AIMTo evaluate the effects of metabolic profiles on lower urinary tract symptoms (LUTS) in men with erectile dysfunction (ED).

METHODSA total of 75 impotent men aged 25-75 years old (mean 58.1 years) were included in the study on a prospective basis. Patients were evaluated with a complete history, physical examination, anthropometry and metabolic profiles. LUTS were assessed using the International Prostate Symptom Score (IPSS).

RESULTSOverall, there was no correlation between the IPSS and continuous parameters. However, when continuous variables were categorized, some parameters were significantly associated with LUTS. Patients with triglyceride level of 150 mg/dL or higher had more severe symptoms than those with triglyceride levels less than 150 mg/dL (19.4 +/- 2.4 vs. 14.3 +/- 1.1, P = 0.033). When 40 mg/dL was chosen as the high-density lipoprotein (HDL)-cholesterol cut-off level, the IPSS was significantly different between the two groups divided by 40 mg/dL (19.4 +/- 2.6 for HDL-cholesterol < 40 mg/dL vs. 14.4 +/- 1.0 for HDL-cholesterol = or > 40 mg/dL, P = 0.042). The area under the receiver operating characteristic curve (AUROCC) of triglyceride was 65.7% (95% confidence interval [CI], 52.6%-82.3%; P = 0.034) for severe LUTS. However, the AUROCC for 'HDL-cholesterol' was not significant (area, 65.4%; 95% CI, 48.2%-82.7%; P = 0.062). No other factors were determined to be significant in this regard.

CONCLUSIONThe results of the present study indicate that some metabolic profiles might influence LUTS in men with ED.

Adult ; Aged ; Aging ; Body Mass Index ; Erectile Dysfunction ; etiology ; pathology ; physiopathology ; Humans ; Male ; Metabolic Syndrome ; etiology ; Middle Aged ; Prostate ; pathology ; Risk Factors ; Triglycerides ; blood ; Urologic Diseases ; etiology ; pathology ; physiopathology

PURPOSE: This study was initiated to establish the hazard ratios for risk of urinary stone formation in chronic spinal cord injury (SCI) patients. MATERIALS AND METHODS: A total of 140 male patients who were injured before 1987 were eligible for this investigation and they were followed up on a yearly basis from January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (27.9%) and 21 patients (15.0%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. On multivariate analysis, bladder stone was more common for the patients who were injured at 24 years old or older than is was for those patients who were injured at less than 24 years old (odds ratio [OR]: 2.490; 95% confidence interval [CI]: 1.092-5.677; p=0.030). In another model, the patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (OR: 4.095; 95% CI: 1.295-12.944; p=0.016). We also found that renal stone was more common for the patients with urethral catheterization (UC) than for the patients who could spontaneous void (OR: 5.668; 95% CI: 1.306-24.604; p=0.021), and for patients with bladder stone than for those without bladder stone (OR: 4.678; 95% CI: 1.447-15.126; p=0.010). CONCLUSIONS: Injury characteristics are important for the development of urinary stone in chronic traumatic SCI patients. In addition, our findings suggest that for the cases who cannot undergo intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than UC is regards to renal stone formation in this population.
Catheterization ; Catheters ; Cystostomy ; Follow-Up Studies* ; Humans ; Male* ; Multivariate Analysis ; Risk Factors* ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder Calculi ; Urinary Calculi* ; Urinary Catheterization ; Urinary Catheters ; Young Adult

Various laparoscopic nephroureterectomy techniques for urothelial carcinoma of the upper urinary tract have been developed to minimize postoperative discomfort and the necessity for a lengthy convalescence. We performed hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device in 3 male patients with urothelial carcinoma of the distal ureter. Average operative time and estimated blood loss were 251 min (range 235 to 280) and 250 mL (range 200 to 300), respectively. Complication did not occur and conversion to open surgery was not necessary in all cases. Postoperative analgesic requirements were moderate and the time to regular diet intake averaged 3 days (range 2 to 4). None of the patients had a positive margin on the final pathologic specimen. At the average follow-up of 8.1 months, no regional recurrence, port-site metastasis, bladder recurrence, or distant metastasis were noted in any patient. We described our initial experience with the described technique, which obviates the need for midprocedural patient repositioning.
Aged ; Humans ; Laparoscopes ; Laparoscopy/*methods ; Male ; Middle Aged ; Nephrectomy/instrumentation/*methods ; Retroperitoneal Space/pathology/*surgery ; Treatment Outcome ; Ureter/pathology/*surgery ; Ureteral Neoplasms/pathology/*surgery

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.
Arachnoid ; Arachnoiditis ; Diagnosis ; Discitis ; Epidural Abscess ; Failed Back Surgery Syndrome* ; Fibrosis ; Gadolinium ; Hematoma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Osteomyelitis ; Retrospective Studies

Acute airway obstruction after anterior cervical surgery is rare, but does occur. Airway obstruction due to prevertebral soft tissue swelling is unpredictable, but potentially lethal. We managed a 67-year-old male who developed acute airway obstruction caused by marked prevertebral soft tissue swelling on the first day after anterior cervical discectomy and fusion at the C4-C5 level.
Aged ; Airway Obstruction ; Diskectomy ; Humans ; Male

For the patients suffering from extensive deep vein thrombosis (DVT), the placement of an inferior vena cava (IVC) filter in conjunction with anticoagulant therapy has been used to prevent pulmonary embolisms. However, for the patients who anticoagulant is contraindicated or if this is complicated, the use of an IVC filter without concurrent anticoagulation may become the sole treatment for pulmonary embolisms. In this situation, the thrombi trapped in the IVC filter may cause significant clinical problems. We report here on a case of IVC filter thrombosis that was successfully treated by aspiration thrombectomy after placing another filter proximal to the previous filter.
Humans ; Pulmonary Embolism ; Thrombectomy* ; Thrombosis* ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Thrombosis

PURPOSE: To identify the predictors of death from other causes in patients with localized renal cell carcinoma (RCC). MATERIALS AND METHODS: We identified 1,101 patients with pathologically confirmed T1 or T2 RCC with a follow-up duration of over 6 months. Survival according to the cause of death was evaluated by using the Kaplan-Meier analysis with log-rank test. Prognostic factors for death from other causes were assessed by multivariate analysis using the Cox proportional hazard regression model. Once the prognostic factors were identified, a risk-group variable was created by counting the number of unfavorable features present for each patient. RESULTS: The median follow-up was 62 months, and RCC-related death occurred in 50 patients (4.5%), whereas death from other causes occurred in 47 (4.3%). Patients who died from other causes had a higher American Society of Anesthesiologist (ASA) score (26.1% vs. 10.2%; p=0.044), older age (63.4 years vs. 55.0 years; p<0.001), smaller mass size (5.1 cm vs. 7.9 cm; p<0.001), and lower nuclear grade (p=0.003). In the multivariate Cox regression analysis, older age, higher ASA score, and lower body mass index were independent factors predicting death from other causes in patients with localized RCC. On the basis of the number of risk factors for death from other causes, the 5-year other-cause-specific survival was 98.3% (0 risk factors), 84.7% (1 risk factor), and 67.6% (2 or 3 risk factors), respectively (p<0.001). CONCLUSIONS: Older age, higher ASA score, and lower body mass index were independent predictors of death from other causes in patients with localized RCC.
Body Mass Index ; Carcinoma, Renal Cell ; Cause of Death ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Multivariate Analysis ; Risk Factors ; Watchful Waiting

PURPOSE: We sought to maximize the antitumor effect of an anticancer vaccine based on genetically modified endothelial cells by combining it with the platelet-derived growth factor receptor inhibitor imatinib. MATERIALS AND METHODS: Human umbilical vein endothelial cells (HUVECs) were infected with 10 MOI of Ad-CMV-mGMCSF to make anticancer vaccines. One million mouse bladder cancer cells (MBT-2) were subcutaneously inoculated in C3H mice. The experimental groups included the following: Group 1 (phosphate-buffered saline), Group 2 (anticancer vaccine and GM-CSF), Group 3 (imatinib), and Group 4 (anticancer vaccine, GM-CSF, and imatinib). Tumor growth and body weight were measured weekly. At 4 weeks, the tumors were immunostained with anti-CD31, and microvessel density (MVD) was measured. To evaluate the immunological mechanism of each treatment, flow cytometry analysis of activated CD4 and CD8 cells was performed. RESULTS: At 4 weeks, the mean body weight of each group, excluding the extracted tumor weight, was not significantly different. Since week 3, the mean tumor volume in Group 4 was the smallest among the treatment groups (p<0.05), and a synergistic suppressive effect on tumor volume was observed in Group 4. The MVD in Group 4 was the most suppressed among the treatment groups (p<0.05), and a synergistic anti-angiogenic effect was observed. Flow cytometry analysis revealed that activated CD4+ and CD8+ cells increased in Group 2 and decreased in Group 3 compared with the other groups. CONCLUSIONS: The combination of genetically modified endothelial cell vaccines and imatinib showed a synergistic antiangiogenic effect in bladder cancer.
Animals ; Benzamides ; Body Weight ; Endothelial Cells ; Flow Cytometry ; Granulocyte-Macrophage Colony-Stimulating Factor ; Human Umbilical Vein Endothelial Cells ; Immunotherapy ; Mice ; Mice, Inbred C3H ; Microvessels ; Piperazines ; Platelet-Derived Growth Factor ; Pyrimidines ; Receptors, Platelet-Derived Growth Factor ; Tumor Burden ; Urinary Bladder ; Urinary Bladder Neoplasms ; Vaccines ; Imatinib Mesylate

PURPOSE: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. MATERIALS AND METHODS: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. RESULTS: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p<0.001). However, the estimated mean blood loss(685ml vs. 1,488.0ml, respectively, p<0.05) and the transfusion rate(24.1% vs. 55%, respectively, p<0.05) were significantly less in group 1. The mean duration of the hospital stay, the days to oral feeding, the duration of analgesics use and the duration of an indwelling drain were similar between the two groups. The complication rate also did not differ significantly between the two groups(27.6% vs. 23.6%, respectively, p>0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. CONCLUSIONS: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naive for prostate cancer surgery, the learning curve is overcome earlier than expected.
Analgesics ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Outcome Assessment (Health Care) ; Prostatectomy ; Prostatic Neoplasms

PURPOSE: The aim of this study is to analyze the correlation between the Androgen Deficiency in Aging Males(ADAM) questionnaire and the Aging Males' Symptoms(AMS) scale and to determine their relationship with the serum testosterone level. MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients who took the self-administered ADAM questionnaire, the AMS scale and the International Index of Erectile Function(IIEF) questionnaire. We enrolled a total of 265 patients older than 40 years who presented a positive result for the ADAM questionnaire(defined as a 'yes' answer to question 1 or 7, or a 'yes' answer to at least three of the other questions). Blood tests were performed, including the total testosterone, prolactin, the lipid profiles and the fasting glucose level. RESULTS: The psychological subscale of the AMS scale was correlated with ADAM questions 2, 3, 5, 7, 8 and 10(p<0.005) and the somato-vegetative subscale was correlated with questions 2, 3, 5, 6, 8 and 10(p<0.05). The sexual subscale was correlated with questions 1, 2, 5, 6, 7, 8 and 10(p< 0.05). Statistically significant differences were found for the IIEF questionnaire scores between the patients with 'yes' and 'no' answer to ADAM question 1 and 7(p<0.05). The IIEF questionnaire scores were significantly lower for the men with a sexual subscale score 11-25 on the AMS scale (p<0.05). The total testosterone was not correlated with the ADAM, AMS and IIEF questionnaire but the total testosterone demonstrated a significantly negative correlation with weight, abdominal circumference, body mass index(BMI) and triglyceride(p<0.05). CONCLUSIONS: This analysis revealed that the ADAM questionnaire and the AMS scale have a significant relationship, and especially the sexual function domain of the two questionnaires showed correlation with the IIEF questionnaire. Serum testosterone was related with weight, abdominal circumference, BMI and triglyceride.
Male ; Humans