Purpose To evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT. Materials and Methods We analyzed two study groups in this retrospective study: 75 patients with a diagnosis of TT (group 1) and 56 age-matched healthy subjects (group 2). We performed a complete blood count as a part of the diagnostic procedure, and NLR, PLR, MPV, and PLT values were recorded. We compared the patient and control groups in terms of these parameters. Then, TT patients were divided into two subgroups according to the time elapsed since the onset of symptoms. Subsequently, we evaluated the relationship between the duration of symptoms and these parameters. Results There were significant differences between groups 1 and 2 in NLR, PLR, and PLT (p<0.001 for all). There was no predictive role of MPV in the diagnosis of TT (p=0.328). We determined significantly high sensitivity and specificity levels for NLR in the prediction of TT diagnosis (84% and 92%, respectively). Furthermore, NLR was significantly related to the duration of symptoms in TT patients (p=0.01). Conclusions NLR may be a useful parameter in the diagnosis of TT. Furthermore, NLR may be used as a predictive factor for testicular viability following TT.
In 2015, the K orean Journal of Urolog y (KJU) ado pted the slogan "A commitment to excellence" with the aim of becoming a premier journal in the field of urology [1].To pursue this goal, the KJU focused on rapid critical reviews, fast publication, and easytoaccess online audiovisual contents.On April 11, a KJU workshop took place in Busan during the Korean Urological Congress & Expo.The workshop was held to educate the possible reviewers of the KJU.Professor OckJoo Kim from Seoul National University gave a lecture on medical ethics, and there were several lectures introducing the online submission system and homepage of the KJU.Furthermore, there was a suggestion to hold regular education programs for both editorial board members and reviewers to establish a rigorous reviewing system.The KJU international editorial board meeting was held on May 17 during the American Urological Association meeting at the Morial Convention Center in New Orleans, USA.The editorial team of the KJU reported the current status of the KJU publication to the editorial board members.There were many suggestions and discussions about how to introduce the KJU to potential authors worldwide.One of the important issues was the lack of acknowledgement of the KJU as an international journal.To overcome this, we should f ind and promote unique features which can specif y the journal's scope and distinguish the KJU from other journals in the field of urology.The KJU will continue to keep the open access policy.The open access policy leads to a high likelihood that the KJU will be accessed and allows for rapid dissemination of clinical and basic science information to physicians and researchers in the field of urology.The KJU is currently
Since the introduction of the prostate-specific antigen (PSA) test, there has been a clear shift towards diagnosis at an earlier stage of prostate cancer. However, patients who receive curative treatment in the contemporary era still face significant risks of recurrence and disease progression. In most cases of tumor recurrence, salvage treatment is performed. As can be seen from general clinical experience, not all forms of salvage therapy guarantee control of disease status or cure. Although debate continues on the benefit of adjuvant therapy in comparison with salvage therapy, it cannot be denied that there may well be a proportion of patients who would benefit from earlier adjuvant intervention rather than salvage therapy given the identification of disease recurrence or progression. Thus, a definite need exists for more accurate predictors of the prognosis and outcome of prostate cancer. It is now clear that PSA and other PSA-related markers are not enough to do the job. Even though the Gleason score is widely regarded as a powerful predictor of outcome of prostate cancer, the possibility of intra- and interobserver variability exists. Certainly, the limitations in prognostications of prostate cancer patients are the primary reason for over- and undertreatment. To overcome such limitations, several genetic classifiers have recently been introduced. Two new molecular classifiers
PURPOSE:To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails.MATERIALS AND METHODS:A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments.RESULTS:The mean patient age was 48.6±16.5 years and the mean follow-period was 39±11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis.CONCLUSIONS:Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.
As the human life-span grows longer with developments in modern medicine and the birth rate slows, the rapid aging of the world population has become a major global demographic trend [1]. Korea is no exception. According to the National Statistics Office, the Korean population over the age of 65 years in 2014 accounted for 12.7% of the total population [2]. This figure increased more than twice compared with 5.1% in 1990. In 2026, about 20% of the total population is expected to be more than 65 years old. This means that in 11 years, one in five people in Korea will be elderly. As the elderly population increases, their health problems have emerged as important personal and social problems. The number of people with age-related disease has increased substantially [3]. Many elderly persons experience disease, disability, and dependency, with high costs for health and social care [4]. With the aging of the population, other specialties such as dementia have been emphasized because they tend to serve the geriatric population. However, Dugan et al. [5] propose that urology holds a unique position in the provision of geriatric care because urologists manage personal, often very “private,” aspects of the elderly adult’s physical and emotional well-being, such as control of urination. Drach and Griebling [6] refer to urologists as the “hidden providers” of geriatric care, ultimately sought out by many geriatric patients. In urology, the percentage distribution of patients by physician specialty by those aged 65 years and older and enrolled in Medicare is 46.2%, whereas the corresponding
PURPOSE:We investigated the prevalence rate of benign prostatic hyperplasia (BPH) among Korean males in a rural area through a cross-sectional, community-based epidemiologic survey and analyzed the correlation with epidemiologic factors.MATERIALS AND METHODS:A total of 779 males who lived in Yangpyeong County participated in a prostate examination campaign. Targeting these men, we collected the International Prostate Symptom Score (IPSS), medical history, demographic information, serum prostate-specific antigen, and prostate volume as measured by transrectal ultrasonography. The data for 599 participants were analyzed, excluding 180 men who had a possibility of prostate cancer. BPH was defined as an IPSS of 8 points or higher and a prostate volume of 25 mL or more.RESULTS:The prevalence rate of BPH was 20.0%. The prevalence rate increased with age. There were 2 subjects (4.4%) in the age group of 40-49 years, 18 subjects (10.9%) in the age group of 50-59 years, 44 subjects (22%) in the age group of 60-69 years, and 56 subjects (26.6%) in the age group of over 70 years; this increase with age was statistically significant (p<0.001). In the BPH group, the average IPSS was 14.67±5.95, the average prostate volume was 37.04±11.71 g, and the average prostate-specific antigen value was 1.56±0.88 ng/mL. In the analysis of correlations between the epidemiologic factors and the risk of BPH, smoking was the only statistically significant factor.CONCLUSIONS:The total prevalence rate of BPH in this study was 20.0%, which was a little lower than the rate reported in other cities or rural areas.
Purpose Genetic variations among prostate cancer (PCa) patients who underwent radical prostatectomy (RP) and pelvic lymph node dissection were evaluated to predict lymph node invasion (LNI). Exome arrays were used to develop a clinicogenetic model that combined clinical data related to PCa and individual genetic variations. Materials and Methods We genotyped 242,186 single-nucleotide polymorphisms (SNPs) by using a custom HumanExome BeadChip v1.0 (Illumina Inc.) from the blood DNA of 341 patients with PCa. The genetic data were analyzed to calculate an odds ratio as an estimate of the relative risk of LNI. We compared the accuracies of the multivariate logistic model incorporating clinical factors between the included and excluded selected SNPs. The Cox proportional hazard models with or without genetic factors for predicting biochemical recurrence (BCR) were analyzed. Results The genetic analysis indicated that five SNPs (rs75444444, rs8055236, rs2301277, rs9300039, and rs6908581) were significant for predicting LNI in patients with PCa. When a multivariate model incorporating clinical factors was devised to predict LNI, the predictive accuracy of the multivariate model was 80.7%. By adding genetic factors in the aforementioned multivariate model, the predictive accuracy increased to 93.2% (p=0.006). These genetic variations were significant factors for predicting BCR after adjustment for other variables and after adding the predictive gain to BCR. Conclusions Based on the results of the exome array, the selected SNPs were predictors for LNI. The addition of individualized genetic information effectively enhanced the predictive accuracy of LNI and BCR among patients with PCa who underwent RP.
Purpose Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR. Materials and Methods We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure. Results Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction. Conclusions Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.
Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.
The treatment of overactive bladder (OAB) is usually started with behavioral treatments [1]. If behavioral treatments are not effective or are only partially effective, oral or oral β3-adrenoceptor agonists can be offered as a second-line therapy. If symptom control is or intolerable adverse events are encountered, a dose modification or switching to another antimuscarinic medication or other β3-adrenoceptor agonist can be tried. As a third-line therapy, intradetrusor injection of onabotulinumtoxinA or peripheral tibial nerve stimulation may be offered in carefully selected patients. Sacral neuromodulation (SNS) is another option for third-line therapy in patients with severe, refractory OAB symptoms who are ready to undergo surgical treatment. Currently, pharmacotherapy is a mainstay of treatment, but one study reported a high rate of non-persistence after the first prescription (44.5%; defined as a gap of >45 days between successive prescription fills or a switch to any other OAB medication) [2], meaning that treatment had been performed insufficiently. The precise pathogenesis of OAB might be multifactorial and remains to be clarified, and OAB symptoms are various. Individuals differ in their sensitivity to drug treatment for a combination of pharmacodynamic and pharmacokinetic reasons. In clinical practice, drug selection should be individualized, taking into account a patient's comorbidities and concomitant medications as well as the available dosages and safety profiles of the various agents. Therefore, the treatment strategy for OAB needs to be individualized. The President's Council of Advisors on Science and Technology defines personalized medicine as the tailoring of medical treatment to the individual characteristics of each patient, classifying individuals into subpopulations that differ in their susceptibility to a particular disease or response to a specific treatment so that preventive or therapeutic interventions can then be focused on those who will benefit, sparing expense and side effects for those who will not [3]. With advances in genome and biomarker assays and targeted therapeutics, personalized medicine enables more accurate diagnosis, better prognostication of patients at risk for more aggressive disease, and identification of who will respond to a treatment. These innovations supporting personalized medicine are expected to result in optimal management while minimizing potential adverse effects and morbidity. The treatment paradigm of OAB has markedly changed with the introduction of mirabegron and intradetrusor onabotulinumtoxinA. Unlike the mechanism of action of antimuscarinics, mirabegron relaxes the detrusor muscle during the storage phase by activation of β3-adrenoceptors, resulting in an increase in bladder capacity. Mirabegron 50 mg showed significant improvements in mean numbers of incontinence episodes and micturitions from baseline versus placebo at weeks 4, 8, and 12 that were maintained throughout 12 months [4]. Mirabegron does not affect the contractility of the detrusor muscle and thus can be used in patients with detrusor overactivity with impaired contractility. Intradetrusor injection of onabotulinumtoxinA can be offered to OAB patients who are refractory to antimuscarinics. Recent research has demonstrated improved drug delivery (e.g., liposome-encapsulated onabotulinumtoxinA); thus, treatment with onabotulinumtoxinA is likely to be facilitated in the future. In accordance with the alternation of mainstream pharmacotherapy, the concept of refractory OAB should be changed: from the current inadequate response to antimuscarinics to inadequate response to combination therapy with and mirabegron. Furthermore, treatment modalities are becoming more diverse as medical treatments advance. Gene therapy has been applied in various ways and has shown potential as a useful modality for the treatment of OAB. Antisense oligonucleotides were shown to block overexpression of nerve growth factor in bladder urothelium, which suppressed bladder overactivity [5]. Optogenetics combines optics with genetics, and light illumination is utilized to modulate neuronal inhibition or excitation through exogenous light-activated proteins [6]. Optogenetics has been applied to investigate diseases of the central nervous system and other organ systems (e.g., heart, pancreas). Optogenetics has potential as a modality of OAB treatment through inhibition of the detrusor muscle or control of the neural system. The current mode of SNS operates via continuous electrical activity without arousing long-term neuroplastic changes. Future technologies are expected to provide miniature or rechargeable batteries and enable closed-loop conditional stimulation as a method to acquire better efficacy without adverse electric-field effects [6]. In recent decades, efforts have been made to investigate biomarkers of OAB, and several urinary markers (e.g., nerve growth factor, adenosine triphosphate) are promising. Although there is no established biomarker as yet, future studies of biomarkers are expected to offer better understanding of OAB and enable diagnosis and prediction of treatment outcome. Personalized medicine is already rapidly becoming mainstream and is expected to grow to 5% to 10% of the entire pharmaceutical market over the next 10 years [7]. In the era of diversification of treatment modality and the discovery of biomarkers of OAB, it is expected that optimal treatment for each patient will become a reality. As we come to better understand patients with OAB through advances in our understanding of the genome and biomarkers, and with advanced therapeutics, the treatment paradigm of OAB will move to being personalized, predictive, preventive, and participatory.
Stem cells (SCs) are undifferentiated cells that are capable of self-renewal and differentiation and that therefore contribute to the renewal and repair of tissues.Their capacity for division, differentiation, and tissue regeneration is highly dependent on the surrounding environment.Several preclinical and clinical studies have utilized SCs in urological disorders.In this article, we review the current status of SC use in benign urological diseases (erectile dysfunction, Peyronie disease, infertility, and urinary incontinence), and we summarize the results of the preclinical and clinical trials that have been conducted.
PURPOSE:We assessed whether weight reduction is an effective intervention for the management of lower urinary tract symptoms (LUTS) and investigated the relationship between obesity and LUTS.MATERIALS AND METHODS:This was a prospective randomized controlled trial that enrolled obese men older than 50 years with LUTS. The study period was 52 weeks. All patients received standardized alpha-adrenergic blocker therapy for the treatment of benign prostatic hyperplasia (BPH) during the run-in period. Patients were randomized to receive either a standardized prerecorded video program on the general principle of weight reduction or a comprehensive weight reduction program. Patients were assessed at different time points with symptom assessment, uroflowmetry, transrectal ultrasound, and metabolic assessment.RESULTS:Sixty-five patients were allocated to each study arm. After the study period, no significant difference in weight reduction was found between the two arms. When the pre- and postintervention parameters were compared, none were statistically different between the 2 arms, namely nocturia, International Prostate Symptom Score, quality of life assessment, and uroflowmetry parameters. When the whole study population was taken as a single cohort, these parameters were also not significantly different between the group with a body mass index of 25 to <30 kg/m(2) and the group with a BMI of 30 to 35 kg/m(2).CONCLUSIONS:We found no association between obesity and LUTS. This could have been due to the less marked weight difference in our cohort. Whereas weight reduction may be an effective measure to improve LUTS, the implementation of a successful program remains a challenge.
The prevalence of renal disease continues to increase worldwide. When normal kidney is injured, the damaged renal tissue undergoes pathological and physiological events that lead to acute and chronic kidney diseases, which frequently progress to end stage renal failure. Current treatment of these renal pathologies includes dialysis, which is incapable of restoring full renal function. To address this issue, cell-based therapy has become a potential therapeutic option to treat renal pathologies. Recent development in cell therapy has demonstrated promising therapeutic outcomes, in terms of restoration of renal structure and function impaired by renal disease. This review focuses on the cell therapy approaches for the treatment of kidney diseases, including various cell sources used, as well recent advances made in preclinical and clinical studies.
PURPOSE:We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR).MATERIALS AND METHODS:Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0 ± 2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2 ± 8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment.RESULTS:The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction.CONCLUSIONS:In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration.
Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Purpose: To evaluate the efficacy, safety and patient satisfaction outcomes following low intensity extracorporeal shock wave therapy (LiESWT) in men with Peyronie's disease (PD) using a standardised protocol.Materials and Methods: In this open-label single arm prospective study, patients with PD were enrolled following informed consent. Patient demographics, change in penile curvature and plaque hardness, International Index of Erectile Function (IIEF)-5 score, and overall satisfaction score (on a 5-point scale) were recorded. Treatment template consists of 3000 shock waves to the Peyronie's plaque over 20 minutes, twice weekly for 6 weeks.Results: The majority of patients have PD history longer than 6 months (mean, 12.8 months; range, 6-28 months). Two thirds of patients have received and failed oral medical therapy. There were improvements in penile curvature (more than 15 degrees in 33% of men), plaque hardness (60% of men) and penile pain (4 out of 6 men) following LiESWT. There was a moderate improvement in IIEF-5 score (>5 points reported in 20% of men). No complication was reported and the majority of patients were satisfied (rated 4 out of 5; 70% of men) and would recommend this therapy to others.Conclusions: In a carefully selected group of men with PD, LiESWT appears to be safe, has moderate efficacy and is associated with high patient satisfaction rate in the short term.
