Persistent and disabling pain is the hallmark of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, disease severity (as measured by objective indexes such as those that use radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely among individuals with CP/CPPS. Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae in CP/CPPS. Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with CP/CPPS. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions.
Catastrophization ; Depression ; Humans ; Pelvic Pain ; Prostatitis

Laparoscopic adrenalectomy has been the standard method for resecting adrenal gland tumors. Recently, laparoscopic retroperitoneal adrenalectomy (RA) has been more popular than conventional transperitoneal laparoscopic adrenalectomy (TLA) as an alternative method. Studies comparing laparoscopic RA and TLA showed that laparoscopic RA was superior or at least comparable to TLA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. At present, laparoscopic RA has been int the limelight procedure for patients with benign adrenal disease. However, surgeons have been reluctant to offer this operation to patients because of the concerns over inadequate working space and overall perceived higher rate of complications, laparoscopic RA is not popular in urologic field up to now. This article summarizes the latest ideas and issues on laparoscopic RA in the expanding field of laparoscopy in urology.
Adrenal Glands ; Adrenalectomy* ; Humans ; Laparoscopy ; Length of Stay ; Urology*

PURPOSE: The aim of this study was to investigate the changes in the clinical and prognostic parameters of prostate cancer in Korean men in the eras before and after prostate-specific antigen (PSA) testing. MATERIALS AND METHODS: The medical records of 303 patients treated for prostate cancer between 1982 and 2005 were reviewed with respect to age, chief complaints, clinical stage, tumor grade, treatment options, and prognosis. We classified the patients as follows: those treated in the pre-PSA era (1982-1995, n=81), and those treated in the PSA era (1996-2000, PSA era phase 1, n=92; and 2001-2005, PSA era phase 2, n=130). RESULTS: There was no significant difference in age or clinical stage between patients treated before and those treated during the PSA era, although there was a downward migration of grade. The cancer-specific survival rates were also not different in all cases and in metastatic prostate cancer cases between the pre-PSA era and the PSA era, although the overall survival rates were significantly greater in all cases in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). However, the cancer-specific survival rates for localized or locally advanced prostate cancer were significantly greater in phase 2 of the PSA era than in the pre-PSA era or in phase 1 of the PSA era (p<0.05). CONCLUSIONS: We observed a downward migration of tumor grade, but there were no migrations in the age of patients or clinical stage, and these findings have not contributed to changes in the cancer survival of Korean men with prostate cancer after the advent of PSA testing.
Humans ; Male ; Mass Screening ; Medical Records ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Survival Rate

PURPOSE: We evaluated the impact of bladder neck stiffness on lower urinary tract symptoms in the patient with benign prostatic hyperplasia using elastography. MATERIALS AND METHODS: A total of 384 patients divided into three different groups according to the bladder neck stiffness based on ultrasound with elastography. Patients age, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), prostate volumetric parameters, residual urine volume, and laboratory data were collected and compared among the three groups. RESULTS: Group 1 (n=121) showed low stiffness in both bladder neck adenoma. Group 2 (n=157) showed low to intermediated stiffness, and group 3 (n=106) showed significantly higher stiffness of bladder neck and adenoma compared to adjacent prostatic tissue. Significant differences among the 3 groups were found in the total prostate volume, transition zone volume, transition zone index, total IPSS, IPSS-voiding, IPSS-storage, residual urine volume, and quality of life. As the stiffness increased, prostate volumetric parameters, and residual urine volume were increased, and lower urinary tract symptoms became exacerbated. No significant difference was found in the patients' age and PSA. CONCLUSIONS Bladder neck stiffness affected the lower urinary tract symptoms and prostate volumetric parameters. These findings suggest that the change of bladder neck stiffness can be a novel parameter for the development of lower urinary tract symptoms/benign prostate hyperplasia.

PURPOSE: Experimental studies have suggested that the stromal-derived factor-1 (SDF-1)/CXCR4 axis is associated with tumor aggressiveness and metastasis in several malignancies. We performed a meta-analysis to elucidate the relationship between CXCR4 expression and the clinicopathological features of prostate cancer. MATERIALS AND METHODS: Data were collected from studies comparing Gleason score, T stage, and the presence of metastasis with CXCR4 levels in human prostate cancer samples. The studies were pooled, and the odds ratio (OR) of CXCR4 expression for clinical and pathological variables was calculated. RESULTS: Five articles were eligible for the current meta-analysis. We found no relationship between CXCR4 expression and Gleason score (<7 vs. > or =7). The forest plot using the fixed-effects model indicated an OR of 1.585 (95% confidence interval [CI]: 0.793~3.171; p=0.193). Further, CXCR4 expression was not associated with the T stage ( or =T3), and the relevant meta-analysis showed OR=1.803 (95% CI: 0.756~4.297, p=0.183). However, increased CXCR4 expression was strongly associated with metastatic disease with a fixed-effects pooled OR of 7.459 (95% CI: 2.665~20.878, p<0.001). CONCLUSIONS: Our meta-analysis showed that the higher CXCR4 protein expression in prostate cancer specimens is significantly associated with the presence of metastatic disease. This supports previous experimental data supporting the role played by the SDF-1/CXCR4 axis in metastasis.
Axis, Cervical Vertebra ; Humans ; Neoplasm Grading ; Neoplasm Metastasis* ; Odds Ratio ; Prostatic Neoplasms* ; Receptors, CXCR4

The purpose of this study was to determine whether contemporary active surveillance (AS) protocols could sufficiently discriminate significant from indolent tumors in men with low-risk prostate cancer. We retrospectively analyzed 312 patients with low-risk prostate cancer treated with radical prostatectomy. After exclusion of patients with fewer than 10 cores taken at biopsy and those who received neo-adjuvant treatment, 205 subjects satisfied the final inclusion criteria. Five widely accepted AS protocols were employed in this study. A total of 82.0% of the patients met the inclusion criteria of at least one protocol, and 18% did not meet any criteria of published AS protocols. A significant proportion of patients had non-organ-confined disease (8.6% to 10.6%) or a Gleason score of 7 or greater (18.6% to 23.9%) between the different AS criteria. Among patients who did not meet any AS criteria, 32.4% of patients had a pathologically insignificant cancer. Our results indicated a significant adverse pathology in patients who met the contemporary AS protocols. On the other hand, some patients in whom expectant management would be appropriate did not meet any criteria of published AS protocols. None of the clinical or histological criteria reported to date is able to sufficiently discriminate aggressive tumors from indolent ones.
Aged ; Humans ; Kallikreins/blood ; Male ; Middle Aged ; Neoplasm Grading ; Prostate/*pathology ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*pathology/surgery ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; *Watchful Waiting

PURPOSE: To evaluate the association of self-reported erectile function and endothelial function using the EndoPAT device. MATERIALS AND METHODS: We prospectively enrolled 76 men (age> or =40 years) after obtaining a complete medical history and a self-reported questionnaire (International Index of Erectile Function-5 [IIEF-5], SEP Q2, Q3). Endothelial function was noninvasively measured with an EndoPAT 2000, recorded as the reactive hyperemia index (RHI), and analyzed according to the patients' baseline characteristics. RESULTS: The mean patient age and IIEF-5 score were 62.50+/-8.56 years and 11.20+/-6.36, respectively. In comparing the RHI according to erectile dysfunction (ED) risk factors, the RHI was significantly lower in older subjects (p=0.004). There was no difference in the RHI according to age, body mass index, waist circumference, obesity, smoking habit, or other comorbidities. When the subjects were divided into four groups according to the severity of ED, no statistical differences in the RHI value were found among the groups. There was no difference in IIEF-5 according to the RHI when categorized according to the normal cutoff value or quartile ranges. The second subdomain of IIEF-5 (erection firmness) was significantly correlated with the RHI value (R=0.309, p=0.007); however, this was not the case with the other IIEF-5 subdomains. Self-assessment showed a tendency toward a negative correlation with the RHI value (R=-0.202, p=0.080). CONCLUSIONS: The role of endothelial function measurement by the EndoPAT in the evaluation and management of ED patients remains inconclusive. However, further studies are needed to validate the role of endothelial function measurement, by the EndoPAT or any other device.
Body Mass Index ; Comorbidity ; Endothelium ; Erectile Dysfunction ; Humans ; Hyperemia ; Male ; Obesity ; Plethysmography ; Prospective Studies ; Risk Factors ; Self-Assessment ; Smoke ; Smoking ; Waist Circumference

We found an error in our published article.

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
Carcinoma, Renal Cell/pathology ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/diagnosis/*pathology ; Lymph Node Excision/methods ; Male ; Middle Aged ; Nephrectomy/methods ; Renal Veins/*radiography ; Thrombectomy/methods ; Thrombosis/*radiography ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*radiography

PURPOSE: To evaluate the efficacy of low-dose computed tomography (LDCT) for detecting urinary stones with the use of an iterative reconstruction technique for reducing radiation dose and image noise. MATERIALS AND METHODS: A total of 101 stones from 69 patients who underwent both conventional nonenhanced computed tomography (CCT) and LDCT were analyzed. Interpretations were made of the two scans according to stone characteristics (size, volume, location, Hounsfield unit [HU], and skin-to-stone distance [SSD]) and radiation dose by dose-length product (DLP), effective dose (ED), and image noise. Diagnostic performance for detecting urinary stones was assessed by statistical evaluation. RESULTS: No statistical differences were found in stone characteristics between the two scans. The average DLP and ED were 384.60+/-132.15 mGy and 5.77+/-1.98 mSv in CCT and 90.08+/-31.80 mGy and 1.34+/-0.48 mSv in LDCT, respectively. The dose reduction rate of LDCT was nearly 77% for both DLP and ED (p<0.01). The mean objective noise (standard deviation) from three different areas was 23.0+/-2.5 in CCT and 29.2+/-3.1 in LDCT with a significant difference (p<0.05); the slight increase was 21.2%. For stones located throughout the kidney and ureter, the sensitivity and specificity of LDCT remained 96.0% and 100%, with positive and negative predictive values of 100% and 96.2%, respectively. CONCLUSIONS: LDCT showed significant radiation reduction while maintaining high image quality. It is an attractive option in the diagnosis of urinary stones.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted/*methods ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Urinary Calculi/*radiography ; Young Adult