Purpose: This study aimed to evaluate the correlation between bladder outlet obstruction (BOO) and bladder trabeculation in patients with benign prostatic hyperplasia (BPH). Methods: We analyzed data from consecutive BPH patients from July 2014 to June 2024, who underwent urodynamic study (UDS) and cystourethroscopy. The results of free uroflowmetry, filling cystometry, and pressure-flow study were analyzed to evaluate functional parameters. For anatomical parameters, bladder trabeculation grade, lateral lobe protrusion of prostate, and bladder neck elevation (BNE) measured in cystourethroscopy were used. BOO was defined as the BOO index of 40 or higher in UDS. Bladder trabeculation was graded using our previous studies. Results: Among total of 1,452 BPH patients, 1,028 patients had trabeculation on cystoscopy. Age, serum prostate-specific antigen, postvoid residual, total prostate volume, transition zone volume, terminal type detrusor overactivity, detrusor pressure at the maximal flow rate, bladder contractility index (BCI), and BOO index increased according to increase in bladder trabeculation. Multivariable logistic analysis showed that bladder trabeculation was significantly associated with age (odds ratio [OR], 1.05; P<0.001), kissing sign (OR, 1.55; P=0.007), BNE (OR, 1.76; P<0.001), detrusor overactivity (OR, 1.88; P=0.002), BCI (OR, 1.01; P=0.037), BOO (OR, 2.27; P<0.001). BOO had the greatest correlation with bladder trabeculation. In addition, BOO index showed a positive correlation (r=0.39, P<0.001) with bladder trabeculation. BOO index well distinguished between moderate trabeculation of grade 2 or higher in receiver operating characteristic analysis (area under curve=0.72, P<0.001). Conclusions Our results showed that the severity of BOO is positively associated with the severity of bladder trabeculation.

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume. Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30–80 mL), B (81–120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups. Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69). Conclusions Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume. Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30–80 mL), B (81–120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups. Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69). Conclusions Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume. Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30–80 mL), B (81–120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups. Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69). Conclusions Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Purpose: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) in a large prospective cohort of patients with benign prostatic hyperplasia (BPH) through systematic follow-up at a single institution. Materials and Methods: Clinical outcomes were analyzed between August 2008 and June 2022. Patients were followed-up at 2 weeks, 3 months and 6 months postoperatively. Results: A total of 3,000 patients (mean age, 69.6±7.7 years) underwent HoLEP. Baseline total International Prostate Symptom Score (IPSS) was 19.3±7.7 and maximum flow rate (Qmax) was 9.4±4.8 mL/s. Mean total prostate volume was 67.7±3.4 mL. Total operation time was 60.7±31.5 minutes, and catheterization time was 1.0 days (range, 1.0–1.0 days). At 6 months postoperatively, the total IPSS decreased to 6.6±5.8 and Qmax increased to 22.2±11.3 mL/s. Complications at 6 months postoperatively included stress urinary incontinence (SUI) in 36 patients (1.9%), urgency urinary incontinence (UUI) in 25 (1.3%), bladder neck contracture (BNC) requiring transurethral incision (TUI) in 16 (0.5%), and urethral stricture in 29 (1.0%). Eleven patients (0.4%) with prostatic fossa stones required stone removal. Sixty-one patients (2.0%) required secondary surgery (transurethral coagulation, 16 [0.5%];TUI for BNC, 16 [0.5%]; stone removal for prostatic fossa stones, 11 [0.4%]; and endoscopic internal urethrotomy for urethral stricture, 18 [0.6%]). Conclusions Mid-term follow-up results after HoLEP in BPH patients showed excellent efficacy and low complication rates. Unlike previous reports, the incidence of SUI and UUI after HoLEP was low, but the occurrence of de novo stone formation in prostatic fossa was notable.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: During coronavirus disease 2019 (COVID-19) pandemic, several COVID-19 vaccines were licensed with fast-track procedures. Although these vaccines have demonstrated high immunogenicity, there has been concerns on the serious adverse events (AEs) following COVID-19 vaccination among adolescents. We aimed to analyze comparative safety of COVID-19 vaccination in adolescents. Methods: In this pharmacovigilance study, we performed a disproportionality analysis using VigiBase, the World Health Organization’s global individual case safety report (ICSR) database. To compare serious AEs reported following COVID-19 vaccines vs. all other vaccines in adolescents aged 12–17 years, ICSRs following any vaccines on adolescents aged 12–17 years were included, defining cases as reports with the AEs of interest, with all other AEs as non-cases. The AEs of interest were myocarditis/pericarditis, multisystem inflammatory syndrome/Kawasaki disease (MIS/KD), anaphylaxis, Guillain-Barré syndrome (GBS), and immune thrombocytopenia (ITP). We conducted a disproportionality analysis to estimate reporting odds ratio (ROR) with 95% confidence interval (CI) for each AE of interest, adjusted for sex by using logistic regression. Results: Of 99,735 AE reports after vaccination in adolescents, 80,018 reports were from COVID-19 vaccinated adolescents (52.9% females; 56.3% America). The AEs of interest were predominantly reported as serious AE (76.1%) with mRNA vaccines (99.4%). Generally, higher reporting odds for the AEs were identified following COVID-19 vaccination in adolescents;myocarditis/pericarditis (2,829 reports for the COVID-19 vaccine vs. 35 for all other vaccines, adjusted ROR [aROR], 19.61; 95% CI, 14.05–27.39), and MIS/KD (104 vs. 6, aROR, 4.33; 95% CI, 1.89–9.88). The reporting odds for anaphylaxis (515 vs. 165, aROR, 0.86; 95% CI, 0.72– 1.02), GBS (94 vs. 40, aROR, 0.64; 95% CI, 0.44–0.92) and ITP (52 vs. 12, aROR, 1.12; 95% CI, 0.59–2.09) were not significantly higher following COVID-19 vaccination. Conclusion In this study, there were disproportionate reporting of immune-related AEs following COVID-19 vaccination. While awaiting definitive evidence, there is a need to closely monitor for any signs of immune-related AEs following COVID-19 vaccination among adolescents.

Background: In the Rivaroxaban Once-daily oral direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial, rivaroxaban 20 mg was the on-label dose, and the dose-reduction criterion for rivaroxaban was a creatinine clearance of < 50 mL/min. Some Asian countries are using reduced doses label according to the J-ROCKET AF trial. The aim of this study was to assess the safety and efficacy of a high-dose rivaroxaban regimen (HDRR, 20/15 mg) and low-dose rivaroxaban regimen (LDRR, 15/10 mg) among elderly East Asian patients with atrial fibrillation (AF) in real-world practice. Methods: This study was a multicenter, prospective, non-interventional observational study designed to evaluate the efficacy and safety of rivaroxaban in AF patients > 65 years of age with or without renal impairment. Results: A total of 1,093 patients (mean age, 72.8 ± 5.8 years; 686 [62.9%] men) were included in the analysis, with 493 patients allocated to the HDRR group and 598 patients allocated to the LDRR group. A total of 765 patients received 15 mg of rivaroxaban (203 in the HDRR group and 562 in the LDRR group). There were no significant differences in the incidence rates of major bleeding (adjusted hazard ratio [HR], 0.64; 95% confidential interval [CI], 0.21–1.93), stroke (adjusted HR, 3.21; 95% CI, 0.54–19.03), and composite outcomes (adjusted HR, 1.13;95% CI, 0.47–2.69) between the HDRR and LDRR groups. Conclusion This study revealed the safety and effectiveness of either dose regimen of rivaroxaban in an Asian population for stroke prevention of AF. Considerable numbers of patients are receiving LDRR therapy in real-world practice in Asia. Both regimens were safe and effective for these patients.