PURPOSE: Peak urinary flow rate is a widely used parameter in the diagnosis and evaluation of treatment erect of BPH because of its objectiveness and non-in vasiveness. The peak urinary flow rate, however is different with each voided volume in the same patient and tends to decrease even in an asymptomatic man with increasing ages. Therefore we need an adjusted peak urinary flow rate corresponding with the age and voided volume. This adjusted peak urinary flow rate can be used to evaluate the voiding function more easily in the same patient periodically or In the different patient of various voided volume and ages. MATERIALS AND METHODS: Data on age, volume voided and peak urinary flow rate were accumulated from 216 male aged from 10 to 80 who were free of voiding symptoms. All combinations of peak urinary flow rate, age and volume voided were tested for equation of bet fit by the least squares method with search for the equation providing least residual standard deviation with SAS package. RESULTS: When the peak urinary flow rate is defined as a function of age and voided volume, the equation is Q=35.01+0.086A-0.0031A2-1612/V(Q: peak urinary flow rate, A: age, V: voided volume). At the point of population means for volume voided(247.5ml) arid age(35.2) the reference peak urinary flow rate was 27.7m1/sec. Adjusted peak flow rate can be obtained by subtracting the difference between the measured and expected peak flow rate(expected minus measured) from the reference peak flow rate. To make the adjusted peak flow rate obtained easily with measured peak flow rate, age and voided volume nomogram that incorporates the equation has been designed. In our nomogram an adjusted peak flow rate < 19.9 ml/sec or > 1.3 standard deviation below mean should be considered suspicious for obstruction. CONCLUSIONS: Nomogram for adjusted peak flow rate that incorporates the age, voided volume and measured peak flow rate would be satisfactory for clinical use.
Diagnosis ; Humans ; Least-Squares Analysis ; Male* ; Nomograms

PURPOSE: Because of the disappointing long-term results of transvaginal bladder neck suspension surgery for anatomical incontinence (AI), a pubovaginal sling, which was formerly operated for sphincteric incontinence (SI), was used to treat AI. The results of the pubovaginal sling for treating AI and the risk factors that affect the result were evaluated. MATERIALS AND MTHODS: A total 39 women with AI underwent a pubovaginal fascial sling using a strip of autologous rectus muscle fascia. The urethral sphincteric function was assessed by measuring the Valsalva leak point pressure. Fifteen patients has type I and 24 patients type II stress incontinence. The results of the pubovaginal sling were compared with those of 51 women who received the Raz precedure. The risk factors for the pubovaginal fascial sling were evaluated. RESULTS: The success rate of an autologous pubovaginal sling (95.6%) at mean follow-up period of (21 months) was significantly higher than that of the Raz bladder neck suspension (80.4%) during the same follow-up period (p<0.05). The success rate of the Raz procedure - 80.4%, 70.8% and 60.7% at 21, 36, 72 months - was decreased after months. The predictive factors for the pubovaginal sling - the number of deliveries, history of hystectomy, the type of stress incontinence, cystocele, urge incontinence, and age - had no significant effect on the success rate of the pubovaginal sling (p<0.05). CONCLUSIONS: A pubovaginal fascial sling may be an effective surgical treatment not only for treating sphincteric incontinence but also anatomical incontinence.
Cystocele ; Fascia ; Female* ; Follow-Up Studies ; Humans ; Neck ; Risk Factors* ; Urethra ; Urinary Bladder ; Urinary Incontinence, Urge

PURPOSE: Because of the disappointing long-term results of transvaginal bladder neck suspension surgery for anatomical incontinence (AI), a pubovaginal sling, which was formerly operated for sphincteric incontinence (SI), was used to treat AI. The results of the pubovaginal sling for treating AI and the risk factors that affect the result were evaluated. MATERIALS AND MTHODS: A total 39 women with AI underwent a pubovaginal fascial sling using a strip of autologous rectus muscle fascia. The urethral sphincteric function was assessed by measuring the Valsalva leak point pressure. Fifteen patients has type I and 24 patients type II stress incontinence. The results of the pubovaginal sling were compared with those of 51 women who received the Raz precedure. The risk factors for the pubovaginal fascial sling were evaluated. RESULTS: The success rate of an autologous pubovaginal sling (95.6%) at mean follow-up period of (21 months) was significantly higher than that of the Raz bladder neck suspension (80.4%) during the same follow-up period (p<0.05). The success rate of the Raz procedure - 80.4%, 70.8% and 60.7% at 21, 36, 72 months - was decreased after months. The predictive factors for the pubovaginal sling - the number of deliveries, history of hystectomy, the type of stress incontinence, cystocele, urge incontinence, and age - had no significant effect on the success rate of the pubovaginal sling (p<0.05). CONCLUSIONS: A pubovaginal fascial sling may be an effective surgical treatment not only for treating sphincteric incontinence but also anatomical incontinence.
Cystocele ; Fascia ; Female* ; Follow-Up Studies ; Humans ; Neck ; Risk Factors* ; Urethra ; Urinary Bladder ; Urinary Incontinence, Urge

PURPOSE: TURP(transurethral resection of prostate) is the standard surgical treatment for BPH. However, myocardial damage is the most serious complication and has been postulated to develop as a result of irrigating fluid absorption during TURP. The aim of this study is to evaluate the relationship between the amount of irrigating fluid absorption and myocardial damage, and the factors that affect irrigating fluid absorption. MATERIALS AND METHODS: From March 2002 to January 2003, 52 patients who had undergone TURP were evaluated. TURP was performed under epidural anesthesia and URIONE(R) solution was used as the irrigating fluid. The amount of absorbed irrigating fluid was measured and serum troponin I was checked as a marker of perioperative myocardial damage. Resection time, weight of resected prostatic tissue, and the amount of blood loss were evaluated as the factors that affect the irrigating fluid absorption. RESULTS: Weight of resected prostatic tissue(r=0.566, p=0.001) and blood loss(r=0.339, p=0.01) were found to have moderate correlation with the amount of absorbed irrigating fluid, whereas the amount of irrigating fluid(r=0.293, p=0.11) and resection time(r=0.296, p=0.062) had no correlation. Myocardial damage was observed in 2 out of the 52 patients(3.8%), whosepostoperative serum troponin I was higher than 0.4microgram/L, and absorbed irrigating fluid being more than 1,000ml. CONCLUSIONS: Therefore, in the case of large prostate volume and excessive blood loss, the use of diuretics during TURP is recommended to reduce the incidence of myocardial damage.
Absorption* ; Anesthesia, Epidural ; Diuretics ; Humans ; Incidence ; Prostate ; Transurethral Resection of Prostate* ; Troponin ; Troponin I

PURPOSE: In situ ESWL is the most attractive treatment for mid-ureteral stones as it is non-invasive and effective. X-ray fluoroscopy is usually used to localize the mid-ureteral stones for in-situ ESWL, since it is easy to manipulate, although a radiation hazard and high maintenance costs are involved. We report our experience of in-situ ESWL, using an ultrasonographic localization system, for the treatment of mid-ureteral stones. MATERIALS AND METHODS: Between June 1992 and June 2001, the mid-ureteral stones overlying the pelvic bone were treated with a Siemens Lithostar Ultra lithotriptor using a Sonoline SL-1 (Siemens, Germany) ultrasonographic localization system, with no anesthesia nor pain control. The mid-ureteral stones, located at the upper half of the pelvic bone, were treated in the prone position, with the shock waves delivered through the back wall using the kidney, renal pelvis and ureter, as landmarks for targeting. The mid-ureteral stones, located at the lower half of the pelvic bone, were treated in supine position, with the shock waves delivered through the abdominal wall using a filled bladder as the landmark for targeting. The localization success, stone free, ESWL success rates, and complications, were evaluated. RESULTS: Of the 96 patients, with mid-ureteral stones, we failed to localize the stone in only 2 patients. Therefore, the success rate for the stone localization was 97.9% (94/96). The stone free rate at 3 months after completion of the in-situ ESWL was 97.9% (92/94). Therefore, in-situ ESWL success rate was 95.8% (92/96). The mean ESWL sessions needed to be free of stones were 1.3+/-0.8 (126 sessions/92 patients). Some patients had hematuria and colicky pain, but serious complications, such as febrile UTI or severe hematuria requiring a transfusion were not encountered. CONCLUSIONS: In-situ ESWL, using an ultrasonographic localization system, is a non- invasive and effective treatment for mid-ureteral stones.
Abdominal Wall ; Anesthesia ; Abdominal Pain ; Fluoroscopy ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Lithotripsy* ; Pelvic Bones ; Prone Position ; Shock* ; Supine Position ; Ultrasonography ; Ureter ; Urinary Bladder

Purpose: A video-urodynamic study is known as the most accurate test to differentiate between benign prostatic hyperplasia (BPH) with overactive bladder and detrusor instability but requires expensive equipment and an expert technique, so is not commonly available. We performed a video- urodynamic study and ice-water test which is easily performed for the diagnosis of a neurogenic bladder in the patients with symptomatic BPH associated with overactive bladder and compared the results. Materials and Methods: The video-urodynamic study using a 10-Fr triple lumen urodynamic catheter was performed in 36 patients with symptomatic BPH associated with overactive bladder that had frequency, weak stream, nocturia, urgency, urge incontinence, dysuria and no clinical neurogenic defect. After the video-urodynamic study, the ice-water test was performed by instilling 4degreesC sterilized water through a catheter at 200ml/ min in the supine position. The volume instilled was about 30% of the bladder capacity. The ice-water test was positive if there was an efflux of water around the catheter during or after water instillation. Results: Thirty two of the 36 symptomatic BPH patients with an overactive bladder were negative on the ice-water test. All 32 patients who had a negative ice-water test were BPH with overactive bladder on the video- urodynamic study. Four of the 36 symptomatic BPH patients with an overactive bladder were positive on the ice-water test. Two of the 4 patients who had a positive ice-water test were BPH with overactive bladder and the other two were detrusor instability on the video-urodynamic study. Conclusions: Therefore, in case of a positive ice water test, a video-urodynamic study is needed to differentiate between BPH with overactive bladder and detrusor instability in patients with symptomatic BPH associated with overactive bladder.
Catheters ; Diagnosis ; Dysuria ; Humans ; Ice ; Nocturia ; Prostatic Hyperplasia* ; Rivers ; Supine Position ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics ; Water

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: Proteins encoded by bcl-2 family as regulators of apoptosis appear to have significant cellular effects such that when abnormally expressed, they may render certain cells more susceptible to aberrant proliferation. The ratio of anti-apoptotic to pro-apoptotic bcl-2 family proteins appears to control the relative sensitivity or resistance of cells to apoptotic stimuli. The primary goal of this study is to determine the expression pattern of bcl-2 and bax in prostate carcinoma and to correlate them with Gleason score, T stage, and PSA to determine their prognostic potential. MATERIALS AND METHODS: We examined the cellular expression of bcl-2 and bax proteins using immunohistochemical metod in a total 35 patients with untreated prostatic carcinoma. All tissues were scored for overall tissue expression as follows: bcl-2(0,<1%; 1+, 1-25%; 2+, 26-50%; 3+, >50%), bax(1+,<50%; 2+, 51-75%; 3+, >75%). RESULTS: Of the 35 cases, 16(45.7%) contained at least 1% bcl-2 positive tumor cells. The bcl-2 positive cases included 1(7.7%) Gleason 2 to 4 grade tumors, 8(66.7%) Gleason 5 to 7 tumors, 7(70.0%) Gleason 8 to 10 tumors. bcl-2 protein expressed more frequently in higher grade(p<0.05) and in higher PSA level(p<0.05) of tumors. bax immunostaining was positive for all 35(100%) and 1+ was 16(45.7%), 2+ was 14(40.0%), 3+ was 5(14.3%). But statistically significant differences in bax expression among grade, T stage, and PSA were not observed. The bcl-2 protein was present mainly in the basal cells, but bax was in both basal and secretory cells of prostate. CONCLUSIONS: bcl-2 protein have some potential role in progression of prostate carcinoma. Therefore, studies that evaluate the expression of these bcl-2 family genes in varoius time during progression of tumors correlate with the state of hormone dependency, response to therapy and duration of response are needed.
Apoptosis ; bcl-2-Associated X Protein ; Humans ; Neoplasm Grading ; Prostate*

BACKGROUND: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. METHODS: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. RESULTS: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. CONCLUSION: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.
Classification ; Drug Therapy* ; Fee-for-Service Plans ; Fees and Charges ; Health Care Costs ; Hospitals, General ; Humans ; Information Systems ; Insurance ; Insurance Claim Review ; Insurance, Health ; Outpatients* ; Product Packaging ; Prospective Payment System ; Referral and Consultation

We report a case of huge seminal vesicle cyst associated with ipsilateral renal agenesis in a 49-year-old man with frequency, urethral discomfort with a full bladder, and tenesmus as complaints.
Humans ; Middle Aged ; Seminal Vesicles* ; Urinary Bladder