PURPOSE: Prostate specific antigen(PSA) is present in a 10(6)-fold higher concentration in semen than in plasma, but serum PSA is elevated during inflammatory conditions such as chronic prostatitis. We evaluated the seminal PSA and its effect on sperm motility in inflammatory chronic nonbacterial prostatitis/chronic pelvic pain syndrome(CPPS). MATERIALS AND METHODS: Twenty-three patients with inflammatory CPPS(group P) and 11 normal controls(group NL) were enrolled in this study. The semen analysis was performed with a computerized analyzer, and seminal PSA was measured twice using a ELSA-PSA2 radioimmunometric kit(Cis Biointernational). We compared the result in groups P and NL. The subjects were then re-sorted into two groups according to the seminal PSA concentration, with 3.0 mg/ml as the cutoff value, and sperm motility was compared for the high- and low-PSA groups. Statistical significance was measured using the unpaired t-test. RESULTS: The average concentrations of seminal PSA in groups P and NL were 3.67 mg/ml and 1.79 mg/ml, respectively(p=0.048). Sperm motility was not different in the two groups. However, motility(straight-line velocity and average path velocity) was lower in the patients with high seminal PSA(p<0.05). CONCLUSIONS: Inflammatory chronic non-bacterial prostatitis increases the seminal secretion of PSA, and high seminal PSA is correlated with decreased sperm motility.
Humans ; Pelvic Pain* ; Plasma ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Semen ; Semen Analysis ; Sperm Motility* ; Spermatozoa*

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.
Calculi ; Constriction, Pathologic ; Female ; Holmium* ; Humans ; Lasers, Solid-State* ; Lithotripsy* ; Lithotripsy, Laser ; Male ; Ureter ; Ureteral Calculi ; Ureteroscopy ; Urinary Tract

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.
Calculi ; Constriction, Pathologic ; Female ; Holmium* ; Humans ; Lasers, Solid-State* ; Lithotripsy* ; Lithotripsy, Laser ; Male ; Ureter ; Ureteral Calculi ; Ureteroscopy ; Urinary Tract

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CPPS) presents various symptoms, such as various pains, voiding and sex-related symptoms. To elucidate the characteristic symptoms of CPPS we compared BPH patients with healthy men. MATERIALS AND METHODS: We obtained questionnaires from 530 men, consisting of three groups: 243 CPPS patients aged 40 or below with small sized prostate (<25ml); 115 BPH patients aged 45 or older with non-small sized prostate (> OR =25ml); and 172 healthy men aged below and equal 40 years without pyuria. We compared various pains and voiding symptoms among the three groups, and the sex-related symptoms between 145 CPPS patients and 64 healthy men who had been married at least 6 months, and had regular sexual intercourse with their wife. RESULTS: In comparison with healthy men, the CPPS patients had a higher prevalence of the various pains and most of the voiding symptoms. The CPPS patients had a higher prevalence of pain over the penis, urethra, perineum and prostate gland compared to the BPH patients (p<0.05). There was no statistical significance in voiding symptoms between the CPPS and BPH patients. In respect to the sex-related symptoms, the CPPS patients had a higher prevalence of decreased maintenance time, rigidity at erection, libido, orgasmic feeling and a more painful ejaculation than the healthy men (p<0.01). The frequencies of sexual intercourse and orgasmic sensation following ejaculation were slightly decreased, bur with no statistical significance (p>0.05). CONCLUSIONS: The CPPS patients showed a higher prevalence of various pains and voiding symptoms than the healthy men. Pains over the penis, urethra, perineum and prostate gland are characteristic in CPPS patients. Both the CPPS and BPH patients felt trouble due to the voiding symptoms. The CPPS patients had a higher prevalence of most of sex-related symptoms, but had similar frequencies of sexual intercourse and orgasmic sensation following ejaculation compared to the healthy men.
Coitus ; Ejaculation ; Humans ; Libido ; Male ; Orgasm ; Pelvic Pain* ; Penis ; Perineum ; Prevalence ; Prostate ; Pyuria ; Surveys and Questionnaires ; Sensation ; Spouses ; Urethra

PURPOSE: Pseudomembranous trigonitis is a common cystoscopic finding in the female patients with voiding symptoms. We evaluated the changes in voiding symptoms of the patients after coagulating this lesion with Holmium:YAG laser. MATERIALS AND METHODS: Six female patients with voiding symptoms including frequency, dysuria, lower abdominal pain who were refractory to the conservative treatment for more than 1 month were enrolled in this study. The mean age was 35(range: 26~43) years. The patients were treated with cystoscopic evaluation and Holmium:YAG laser with 365 and 500 micrometer probe fibers. Power setting was between 6 and 11 watts. Only the lesions at the trigone and bladder neck were coagulated. No indwelling urethral catheter was used postoperatively. We evaluated patient's symptoms with out-patient follow-up or telephone up to 16 months. RESULTS: The mean duration of symptoms were 3.8(range: 6 months~13 years) years, and the mean follow-up was 13.3(range: 8~16) months. In all cystoscopic evaluations, pseudomembranous trigonitis was seen. After treatment, 3 of the 6 patients showed symptomatic improvements within 3 months and retained the improved state up to the last follow-up period. However, in the other 3 patients, no change in symptoms or initial response with following recurrence was seen. In the 3 patients who showed good response, transient worsening period of 1~3 months preceded the improvement. Follow-up cystoscopy at 3 months showed complete regeneration of the trigone and bladder neck mucosa. CONCLUSION: In the patients of pseudomembranous trigonitis with voiding symptoms refractory to conservative therapy, laser coaulation of the trigonal lesion was not so satisfactory but may be one of therapeutic options. Further investigation is needed.
Abdominal Pain ; Cystoscopy ; Dysuria ; Female* ; Follow-Up Studies ; Humans ; Laser Coagulation* ; Laser Therapy ; Mucous Membrane ; Neck ; Outpatients ; Recurrence ; Regeneration ; Telephone ; Urinary Bladder ; Urinary Catheters

No abstract available.
Pregnancy*

Long QT syndrome is a cardiac disorder of repolarization which is characterized by elctrocardiographic abnormalities including prolonged QT interval, T-wave abnormalities and polymorphic ventricular tachycardia known as Torsades de Pointes. Its clinical manifestation are recurrent syncope, seizure, and sudden death. Recently,we experienced Torsades de Pointes(TdP) by head-up tilt test in 24 year-old female patient presenting recurrent syncope and long QT interval. Beta-blocker and left cervicothoracic sympathetic ganglionectomy were not effictive, then we tried mexiletine. After mexiletine medication, the QT interval was significantly shortened and there was no more syncope.
Death, Sudden ; Female ; Ganglionectomy ; Humans ; Long QT Syndrome* ; Mexiletine ; Seizures ; Syncope ; Tachycardia, Ventricular ; Torsades de Pointes* ; Young Adult

PURPOSE: We assessed the predictive factors for renal insufficiency in patients followed for more than 5 years after radical nephrectomy. MATERIALS AND METHODS: Age, gender, history of diabetes, history of hypertension, body mass index, preoperative estimated glomerular filtration rate (eGFR), serum uric acid, urine albumin, normal renal parenchymal volume, tumor size, and ratio of normal parenchymal volume of the removed kidney to that of the remaining kidney were evaluated retrospectively in 89 patients who underwent radical nephrectomy from January 2001 to December 2005. Patients were included whose renal parenchymal volume was measurable by use of perioperative imaging (computed tomography or magnetic resonance imaging), whose preoperative eGFR was greater than 60 mL/min/1.73 m2, and who were followed for more than 5 years. To measure renal parenchymal volume from imaging, we integrated the extent of the normal renal parenchyma from axial slides of images. RESULTS: In univariate and multivariate binary regression analysis, the parenchymal volume of the remnant kidney (p=0.001), a history of diabetes (p=0.035), and preoperative eGFR (p=0.011) were independent factors for renal insufficiency. By use of a receiver operating characteristic curve, a volume of 170 mL was determined to be an appropriate cutoff value, with sensitivity of 58.7% and specificity of 74.4% for the parenchymal volume of the remnant kidney for predicting eGFR less than 60 mL/min/1.73 m2 (area under the curve, 0.678). The parenchymal volume of the remnant kidney was also an independent factor for the downgrading of the chronic kidney disease category in the multivariate linear regression analysis (p=0.021). CONCLUSIONS: Preoperative eGFR, a history of diabetes, and the radiologic volume of the remaining kidney parenchyma could be useful factors for predicting postoperative renal function. Patients with parenchymal volumes of less than 170 mL have a higher risk of postoperative renal insufficiency, which should be considered carefully when choosing a treatment modality.
Body Mass Index ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney ; Linear Models ; Magnetic Resonance Spectroscopy ; Nephrectomy ; Organ Size ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tumor Burden ; Uric Acid

PURPOSE: Partial nephrectomy has a similar oncologic outcome to radical nephrectomy while reducing cardiac and metabolic morbidity. However, previous studies reported that partial nephrectomy had been underutilized. The purpose of this study is to analyze trends in the use of partial nephrectomy in Korea and evaluate which individual factors and hospital factor influenced the operative approach. MATERIALS AND METHODS: Using URO-PDS database, 11560 patients underwent nephrectomy for renal cell carcinoma between 2006 and 2010 were identified. International Classification of Disease (ICD-9) diagnosis codes were applied to target subject of interest. Logistic regression was applied to identify determinants of partial nephrectomy. RESULTS: Over the study period, the proportion of partial nephrectomies has steadily increased from 9.4% in 2006 to 30.4% in 2010 (p<0.001). Deviation of utilization in partial nephrectomy has been observed based on the area (p<0.001) and type of surgery (p<0.001). Individual of younger age, as well as male, were more likely to be treated with partial nephrectomy (p<0.001 for each). Furthermore, Patient treated at hospitals with higher nephrectomy volume were more prone to be treated with partial nephrectomy (p<0.001 for each). CONCLUSIONS: Partial nephrectomies have been increasingly performed over the study period but are still underutilized.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Humans ; Korea* ; Logistic Models ; Male ; Nephrectomy*

BACKGROUND/AIMS: The post-reflux swallow-induced peristaltic wave (PSPW) index and esophageal baseline impedance (BI) are novel impedance parameters used to evaluate esophageal chemical clearance and mucosal integrity. However, their relationship with reflux symptoms is not known. We aim to evaluate the correlations of PSPW index and esophageal BI with gastroesophageal reflux disease (GERD) symptoms. METHODS: We performed a retrospective review of multichannel intraluminal impedance and pH (MII-pH) tracings in patients with suspected GERD. Reflux symptoms were also analyzed from checklists using ordinal scales. The PSPW index and esophageal BIs in 6 spots (z1–z6) were measured. Bivariate (Spearman) correlation was used to analyze the relationship between the PSPW index or esophageal BI, and the degree of GERD symptoms measured. RESULTS: The MII-pH records of 143 patients were analyzed. The PSPW index was significantly lower in patients who had heartburn and negatively correlated with the degree of heartburn (r = −0.186, P < 0.05). On the contrary, the PSPW index was not significantly correlated with the degree of dysphagia (r = −0.013, P = 0.874). Distal esophageal BI was not significantly correlated with heartburn, but negatively correlated with the degree of dysphagia (z3: r = −0.328, z4: r = −0.361, z5: r = −0.316, z6: r = −0.273; P < 0.05). CONCLUSIONS: These findings suggest that delayed chemical clearance of the esophagus may induce heartburn, but that it is not related to dysphagia. However, a lack of esophageal mucosal integrity may be related to dysphagia.
Checklist ; Deglutition Disorders ; Electric Impedance* ; Esophagus ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Retrospective Studies ; Weights and Measures