PURPOSE:To characterize nationwide patterns of initial prostate cancer (PCa) management in Korea from 2010 to 2020, stratified by clinical stage, risk, and residential context. MATERIALS AND METHODS:We performed a secondary analysis of a chart-abstracted cohort from 51 general hospitals. Initial treatment was classified into ten mutually exclusive categories (active surveillance; surgery; surgery after androgen deprivation therapy [ADT]; radiotherapy; radiotherapy after ADT; docetaxel after ADT; androgen receptor-targeted agent [ARTA] after ADT; ADT-only ≥1 year; other active treatment; unknown). Localized disease (T1-T4N0M0) was stratified by risk (low, intermediate, and high). Residential context was coded as capital versus non-capital and urban versus rural. National Comprehensive Cancer Network risk stratification (version 2.2024) was applied uniformly across survey years. RESULTS:Among 27,075 men, initial management differed significantly by stage, risk, and residence. In localized disease, surgery predominated, active surveillance was most frequent in low-risk disease, and radiotherapy and ADT-only increased with higher risk (p<0.001). Over time, ADT-only decreased in metastatic disease, with increases in radiotherapy and systemic intensification (p=0.004). Capital and urban residence were associated with greater use of surgery in localized disease and systemic intensification in metastatic disease, whereas non-capital and rural residence relied more on ADT-only (all p<0.001). In multivariable analyses, residential context remained independently associated with treatment selection after adjustment for age, prostate-specific antigen, grade, and stage. CONCLUSIONS:Initial PCa management in Korea during the 2010s reflected contemporary adoption of surgical and systemic therapies but demonstrated persistent geographic variation, indicating residential context influences real-world access to guideline-concordant care.
PURPOSE:To evaluate the long-term outcomes and molecular correlates of response after immediate preoperative intravesical chemotherapy (IPeIC) with mitomycin-C (MMC) in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS:In this single-center, open-label, randomized phase II trial, 33 patients received two split doses of IPeIC/MMC (40 mg/20 mL), whereas 38 patients underwent transurethral resection of bladder tumor (TURBT) alone. The primary endpoint was 3-year recurrence-free survival (RFS), and secondary endpoints included progression-free survival (PFS). Exploratory RNA sequencing was performed on IPeIC-treated patients (three with recurrence, 25 without) using a Monte Carlo-based resampling strategy. RESULTS:The median follow-up durations were comparable between the intervention (60.0 months) and control arms (60.4 months). IPeIC/MMC reduced recurrence risk by 76.8% versus TURBT alone (p=0.024), yielding a 3-year RFS rate of 90.7% versus 78.6%. On multivariable analysis, IPeIC/MMC independently improved RFS (hazard ratio [HR] 0.266, p=0.044). IPeIC was associated with superior PFS, with 3-year and 5-year rates of 100% versus 92.1% and 85.8%, respectively, in the controls (HR 0.078, p=0.014). Exploratory transcriptomics identified low Glutathione S-transferase Mu 1 (GSTM1) expression as the factor most strongly associated with recurrence. CONCLUSIONS:IPeIC/MMC is associated with improved long-term oncological outcomes compared with TURBT alone and represents a safe prophylactic option for patients with NMIBC who are unable to receive standard immediate postoperative intravesical chemotherapy because of safety concerns or practical constraints. The GSTM1 findings are hypothesis-generating and support future biomarker-driven validation studies.
PURPOSE:Active surveillance (AS) is an established management strategy for favorable-risk prostate cancer (PCa). In real-world practice, decisions to continue AS or active treatment (AT) are influenced by both disease-related and patient-related factors. This study aimed to identify factors associated with the transition from AS to AT in a large multicenter cohort. MATERIALS AND METHODS:We analyzed 716 patients with PCa managed with AS across 12 institutions. Baseline clinical characteristics, comorbidity burden assessed via the Charlson comorbidity index (CCI), performance status evaluated using the Eastern Cooperative Oncology Group (ECOG) score, and disease-related factors, including prostate-specific antigen (PSA), PSA density (PSAD), and magnetic resonance imaging findings, were collected. Cox proportional hazards regression was used to identify factors associated with conversion to AT. RESULTS:During a mean follow-up of 28.4 months, 224 patients (31.3%) transitioned from AS to AT, most frequently because of pathologic reclassification (60.3%). In multivariate analysis, maximum core involvement (hazard ratio [HR] 1.015, p=0.003) and PSAD ≥0.10 ng/mL/cm³ (HR 1.478, p=0.044) were independently associated with conversion to AT. Although ECOG performance status and CCI were not statistically significant in multivariate models, patients with poorer functional status or greater comorbidity burden remained on AS rather than proceeding to AT. CONCLUSIONS:In this large multicenter study, PSAD was the strongest predictor of transition to AT during AS for PCa. Beyond disease-related factors, patient condition also appeared to influence real-world decisions about continuing AS.
Recurrent urinary tract infections (UTIs) are a significant global health burden, increasingly complicated by antibiotic resistance. Traditional approaches with antibiotics increase the risk of multidrug-resistant (MDR) strains, emphasizing the need for new non-antibiotic treatments. Several promising approaches have emerged during the last decade. Microbiome-based therapies, including probiotics, asymptomatic bacteriuria strains, and fecal microbiota transplantation, aim to restore microbial balance. Immunomodulation, through cytokine targeting and bacterial vaccines, shows potential for boosting host defenses. Bacteriophage therapy offers precision targeting of MDR pathogens and biofilms. Nanoparticles enable targeted delivery and biofilm disruption through both organic and inorganic carriers. Additionally, agents like methenamine hippurate, D-mannose, estrogen, and cranberry extracts have shown varying degrees of efficacy and safety. These strategies represent essential steps toward sustainable UTI management, but most will require further clinical validation before their use in the general population.
PURPOSE:To evaluate the incidence and perinatal risk factors associated with undescended testis (UDT) in neonates and to identify predictors of persistent UDT at 6 months of age. MATERIALS AND METHODS:This retrospective cohort study included 976 male neonates born at Chonnam National University Hospital between 2018 and 2023. Clinical variables included birth weight, gestational age, Apgar score, delivery mode, urogenital anomalies, maternal age, estrogen exposure, and family history. UDT was diagnosed at birth, and spontaneous descent was assessed at 6 months. Logistic regression identified significant predictors. RESULTS:UDT incidence was 8.8% (86/976), significantly higher in preterm than term infants (28.1% vs. 3.1%, p<0.001). Low birth weight (odds ratio [OR] 3.82, p<0.001), prematurity (OR 2.75, p=0.001), maternal estrogen exposure (OR 2.57, p=0.006), and urogenital anomalies (OR 2.13, p=0.026) were independent predictors of UDT at birth. Among infants with UDT, 72.1% showed spontaneous descent by 6 months. Urogenital anomalies were associated with a lower likelihood of spontaneous descent (OR 0.32, p=0.028), whereas prematurity, low birth weight, and maternal estrogen exposure increased the likelihood of descent. CONCLUSIONS:UDT is relatively common in Korean neonates, particularly among preterm infants. While most cases resolve spontaneously within 6 months, infants with urogenital anomalies are less likely to descend spontaneously and may need closer follow-up and earlier surgical consideration. Early perinatal characteristics may help stratify the risk of persistent UDT and guide clinical decision-making.
PURPOSE:To evaluate the safety, toxicity, efficacy, and health-economic context of intravesical gemcitabine (GEM) in patients with non-muscle-invasive bladder cancer (NMIBC), and compare outcomes with Bacillus Calmette-Guérin (Onco-BCG; Cipla Ltd.), particularly during shortages. MATERIALS AND METHODS:This prospective observational study included 128 patients with intermediate- or high-risk NMIBC. Sixty-six received intravesical GEM after transurethral resection of bladder tumor (TURBT), while 62 received Onco-BCG. GEM was administered according to the GUBGEM protocol. Safety was assessed through clinical, laboratory, I-PSS (International Prostate Symptom Score), and CTCAE (Common Terminology Criteria for Adverse Events) v5.0 grading. Efficacy was evaluated by recurrence-free survival (RFS), progression rates, and Kaplan-Meier analysis. RESULTS:Baseline demographic and pathological characteristics were similar. GEM demonstrated a favorable safety profile, with 90.9% experiencing none or grade 1 adverse events. Urinary tract infection (20.0%), dysuria (17.3%), and musculoskeletal pain (10.8%) were the most common symptoms. No severe systemic toxicities were observed. Recurrence occurred in 34.8% of GEM patients versus 16.1% with Onco-BCG (p=0.016). Median RFS was 32 months for GEM and 60 for Onco-BCG. Log-rank analysis showed significantly lower RFS with GEM (p=0.017), confirmed by Cox regression (hazard ratio 2.92, 95% confidence interval 1.30-6.54; p=0.009). Most recurrences occurred within the first 12 months. CONCLUSIONS:Intravesical GEM was safe, well tolerated, and associated with high adherence. Although recurrence prevention was inferior to Onco-BCG-particularly within the first 12 months, with no difference in progression-GEM represents a pragmatic, budget-sensitive alternative during Onco-BCG shortages or intolerance.
Castration-resistant prostate cancer (CRPC) remains poorly controlled after sequential androgen receptor-targeted agents, taxanes, and radiopharmaceuticals. Tumor-tropic adipose-derived mesenchymal stem cells (ADSCs) offer a compelling platform for local delivery of gene-based therapeutics. This review synthesizes the mechanistic rationale, preclinical evidence, and translational strategy for hTERT-immortalized ADSCs engineered to express carboxylesterase (CE), secreted TRAIL (sTRAIL), or both, administered with irinotecan (CPT-11) in CRPC. We compared five studies from our group with independent work using mesenchymal stem cells, neural stem cells, and other carriers delivering CE- or TRAIL-based payloads, situating this platform within the broader field. Our studies used ubiquitin C promoter lentiviral vectors to express rabbit CE, rabbit CE2, human sTRAIL, or CE+sTRAIL. Efficacy was assessed mainly in subcutaneous PC3 xenografts and a PC3 tibial bone-metastasis model in male nude mice, using standardized migration, cytotoxicity, and apoptosis assays with in vivo tumor volume and osteolysis endpoints. Across all five studies, engineered ADSCs showed preferential tumor-tropic migration and localization after systemic delivery and consistently enhanced irinotecan efficacy at low prodrug doses, while becoming SN-38-sensitive themselves, providing built-in self-elimination. CE2, with superior CPT-11 hydrolytic efficiency over CE1, added anti-tumor potency and was active against bone-metastatic CRPC, including suppression of osteolysis. This program establishes a biologically coherent, iteratively refined platform for tumor-selective enzyme-prodrug activation and death receptor-mediated apoptosis in CRPC. Translation requires resolving integrating-vector and hTERT immortalization safety concerns, quantitative biodistribution and persistence characterization, pharmacogenomics-informed irinotecan dosing, and immunogenicity assessment of xenogeneic CE.
PURPOSE:Intrinsic sphincter deficiency (ISD) is associated with lower stress urinary incontinence (SUI) treatment success. Polyacrylamide hydrogel (PH) is a widely used urethral bulking material in treating SUI. Our goal is to compare treatment outcomes in women with and without ISD who underwent urethral bulking with PH for SUI. MATERIALS AND METHODS:We conducted a retrospective cohort analysis of women who underwent urethral bulking with PH from October 2022 to November 2024. Exclusions included no SUI on preoperative urodynamics, prior surgical SUI treatment, or no follow-up visit. ISD was defined as cough or Valsalva leak point pressure ≤60 cm H₂O or maximal urethral closure pressure ≤20 cm H₂O on preoperative urodynamics. Treatment success was defined as no SUI or improved SUI at initial follow-up. RESULTS:Of the 171 participants included, 21 (12.3%) met criteria for ISD. Those with ISD were older and received a greater amount of PH compared to those without ISD (1.79 mL vs. 1.65 mL, p=0.05). There were no differences in self-reported race/ethnicity, body mass index, parity, or rates of concomitant prolapse repair. There were no differences in uroflow or micturition pattern or bladder sensation on preoperative urodynamics. Treatment success was high in both (95.2% with ISD vs. 89.9% without ISD, p=0.70). Rates of SUI retreatment were low in both and did not differ. CONCLUSIONS:While there were some differences between those with and without ISD, both had high treatment success rates. Using PH bulking injection to treat SUI in those with ISD is reasonable.
PURPOSE:To evaluate career satisfaction, mentorship experience, work-life balance, and perceptions of gender discrimination among female urology residents and specialists in Korea. MATERIALS AND METHODS:A nationwide cross-sectional survey was conducted among female urologists, including residents and board-certified specialists. The questionnaire assessed demographic characteristics, mentorship experience, career satisfaction, personal life satisfaction, work-related stress, and experiences of gender discrimination. RESULTS:A total of 41 respondents participated, including 11 residents and 30 specialists. Most specialists (63.3%) practiced in tertiary or secondary hospitals, and 21 (70.0%) specialized in female urology or voiding dysfunction. Only 9.1% of residents and 33.3% of specialists reported substantial mentorship during training, with the most common barrier being the absence of experts in the desired field. While 60.0% of specialists and 54.5% of residents stated they would choose urology again, 56.7% and 45.5%, respectively, would not recommend the specialty to their children. Residents reported higher work-related stress (median, 7 vs. 5, p>0.05), whereas personal life satisfaction was similar between groups (median, 6 vs. 7, p>0.05). All residents reported workload adjustments, whereas 95.0% of specialists reported unchanged duties. Approximately one-third experienced gender discrimination, mainly during residency, most often from colleagues or patients, and 81.6% perceived male preference in employment. CONCLUSIONS:Female urologists in Korea demonstrate strong professional dedication but there remain challenges related to mentorship scarcity, gender bias, and work-life imbalance. Efforts to strengthen mentorship and promote equitable workplace policies are essential to enhance satisfaction and retention among women in urology.
PURPOSE:To evaluate whether time-varying changes in metabolic health and obesity status are associated with incident urolithiasis using a nationwide health-screening cohort. MATERIALS AND METHODS:The National Health Insurance Service-National Health Screening database was used for this study. The study cohort consisted of 514,866 health screening examinees between 2009 and 2010. Metabolic health was determined based on triglyceride, high-density lipoprotein cholesterol, fasting glucose, blood pressure, and waist circumference criteria, while obesity was determined by body mass index. The participants were stratified into metabolically healthy non-obese (MHNO); metabolically unhealthy non-obese (MUNO); metabolically healthy obese (MHO); metabolically unhealthy obese (MUO). According to the second health screening, each group was divided according to changes in metabolic status and obesity. Cox proportional hazards regression was used to determine adjusted hazard ratios (aHRs) and 95% confidence intervals. RESULTS:A total of 286,175 examinees who contributed 1,958,405 person-years of follow-up were eligible for this cohort study, during which 12,403 subjects developed urolithiasis. Compared with MHNO individuals, aHRs for incident urolithiasis were higher in MUO, MHO, and MUNO groups. Persistent obesity or metabolic unhealthiness was associated with higher aHRs, whereas improvement in either status was associated with lower aHRs. CONCLUSIONS:We found that aHRs for incident urolithiasis were similarly elevated in metabolically healthy and unhealthy obese individuals compared with MHNO individuals, indicating that excess adiposity may be a key driver of stone risk. Maintaining metabolic health and normal weight or improving metabolic health and reducing weight may lead to decreased risk of urolithiasis development.
PURPOSE:Gleason grade group (GG) concordance between prostate biopsy and radical prostatectomy (RP) is critical for treatment planning, particularly for active surveillance (AS). We compared GG concordance, upgrade rates, and AS misclassification between institutional and outside biopsies and evaluated the impact of pathologic re-evaluation. MATERIALS AND METHODS:In this propensity score-matched cohort study, 3,744 patients (1,872 institutional and 1,872 outside biopsies) who underwent RP were analyzed. Outside biopsies were stratified by re-evaluation status (re-evaluated, n=570; not re-evaluated, n=1,302). Primary outcomes included overall GG concordance, clinically significant upgrade (≥2 GG), and AS misclassification (biopsy GG 1 to RP ≥GG 3). Agreement was assessed using weighted kappa statistics, and predictors of upgrade were identified by multivariable logistic regression. RESULTS:Overall GG concordance was 44.7%. Institutional biopsies showed the highest concordance (47.8%) compared to outside biopsies with (45.3%) and without re-evaluation (40.0%) (p<0.001). Among biopsy GG 1 patients, AS misclassification to ≥GG 3 occurred in 9.6% of institutional biopsies, compared to 27.0% of outside re-evaluated biopsies and 20.0% of outside non-re-evaluated biopsies (p<0.0001). Outside biopsy source (odds ratio [OR] 1.351, p=0.013) and absence of re-evaluation (OR 1.451, p=0.028) were identified as independent predictors of GG upgrade. CONCLUSIONS:Outside prostate biopsies exhibit 2.1- to 2.8-fold higher AS misclassification rates compared to institutional biopsies. Pathologic re-evaluation provides only modest improvement and does not eliminate upgrade risk, supporting systematic second-opinion review and careful confirmation before AS enrollment.
PURPOSE:Recent work by our group demonstrated that a treatment cycles per unit prostate volume (CPV) ratio >0.15 significantly improves outcomes in transurethral water vapor therapy (Rezūm) for catheter-dependent patients. Prostates have highly variable morphology and the treatment planning approach in Rezūm is not well reported. MATERIALS AND METHODS:The double-decker technique, which conceptually divides the prostate into anterior and posterior 'decks', is detailed step-by-step and illustrated in the supplementary video. The outcomes of double-decker technique versus conventional technique were compared in a prospective registry of men with refractory retention undergoing Rezūm. RESULTS:Among 144 catheter-dependent patients, 102 underwent the conventional technique and 42 were treated with the double-decker technique. Baseline characteristics were comparable. The double-decker technique had a higher mean CPV (0.204 vs. 0.132, p<0.001) with more injections (10.4 vs. 6.7, p<0.001). This was associated with a significantly greater percentage reduction in prostate volume at three months (34.3% vs. 26.1%, p=0.029) and a superior International Prostate Symptom Score (IPSS) at one year (3.70 vs. 8.13, p=0.041). Multivariable regression showed that the double-decker technique was associated with a lower one-year IPSS (coefficient: -4.86, p=0.045). There was no significant difference in 30-day readmission rates (4.8% vs. 12.7%, p=0.145). CONCLUSIONS:The double-decker technique in Rezūm is a systematic and reproducible method to optimize prostate volume shrinkage in catheter-dependent patients. It shows promise with better one-year IPSS and greater prostate volume shrinkage against the conventional technique. Prospective and randomized studies are warranted to confirm its advantage against conventional field-of vision-based technique.
PURPOSE:Resistance to empiric antimicrobials has become markedly higher among gram-negative uropathogens in Korea, compared to those in Europe and North America. To guide empiric treatment strategies and to build real evidence, we conducted a retrospective analysis of antimicrobial susceptibility patterns from urine cultures obtained at a university hospital. MATERIALS AND METHODS:Antimicrobial susceptibility test (AST) results from initial positive urine cultures (n=11,358, both inpatients and outpatients) collected between 2016 and 2024 were reviewed. The analysis focused on predominant gram-negative isolates-Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Resistance rates were determined for twelve commonly used antimicrobials, including third- and fourth-generation cephalosporins, β-lactam/β-lactamase inhibitor combinations, carbapenems, aminoglycosides, fluoroquinolones, trimethoprim/sulfamethoxazole, nitrofurantoin, and fosfomycin. RESULTS:Between 2016 and 2024, AST identified E. coli (n=6,533), K. pneumoniae (n=1,348), P. mirabilis (n=677), and P. aeruginosa (n=663). While fluoroquinolone resistance remained persistently high (31.5%-44.5% in E. coli, 6.9%-37.0% in K. pneumoniae), its annual trend showed to be stable. Cefepime resistance increased steadily in most gram-negative isolates (annual percentage change [APC]=16.1%-25.0%). Although Carbapenem resistance remained low but it increased steadily in E. coli and K. pneumoniae (APC=22.2%). Nitrofurantoin and fosfomycin retained strong activity against E. coli, though their efficacy varied among other pathogens. CONCLUSIONS:This 9-year longitudinal study reveals sharp cefepime resistance increases post-2019 and persistently high fluoroquinolone resistance among major four gram-negative uropathogens. Targeted antimicrobial stewardship are essential to optimize urinary tract infection management and reduce unnecessary broad spectrum antimicrobials in Korea.
PURPOSE:Prostate cancer (PCa) is traditionally diagnosed using prostate-specific antigen (PSA)-based testing together with demographic and clinical factors. Building on this framework, we aimed to develop an AI (artificial intelligence) model for prebiopsy PCa diagnosis by integrating Korean population-relevant risk-associated single nucleotide polymorphisms (SNPs) to improve diagnostic accuracy. MATERIALS AND METHODS:Three models were developed in this study: Korean PCa-specific genomic score (GenPCa-Kor score), electronic medical record (EMR) meta-model, and Geno-EMR meta-model. From genome-wide association study summary statistics, 1,347 PCa-associated SNPs were selected for a deep neural network to derive the GenPCa-Kor score. Thirteen clinico-laboratory EMR parameters were used to build a stacking ensemble (EMR meta-model) with Light Gradient Boosting Machine, and Histogram-based Gradient Boosting Machine, and logistic regression as base learners and logistic regression as the meta-learner, using 10-fold cross-validation and Bayesian hyperparameter optimization. The Geno-EMR meta-model added the GenPCa-Kor score as a 14th feature to the same architecture. RESULTS:Of 1,590 systematic biopsy-confirmed participants, 1,006 were analyzed; 757 comprised the training cohort and 249 consecutive patients comprised the independent test cohort. In the training cohort, the EMR meta-model and Geno-EMR meta-model achieved area under curves (AUCs) of 0.868 and 0.924, respectively. In the test cohort, their AUCs were 0.859 and 0.892, respectively. For clinically significant PCa (Grade Group ≥2), the Geno-EMR meta-model further improved the AUC from 0.887 to 0.911. CONCLUSIONS:The Geno-EMR meta-model that integrate routine clinico-laboratory parameters with the SNP-based GenPCa-Kor score showed improved discrimination for PCa compared with the EMR meta-model alone.
Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management following robot-assisted renal surgery. However, concurrent dual NSAID administration raises concerns regarding an increased risk of acute kidney injury (AKI). This study evaluated the renal safety of adding an intravenous combination of acetaminophen and ibuprofen to ketorolac-based patient-controlled analgesia (PCA) in patients undergoing robot-assisted renal surgery. Materials and Methods: This retrospective cohort study analyzed 200 adult patients who underwent robot-assisted renal surgery between September 2023 and September 2025. Patients receiving a combination of ketorolac PCA plus acetaminophen/ibuprofen (n=90, treatment group) were compared with those receiving ketorolac PCA alone (n=110, control group). After 1:1 propensity score matching, 72 patients per group were analyzed. The primary outcome was postoperative AKI diagnosed by serum creatinine changes through postoperative day 7 or until discharge, whichever occurred first. Results: In the matched cohort, postoperative AKI occurred in 28 patients (38.9%) in the treatment group and 32 patients (44.4%) in the control group, with no significant difference (p=0.499; risk ratio 0.89, 95% confidence interval [CI] 0.64-1.24). Serial serum creatinine trajectories were similar between groups. Multivariable logistic regression identified pneumoperitoneum duration as an independent risk factor for AKI (odds ratio 1.02, 95% CI 1.01-1.04, p=0.012), while an acetaminophen/ibuprofen combination was not associated with increased AKI risk (odds ratio 0.80, 95% CI 0.41-1.54, p=0.499). Conclusions: Adding intravenous acetaminophen/ibuprofen combination to ketorolac PCA was not significantly associated with postoperative AKI risk in patients who underwent robot-assisted renal surgery.
PURPOSE:Xanthogranulomatous pyelonephritis (XGP) is a destructive renal infection typically requiring nephrectomy. Although laparoscopy is increasingly feasible, morbidity remains high and predictors of adverse outcomes are not well defined. We aimed to explore predictors of postoperative complications and compare laparoscopic versus open approaches. MATERIALS AND METHODS:We retrospectively analyzed 42 XGP nephrectomies (2014-2024) at a tertiary referral center. Demographics, imaging features, intraoperative findings, and 30-day outcomes were collected. Complications were graded by Clavien-Dindo, defining major complications as grade ≥III. Comparative analyses used nonparametric and exact tests; exploratory regression identified pre- and intraoperative predictors. RESULTS:Median age was 47.0 years; 78.6% were females. Laparoscopy was attempted in 32 cases, with 5 conversions (15.6%). Overall, 69.0% experienced complications and 50.0% major events, but no deaths occurred. Compared with open surgery (n=10), laparoscopy showed lower transfusion requirements (34.4% vs. 60.0%) and less blood loss, while overall complication rates were similar. Hydronephrosis, perinephric/psoas abscesses, and higher blood loss were associated with increased morbidity. CONCLUSIONS:XGP nephrectomy remains a high-morbidity operation. Laparoscopy appears feasible and safe in selected cases, with trends toward reduced transfusion and blood loss. Disease complexity-rather than surgical approach-primarily drives outcomes. These exploratory findings warrant validation in multicenter studies.
PURPOSE:This study aimed to evaluate the safety, including blood pressure changes, and medication compliance associated with a generic prolonged-release formulation of mirabegron (Selebeta® PR Tab. 50 mg) in Korean adults with overactive bladder (OAB) through a large-scale, real-world, multicenter, retrospective observational study. MATERIALS AND METHODS:Patients with OAB who were prescribed Selebeta® PR once daily for at least 3 months between July 2020 and July 2021 from 95 medical institutions in Korea were included. The primary endpoint was the proportion of patients with an increase in systolic blood pressure (SBP) of ≥10 mmHg after 3 months of treatment. Secondary endpoints included additional thresholds of blood pressure elevation, changes in SBP and diastolic blood pressure (DBP) and pulse rate over time, improvement in OAB symptom, incidence of adverse events, and medication compliance. RESULTS:A total of 2,091 patients were enrolled in the study. After 3 months of treatment, 8.8% of the patients had an SBP increase of ≥10 mmHg; 3.7%, ≥15 mmHg; and 2.3%, ≥20 mmHg. DBP increased by ≥5 mmHg in 16.8% and by ≥10 mmHg in 6.7% of patients. OAB symptoms also improved significantly in the subgroup with available OAB symptom score data. The overall incidence of adverse events was 2.1%, mostly mild, and mean medication coverage was 73.6%. CONCLUSIONS:This study demonstrated that Selebeta® PR is an effective and well-tolerated treatment for adults with OAB, with no clinically meaningful increase in blood pressure and a low incidence of adverse events.
Purpose: To evaluate whether repeated prostate-specific antigen (PSA) testing influences treatment patterns and healthcare costs for prostate cancer (PCa). Materials and Methods: We analyzed a nationwide insurance cohort of men newly registered with PCa from 2010 to 2020. Patients were classified as PSA-tested (≥3 tests across ≥2 years before registration) or PSA non-tested (first PSA test within 3 months before registration). We compared the initial and subsequent treatment patterns between localized and systemic therapies, and per-patient medical expenditures by treatment modality. The analyses focused on 2016 to 2020, when government-set prices stabilized. Primary endpoints were cumulative medical costs and downstream medical utilization patterns. Results: Of the 166,848 men, 26.7% were PSA-tested, 42.2% were non-tested, and 31.1% were undetermined. Localized therapy was more frequent after repeated testing: surgery, 45.6% versus 33.8% (p<0.001); radiotherapy, 17.0% versus 14.9% (p<0.001); and focal therapy, 0.8% versus 0.3% (p<0.001). Systemic therapy predominated without prior testing: hormone therapy, 59.7% versus 42.3% (p<0.001), chemotherapy, 2.7% versus 1.0% (p<0.001), and androgen receptor-targeted agents, 1.4% versus 0.5% (p<0.001). For localized modalities delivered during 2016 to 2020, the per-patient costs of non-robotic surgery and radiation therapy were comparable between the groups. In contrast, expenditures for hormone therapy and androgen receptor-targeted agents were significantly higher in the PSA non-tested group, primarily reflecting a longer treatment duration rather than higher monthly spending. Conclusions: Once national prices stabilized, repeated PSA testing was associated with greater use of localized therapy and lower cumulative spending on prolonged systemic treatment without increasing the costs for localized modalities.
Purpose: Radical cystectomy (RC) is among the most complex procedures in urology, with early morbidity rates exceeding 50%. Understanding which complications occur most often and identifying their predictors may improve perioperative optimization and postoperative surveillance. This study aimed to determine the most common complications occurring within 30 days after RC and to identify their predictors. Materials and Methods: We conducted a retrospective observational study of all adult patients undergoing RC with urinary diversion at a single institution between January 2014 and December 2024. A total of 202 patients met inclusion criteria. The seven most frequent complications were identified. Univariable logistic regressions and three separate multivariable models were generated for each complication. Adjusted odds ratios with 95% confidence intervals were reported. Results: Overall, 53.0% of patients experienced at least one complication within 30 days. The seven most frequent complications were ileus (25.7%), wound complications (18.8%), urinary tract infection (UTI) (18.3%), sepsis (13.4%), evisceration (11.9%), respiratory infection (5.9%), and bowel anastomotic leak (4.5%). Ileus was predicted by intraoperative complications and urinary diversion type. Wound complications were associated with higher Charlson comorbidity index (CCI), sepsis, ileus, and open surgery. Sepsis was predicted by hypertension, advanced-stage disease, ileus, wound complications, and bowel anastomotic leak. No independent predictors were identified for early UTI. Respiratory infection was associated with postoperative ileus. Evisceration was strongly associated with CCI, intraoperative complications, ileus, and bowel anastomotic leak. Conclusions: Early morbidity after RC remains high. Predictor profiles differed across complications, supporting the need for complication-specific perioperative strategies.
Purpose: Carcinoma in situ (CIS) of the bladder is a high-grade, non-invasive lesion known to increase the risk of recurrence and progression. However, the prognostic significance of CIS identified at transurethral resection of bladder tumor (TURB) versus radical cystectomy (RC) remains controversial. This study aimed to evaluate the impact of CIS at different treatment stages on recurrence-free survival (RFS) and cancer-specific survival (CSS). Materials and Methods: A retrospective multicenter study was conducted using data from 2,553 patients who underwent TURB followed by RC between 2010 and 2019 across eleven Korean institutions. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess the association of CIS at TURB and RC with RFS and CSS, adjusting for clinicopathological variables. Results: CIS was identified in 731 TURB specimens (28.6%) and 821 RC specimens (32.2%). Patients with CIS at TURB had significantly higher RFS (p<0.001) and CSS (p=0.002) compared to those without. In multivariate analysis, CIS at TURB was independently associated with better RFS (hazard ratio [HR] 0.787, p=0.001) but not CSS (HR 0.989, p=0.905). CIS at RC showed no significant association with either RFS or CSS. Independent predictors of poor survival included advanced stage, lymph node involvement, lymphovascular invasion, and positive surgical margins. Adjuvant therapy was associated with improved CSS. Conclusions: CIS at TURB is associated with a lower recurrence risk following RC, whereas CIS in RC specimens has limited prognostic impact. These findings suggest CIS at TURB may carry different prognostic implications than traditionally assumed, warranting careful clinical interpretation.
