We report a case of coronary artery-pulmonary artery fistula in 53-year-old man with review of literature. He complained of anterior chest pain with tightness, but all physical findings were normal. Routine laboratory findings in cluding EKG and chest PA were normal. For evaluation of angina, we performed the coronary arteriogram and established the diagnosis of coronary artery-pulmonary artery fistual incidentally. There was no hemodynamic significance.
Angina Pectoris* ; Arteries* ; Chest Pain ; Diagnosis ; Electrocardiography ; Fistula* ; Hemodynamics ; Humans ; Middle Aged ; Thorax

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: We have evaluated the patterns of diagnostic and treatment practices for benign prostatic hyperplasia (BPH) in a country that does not have country-specific clinical practice guidelines. MATERIALS AND METHODS: Probability samples were taken from the Korean Urological Association Registry of Physicians, and randomly sampled Korean urologists were asked to complete a questionnaire. The survey explored practice characteristics and attitudes, as well as diagnostic and treatment strategies, for the management of BPH. RESULTS: Of the 850 questionnaires sent, 302 were returned, and 277 of those were included in the final analysis (response rate 32.6%). For the initial evaluation, most urologists routinely used digital rectal examinations (DRE) and urinalysis. Uroflowmetry was used 34.7% of the time. Pressure-flow studies were rarely done. Symptom assessment was used in only 46.9% of cases. In addition, a significant number (58.8%) reported that treatment decisions were not based on the symptom questionnaire. Before surgery, almost all urologists routinely used DRE, urinalysis, and prostate-specific antigen tests. Of the respondents, 55.6% and 41.9% had prescribed alpha- blockers and alpha-blockers with 5-alpha reductase inhibitors, respectively. 81.2% of urologists perceived that selective alpha-blockers are different in terms of efficacy, and 82.7% felt that they differed in safety. Most respondents prescribed 5-alpha reductase inhibitors based on the prostate size. CONCLUSION: These data provide a picture of current practices regarding the management of BPH in Korea. The diagnostic and treatment practices for BPH do not follow published guidelines. Our findings ask the question "How influential are international guidelines, and do they really affect patient management in countries that do not have country-specific guidelines?"
Urology/standards ; Societies, Medical ; Questionnaires ; Prostatic Hyperplasia/diagnosis/*therapy ; Practice Guidelines ; Middle Aged ; Male ; Korea ; Humans ; Diagnosis, Differential ; Developing Countries ; Aged ; Adult

PURPOSE: We determined the impact of prostate volume on the efficacy of the high-power (80 W) potassium-titanyl-phosphate (KTP) photoselective laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Patients were stratified into 3 groups according to prostate volume: '< 40 g' (n = 49) and '40-59 g' (n = 49) and '> or = 60 g' (n = 22). Median follow-up was 9 months (range 6 to 21). RESULTS: No differences in age and follow-up duration were observed in the three groups. At baseline, no significant differences were noted in the three groups in terms of the International Prostate Symptom Score (IPSS) (21.4, 19.4 and 19.1; p = 0.412) as well as the maximum flow rate (Qmax) (10.2, 9.2, and 8.6 mL/s; p = 0.291) and post-void residual (PVR) (66.2, 80.4, and 71.5 mL; p = 0.856). The mean operative times were 30.9, 46.9, and 58.6 minutes (p < 0.001) and total median energy deliveries for each group were 62.3, 97.6, and 135.9 kJ, respectively (p < 0.001). No severe intraoperative complication was observed. At the last follow-up, these parameters improved significantly regardless of prostate volume, and the IPSS (11.1, 9.4, and 12.3; p = 0.286) as well as Qmax (15.9, 15.9, and 14.2 mL/s; p = 0.690) and PVR (33.7, 28.4, and 14.2 mL; p = 0.395) were not significantly different among the groups. CONCLUSION: Although a larger prostate requires more time and energy delivery, photoselective laser vaporization of the prostate is safe and efficacious for patients with LUTS regardless of prostate volume.
Aged ; Aged, 80 and over ; Feasibility Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Phosphates/*chemistry ; Prostate/*physiology/surgery ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/complications/*surgery ; Retrospective Studies ; Titanium/*chemistry ; Treatment Outcome ; Urinary Tract/pathology ; Volatilization

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.
*Urodynamics ; Urination Disorders/*diagnosis/*urine ; Urinary Incontinence/diagnosis ; Questionnaires ; Pain Measurement ; Pain ; Monitoring, Ambulatory/*methods ; Middle Aged ; Male ; Humans ; Fluoroscopy/*methods ; Female ; Anxiety ; Aged ; Adult

Hematuria is a common condition caused by various factors, including infections, inflammations, stone diseases, and anatomical abnormalities. While hematuria can be mistaken for other conditions, its significance should not be overlooked, as studies have shown that some patients with hematuria are diagnosed with urological cancers.Current Concepts: Experts agree on the need for specific diagnostic tests such as cystoscopy, upper urinary tract imaging, and urine cytology for visible hematuria. However, opinions differ when it comes to microscopic hematuria. Delays in diagnosing bladder cancer can significantly impact mortality rates. Therefore, objective diagnostic criteria, as well as guidelines to reduce excessive evaluations, costs, and side effects, are required. As of 2020, the American Urological Association has released new guidelines for the diagnosis and management of microscopic hematuria, that focus on assessing the risk of urological malignancies in individual patients and recommend tailored evaluations based on risk levels. This article provides an overview of these guidelines, discussing diagnostic criteria, initial evaluations, risk stratification, and recommended evaluations of the urinary tract.Discussion and Conclusion: Guidelines on hematuria aim to reduce unnecessary invasive procedures, provide appropriate follow-up strategies to patients with persistent or recurrent microscopic hematuria, and improve patient outcomes while minimizing unnecessary tests and procedures.

PURPOSE: The factors for predicting persistent urge symptom and urge incontinence following a tension-free vaginal tape (TVT) procedure were investigated in patients with mixed urinary incontinence. MATERIALS AND METHODS: Two hundred and seventy-four women, with a mean age of 55 years, ranging from 28 to 80, with female urinary incontinence (stress urinary incontinence; 201, mixed urinary incontinence; 73) were the subjects of this study. After a TVT procedure, the patients were followed up at 1, 6 and 12 months and every 1 year thereafter. Cure of incontinence after the procedure was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, with all other cases considered as failures. RESULTS: There was no significant difference in the cure rates for stress urinary incontinence in patients with stress and mixed urinary incontinence. However, of 73 patients with mixed urinary incontinence, 20 (27.4%) ans 12 (16.4%) had persistent urgency and continued urge incontinence, respectively. In a multivariate analysis, a low maximal urethral closure pressure (MUCP) was found to be associated with an increased likelihood of persistent urgency (odds ratio, 0.94; 95% confidence interval, 0.38-0.99; p=0.029) and the persistent urge incontinence (odds ratio, 0.94; 95% confidence interval, 0.88-0.99; p=0.030) after a TVT procedure in patients with mixed urinary incontinence. CONCLUSIONS: Our findings suggest that a low MUCP may be associated with the persistent urgency and urge incontinence after a TVT procedure in patients with mixed urinary incontinence.
Exercise Test ; Female ; Humans ; Multivariate Analysis ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Urge*

Purpose: According to the American Joint Committee on Cancer’s 8th Edition Manual, lobular carcinoma in situ (LCIS) is no longer considered a malignant disease, although it may be a precursor to the development of breast cancer. The present study aimed to evaluate the clinicopathological features and prognosis of LCIS. Methods: This study retrospectively analyzed clinicopathological features and prognosis data of LCIS among patients who underwent breast surgery at Severance Hospital, Seoul, South Korea from 1991 to 2016. Results: Of the 47 patients, 49 cases of LCIS were confirmed by postoperative pathology. The mean patient age was 48.15±8.34 years. Most patients (81.6%) did not have palpable tumors at diagnosis, and 51.0% showed no microcalcification on mammography. Breast-conserving surgery was performed more frequently than total mastectomy (77.6% vs. 22.4%). The mean tumor size was 1.63±2.11 cm. There were only 3 cases of pleomorphic LCIS. Hormone receptor-positive tumors were noted in 47 cases, however, the hormone receptor status was unknown in the other 2 cases. There were no LCIS recurrences or deaths during the follow-up period (mean 56 months). Conclusion LCIS is often incidentally diagnosed without clinical symptoms, especially in women aged <50 years. The prognosis of LCIS is excellent in cases that are surgically treated.

Purpose: According to the American Joint Committee on Cancer’s 8th Edition Manual, lobular carcinoma in situ (LCIS) is no longer considered a malignant disease, although it may be a precursor to the development of breast cancer. The present study aimed to evaluate the clinicopathological features and prognosis of LCIS. Methods: This study retrospectively analyzed clinicopathological features and prognosis data of LCIS among patients who underwent breast surgery at Severance Hospital, Seoul, South Korea from 1991 to 2016. Results: Of the 47 patients, 49 cases of LCIS were confirmed by postoperative pathology. The mean patient age was 48.15±8.34 years. Most patients (81.6%) did not have palpable tumors at diagnosis, and 51.0% showed no microcalcification on mammography. Breast-conserving surgery was performed more frequently than total mastectomy (77.6% vs. 22.4%). The mean tumor size was 1.63±2.11 cm. There were only 3 cases of pleomorphic LCIS. Hormone receptor-positive tumors were noted in 47 cases, however, the hormone receptor status was unknown in the other 2 cases. There were no LCIS recurrences or deaths during the follow-up period (mean 56 months). Conclusion LCIS is often incidentally diagnosed without clinical symptoms, especially in women aged <50 years. The prognosis of LCIS is excellent in cases that are surgically treated.

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