PURPOSE: With the widespread use of screening for prostate-specific antigen (PSA), T1c prostate cancer has shown a marked increase in Western countries. We reviewed the trends in clinical stage migration and the changes in the clinical characteristics for patients with prostate cancer in Korea, and we compared these values with those of Western men. MATERIALS AND METHODS: Between 1997 and 2006, 758 men (mean age: 68.6 years) were diagnosed with prostate cancer at our institution. According to the diagnostic period, the patients were divided into 3 groups (the 1997-2000, 2001-2003 and 2004-2006 groups) for comparative analysis of the clinical stage, the serum PSA level and the biopsy Gleason score. RESULTS: The proportion of clinically localized prostate cancer significantly increased by the period (56.8%, 62.5% and 75.4%, respectively; p<0.001) with that of metastatic disease showing a decreasing according to groups (40.0%, 27.5% and 17.6%, respectively; p<0.001). For localized disease, T1c cancers also increased from 26.4% to 19.2% to 31.6% (p=0.002), respectively. The median serum PSA level at diagnosis decreased from 34.5 ng/ml to 16.6ng/ml to 10.8ng/ml (p<0.001), respectively, with the proportion of patients with a PSA level< or =10ng/ml increasing significantly (19.2%, 33.3% and 47.7%, respectively; p<0.001). Although the proportion of biopsy Gleason scores that were 8-10 decreased from 71.2% to 50.2% to 38.3%, respectively, it still comprised 20.8% of the T1c cancers and 22.8% of the cancers with a PSA< or =10ng/ml in the last period, and these values were significantly higher than those in the Western reports. CONCLUSIONS: Downward migration of the clinical stage along with decreases for the serum PSA level and biopsy Gleason score were evident in Korean men. However, the proportion of T1c cancer was still lower than that in the Western series and the fraction of Gleason score 8-10 cancer was distinctively high. We believe this mandates establishing PSA screening programs and administering vigorous management.
Biopsy ; Diagnosis ; Humans ; Korea* ; Male ; Mass Screening ; Neoplasm Grading ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

The incidence of low-stage renal cell carcinoma is rising and is observed to demonstrate excellent prognosis following surgical treatment irrespective of method. However, several epidemiologic observational and population-based studies suggest that radical nephrectomy is associated with increased adverse renal outcomes such as chronic kidney disease (CKD) compared with partial nephrectomy. This is suggested in turn to lead to increased mortality via an increase in cardiovascular complications and mortality. Prospective data are scarce, and there are conflicting data as well on whether surgically induced CKD is as debilitating as medically induced CKD. Further research is needed to assess the presence and the extent of the relationship between nephrectomy, CKD, and noncancer mortality.
Carcinoma, Renal Cell/*surgery ; Humans ; Kidney Neoplasms/*surgery ; Nephrectomy/*adverse effects/methods ; Renal Insufficiency, Chronic/epidemiology/*etiology ; Risk Assessment/methods

PURPOSE: Urethrocutaneous fistulas and urethral strictures are the most frequent complications after hypospadias repair. We reviewed outcomes after surgical repair of these complications to evaluate the factors determining successful outcome. MATERIALS AND METHODS: In 60 patients with fistula or stricture after hypospadias repair performed between September 1993 and January 2008, we reviewed incidences, clinical features, and outcome after repair with respect to initial hypospadias types. RESULTS: Fistulas were observed in 42 patients and were surgically repaired in 39 (92.8%). In 8 (19.0%) and 3 (7.1%) patients, concurrent meatal and urethral strictures were noted, respectively. The number of fistulas was single in 38 (90.5%) and 2 in 4 (9.5%) patients. Fistulas occurred most frequently from the penoscrotal type hypospadias (22/65, 33.8%) and had initially undergone transverse preputial island flap repair (13/26, 50%). Complete excision of the fistulous tract and multilayer advancement flap closure was the most common method for fistula repair (24), followed by cross-suture in 9 and repeat urethroplasty in 6. Initial management was successful in 35 (89.7%) patients. Urethral strictures were observed in 16 patients with equal incidences at the meatus and the other portion of the urethra. Successful outcome was achieved in all metal stenosis after repeat meatoplasty, whereas for urethral strictures, 4 (20%) patients who underwent visual urethrotomy experienced recurrent strictures. CONCLUSIONS: Urethrocutaneous fistulas can be successfully repaired by complete excision and cross-suture closure and multiple coverage with healthy tissues. In urethral strictures, reconstruction of ample neo-meatus is the key to achieving sufficient stream regardless of the stricture site.
Constriction, Pathologic ; Female ; Fistula ; Humans ; Hypospadias ; Incidence ; Male ; Rivers ; Urethra ; Urethral Obstruction ; Urethral Stricture

We analyzed the prostate cancer data of 317 Korean men with clinically localized prostate cancer who underwent radical prostatectomy at Asan Medical Center between June 1990 and November 2003 to construct nomograms predicting the pathologic stage of these tumors, and compared the outcome with preexisting nomograms. Multinomial log-linear regression was performed for the simultaneous prediction of organ-confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node metastasis (LNM) using serum prostate-specific antigen (PSA), Gleason score and clinical stage. Nomograms representing percent probabilities were constructed and compared with those presented by Partin et al. by calculating areas under the receiver operating characteristics (ROC) curves. Median serum PSA at surgery was 10.8 ng/mL, and median biopsy Gleason score was 7. Overall OCD, ECE, SVI and LNM rates were 59.6%, 20.5%, 11.7% and 8.2%, respectively, and areas under the curves were 0.724, 0.626, 0.662, and 0.794, respectively. Pathologic stage of localized prostate cancer in Korean men may be predicted using the Partin table, with acceptable accuracy for OCD and LNM, but less so for ECE and SVI.
Adult ; Aged ; Aged, 80 and over ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/blood/ethnology/*pathology ; ROC Curve

Purpose: We reviewed our experience in the management of ureteroceles in children as we selected the surgical method according to the patients' age and the differential function of the affected renal unit. Materials and Methods: Thirty-six children (10 boys, 26 girls) with ureteroceles who received surgical management between 1991 and 2003 and were followed up for at least 12 months postoperatively were the subjects of this study. Age at operation ranged from 1 month to 10 years (median 6.5 months) and patients were followed up for an average of 43 months postoperatively (12-103 months). Results: Twenty patients had functioning renal units, 16 including 4 infants, of which received transurethral incision (TUI), 3 ureteroureterostomy and 1 ureteroneocystostomy after ureterocelectomy. Eight of the 16 patients (50%) who received TUI developed de novo vesicoureteral reflux (VUR), 5 of whom requiring secondary open procedure. Of the 16 patients with nonfunctioning renal units who received either heminephrectomy or nephrectomy, 6 required secondary open procedures for persistent ureteral obstruction or bladder outlet obstruction. On follow-up, of the 20 patients with initially functioning renal units, 19 maintained preoperative level of renal function and all remained free of urinary tract infection (UTI). Conclusions: In surgical approach to the ureteroceles, individualization with respect to the function of the affected unit and the age of the patient appears to be effective in controlling UTI and preserving the renal function. TUI, despite the high rate of de novo VUR, may be a useful option in immediate decompression of the obstructed urinary tract in the face of acute UTI especially in younger children.
Child* ; Decompression ; Follow-Up Studies ; Humans ; Infant ; Nephrectomy ; Ureteral Obstruction ; Ureterocele* ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: There are few reports concerning the first-line treatment of choice for an overactive bladder. The aim of this study was to compare the effects of bladder training, tolterodine, and bladder training with tolterodine, as first-line treatments in patients with an overactive bladder. MATERIALS AND METHODS: A prospective randomized study was conducted on 99 female patients with overactive bladders. The patients were treated with bladder training, tolterodine (2mg twice daily), and bladder training with tolterodine, as first-line treatments, for 12 weeks. Of the 99 patients, 74 (bladder training: 24, tolterodine: 24, combined: 26) were followed up for 12 weeks. The treatment efficacy was measured by a micturition diary, subjective urgency scores and subjective perception of bladder condition at the end of the treatment. The safety and tolerability were assessed from adverse events and treatment withdrawals. RESULTS: After 12 weeks of treatment, the mean frequency of micturition and nocturia decreased by 27.1 and 55.8% in the bladder training group, 30.3 and 61.9% in the tolterodine group and 32.6 and 63.2% in the combined therapy group. The subjective mean urgency score decreased by 48.4, 62.5 and 63.2% in the three respective groups. The subjective perception of bladder symptom scores at the end of the treatments were 1.5, 1.42 and 1.31, with significant improvement rates of 50.0, 58.3 and 69.3% in the bladder training, tolterodine and combined therapy groups, respectively. Adverse events, and withdrawals due to adverse events, were 23.1 and 7.7% in the tolterodine and 28.6 and 7.1% in the combined therapy groups, but there were none in the bladder training group. CONCLUSIONS: Bladder training, tolterodine and combined therapy are all effective first-line treatments in female patients with overactive bladders. There are some enhanced effects with the combined therapy than with the bladder training and tolterodine monotherapies. Because of its high success rate, relatively low cost and absence of adverse events, bladder training should be included as a first-line treatment.
Female* ; Humans ; Nocturia ; Prospective Studies* ; Treatment Outcome ; Urinary Bladder* ; Urinary Bladder, Overactive* ; Urination ; Tolterodine Tartrate

PURPOSE: To assess the prognostic factors for recurrence-free survival after salvage radiotherapy (RT). MATERIALS AND METHODS: Between 1990 and 2003, 20 patients underwent RT for biochemical failure after a radical prostatectomy (prostate-specific antigen; PSA>0.2ng/ml). The biochemical failure developed at a mean of 17.3 months (3-58) after the RP, and the mean PSA level at failure was 0.62ng/ml (0.4-1.0). All patients received curative radiation (mean dosage 64.5Gy); with a mean follow-up of 42.7 months after the RT. The pre-RT clinical and pathological parameters were evaluated to find prognostic factors affecting the biochemical recurrence-free survival (bRFS) after RT. RESULTS: The mean time to RT from biochemical failure was 5.1 months (1-21), with a mean PSA level at the commencement of RT of 1.39ng/ml (0.36-6.70). In 18 patients, the serum PSA declined to an undetectable level, at a mean of 4.9 months (1-12) after RT. Of these, 8 (44.4%) showed a biochemical relapse, at a mean of 19.3 months (1-38). The actuarial 1, 3 and 5-year bRFS were 75.0, 48.5 and 39.0%, respectively. The bRFS was significantly increased with an interval to RT after failure of within 3 months (p=0.002) and the PSA level at RT was below 0.7ng/ml (p=0.036). No other clinicopathological factors had a significant influence. CONCLUSIONS: Salvage RT for biochemical failure provides effective local tumor control, with a modest durable biochemical response. A more favorable outcome may be expected when the RT is instituted earlier, with a lower PSA level after failure.
Biochemistry ; Follow-Up Studies ; Humans ; Prostatectomy* ; Prostatic Neoplasms ; Radiotherapy* ; Recurrence ; Treatment Failure

PURPOSE: To analyze the biochemical recurrence-free and cancer-specific survival after radical prostatectomy in a consecutive series of patients with prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed data for 1,822 patients who underwent radical prostatectomy with pelvic lymph node dissection at our institution between 1990 and 2009. After excluding 498 patients who were treated with neoadjuvant androgen deprivation therapy or who were followed up for < or =6 months, we included 1324 patients (mean age, 64.4 years; mean prostate-specific antigen [PSA] level, 12.3 ng/ml). We assessed patient age at the time of surgery, preoperative PSA concentration, biopsy and pathologic Gleason scores, pathologic stage, surgical margin status, disease progression, and survival. RESULTS: The mean follow-up time was 40 months (range, 6-193 months). The 5- and 10-year biochemical recurrence-free survival rates were 73.2% and 66.2%, respectively, and the 10-year cancer-specific survival rate was 92.4%. The mean time from surgery to biochemical recurrence was 18 months. In the multivariate analysis, Gleason score (4+3 vs. 2-6, p=0.004; 8-10 vs. 2-6, p<0.001), pathologic stage (pT3a vs. pT2, p=0.001; pT3b-4 vs. pT2, p<0.001; pN1 vs. pT2, p<0.001), and resection margin status (p<0.001) were statistically significant predictors of biochemical recurrence, with only pathologic stage (pT3b-4 vs. pT2, p=0.006; pN1 vs. pT2, p=0.010) being a statistically significant predictor of cancer-specific survival. CONCLUSIONS: Radical prostatectomy resulted in favorable cancer control in more than 70% of patients after 5 years and a low (<10%) cancer-specific mortality rate after 10 years. The factors predictive of biochemical recurrence were Gleason score, pathologic stage, and resection margin status.
Biopsy ; Disease Progression ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Multivariate Analysis ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND: Renal cell carcinoma (RCC) is notorious for its high metastatic potential, and 30% of RCC patients present with metastatic disease at the initial presentation and 50% of them will develop metastasis or recurrence after radical surgery. METHODS: In an attempt to identify the best predictive marker(s) for metastasis in patients with clear cell RCCs (CRCCs), we examined the expression patterns of 7 metastasis/prognosis-related markers by constructing a tissue microarray including primary CRCC specimens from 30 metastatic and 60 nonmetastatic CRCCs. The markers we studied were Ki-67, MUC1, CD44s, PTEN, gelsolin, CA9 and p53. RESULTS: The expressions of Ki-67, PTEN, CD44s, gelsolin and p53 were increased, whereas those of MUC1 and CA9 were decreased in the metastatic CRCCs compared with the non-metastatic CRCCs. The receiver operating characteristic curve-area under the curve (AUC) value of Ki-67 was 0.671, which was the highest among the 7 markers. The optimal cut-off value, sensitivity and specificity of the Ki-67 expression were 1.67%, 86.7% and 41.7%, respectively. CONCLUSIONS: These results demonstrate that the Ki-67 expression was increased in metastatic CRCCs, and it had the highest predictive value among the 7 markers. This suggests that Ki-67 could be an excellent predictive marker for metastasis in CRCC patients.
Sensitivity and Specificity ; Predictive Value of Tests ; Neoplasm Metastasis

PURPOSE: Development of drug resistance has been the major obstacle in cis-Diamminedichloroplatinum (II) (cisplatin)-based combination chemotherapy in the treatment of advanced bladder cancer for which a variety of mechanisms has been suggested. We investigated to determine the changes of expression of apoptotic regulator proteins Bcl-2 and Bax in cisplatin-resistant bladder cancer cell lines and the reversibility of chemoresistance with antisense oligonucleotide against Bcl-2. MATERIALS AND METHODS: In T24, J82, 253J, 253J-BV and HT-1376 bladder cancer cell lines, we established cisplatin-resistance using stepwise exposure to cisplatin. The changes of Bcl-2 and Bax proteins in the resistant cell lines were determined by Western blot. Then, after administration of antisense oligonucleotide targeting the Bcl-2 coding sequence to the T24, T24-R1, and T24-R2 cell lines with lipofectamine, changes of Bcl-2 expression were determined along with cisplatin cytotoxicity before and after transfection. RESULTS: We confirmed the acquisition of cisplatin resistance in all 5 cell lines as the percent increase of IC50 in each cell lines were 210%, 175%, 181%, 280% and 153%, respectively. The expression of Bcl-2 protein increased in all 5 cisplatin-resistant cell lines, while the expressions of Bax decreased in 4 of 5 cisplatin-resistant cell lines. Treatment with antisense oligonucleotide significantly enhanced the cytotoxicity of cisplatin in T24, T24-R1 and T24-R2 cell lines. CONCLUSIONS: These results suggest that the up-regulation of Bcl-2 expression as well as down-regulation of Bax expression may be one of the mechanisms of cisplatin resistance in bladder cancer cells, and antisense Bcl-2 oligonucleotide may be helpful in chemotherapy of bladder cancer by reversing cisplatin resistance.
bcl-2-Associated X Protein ; Blotting, Western ; Cell Line* ; Cisplatin* ; Clinical Coding ; Down-Regulation ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Genes, bcl-2 ; Inhibitory Concentration 50 ; Oligonucleotides, Antisense ; Transfection ; Up-Regulation ; Urinary Bladder Neoplasms* ; Urinary Bladder*