Effect of Varicocelectomy on Male Infertility

조강수,서주태 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.11

Varicocele is the most common cause of male infertility and is generally correctableor at least improvable by various surgical and radiologic techniques. Therefore, it seemssimple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questionedduring the past decades. Although varicocele repair can induce improvementof semen quality, the obvious benefit of spontaneous pregnancy has not been shownthrough several meta-analyses. Recently, a well-designed randomized clinical trial wasintroduced, and, subsequently, a novel meta-analysis was published. The results ofthese studies advocate that varicocele repair be regarded as a standard treatment modalityin infertile men with clinical varicocele and abnormal semen parameters, whichis also supported by current clinical guidelines. Microsurgical varicocelectomy has beenregarded as the gold standard compared to other surgical techniques and radiologicalmanagement in terms of the recurrence rate and the pregnancy rate. However, noneof the methods has been proven through well-designed clinical trials to be superior tothe others in the ability to improve fertility. Accordingly, high-quality data fromwell-designed studies are needed to resolve unanswered questions and update currentknowledge. Upcoming trials should be designed to define the best technique and alsoto define how to select the best candidates who will benefit from varicocele repair.

저등급 관상 점액성 신장 종양 1례

조강수,한경석,임영재,주정민,조남훈,최영득 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.8

A low-grade tubular-mucinous renal neoplasm(LGTMRN) is a recently established renal tumor, which was thought to be of collecting duct origin. A 43-year-old man presented with acute abdominal pain and underwent abdominopelvic computed tomography(CT). The CT scan showed a 5cm sized low contrast attenuated homogeneous renal mass in the mid portion of the left kidney. A left radical nephrectomy was performed and the cut-section revealed a well-demarcated, homogeneous and dark-yellowish mass confined to the renal parenchyme, and a focal hemorrhage was also seen. A histological examination showed predominant tubular growth, with focal intraluminal and stromal mucin depositions and aggregates of foamy histiocytes. No infiltrative growth and significant nuclear atypia were found. These findings were compatible with a low-grade tubular-mucinous renal neoplasm. (Korean J Urol 2004;45:837-840)

Prognostic Impact of Peripelvic Fat Invasion in pT3 Renal Pelvic Transitional Cell Carcinoma

조강수,조남훈,Sung Yul Park,Sung Yong Cho,최영득,정병하,양승철,홍성준 대한의학회 2008 Journal of Korean medical science Vol.23 No.3

Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved.

근치적 전립선 적출술 후 절제 변연 양성이 생화학적 재발에 미치는 영향

조강수,홍성준,정병하 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.5

요막관암의 임상적 특성 및 예후

조강수,양원재,조남훈,양승철,홍성준,최영득 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.12

양측 방광근 외봉법을 이용한 방광요관역류 교정술 후의 배뇨장애

조강수,이혜영,한상원,전형진 대한비뇨의학회 2005 Investigative and Clinical Urology Vol.46 No.1

Purpose: We evaluated the incidence and duration of voiding dysfunction following bilateral detrusorrhaphy to correct vesicoureteral reflux(VUR), and we also evaluated the factors that influence the development of voiding dysfunction and recovery from voiding function. Materials and Methods: We performed a retrospective review on 36 children, 27 boys and 9 girls, who showed normal voiding function on preoperative video-urodynamic study and for whom data on post-void residual urine volume(PVR) were available postoperatively. The mean age and duration of follow-up were 3.1±2.6 years and 17.5±10.4 months, respectively. Postoperative voiding dysfunction included urinary retention and incomplete bladder emptying. Results: The overall success rate was 97.2%. The urethral catheter was kept in for a mean period of 4.0±3.6 days. After urethral catheter removal, postoperative voiding dysfunction developed in 24 children and urinary retention developed in 5 children. The differences in age, grade of VUR or sex did not have significant influence on the development of voiding dysfunction. 35 children achieved normal PVR during the postoperative follow-up. The mean time to recovery of voiding function was 34.1±37.9 days. The differences in age, sex or grade of VUR did not have any significant influence on the recovery rate of voiding function. The time to recovery of the voiding function was significantly longer in the patients aged less than 2 years or those patients with bilateral high-grade VUR. However, sex did not significantly influence the time to recovery of voiding function. Conclusions: The development of postoperative voiding dysfunction is frequent, but temporary. However, it is necessary to consider a longer period of catheterization for the group of patients aged less than 2 years or those patients with bilateral high grade VUR.

현장 속 논설위원들… 중앙일보의 실험은?

조강수 관훈클럽 2018 관훈저널 Vol.- No.149

호르몬 불응성 전립선암 환자에서 Epidermal Growth Factor Receptor와 HER-2 유전자의 역할

조강수,김동준,이중식,박경미,함원식,최영득,조남훈 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.1

Purpose: Amplification and mutation of the epidermal growth factor receptor(EGFR) and HER-2 genes were analyzed in the tissues of hormone refractory prostate cancer(HRPC) patients. Materials and Methods: Gene amplifications of the EGFR and HER-2 gene were analyzed by fluorescence in situ hybridization(FISH) with direct sequencing. Studies were performed on 10 patients; tissues were sampled at the time of initial diagnosis and after the conversion to HRPC(a total of 20 tissue samples). Direct sequencing was performed on exons 18-24 of the EGFR gene and exons 19 and 20 of the HER-2 gene. The amplifications and mutations were compared with the clinicopathologic features. Results: Gene amplification of the EGFR gene was observed in 6(30%) out of 20 samples. A total of six EGFR mutations in exons 18 and 19 were detected in three pairs of tissues(three patients). One patient with a hormone refractory status had a novel deletion mutation in EGFR exon 19. EGFR mutations were associated with the acinar type of prostate cancer, but they were not associated with the ductal type. No significant correlation was found between mutation change and the hormone sensitive or refractory status. However, the time to convert to HRPC was significantly shorter in the patients with a mutation in the EGFR gene (p=0.017). There were no HER-2 gene amplifications or mutations found in any of the samples. Conclusions: EGFR gene mutation and amplification occurred frequently in these advanced prostate cancer cases, but EGFR mutations do not appear to play a significant role in the hormone refractory pathway. However, EGFR gene mutation is closely associated with the time to convert to HRPC. (Korean J Urol 2008;49:24-30) Purpose: Amplification and mutation of the epidermal growth factor receptor(EGFR) and HER-2 genes were analyzed in the tissues of hormone refractory prostate cancer(HRPC) patients. Materials and Methods: Gene amplifications of the EGFR and HER-2 gene were analyzed by fluorescence in situ hybridization(FISH) with direct sequencing. Studies were performed on 10 patients; tissues were sampled at the time of initial diagnosis and after the conversion to HRPC(a total of 20 tissue samples). Direct sequencing was performed on exons 18-24 of the EGFR gene and exons 19 and 20 of the HER-2 gene. The amplifications and mutations were compared with the clinicopathologic features. Results: Gene amplification of the EGFR gene was observed in 6(30%) out of 20 samples. A total of six EGFR mutations in exons 18 and 19 were detected in three pairs of tissues(three patients). One patient with a hormone refractory status had a novel deletion mutation in EGFR exon 19. EGFR mutations were associated with the acinar type of prostate cancer, but they were not associated with the ductal type. No significant correlation was found between mutation change and the hormone sensitive or refractory status. However, the time to convert to HRPC was significantly shorter in the patients with a mutation in the EGFR gene (p=0.017). There were no HER-2 gene amplifications or mutations found in any of the samples. Conclusions: EGFR gene mutation and amplification occurred frequently in these advanced prostate cancer cases, but EGFR mutations do not appear to play a significant role in the hormone refractory pathway. However, EGFR gene mutation is closely associated with the time to convert to HRPC. (Korean J Urol 2008;49:24-30)

Identification of Enhancer of Zeste Homolog 2 Expression in Peripheral Circulating Tumor Cells in Metastatic Prostate Cancer Patients: A Preliminary Study

조강수,오혜영,이은진,홍성준 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.6

Purpose: Enhancer of zeste homolog 2 (EZH2), a kind of transcriptional repressor, is reportedly over-expressed in metastatic prostate cancer. In this study, we analyzed EZH2 mRNA in circulating tumor cells (CTCs) in peripheral blood as a biomarker in patients with metastatic prostate cancer. Patients and Methods: Ber-EP4 coated immunomagnetic beads were used to harvest CTCs, and mRNA was isolated by oligo- dT conjugated immunomagnetic beads. Reverse transcriptase- polymerase chain reaction for EZH2 mRNA was performed and the expression density was measured. The sensitivity of this test for detection of EZH2 mRNA was determined by serial dilutions of a human prostate cancer cell line. Blood samples were collected from 20 patients each with metastatic or localized prostate cancer and 10 healthy volunteers. Results: Sensitivity experiments showed that the test was highly sensitive as it could detect 10 tumor cells per 5mL. EZH2 mRNA expression was obtained from peripheral blood samples of patients and control subjects. EZH2 mRNA expression density in the metastatic prostate cancer group was significantly higher than in the control (p=0.023) and localized prostate cancer groups (p=0.019). There was no difference between the control and localized prostate cancer groups (p>0.05). Conclusion: EZH2 mRNA expression in circulating epithelial cells represents a promising marker for detecting early metastasis in prostate cancer. However, more specific and sensitive techniques for detection of CTCs are needed to avoid mononuclear cell contamination.

A Comprehensive Prognostic Stratification for Patients with Metastatic Renal Clear Cell Carcinoma

조강수,최영득,김세중,김천일,정병하,성도환,이동현,조진선,조인래,홍성준 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.3

Purpose: To develop a reliable prognostic model for patients with metastatic renal cell carcinoma (RCC) based on features readily available in common clinical settings. Patients and Methods: A total of 197 patients with RCC who underwent nephrectomy and immunotherapy from 1995 to 2004 were retrospectively reviewed. Their mean age was 55.1 ±11.8 yrs (24-83yrs) and mean survival time from metastasis was 22.6 ±20.2mos (3-120mos). The impact of 24 clinicopathological features on disease specific survival was investigated. Results: On univariate analysis, constitutional symptoms, sarcomatoid differentiation, tumor necrosis, multiple primary lesions, liver metastasis, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), thrombocytosis, alkaline phosphatase, hematocrit, T stage, N stage, and nuclear grade had significant influence on survival (p<0.05). Multivariate analysis revealed the following features associated with survival: sarcomatoid differentiation [hazard ratio (HR)=2.99, p<0.001], liver metastasis (HR=2.09, p= 0.002), ECOG-PS (HR=1.95, p= 0.005), N stage (HR=1.94, p=0.002), and number of metastatic sites (HR=1.76, p=0.003). An individual prognostic score was defined as the sum of the weight of these features. According to prognostic scores, patients could be subdivided into 3 groups: low risk (score 0), intermediate risk (score 1 or 2), and high risk (score ≥3). Conclusion: A comprehensive prognostic stratification model was developed to predict survival and stratify patients for prospective clinical trials.