of pharmacokinetics, safety, efficacy, and distinct features.
성현환,김하나,김률,김찬교,권기영,박원,송완,정병창,박세훈 대한비뇨의학회 2022 Investigative and Clinical Urology Vol.63 No.2
Purpose: To assess the safety and efficacy of gemcitabine and cisplatin as neoadjuvant chemotherapy followed by selective bladder preservation chemoradiotherapy in muscle-invasive bladder cancer (MIBC). Materials and Methods: Patients with clinical T2-T4aN0M0 MIBC eligible for radical cystectomy and cisplatin-based chemotherapy were treated with gemcitabine 1,000 mg/m2 on days 1, 8 and 15, and cisplatin 70 mg/m2 on day 1 every 28 days for 3 cycles. After clinical re-staging with computed tomography scans and cystoscopy, patients with clinical complete response (CR) were eligible to proceed without cystectomy and receive bladder preservation chemoradiotherapy involving weekly cisplatin 10 mg/m2 and up to 70.2 Gy of radiation. The primary endpoint of the present prospective phase II study was metastasis-free survival (MFS). Results: Between Oct 2017 and Nov 2019, a total of 138 MIBC patients were enrolled and treated with neoadjuvant gemcitabine/cisplatin. Neoadjuvant chemotherapy was well-tolerated, with fatigue, nausea, and pruritus being the most commonly observed adverse events. After completion of planned neoadjuvant chemotherapy, 54 patients with a clinical CR and 10 patients who did not have CR but refused surgery received bladder preservation chemoradiotherapy. With a median follow-up duration of 34 months (95% confidence interval [CI], 32%–36%), the 3-year MFS rate in 64 chemoradiotherapy patients was calculated to be 70% (95% CI, 58%–82%). Conclusions: Neoadjuvant chemotherapy followed by selective bladder preservation chemoradiotherapy based on the clinical CR was feasible and efficacious in the treatment of MIBC.
성현환,주명수,김준철,김장환,이규성 대한배뇨장애요실금학회 2020 International Neurourology Journal Vol.24 No.2
Purpose: The aim of this study was to evaluate the efficacy and safety of naftopidil compared with tamsulosin in patients with neurogenic lower urinary tract dysfunction (LUTD). Methods: This study was conducted as an 8-week, active-controlled, stratified-randomized, double-blind, double-dummy, parallel group, noninferiority, and multicenter clinical trial. After 2 weeks of screening, eligible subjects were randomly assigned to receive naftopidil (25 mg for 1 week followed by 75 mg for 7 weeks) or tamsulosin (0.2 mg for 8 weeks). Primary endpoint was a change of International Prostatic Symptom Score (IPSS) total score after 8 weeks of treatment. Results: One hundred ninety-four subjects with neurogenic LUTD were included into this trial. There were no differences between the 2 groups in baseline characteristics, including urodynamic study results, subtype of LUTD, pretreatment and concomitant medication, and causes of neurogenic bladder. The medication compliance rate was 94.0% (naftopidil, 93.6%; tamsulosin, 94.4%). There was a statistically significant decrease of IPSS total score at 8 weeks versus baseline in both the naftopidil (-5.64±0.66) and tamsulosin (-6.53±0.65) groups (P<0.0001 each). The mean difference between both groups was 0.89 (upper limit of 95% confidential interval, 2.72), which was lower than the noninferiority limit of 3 points. A subgroup analysis of neurologic lesions and sex found no mean difference of IPSS total score in each group. There was also no difference in safety profiles, including treatment emergent adverse events. Conclusions: Naftopidil was not inferior to tamsulosin as a therapeutic drug for patients with neurogenic LUTD and had a similar safety profile.
Laparoscopic Partial Nephrectomy Using a Water(Hydro)-Jet System: A Case Report
이신우,성현환,전황균,정병창,전성수,이현무,최한용,서성일 대한비뇨기종양학회 2015 대한비뇨기종양학회지 Vol.13 No.3
The water-jet system(WJS) can be used for selective dissection of kidney parenchyma without renal artery clamping in laparoscopic partial nephrectomy(LPN). We report our experiences regarding LPN with a WJS. The first case was a 59 year old male with a 1.8 cm solid mass in the Rt. mid-lateral area(R.E.N.A.L score: 5a). The second case was a 24 year old female with a 2.3cm solid mass in the Lt. mid-lateral area(R.E.N.A.L score: 7x). We successfully finished non-clamping LPN using a WJS without perioperative complications. Surgical margins were negative(7mm and 1mm for cases 1 and 2, respectively). Post-operative renal function was not decreased significantly. LPN using a WJS is a feasible and safe technique which can be performed for small renal masses without ischemic damage.
Optimal Management of Bacillus Calmette-Guérin–Refractory Non–Muscle-Invasive Bladder Cancer in 2023
유지웅,성현환 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.3
Bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, prompting a need for effective treatment options. Although radical cystectomy is a standard approach, it is burdened by high morbidity, mortality, and adverse effects on patients’ quality of life, necessitating the exploration of alternative bladder preservation strategies. This review presents a diverse range of bladder preservation options to improve outcomes in patients with BCG-unresponsive NMIBC. The interventions discussed include intravesical chemotherapy, device-assisted therapy, immunotherapy with checkpoint inhibitors, antibody-drug conjugates, intravesical gene therapy, and combinations of these treatments.
이상은,이학민,성현환,서성일,전성수,이현무,최한용,정병창 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.3
Purpose: We compared the staging ability and early complications of standard and extended pelvic lymph node dissection (sPLND and ePLND, respectively) in patients with localized bladder cancer during radical cystectomy. Materials and Methods: We prospectively collected and analyzed the data of 261 patients who underwent radical cystectomy for localized bladder cancer. The resected lymph nodes were categorized according to anatomic locations and were carefully inspected by an experienced pathologist. The perioperative complications were classified using the Clavien-Dindo classification system. Results: The 2 groups showed no significant differences in preoperative characteristics except for preoperative clinical stage (p=0.015). There were no significant differences in pathologic outcomes including pathologic stage, positive surgical margin, and lymphovascular invasion (all p>0.05), but the sPLND group showed a significantly higher cellular grade (p<0.001). The ePLND group showed a higher number of removed lymph nodes than the sPLND group (p=0.015) and a higher rate of positive lymph node invasion (35.8% vs. 28.9%). There were no significant differences in complication rates according to the extent of lymph dissection and urinary diversion type, respectively (p=0.063 and p=0.486). Conclusions: The ePLND showed more accurate nodal staging ability with comparable complication rates when compared to sPLND in patients who underwent radical cystectomy for localized bladder cancer. A further, larger prospective study is needed to confirm the result of the present study.
최중원,김태진,성현환,전황균,정병창,전성수,이현무,최한용,강민용,서성일 대한비뇨기종양학회 2019 대한비뇨기종양학회지 Vol.17 No.3
Purpose: To determine whether systemic inflammatory response (SIR), particularly platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), has different prognostic role between patients with metastatic renal cell carcinoma (mRCC) receiving first-line tyrosine kinase inhibitors (TKI). Materials and Methods: We retrospectively reviewed 547 patients with mRCC who were diagnosed and treated with a first-line TKI between 2007 and 2015. The primary endpoint was overall survival (OS) and secondary endpoint was progression-free survival (PFS). We evaluated differences in survival outcomes according to SIR and identified predictors of OS and PFS. Results: In synchronous mRCC, patients with a higher PLR had significantly worse OS and PFS. Moreover, a higher NLR was also associated with both worse OS and PFS in these patients. However, PLR was not associated with either OS or PFS in metachronous mRCC patients. While metachronous mRCC patients with a higher NLR had worse OS compared to those with lower NLR, there was no difference in PFS according to the status of NLR. On multivariate analysis, PLR was identified as predictive factor for OS (hazard ratio [HR], 1.55) as well as PFS (HR, 1.39) in patients with synchronous mRCC, but not in patients with metachronous mRCC. Additionally, higher NLR was also remained as predictive factor of both OS (HR, 1.83) and PFS (HR, 1.57) in patients with synchronous mRCC. Conclusions: Our study indicates that simple biomarkers of SIR, particularly PLR and NLR, can be more useful predictors of survival outcomes in patients with synchronous mRCC rather than metachronous mRCC.