전립선암의 방사선치료시 방광 부피가 비뇨기계 부작용에 미치는 영향

이지혜(Jihae Lee),서현숙(HyunSuk Suh),이경자(Kyung-ja Lee),이레나(Rena Lee),김명수(Myungsoo Kim) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.4

목 적: 국소적 전립선암에 대한 근치적 목적의 방사선치료시 3차원 입체조형방사선치료(3-dimensional conformal radiotherapy, 3DCRT) 또는 세기조절방사선치료(intensity modulated radiotherapy, IMRT)를 시행하면 직장의 부작 용이 현저히 감소하지만 비뇨기계 부작용의 발생률은 감소하지 않는다. 방사선 치료로 인한 급성 비뇨기계 부작용 은 환자의 삶의 질을 저하시킬 뿐 아니라 만성 비뇨기계 부작용의 발생을 증가시킨다. 따라서 비뇨기계 부작용을 줄이기 위해 방광을 채운 상태에서 방사선치료를 하는 방법이 제안되었는데 이 경우 방사선 조사야에 포함되는 방 광의 면적이 줄어들어 부작용이 감소한다고 알려져 있다. 본 연구에서는 전립선암의 방사선치료시 방광의 부피가 급성 비뇨기계 부작용에 미치는 영향에 대하여 알아보고자 한다. 대상 및 방법: 전립선암으로 근치적 목적의 방사선치료를 받은 환자 42명을 대상으로 하였으며 대조군과 실험군이 각각 21명씩 포함되었다. 대조군은 본 연구가 계획되기 전에 방광 조절을 하지 않고 방사선치료를 시행 받은 환자 중 무작위로 추출하였고, 실험군은 치료 1시간 전 450 ml의 물을 마셔 방광을 채운 상태에서 방사선치료를 받은 환자들이었다. 모의치료시 설계용 CT와 초음파를 이용하여 방광의 부피를 측정하였고, 실험군에서는 방사선 치료 기간 동안 초음파로 매주 방광의 부피를 측정하였다. 결 과: 모의치료시 초음파로 측정한 방광의 부피와 CT로 측정한 방광의 부피는 유의한 상관성을 보여(r=0.679) 방광 부피를 측정하는 데 있어 초음파의 정확성을 확인하였다. 실험군에서 같은 양의 물을 마셔도 방광의 부피는 환자에 따라 차이가 컸고(범위 22∼352 ml), 방사선치료 기간 동안 방광의 부피는 일정하게 유지되지 않았다. 그러나 모의치료시 방광의 부피가 컸던 환자는 치료기간 중에도 방광의 부피가 큰 경향을 보였다. 실험군의 방광 부피는 평균 299±155 mL이었고 대조군은 평균 187±155 ml로, 일정량의 물을 마시면 방광 조절을 하지 않았을 때보다 방광 부피가 유의하게 증가하였고(p=0.009), 실험군에서 급성 비뇨기계 부작용이 대조군보다 감소하였지만 통계적으로 유의하지는 않았다. 또한 방광의 부피가 클수록 부작용이 감소하는 경향을 보였고, 모의치료시 CT로 측정한 방광의 부피가 150 ml 이상이면 1등급과 2등급의 비뇨기계 부작용이 현저히 감소하였다(p=0.023). 치료 기간 중의 방광 부피에 따른 부작용 발생률은 통계적으로 유의한 변화를 보이지 않았으나 방광의 부피가 클수록 1등급 부작용이 감소하는 경향을 보였고, 100 ml 이상인 경우에는 모든 등급의 부작용이 감소하는 경향을 보였다.결 론: 방광을 채우고 방사선치료를 할 때 치료 기간 중 방광의 부피가 일정하게 유지되지 않았음에도 불구하고 방광 조절을 하지 않았을 때보다 비뇨기계 급성 부작용이 감소하는 경향을 보였고, 모의치료시 방광 부피가 150mL 이상인 경우 부작용은 현저히 감소하였다. 따라서 전립선암 환자에서 방사선치료를 할 때 방광을 채우는 것이 급성 비뇨기계 부작용을 줄이는 데 도움이 될 것으로 생각한다. Purpose: Three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) were found to reduce the incidence of acute and late rectal toxicity compared with conventional radiation therapy (RT), although acute and late urinary toxicities were not reduced significantly. Acute urinary toxicity, even at a low-grade, not only has an impact on a patient’s quality of life, but also can be used as a predictor for chronic urinary toxicity. With bladder filling, part of the bladder moves away from the adiation field, resulting in a small irradiated bladder volume; hence, urinary toxicity can be decreased. The purpose of this study is to evaluate the impact of bladder volume on acute urinary toxicity during RT in patients with prostate cancer. Materials and Methods: Forty two patients diagnosed with prostate cancer were treated by 3DCRT and of these, 21 patients made up a control group treated without any instruction to control the bladder volume. The remaining 21 patients in the experimental group were treated with a full bladder after drinking 450 mL of water an hour before treatment. We measured the bladder volume by CT and ultrasound at simulation to validate the accuracy of ultrasound. During the treatment period, we measured bladder volume weekly by ultrasound, for the experimental group, to evaluate the variation of the bladder volume. Results: A significant correlation between the bladder volume measured by CT and ultrasound was observed. The bladder volume in the experimental group varied with each patient despite drinking the same amount of water. Although weekly variations of the bladder volume were very high, larger initial CT volumes were associated with larger mean weekly bladder volumes. The mean bladder volume was 299±155 mL in the experimental group, as opposed to 187±155 mL in the control group. Patients in experimental group experienced less acute urinary toxicities than in control group, but the difference was not statistically significant. A trend of reduced toxicity was observed with the increase of CT bladder volume. In patients with bladder volumes greater than 150 mL at simulation, toxicity rates of all grades were significantly lower than in patients with bladder volume less than 150 mL. Also, patients with a mean bladder volume larger than 100 mL during treatment showed a slightly reduced Grade 1 urinary toxicity rate compared to patients with a mean bladder volume smaller than 100 mL. Conclusion: Despite the large variability in bladder volume during the treatment period, treating patients with a full bladder reduced acute urinary toxicities in patients with prostate cancer. We recommend that patients with prostate cancer undergo treatment with a full bladder.

신생쥐와 성숙쥐에 있어서 방광의 수동적 성질에 관한 비교 실험

하태준,오승준,최황 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.12

論文(론문) : 民火(민화)의 개념 및 膀胱氣化(방광기화)와의 상관성에 대한 연구

은석민 ( Seok Min Eun ) 대한한의학원전학회(구 대한원전의사학회) 2013 대한한의학원전학회지 Vol.26 No.4

Objective: Min fire(民火) is mentioned as a kind of fire that exists in human body, which rarely appears in traditional medical books. It was mainly mentioned as a fire in urinary bladder, and was referred to have some function in the process of qi transformation(氣化) in urinary bladder. As the concept of min fire was originated from the Taoist internal alchemy, this study will make a comparative research between the examples of min fire in medical theory and Taoist internal alchemy, and will find out the conceptual significance of min fire in medical theory. Method: Among traditional medical books, min fire appears in such books as Yixuerumen(醫學入門), Youyoujicheng(幼幼集成), Fengshijinnangmilu(馮氏錦囊秘錄), and also in some books of Taoist internal alchemy. Though rather brief and informal, they show us some information about the performance of min fire in human body. So based on the information about min fire that was acquired from those books, this study will apply the concept of min fire to the traditional dispute on the problem of qi transformation in urinary bladder. Result & Conclusion: The concept of min fire that is related to the problem of qi transformation in urinary bladder, shows well that qi transformation in urinary bladder produces not only urine but also the ascent of shuijing(水精). And it also shows well that min fire acts as a power for the qi transformation in urinary bladder, which would perform well in the cooperation with sovereign fire(君火). This can be presented as a theoretical basis that the power for the qi transformation in urinary bladder is basically prepared in urinary bladder itself.

Three-Dimensional Reconstruction of Neurovascular Network in Whole Mount Preparations and Thick-Cut Transverse Sections of Mouse Urinary Bladder

Nguyen Nhat Minh,Song Kang-Moon,Choi Min-Ji,Ghatak Kalyan,Limanjaya Anita,Kwon Mi-Hye,Chung Doo Yong,Ock Jiyeon,Yin Guo Nan,Park Chang-Shin,Suh Jun-Kyu,Ryu Ji-Kan 대한남성과학회 2021 The World Journal of Men's Health Vol.39 No.1

Purpose: Proper functional and structural integrity of nervous and vascular system in urinary bladder plays an important role in normal bladder function and the disruption of these structures is known to be related to lower urinary tract symptoms. Here, we present an immunohistochemical staining method that delineates neurovascular structures in the mouse urinary bladder by using immunohistochemical staining with three-dimensional reconstruction. Materials and Methods: The urinary bladder was harvested from 8-week-old C57BL/6 male mouse. Lamina propria and detrusor muscle layer were dissected for whole mount staining, and thick-cut (60-μm) sections were prepared for full-thickness bladder staining. Immunofluorescent staining of bladder tissue was performed with antibodies against CD31 (an endothelial cell marker), smooth muscle α-actin (a smooth muscle cell marker), NG2 (a pericyte marker), and βIII-tubulin (a neuronal marker). We reconstructed three-dimensional images of bladder neurovascular system from stacks of two-dimensional images. Results: Three-dimensional images obtained from thick-cut sections clearly provided good anatomic information about neurovascular structures in the three layers of bladder, such as urothelium, lamina propria, and detrusor muscle layer. Whole mount images of lamina propria and detrusor muscle layer also clearly delineated spatial relationship between nervous and vascular systems. The microvessel density was higher in the lamina propria than in the detrusor muscle layer. Nerve fibers were evenly innervated into the lamina propria and detrusor muscle. Conclusions: This study provides comprehensive insight into three-dimensional neurovascular structures of mouse urinary bladder. Our technique may constitute a standard tool to evaluate pathologic changes in a variety of urinary bladder diseases.

Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients: early experience of bladder volume assessment using ultrasound scanner

장지석,윤홍인,차혜정,정윤선,조예나,금기창,금웅섭 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: To describe the early experience of analyzing variations and time trends in bladder volume of the rectal cancer patients who received bladder ultrasound scan. Materials and Methods: We identified 20 consecutive rectal cancer patients who received whole pelvic radiotherapy (RT) and bladder ultrasound scan between February and April 2012. Before simulation and during the entire course of treatment, patients were scanned with portable automated ultrasonic bladder scanner, 5 times consecutively, and the median value was reported. Then a radiation oncologist contoured the bladder inner wall shown on simulation computed tomography (CT) and calculated its volume. Results: Before simulation, the median bladder volume measured using simulation CT and bladder ultrasound scan was 427 mL (range, 74 to 1,172 mL) and 417 mL (range, 147 to 1,245 mL), respectively. There was strong linear correlation (R = 0.93, p < 0.001) between the two results. During the course of treatment, there were wide variations in the bladder volume and every time, measurements were below the baseline with statistical significance (12/16). At 6 weeks after RT, the median volume was reduced by 59.3% to 175 mL. Compared to the baseline, bladder volume was reduced by 38% or 161 mL on average every week for 6 weeks. Conclusion: To our knowledge, this study is the first to prove that there are bladder volume variations and a reduction in bladder volume in rectal cancer patients. Moreover, our results will serve as the basis for implementation of bladder training to patients receiving RT with full bladder.

Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients

Jee Suk Chang,Hong In Yoon,Hye Jung Cha,Yoonsun Chung,Yeona Cho,Ki Chang Keum,Woong Sub Koom 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: To describe the early experience of analyzing variations and time trends in bladder volume of the rectal cancer patients who received bladder ultrasound scan. Materials and Methods: We identified 20 consecutive rectal cancer patients who received whole pelvic radiotherapy (RT) and bladder ultrasound scan between February and April 2012. Before simulation and during the entire course of treatment, patients were scanned with portable automated ultrasonic bladder scanner, 5 times consecutively, and the median value was reported. Then a radiation oncologist contoured the bladder inner wall shown on simulation computed tomography (CT) and calculated its volume. Results: Before simulation, the median bladder volume measured using simulation CT and bladder ultrasound scan was 427 mL (range, 74 to 1,172 mL) and 417 mL (range, 147 to 1,245 mL), respectively. There was strong linear correlation (R = 0.93, p < 0.001) between the two results. During the course of treatment, there were wide variations in the bladder volume and every time, measurements were below the baseline with statistical significance (12/16). At 6 weeks after RT, the median volume was reduced by 59.3% to 175 mL. Compared to the baseline, bladder volume was reduced by 38% or 161 mL on average every week for 6 weeks. Conclusion: To our knowledge, this study is the first to prove that there are bladder volume variations and a reduction in bladder volume in rectal cancer patients. Moreover, our results will serve as the basis for implementation of bladder training to patients receiving RT with full bladder.

신경탓 방광 환자에서의 회장을 이용한 Goodwin형 방광 확대술의 임상 경험

이주형,오철영,마상열 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.7

Purpose: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin’s ileal cup patched bladder. Materials and Methods: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. Results: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. Conclusions: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladders. Purpose: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin’s ileal cup patched bladder. Materials and Methods: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. Results: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. Conclusions: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladders.

Implantable Bladder Sensors: A Methodological Review

Mathias Naangmenkpeong Dakurah,구치완,최원석,정연호 대한배뇨장애요실금학회 2015 International Neurourology Journal Vol.19 No.3

The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient’s quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor.

성숙흰쥐와 비교한 신생흰쥐 방광에서의 능동적 방광근 수축 성질과 수동적 성질

오승준,이안기,김시황,김기환,김광명,최황 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.2

골반 골절 위치와 방광, 요도, 하부 위장관계 손상의 관련성

김창호 ( Chang Ho Kim ),박정배 ( Jung Bae Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),서준석 ( Jun Seok Seo ),정제명 ( Jae Myung Chung ),제동욱 ( Dong Wook Je ),성애진 ( Ae Jin Sung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher`s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts. (J Korean Soc Traumatol 2007;20:90-95)