PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding <4 times per night, and Group II had severe nocturia with voiding > or =4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia (<4 times/night) and of 2 times in patients with severe nocturia (> or =4 times/night) are needed to improve the QoL.
Deamino Arginine Vasopressin ; Humans ; Nocturia ; Quality of Life

PURPOSE: The aim of this study was to determine whether or not the 1-hour pad test demonstrates the objective severity of female stress urinary incontinence. MATERIALS AND METHODS: One hundred eighteen female patients with stress urinary incontinence symptom were prospectively evaluated with a 1-hour pad test as recommended by the International Continent Society and they also underwent videourodynamics to determine the ALPP. The patients were divided into 2 groups by the ALPP: group A (n=94) was the low leak point pressure group (ALPP< or=100cmH2O), and group B (n=24) was the high leak point pressure group (ALPP>100cmH2O or no leakage). A pad gain < or=2g was considered a negative pad test. Student's t-test was done to evaluate the difference of urine leakage between the two groups. RESULTS: The mean amount of urine leakage measured by the 1-hour pad test for groups A and B were 53.4+/-47.2 and 50.9+/-53.9g, respectively, and there was no statistically significant differences between two groups (p=0.839). Eighteen (15.2%) women did not leak during the ALPP measurement and 6 (5.1%) women had a negative pad test. Among the 18 women with no leakage on the ALPP, 15 had a positive pad test and 3 had a negative pad test. Among the 6 women with a negative pad test, 3 had leakage and 3 had no leakage during the ALPP measurement. One hundred fifteen patients received an operation for stress urinary incontinence. The three patients who had no leak on the ALPP and who also had a negative pad test did not receive the operation. CONCLUSIONS: These data suggest that the 1-hour pad test did not demonstrate the objective severity of stress urinary incontinence. However, the 1-hour pad test was more sensitive to demonstrate leakage than the ALPP; therefore, in the case of no leakage during the ALPP measurement, the 1-hour pad test is needed to check the leakage.
Female ; Humans ; Incontinence Pads ; Prospective Studies ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

Bacillus Calmette-Guerin(BCG) has been widely used for the prophylaxis of superficial bladder tumor recurrence and for the treatment of bladder carcinoma in situ. More than 95% of patients who receive BCG instillation tolerate the treatment well and side reactions have been reported in less than 5% of patients. Most side effects are minor and self-limiting. However, a rear occurrence of severe systemic reactions have been reported. Among the severe systemic reactions, hypersensitivity pneumonitis should be considered in patients with pneumonic complications after BCG instillation in cases where the culture for mycobacteria is negative in the sputum, brochoalveolar lavage and blood specimen. In addition, a fiberoptic bronchoscopy with transbronchial lung biopsy demonstrates a fibrosis of the alveolar septums, where there is and an increased lymphocyte count without tuberculous inflammatory changes, the and CD4:CD8 ratio is increased and no symptomatic response to antituberculosis chemotherapy is observed. Here we report a 68 years old man with interstitial pneumonitis following intravesical BCG instillation.
Administration, Intravesical* ; Alveolitis, Extrinsic Allergic ; Bacillus ; Biopsy ; Bronchoscopy ; Carcinoma in Situ ; Drug Therapy ; Fibrosis ; Humans ; Lung ; Lung Diseases, Interstitial* ; Lymphocyte Count ; Mycobacterium bovis* ; Recurrence ; Sputum ; Therapeutic Irrigation ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Nocturia is one of the most bothersome of all benign prostatic hyperplasia(BPH) symptoms. Nocturia with BPH is generally thought to be closely associated with change of detrusor receptor and infection secondary to bladder outlet obstruction. However, age-associated physiological changes in bladder function and concurrent disease, for example, congestive heart failure, cause nocturia in elderly. Therefore, in BPH with nocturia, evaluation for etiology of nocturia is important for proper control of nocturia permanently and this study was performed to investigate the underlying etiology of nocturia. MATERIALS AND METHODS: The twenty-seven BPH patients who complained more than three times of nocturia were included in this study. Evaluation included voiding diary for 24 hour, and urodynamic study. Based on diary and urodynamic study, functional bladder capacity was determined and etiology of nocturia was classified into one of three groups : noctural polyuria, hyperactivity nocturia and functional nocturia. Noctural polyuria was defined as overnight urine volume is over than 33% of 24 hour urine volume, hyperactive nocturia as the number of nocturia is more than (overnight urine volume/functional bladder capacity)-1 and functional nocturia as the number of nocturia is equal to (overnight urine volume/functional bladder capacity)-1. RESULTS: Overall 7(26%) had noctural polyruia. 4(15%) hyperactive nocturia and 13(48%) were mixed with noctual polyuria and hyperactive nocturia. The other 3(11%) were classified into functional nocturia. CONCLUSIONS: The cause of nocturia in the patient with BPH was multifactorial and unrelated to bladder outlet obstruction in significant proportion of BPH patients. Therefore in BPH patients with nocturia, we think that sufficient evaluation to find cause of nocturia is needed preoperatively and treatment should be directed to each condition with BPH management.
Aged ; Heart Failure ; Humans ; Nocturia* ; Polyuria ; Prostatic Hyperplasia ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urodynamics

PURPOSE: The aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB). MATERIALS AND METHODS: We included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups. RESULTS: Groups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume. CONCLUSIONS: Desmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.
Cholinergic Antagonists ; Deamino Arginine Vasopressin ; Female ; Humans ; Quality of Life ; Quinuclidines ; Tetrahydroisoquinolines ; Urinary Bladder, Overactive ; Solifenacin Succinate

Papillary cystadenoma of the epididymis is a rare benign tumor that accounts for only 5% of all epididymal tumors. A case of epididymal cystadenoma was presented in a 25 year old man. The patient was hospitalized initially because of infertility and bilateral painless palpable scrotal masses. He had multiple renal cysts and pancreatic cysts. He had no renal, adrenal, cerebellar or retinal lesion as cardinal manifestation of the Von Hippel-Lindau Syndrome (VHL). The VHL gene mutation in this case was not identified. For evaluation and management, we planned left epididymovasostomy and left testicular biopsy. However, due to a cystic change on the left epididymis and left tunica albuginea, we instead performed a left partial epididymectomy for the cystic lesion, excision of the cystic mass from the left tunica albuginea, and diagnostic left testicular biopsy. The pathologic evaluation revealed a papillary cystadenoma of the epididymis and tunica albuginea, but with normal spermatogenesis.
Adult ; Biopsy ; Cystadenoma ; Cystadenoma, Papillary* ; Epididymis* ; Humans ; Infertility ; Male ; Pancreatic Cyst* ; Retinaldehyde ; Spermatogenesis ; von Hippel-Lindau Disease

type presents as a prolonged painful erection and is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high-flow priapism, is characterized by absence of pain and ischemia. We report two cases of high-flow priapism caused by rupture of the cavernosal artery following blunt perineal trauma. The patients complained of painless and persistent penile erection. By trauma history, cavernosal blood gas analysis, and color Doppler sonography, arterial high-flow priapism was confirmed, In both cases, left cavernosal artery leakage was revealed by internal pudendal selective angiography. The cavernosal artery was embolized with coils in both patients, and penile detumescence was achieved.
Angiography ; Arteries ; Blood Gas Analysis ; Humans ; Ischemia ; Male ; Penile Erection ; Priapism* ; Rupture

type presents as a prolonged painful erection and is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high-flow priapism, is characterized by absence of pain and ischemia. We report two cases of high-flow priapism caused by rupture of the cavernosal artery following blunt perineal trauma. The patients complained of painless and persistent penile erection. By trauma history, cavernosal blood gas analysis, and color Doppler sonography, arterial high-flow priapism was confirmed, In both cases, left cavernosal artery leakage was revealed by internal pudendal selective angiography. The cavernosal artery was embolized with coils in both patients, and penile detumescence was achieved.
Angiography ; Arteries ; Blood Gas Analysis ; Humans ; Ischemia ; Male ; Penile Erection ; Priapism* ; Rupture

We studied intraoperative changes of transurethral resection of the prostate in blood coagulation-fibrinolysis system by thromboelastography (TEG) in 31 patients with benign prostatic hyperplasia. As TEG parameters reaction time (R), clot formation time (K), maximum amplitude (MA), coagulation time (R+K), clot lysis index after 60 minutes (Ly60) were measured. The coagulability was evaluated by R and R+K, the absolute strength of clot by MA, and fibrinolysis by Ly60. Coagulation time (R+K) was shortened in patients with decreased platelet count under 30,000 u/L (p<0.05), irrigating fluid volume over 20,000 ml (p<0.05) and had a tendency of shortening in patient with resection time over 50minutes (p=0.078). MA had a tendency of increasing but significant contributing factor was not detected. The mean value of Ly60 was increased significantly but the change was in normal range. Irrigating fluid volume (r=-0.407, p<0.05) and resection time (r=-0.456, p<0.05) showed negative correlation significantly with the change of R + K. There was no significant correlation between resected prostatic weight and TEG parameters. We concluded that coagulability is increased during TURP suggesting a possible role in postoperative clot retention, but the risk of fibrinolysis is not increased in patients with normal coagulation-fibrinolysis system.
Fibrinolysis ; Humans ; Platelet Count ; Prostate* ; Prostatic Hyperplasia ; Reaction Time ; Reference Values ; Thrombelastography* ; Transurethral Resection of Prostate

Background/Aims: Tracheostomy is a crucial intervention for severe pneumonia patients requiring prolonged mechanical ventilation (MV). However, debate persists regarding the influence of tracheostomy timing and performance on long-term survival outcomes. This study utilized propensity score matching to assess the impact of tracheostomy timing and performance on patient survival outcomes. Methods: A retrospective observational study employing propensity score matching was conducted of respiratory intensive care unit (ICU) patients who underwent prolonged acute MV due to severe pneumonia from 2008 to 2023. The primary outcome was the 90-day cumulative mortality rate, with secondary outcomes including ICU medical resource utilization rates. Results: Out of 1,078 patients, 545 underwent tracheostomy with a median timing of 7 days. The tracheostomy group exhibited lower 90-day cumulative mortality and a higher survival probability (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.43–0.63) than the no-tracheostomy group. The tracheostomy group had higher ICU medical resource utilization rates and medical expenditures. The early tracheostomy group (≤ 7 days) had lower ICU medical resource utilization rates and medical expenditures than the late tracheostomy group (> 7 days). However, there were no significant differences in the 90-day cumulative mortality rate and survival probability based on tracheostomy timing (HR 0.94, 95% CI 0.70–1.28). Conclusions Tracheostomy in patients with severe pneumonia requiring prolonged MV significantly reduced the 90-day mortality rate, and early tracheostomy may offer additional benefits for resource utilization efficiency. These findings underscore the importance of considering tracheostomy timing in optimizing patient outcomes and healthcare resource allocation.