Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?

Jeonghyouk Choi,Taesoo Choi,이동기,민경은,이형래,유구한 대한요로생식기감염학회 2019 Urogenital Tract Infection Vol.14 No.3

Purpose: This study compared the clinical benefits of double J (DJ) ureteral stenting with percutaneous nephrostomy (PCN) for the management of acute pyelone-phritis (APN) with complicated ureteral stones.Materials and Methods: The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also anal-yzed.Results: In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate com-plications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V). Urologists preferred PCN to DJ stenting in cases with an elevated serum creatinine level (p=0.001) and higher C-reactive protein (CRP) level (p<0.001). The indicative parameters for renal injury and septic conditions (white blood cell count, segment neutrophil, and creatinine levels) tended to show immediate improvement, whereas CRP did not; however, the differences in markers were not significant (p=0.701, 0.962, 0.288, and 0.360, respectively).Conclusions: Both DJ stenting and PCN were safe and feasible methods for the management of complicated APN. With experienced urologists or radiologists, there may be little danger of prolonged renal failure or other procedure-related complications.

Male Human Papilloma Virus Infections: How to Prepare for Vaccination Strategies

Jeonghyouk Choi,Koo Han Yoo 대한요로생식기감염학회 2024 Urogenital Tract Infection Vol.19 No.1

Human papillomavirus (HPV) infections are linked to benign and malignant urogenital conditions, with varying risks associated with different HPV genotypes. Genital warts, mainly caused by low-risk HPV types, have seen a recent surge in incidence, leading to escalating medical costs. While vaccines like Cervarix and Gardasil target females, the exclusion of Gardasil 9 raises questions about gender-neutral vaccination strategies. Studies highlight potential cost savings through male HPV vaccination but note the rising prices of HPV vaccines, particularly Gardasil 9. Recent findings underscore HPV's expansion into nasopharyngeal cancer, urging the introduction of male HPV vaccination programs. However, the increasing vaccine costs raise concerns about accessibility and affordability. Regulatory bodies and healthcare stakeholders must address these challenges to ensure equitable HPV prevention and control measures. Efforts to control vaccine pricing and promote comprehensive immunization strategies are crucial in mitigating the growing burden of HPV-related diseases.

Differences between Risk Factors for Sepsis and Septic Shock in Obstructive Urolithiasis

이상협,최태수,Jeonghyouk Choi,유구한 대한의학회 2020 Journal of Korean medical science Vol.35 No.43

Background: Complicated acute pyelonephritis (APN) is a life-threatening condition that requires immediate intervention. This study examined the characteristics of APN occurring as a complication of ureteral stone. Methods: We retrospectively reviewed 85 patients diagnosed with APN complicated by ureteral stone between December 2006 and July 2017 at our institution. Patients with concomitant renal stone, multiple ureteral stones, ureteral strictures, ureteral cancer, and urogenital anomalies, including vesicoureteral reflux were excluded. Clinical characteristics including age, sex, underlying disease, medical history, stone characteristics, initial laboratory data, and the procedure used to correct urinary obstruction were summarized, and the risk factors associated with sepsis and septic shock were analyzed. Results: Sepsis was diagnosed at initial presentation in 62 patients, 17 of whom suffered from septic shock. Disease-related death did not occur in any patient. Previous history of stone (P = 0.015), leukocytosis (P < 0.001), elevated C-reactive protein levels (P = 0.006), and low albumin (P = 0.038) were significant risk factors for progression to sepsis. The absence of hypertension (P = 0.047), thrombocytopenia (P = 0.006), decreased erythrocyte sedimentation rate (ESR) (P = 0.003), elevated blood urea nitrogen (P = 0.016), and positive blood culture (P = 0.018) were significant predictors for progression to septic shock. Multivariate analysis revealed that previous history of stone (P = 0.015) was an independent risk factor for sepsis, while the absence of hypertension (P = 0.047), thrombocytopenia (P = 0.013), and decreased ESR (P = 0.009) were risk factors for shock. Conclusion: The risk factors associated with the progression from APN to sepsis differed from those associated with the progression from sepsis to septic shock. Various factors should be considered while selecting treatment options based on the severity of APN associated with ureteral stone. It should be managed with aggressive treatment and close observation, especially in the presence of risk factors.

투명세포신세포암에서 NF-κB의 발현과 임상병리인자에 관한 분석

이영(Young Lee),최정혁(Jeonghyouk Choi),이동기(Dong-Gi Lee),유구한(Koo Han Yoo),민경은(Gyeong Eun Min),이형래(Hyung-Lae Lee),원규연(Kyu Yeoun Won),임성직(Sung-Jig Lim) 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.2

Purpose: A multi-subunit transcription factor NF-κB is associated with anti-apoptotic signals in several cancers including renal cell carcinoma (RCC). In this study, we investigated whether the expression levels of the NF-κB were related to the clinical properties of human renal cell carcinoma such as nuclear grade, TNM stage, and recurrence free survival. Materials and Methods: Patients who were diagnosed with clear cell RCC between January 2006 and February 2013 were included. Clinicopathological data and survival were investigated. The expressions of NF-κB were investigated by performing immunohistochemical staining on 61 clear cell RCC. The expression levels of NF-κB were divided two groups by the expression levels. Results: Results on the expression of NF-κB were not significant. Analysis of NF-κB expressions is not associated with any of the clinical properties including age, nuclear grade and TNM stage (p=0.613, p=0.059, p=0.107, p=0.570, and p=0.760, respectively). Also, a statistically correlation was not observed between recurrence free survival and NF-κB expression levels (p=0.573). Conclusions: The expressions of the NF-κB were not associated with the clinical properties of clear cell RCC such as age, nuclear grade, TNM stage, and recurrence free survival.

Risk Factors for Sepsis after Retrograde Intrarenal Surgery: Single Center Experience

Kang Jinseok,Yoo Koo Han,Choi Taesoo,Min Gyeong Eun,Lee Dong-Gi,Lee Hyung-Lae,Choi Jeonghyouk 대한요로생식기감염학회 2023 Urogenital Tract Infection Vol.18 No.3

Purpose: To evaluate risk factors for sepsis after retrograde intrarenal surgery for treatment of renal stones. Materials and Methods: We analyzed the clinical data of 243 patients with kidney stones who visited our institution between April 2017 and April 2023. Age, sex, body mass index, underlying disease, location and size of stones, previous history of stones, previous history of urinary tract infections, duration of surgery, preoperative drainage, application of ureteral balloon dilation, and laboratory test results were included in the analysis. Results: The mean age of the patients was 58.4 (±15.0) years; there were more men (53.1%) than women (46.9%). Of the 243 patients, the overall rate of sepsis was 5.8% (n=14) and the total mortality rate was 0.4% (n=1). In univariate analysis, history of urinary tract infection (p=0.019), positive preoperative urine culture test (p=0.009), operative duration of more than 90 min (p=0.004), and application of ureter balloon dilation (p=0.016) were statistically significant. In multivariate analysis, positive finding in the urine culture test performed before surgery (p=0.003), operation duration >90 min (p=0.005), and use of balloon dilation during surgery (p=0.011) were statistically significant. Conclusions: There is a risk of progression to postoperative sepsis if bacteria are detected in the urine culture before surgery, if the operative time exceeds 90 min, or if balloon dilation is performed during surgery. Given that the probability of progression to sepsis is approximately 6%, close observation and active treatment are needed for patients with these risk factors.