Over the past decade, continent urinary diversion, especially orthotopic bladder substitutions, has become increasingly popular following radical cystectomy for bladder cancer. The ultimate goal of orthotopic bladder substitution is to offer patients the best quality of life, similar to that of patients with native bladders. To achieve that purpose, surgeons should be familiar with the characteristics of good candidates for neobladders, the possible intraoperative and postoperative problems related to the surgery, and the solutions to these problems. Postoperative surveillance and instructions given to the patients also contribute to successful, functional results. Here, we reviewed the indications, pitfalls, and solutions for orthotopic bladder substitutions and the patients' quality of life after surgery. When performed properly, orthotopic continent diversion offers good quality of life with few long-term complications. Therefore, we believe it is the best option for the majority of patients requiring cystectomy.
Cystectomy ; Humans ; Ileum ; Quality of Life ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

The prostatic glandular cells are largely composed of secretory cells and basal cells. Secretory cells produce various enzymatic substance including prostatic specific antigen (PSA), while basal cells have been known to play an important role in the proliferation of the glandular cells. We evaluated the proliferative potential of secretory cells and basal cells in benign prostatic hyperplasia (BPH) and prostate cancer (CAP) by immunohistochemistry. The prostate tissue obtained from 19 patients with BPH and 19 patients with CaP was used in this study. Double staining with PSA and a basal cell marker, cytokeratin (34betaE12) was performed to evaluate the distribution of each cell type in BPH and CaP. Double staining with proliferating cell nuclear antigen (PCNA) and 34betaE12 was carried out to determine the proliferative potential of each cell type. Partial or total loss of basal cell layer was identified in CaP in contrast to intact basal cell layer in BPH. Proportion of basal cells and secretory cells in PCNA positive cells in BPH were 84.6+/-2.0% and 15.4+/-2.0%. In contrast, proportion of basal cells and secretory cells in PCNA positive cells were 1.1+/-1.5% and 98.9+/-1.5% in CaP. PCNA index (PCNA positive cells in 1,000 cells) in CaP was well correlated with Gleason score, but not with pathologic stage. Interestingly, PCNA index in basal cell was significantly higher in stromal type BPH (including fibrous, fibromuscular and muscular type) than that in glandular type BPH (including fibroadenomatous and fibromyoadenomatous type). Taken together, the basal cell play a major role in the proliferation of glandular cells of BPH, while loss of basal cell layer and overproliferation of secretory cells in CaP might lead cancer cells to invade into the stroma. Since higher basal cell PCNA index was noted in glandular type BPH, it is probable that the proliferative potential of basal cell induce secretory cell proliferation.
Cell Proliferation ; Humans ; Immunohistochemistry ; Keratins ; Neoplasm Grading ; Proliferating Cell Nuclear Antigen ; Prostate ; Prostatic Hyperplasia* ; Prostatic Neoplasms*

PURPOSE: A systematic review and meta-analysis was conducted to evaluate the effects of smartphone-based mobile learning for nurses and nursing students. METHODS: Electronic literature search of PubMed, Cochrane Library, Embase, SCOPUS, Web of Science, ProQuest Central, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Educational Resource Information Center (ERIC) was conducted. Two authors independently reviewed empirical studies for inclusion and extracted the design, sample size, intervention method, outcome variables, and statistical values of them. Methodological quality was assessed using Cochrane collaboration risk of bias tool. To estimate the effect size, meta-analysis was performed using R meta program. RESULTS: Authors identified 11 randomized or nonrandomized controlled trials of a total of 3,419 studies. Overall effect sizes by random-effects model was large [Hedges'g (g) = 1.12, 95% confidence interval (CI) 0.72−1.52], with learning attitude (g = 1.69), skills (g = 1.41), knowledge (g = 1.47), and confidence in performance (g = 1.54). For heterogeneity, subgroup analyses using meta-analysis of variance were performed, but no significant difference was found. Finally, a funnel plot and Egger's regression test along with trim-and-fill analysis and fail-safe N were conducted to check for publication bias, but no significant bias was detected. CONCLUSION: Smartphone-based mobile learning had significantly positive influence on nursing students' knowledge, skills, confidence in performance, and learning attitude. Smartphone-based mobile learning may be an alternative or supportive method for better education in nursing fields.
Bias (Epidemiology) ; Cooperative Behavior ; Education ; Education, Nursing ; Humans ; Information Centers ; Learning ; Methods ; Nursing ; Population Characteristics ; Publication Bias ; Sample Size ; Smartphone ; Students, Nursing

Purpose: This study aimed to identify the mediating effects of depression amid the influence of fear and social distancing arising from Coronavirus disease 2019 (COVID-19) in Korean women’s suicidal ideation. Methods: A descriptive correlation study was conducted. Study participants, recruited by Hankook Research from March 2 to March 5, 2021, included 300 women aged 19 to 49 living in South Korea, and 100 people were randomly allocated and enlisted for each age group out of 700,000 Hankook Research Panels recruited in advance from 17 cities and provinces nationwide. Data were collected through a self-reported questionnaire and analyzed using Pearson’s correlation coefficient and Hayes’ Process Macro Model 4 with 95% bias-corrected bootstrap confidence interval via SPSS statistics 27.0. Results: Suicidal ideation was significantly correlated with fear of COVID-19 (r = .16, p = .006) and depression (r = .65, p < .001). The mediation effect of depression in the relationship between the fear of COVID-19 and suicidal ideation was found to be significant (B = 0.40, boot 95% CI: 0.21~0.61). However, social distancing did not significantly affect suicidal ideation via depression (B = - 0.79, boot 95% CI: - 1.94~0.26). Conclusion It is necessary to develop and apply interventions to prevent depression and suicidal behaviors by continuously observing and reducing the negative psychological responses caused by COVID-19.

PURPOSE: To investigate the effect of nurses' emotional labor on their turnover intention that was mediated by burnout and to examine the moderated mediation effect of authentic leadership. METHODS: A total of 227 nurses working at two general hospitals in Seoul were recruited from March 21 to May 6 in 2016. Emotional labor including surface acting and deep acting; burnout factors such as emotional exhaustion and personal accomplishment; and turnover intention were assessed. The data were analyzed using SPSS 22.0 and SPSS PROCESS macro. RESULTS: Surface acting significantly increased emotional exhaustion and reduced personal accomplishment. Deep acting significantly increased personal accomplishment. Emotional exhaustion significantly increased turnover intention. Conversely, personal accomplishment significantly reduced turnover intention. Surface acting had an indirect effect on turnover intention that was mediated by emotional exhaustion. Deep acting had an indirect effect on turnover intention that was mediated by personal accomplishment. Authentic leadership had a moderated mediation effect on the relationship between surface acting and turnover intention that was mediated by emotional exhaustion. CONCLUSION The findings of this study indicate that the establishment of strong authentic leadership by head nurses would help nurses reduce their burnout and turnover intention. Conducting intervention studies would be also important to promote better work environments that would enable nurses to fortify the positive aspect of emotional labor and to reduce their burnout levels.

PURPOSE: To investigate the effect of nurses' emotional labor on their turnover intention that was mediated by burnout and to examine the moderated mediation effect of authentic leadership. METHODS: A total of 227 nurses working at two general hospitals in Seoul were recruited from March 21 to May 6 in 2016. Emotional labor including surface acting and deep acting; burnout factors such as emotional exhaustion and personal accomplishment; and turnover intention were assessed. The data were analyzed using SPSS 22.0 and SPSS PROCESS macro. RESULTS: Surface acting significantly increased emotional exhaustion and reduced personal accomplishment. Deep acting significantly increased personal accomplishment. Emotional exhaustion significantly increased turnover intention. Conversely, personal accomplishment significantly reduced turnover intention. Surface acting had an indirect effect on turnover intention that was mediated by emotional exhaustion. Deep acting had an indirect effect on turnover intention that was mediated by personal accomplishment. Authentic leadership had a moderated mediation effect on the relationship between surface acting and turnover intention that was mediated by emotional exhaustion. CONCLUSION: The findings of this study indicate that the establishment of strong authentic leadership by head nurses would help nurses reduce their burnout and turnover intention. Conducting intervention studies would be also important to promote better work environments that would enable nurses to fortify the positive aspect of emotional labor and to reduce their burnout levels.
Burnout, Professional ; Hospitals, General ; Humans ; Intention ; Leadership ; Negotiating ; Nursing, Supervisory ; Personnel Turnover ; Seoul

PURPOSE: We investigated changing patterns of primary treatment in Korean men with prostate cancer (PC) and impact of sociodemographic factors on treatment choice from a nationwide cohort over 10 years. MATERIALS AND METHODS: We conducted a cohort study of a 2% nationwide random sample of Korean National Health Insurance. A total of 1,382 patients who had undergone active treatments for newly diagnosed PC between 2003 and 2013 were included. Time trends in primary treatment of PC, including radical surgery, radiation therapy (RT), and androgen deprivation therapy (ADT) were analyzed. RESULTS: Total number of patients undergoing active treatments increased significantly (162%). Surgery cases showed the most significant increase, from 22.4% in 2003 to 45.4% in 2013, while the relative proportion of ADT showed a tendency to decrease from 60.3% in 2003 to 45.4% in 2013, and the relative proportion of RT was variable over 10 years (from 7.2% to 18.4%). While treatment patterns differed significantly according to age (p < 0.001) and income classes (p=0.014), there were differences in primary treatment according to residential area. In multinomial logistic regression analysis, older patients showed significant association with ADT or RT compared to surgery, while patients with higher income showed significant association with surgery. CONCLUSION: Treatment pattern in Korean PC patients has changed remarkably over the last 10 years. Sociodemographic factors do affect the primary treatment choice. Our results will be valuable in overviewing changing patterns of primary treatment in Korean PC patients and planning future health policy for PC.
Cohort Studies ; Health Policy ; Humans ; Logistic Models ; Male ; National Health Programs ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Radiotherapy

PURPOSE: According to the presence of proper muscle in the resected specimens from primary T1G3 bladder tumors, we compared the prognosis and investigated factors that were predictive of disease progression during the follow-up and upstaging after radical cystectomy. MATERIALS AND METHODS: We reviewed the records of 157 patients who were diagnosed with primary T1G3 bladder cancer for the assessment and comparison of disease recurrence, disease progression and patient survival. There were 101 and 56 patients with and without proper muscle in the their transurethral resection (TUR) specimens (T1G3 and T1xG3, respectively); 30 and 20 of these patients, respectively, had undergone immediate cystectomy. RESULTS: Among the patients who were followed up after transurethral surgery, there were no differences in the survival between the two groups. For the patients treated by immediate cystectomy, the 5-year cancer-specific survival was 100% for the T1G3 patients at a mean follow-up of 54.5 months while it was 76.6% for the T1xG3 patients at a mean follow-up of 46.0 months (p=0.042). With the absence of radiologic findings suggestive of invasive bladder cancer, 55.6% of the T1xG3 patients were upstaged after radical cystectomy, whereas only 12.0% of the T1G3 patients were upstaged (p=0.002). Between the followed-up group and the cystectomy groups, more patients in the cystectomy group had non-papillary shaped bladder tumor (75.0% vs. 38.9%, respectively, p=0.010). Similarly, the T1x-G3 patients who progressed during follow-up or who were upstaged after radical cystectomy had more non-papillary shaped tumor than the patients who were without progression or upstaging (80.1% vs. 38.5%, respectively, p=0.006). CONCLUSIONS: For primary T1G3 bladder cancer, non-papillary shaped tumor without proper muscle in the resected specimen is a risk factor for the progression during follow-up or upstaging after radical cystectomy that should warrant consideration for repeated resection or early cystectomy.
Cystectomy ; Disease Progression ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence ; Risk Factors ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We report our experiences of nerve and seminal sparing cystectomy to improve of daytime and nighttime urinary continence and sexual function in patients requiring a radical cystoprostatectomy. MATERIALS AND METHODS: Between December 1999 and December 2003, the data from 17 patients who underwent a nerve and seminal sparing cystectomy were compared with those from 18 patients who underwent a radical cystoprostatectomy for a malignant neoplasm of the bladder. No patient had erectile dysfunction or voiding problems prior to surgery. All patients had organ-confined tumors (stage Ta-2N0M0). The mean ages and follow- up periods were 54.4 years and 16.1 months for the study group and 59.4 years and 17.9 months for the control group. RESULTS: The rates of potency, daytime continence and night-time continence were 93.8, 100 and 81.3%, respectively, in the patients who underwent nerve and seminal sparing cystectomy, and 0, 94.4 and 50%, respectively in those who underwent radical cystoprostatectomy. Within 3 days of the Foley catheter removal, 31 and 19% had daytime and nighttime continence, respectively, in those who underwent nerve and seminal sparing cystectomy. CONCLUSIONS: In patients with considerable concern relating to sexual activity, and in those anxious about loss of urinary continence after radical cystoprostatectomy, a nerve and seminal sparing cystectomy can be used, which elevates the quality of life via preservation of physiological voiding and normal sexual function with oncological safety if patients are selected carefully.
Catheters ; Cystectomy* ; Erectile Dysfunction ; Humans ; Male ; Quality of Life ; Sexual Behavior ; Sexuality ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Incontinence

PURPOSE: To assess the ability of multiple variables to predict the extracapsular extension and lateralities of the extension on ten-core prostate needle biopsies. MATERIALS AND METHODS: Eighty-five ten-core prostate biopsies and corresponding radical prostatectomy specimens were studied. Using univariate and multivariate regression analyses, variables, such as Gleason score, preoperative PSA, bilaterality of cancer, number of positive cores, total length of cancer, maximum length and percent of cancer on one core and maximum percent of cancer on one site were determined for their prediction of extracapsular extension. RESULTS: Thirty-seven of the 85 patients (44%) showed extracapsular extension. In a univariate analysis, all variables, with the exception of the PSA, were significant. The number of positive cores was the only independent predictive factor in a multivariate analysis (p=0.0007). Nineteen (39.6%) of the 48 unilateral cancers cases on biopsy showed ipsilateral extracapsular extension, including 3 bilateral extensions on prostatectomy specimens. Significant differences in the Gleason score and number of positive cores were noted between organ confined and extracapsular tumors on the prostatectomy specimens. Among 37 bilateral cancers on biopsy, the probability of organ confined, unilateral extracapsular and bilateral extracapsular diseases were 51, 16 and 32%, respectively. The number of positive cores had a significant impact on the extension of tumors, with a dominant number of positive cores on the ipsilateral side. CONCLUSIONS: The number of positive cores is the most important predictive factor for the extracapsular extension. The laterality of the extracapsular extension can be predicted by the laterality and dominance of positive cores on biopsies.
Biopsy* ; Biopsy, Needle ; Humans ; Multivariate Analysis ; Neoplasm Grading ; Prostate* ; Prostatectomy ; Prostatic Neoplasms*