OBJECTIVES: This study examined the role of free/total prostate specific antigen (PSA) in the differentiation between prostate cancer and benign prostatic hyperplasia (BPH) in patients with total PSA higher than 4.0 ng/ml. MATERIALS AND METHODS: Fourteen untreated patients with prostate Cancer and 63 patients with BPH were included in this study. All patients were pathologically diagnosed by sextant transrectal biopsy before treatment. The level of total PSA and free PSA were determined by immunoradiometric assay (Cis bio international). The median values of total PSA and F/T (free/ total PSA) were compared between prostate cancer and BPH in the three different ranges of total PSA (PSA>4.0ng/ml, 4.0 ng/ml Characteristic (ROC) curves were obtained using sensitivity and specificity of total PSA and F/T at each cutoff level. RESULTS: In the range of PSA between 4.0 and 10.0 ng/ml, the median value of F/T was significantly different between prostate cancer and BPH (p<0.05), while that of total PSA was not. In other ranges of PSA, both total PSA and F/T were significantly different between prostate cancer and BPH. The area under the F/T ROC curve was significantly larger than that of total PSA ROC curve only in the range of PSA between 4.0 and 10.0 ng/ml.. In the mean time, F/T was more specific than total PSA (52% vs 32%) at the identical sensitivity (93%) of F/T and total PSA cutoff values (F/T cutoff, 0.2; total PSA cutoff, 6.0 ng/ml). CONCLUSIONS: Free/Total PSA might provide us more reliable information on the differential diagnosis of the prostate cancer, especially in patients with PSA range between 4.0 and 10.0 ng/ml.
Biopsy ; Diagnosis, Differential* ; Humans ; Immunoradiometric Assay ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Prostatic Neoplasms* ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Solvent 5200(heptane 1.97%, 2-bromopropane 97.92% and 1,2-dibromopropane 0.02%) is a widely used detergent in electronic industries. The toxic effect of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: Eight employees who showed abnormal semen analyses after exposure to Solvent 5200 for one year to eleven years underwent hormonal tests, semen analyses, testicular biopsies one month after cessation of exposure and then three consecutive semen analyses during 8 months follow-up period. RESULTS: All patients(mean age: 33 years old) had decreased sperm count including azoospermia in one Patient. Five patients also had decreased sperm motility. One azoospermic and two oligospermic patients had elevated serum FSH level. Histology of testes in six patients showed abnormal histologic findings such as atrophy of seminiferous tubules, thickening of the basement membrane and hyperplasia of Leydig cells. Follow-up semen analysis during eight months period after cessation of exposure to Solvent 5200 revealed increased sperm count in all patients including four patients recovering to normal range. Conclusion: Our studies suggest that Solvent 5200 could induce histolcgic change of testes as well as impairment of spermatogenesis and this process could be reversed by avoidance of exposure to this chemical substance.
Atrophy ; Azoospermia ; Basement Membrane ; Biopsy ; Detergents ; Follow-Up Studies ; Humans ; Hyperplasia ; Leydig Cells ; Male ; Reference Values ; Semen Analysis ; Seminiferous Tubules ; Sperm Count ; Sperm Motility ; Spermatogenesis* ; Testis

PURPOSE: There is a trend towards early catheter removal after radical retropubic prostatectomy (RRP). Therefore, the feasibility of early catheter removal after RRP was explored. MATERIALS AND METHODS: Twenty-four consecutive patients having undergone a RRP performed by one surgeon were divided into two groups. Groups A and B comprised the patients who had their cystography taken either 6 or 14 days after surgery, respectively. Voiding symptoms in the immediate (after catheter removal) and late postoperative (1 month after catheter removal) periods were assessed. The mean patient ages were 68.8, ranging from 59 to 76 and 66.8, ranging from 61 to 73 years in groups A and B (p=0.37), respectively. The Mean follow-up was 4.3 months (1-9). RESULTS: One patient in each group showed significant urine leakage on cystography, which required a further week of catheter indwelling. In group A, 8 patients (72.7%) needed pads for their incontinence immediately after catheter removal and 3 (27.3%) required pads continuously 1 month after catheter removal. In group B, incontinence that required pads developed in 9 patients (81.8%) immediately after catheter removal, and in 3 (27.3%) 1 month after catheter removal. One patient in group A required a 3-day Foley catheter indwelling for urinary retention. There were 4 (36.4%) and 2 (18.2%) patients in groups A and B, respectively, with weak urinary stream (Qmax<15ml/sec). CONCLUSIONS: A catheter can be safely removed, with caution, 6 days after a radical retropubic prostatectomy for the development of urinary retention and weak stream, which might be caused by anastomotic edema and transiently decreased bladder contractility.
Catheters* ; Edema ; Follow-Up Studies ; Humans ; Prostatectomy* ; Rivers ; Urinary Bladder ; Urinary Catheterization ; Urinary Retention

PURPOSE: Solvent containing 2-bromopropane has been widely used as a detergent in the electronic industries. The long-term toxic effects of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: All eight employees (mean age 33 years) who were exposed to the solvent underwent semen analysis, hormonal tests, and testicular biopsies 2 to 3 months after cessation of the exposure. The patients' semen quality had been followed at regular intervals for 1 year as long as the results remained abnormal. We monitored the long-term outcome of 3 patients whose semen remained abnormal during 1 year of follow-up. RESULTS: All patients had decreased sperm counts, with azoospermia being found in one patient. Six patients showed abnormal histologic findings such as atrophy of the seminiferous tubules, thickening of the basement membrane, and hyperplasia of Leydig cells. Of 8 patients, 5 (mean age 37.3 years) showed complete recovery of semen quality during the year after exposure ceased. These patients initially had sperm numbers more than 75 104/mL and a normal serum concentration of FSH. Of 3 patients with abnormal serum FSH and sperm numbers below 3,000/mL, 2 recovered normal sperm numbers at 18th and 24th months after cessation of exposure. Their ages and initial serum FSH concentration were 29 and 26 years and 19.6 and 74.7 mIU/mL, respectively. One patient (37 years old) with relatively normal testicular histology and a serum FSH concentration of 23.7 mIU/mL still had abnormal findings at the last semen analysis, performed 6 years after cessation of exposure. CONCLUSIONS: Solvent containing 2-bromopropane can impair spermatogenesis. This process may be reversed by avoidance of the exposure to this chemical substance. However, an abnormally elevated serum FSH concentration after exposure is an ominous sign for recovery of semen quality.
Atrophy ; Azoospermia ; Basement Membrane ; Biopsy ; Detergents ; Follow-Up Studies* ; Humans ; Hyperplasia ; Leydig Cells ; Male ; Semen ; Semen Analysis ; Seminiferous Tubules ; Sperm Count ; Spermatogenesis*

PURPOSE: We wanted to investigate the effect of dominant kidney nephrectomy on the postoperative renal function and we wanted to determine the preoperative risk factors that influence the postoperative renal function in living donor nephrectomy. MATERIALS AND METHODS: A total of 297 living kidney donors(159 males and 138 females) who underwent nephrectomy were included in this study. Renal function was measured by the serum creatinine levels and (99m)Tc-diethylenetriamine penta-acetic acid(DTPA) renal scanning. Using univariate and multivariate analyses, the following independent variables were evaluated to predict a postoperative serum creatinine level 1.5mg/dl or higher: removal of a functionally dominant kidney or a larger kidney according to the DTPA renal scan or CT, age, gender, body mass index (BMI), comorbidity, preoperative serum creatinine and the preoperative glomerular filtration rate(GFR). RESULTS: Of the 297 subjects, 134(55%) underwent donor nephrectomy on the left side, and 163(45%) underwent donor nephrectomy on the right side. Univariate analysis showed that gender and the preoperative creatinine level were significantly associated with postoperative serum creatinine elevation(1.5mg/dl or higher)(p<0.05). Multivariate analysis showed that the preoperative creatinine level(p<0.001), the preoperative GFR (p=0.015) and removal of a functionally dominant kidney(p=0.049) were significant factors. The cut-off values from the receiver operating characteristics(ROC) curves were 1.0mg/dl for the preoperative creatinine level, 90.24ml/min/1.73m2 for the preoperative GFR, and 10.94% for the difference of the relative renal function on DTPA. CONCLUSIONS: The preoperative serum creatinine level and the preoperative GFR are critical predictive factors for renal function after living donor nephrectomy. The impact of removing a functionally dominant kidney on the postoperative renal function should be cautiously interpreted in patients where the function of the nondominant kidney is favored.
Azotemia ; Body Mass Index ; Comorbidity ; Creatinine ; Filtration ; Humans ; Kidney ; Living Donors ; Male ; Multivariate Analysis ; Nephrectomy ; Pentetic Acid ; Risk Factors ; Tissue Donors

PURPOSE: We investigated whether free testosterone measured by direct immunoassay(aFT) reflects aging as well as bioavailable testosterone(free testosterone index; cBT) calculated from serum testosterone(T) and sex hormone-binding globulin(SHBG). MATERIALS AND METHODS: Serum T, SHBG, and aFT were measured in sera of 414 patients who presented with erectile dysfunction and partial androgen deficiency symptoms but no serious medical comorbidities. Their mean age was 52.5 years(<50: 152, >or=50: 262). The cBT was obtained by calculation from T and SHBG. The mean values of T, aFT, SHBG, and cBT were compared according to the age range. We analyzed the correlation between cBT and aFT and calculated the correlation coefficient. RESULTS: The mean values of T(ng/mL), aFT(pg/mL), SHBG(nmol/L), and cBT(nmol/L) were 3.39, 13.08, 24.3, and 6.04, respectively, in the 3rd and 4th decades; 4.34, 14.72, 23.36, and 7.74 in the 5th and 6th decades; and 4.05, 13.83, 27.32, and 5.96 in the 7th and 8th decades. The SHBG increased and T/aFT/cBT declined as age increased from the 5th and 6th to the 7th and 8th decades. The change was statistically insignificant only for aFT. The correlation between cBT and aFT was weak, with a correlation coefficient of 0.391. CONCLUSIONS: Because free testosterone measured by direct immunoassay did not reflect the age-related changes of SHBG, a single measurement is not a reliable index of bioavailable testosterone.
Aging ; Comorbidity ; Erectile Dysfunction ; Humans ; Immunoassay* ; Male ; Testosterone*

PURPOSE: To compare the clinical efficacy and safety of three phosphodiesterase type 5 (PDE5) inhibitors in the treatment of mele erectile dysfunction according to patient preference. MATERIALS AND METHODS: Between January 2004 and August 2005, 113 male erectile dysfunctional patients were enrolled to this randomized, prospective, comparative, open-label, triple-crossover study of three PDE5 inhibitors. Patients were assigned to one of six medication schedules, and were prescribed a full dose of the drugs for 8 weeks, with a week of washout period prior to the next drug cycle. The International Index of Erectile Function (IIEF) scores and side effects related with each medication were obtained at the end of study. 48 patients finished all the medications, and completed the study with a global assessment questionnaire on their drug preference and reasons for that preference. RESULTS: The mean age of the patients was 54.6 (33-73) years. The mean pre-treatment IIEF and EF domain scores (+/-S.D.) were 28.2+/-14.7 and 10.6+/-6.6, respectively. The scores were significantly improved, to 47.9+/-14.6 and 19.9+/-6.6 with sildenafil, to 49.7+/-12.3 and 21.3+/-5.8 with vardenafil, and to 47.9+/-14.9 and 19.8+/-7.2 with tadalafil (p < 0.01). There were no significant differences in the scores or frequencies of side effects between the drugs. The preference percentages were 29.2, 29.2 and 35.4% for sildenafil, vardenafil and tadalafil, respectively. Patient preference was mainly due to improvement in erectile function (70.9%), such as rigid erection, prolonged erection and fast erection, and not to the infrequent rate of side effects (20.8%). CONCLISIONS: There were no significant differences of the efficacy and safety among the three PDE5 inhibitors. The preference for a drug for the treatment of erectile dysfunction was mainly related to the efficacy on the improvement of erectile function rather than the less frequent side effects.
Appointments and Schedules ; Erectile Dysfunction* ; Humans ; Male ; Patient Preference* ; Phosphodiesterase 5 Inhibitors* ; Phosphodiesterase Inhibitors ; Prospective Studies ; Questionnaires

Purpose: We evaluated the risk factors associated with failure to complete gemcitabine–cisplatin (GP) neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC). Materials and Methods: In total, 231 patients with MIBC treated with NAC before undergoing radical cystectomy between 2013 and 2022 participated in this study. Logistic regression analysis was performed to assess the relationship between the likelihood of incomplete NAC and clinical and demographic variables, including age, sex, hypertension (HTN), diabetes mellitus (DM), prechemotherapy glomerular filtration rate, clinical T stage, clinical N stage, and body mass index (BMI). Results: Of 231 patients, 209 (90.5%) and 22 (9.5%) completed and discontinued the NAC course, respectively. The mean age was 66.13±9.15, 65.63±9.07, and 70.86±8.66 years for the total sample, continuation, and discontinuation groups, respectively (p=0.010). No significant inter-group differences in sex, HTN, height, weight, BMI, pre-chemotherapy glomerular filtration rate, clinical T stage, or clinical N stage were observed. According to the results of the multivariable analysis, age (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.013–1.143, p=0.018) and the presence of DM (OR 2.541, 95% CI 1.028–6.281, p=0.043) were significantly associated with NAC discontinuation. Conclusions Thus, older age and presence of DM are potential risk factors for GP NAC discontinuation in patients with MIBC.Further studies are required to validate our findings and develop strategies to minimize the rate of GP NAC discontinuation in this population.

PURPOSE: It is well known that male erectile dysfunction and lower urinary tract symptoms are common in aging men. We evaluated whether treatment for erectile dysfunction with vardenafil might improve lower urinary tract symptoms. MATERIALS AND METHODS: From January 2004 to May 2005, 34 patients with erectile dysfunction attending the outpatient clinic were treated with vardenafil and followed up 1, 3, and 6 months after the treatment. They completed the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaire at baseline and at each follow-up (1, 3, 6 months). RESULTS: After treatment with vardenafil, IIEF and IPSS were significantly improved at 1 month compared to baseline,and the improvement was maintained during the 3 to 6 month follow-up period. There was no correlation between IPSS and IIEF score either before or after treatment. There was no statistical significance between the severity of IPSS and the response to vardenafil. There were mild side effects, including 2 patients with headache, 2 patients with facial flushing, and 1 patient with eye discomfort. CONCLUSIONS: Vardenafil appears to improve not only erectile function but also lower urinary tract symptoms in men with erectile dysfunction. However, the severity of IPSS does not appear to predict the response to vardenafil therapy.
Aging ; Ambulatory Care Facilities ; Erectile Dysfunction* ; Flushing ; Follow-Up Studies ; Headache ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate ; Vardenafil Dihydrochloride

PURPOSE: To assess the impact of traditional prognostic factors and tumor location on the survival of patients treated surgically for upper urinary tract transitional cell carcinoma(TCC). MATERIALS AND METHODS: We retrospectively analyzed data from 84 patients with upper urinary tract TCC who underwent nephroureterectomy with bladder cuff(95%) or renal parenchymal sparing surgery(5%). Mean patient age was 59.5 years and median follow-up was 44.3 months. The influence of traditional prognostic factors including age, sex, tumor stage, grade, and location on 5-year disease-specific and 5-year recurrence(local recurrence or distant metastasis)-free survival rates were analyzed. The difference in survival rates between renal pelvis(n=43) and ureter(n=41) was analyzed according to the respective T stage and grade. RESULTS: Overall 5-year disease-specific and recurrence-free survival rates were 84% and 73%, respectively. Significant prognostic factors for 5-year disease-specific and recurrence-free survival by univariate analysis were tumor stage, grade, and location. On multivariate analysis, tumor location was the only independent prognostic factor for survival. Patients with ureter tumor had worse prognosis than those with renal pelvis tumor in the same stage or grade. CONCLUSIONS: When treating upper tract TCC with a radical nephroureterectomy, tumor location was the most significant factor influencing survival. Ureter TCC is associated with a higher local or distant recurrence than renal pelvis TCC even at the same stage or grade. A radical surgical attitude, including meticulous lymphadenectomy, may provide a therapeutic role in patients with invasive ureter TCC.
Carcinoma, Transitional Cell* ; Follow-Up Studies ; Humans ; Kidney Pelvis ; Lymph Node Excision ; Multivariate Analysis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Ureter ; Urinary Bladder ; Urinary Tract*