Prostate, kidney, and bladder cancers are the three most prevalent urologic cancers in the Korean population. Throughout the last decade, there has been an upsurge in the incidence and prevalence of prostate and kidney cancers, along with a marked improvement in survival. A stage migration has been observed towards early detection of localized cancers, and accordingly, the landscape of urologic cancer treatment in Korea has been characterized by an exponential increase in the number of patients receiving surgery with curative intent. Herein, a substantial proportion of surgeries were performed using minimally-invasive methods, especially robot-assisted surgery. Current management strategies of urologic cancers in Korea are mostly based on evidences provided by international guidelines. There is prompt adoption and clinical application of novel systemic agents for advanced stage cancer, and surgical and oncological outcomes are comparable to those of Western reports. Multidisciplinary treatment options are available for various cancers at different stages. At the same time, treatment decisions are influenced by the availability of health-care resources, which is regulated by the National Health Insurance policy guidelines. Accumulating information on characteristics of urologic cancers in Korean patients demonstrates that Korean patients harbor more aggressive prostate cancer features compared to Western men. Due to the racial disparity in features of certain cancers, the optimal management strategy specific for the Korean population is yet to be validated. A comprehensive national cancer database may help to identify risk factors, select sequential strategies, and to assess survival outcome of Korean urologic cancer patients.
Epidemiology* ; Humans ; Incidence ; Kidney ; Kidney Neoplasms ; Korea* ; Male ; National Health Programs ; Prevalence ; Prostate ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder Neoplasms ; Urologic Neoplasms*

With advancements in diagnostic techniques, including molecular and clinical imaging, that directly target cancer cells, oligometastatic prostate cancer (PCa) is being diagnosed in patients who were, in the past, considered to have localized disease. With accumulating evidence, there has been a paradigm shift in considering aggressive treatments targeted at both the primary tumor and metastatic lesions in an aim to avoid and delay the need for palliative treatments and, ultimately, to achieve survival benefits. However, many questions still remain unanswered regarding the understanding of oligometastatic PCa, from its definition to optimal treatment strategies for each individual. Limited retrospective studies have suggested that interventions, including local and/or metastasis-directed therapy using surgery and radiation therapy (RT), can improve survival outcomes with minimal risk of adverse effects. Such treatments have been shown to decrease the risks of subsequent palliative interventions and to delay the start of androgen-deprivation therapy. Nevertheless, available data are insufficient to draw a reliable conclusion regarding their effect on quality of life measures and overall survival. This comprehensive review overviews data from contemporary literature that have investigated treatments, including surgery and RT, for patients with oligometastatic PCa, namely pelvic lymph node positive disease and limited distant metastases, and summarizes ongoing trials that are evaluating the feasibility of aggressive multimodal treatments.
Combined Modality Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Palliative Care ; Passive Cutaneous Anaphylaxis ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Quality of Life ; Radiotherapy ; Retrospective Studies

Purpose: To investigate the clinical factors associated with the feeling of incomplete bladder emptying in female patients with lower urinary tract symptoms (LUTS). Methods: Records were obtained from a prospectively maintained database for 353 female patients without a history of treatment for LUTS. Patients with comorbidities that may affect voiding function and with postvoid residual (PVR) volume >20 mL or PVR volume-to-bladder capacity ratio of >10% were excluded. Finally, 211 patients were eligible for the study. Results: Patients were stratified according to the severity of the feeling of incomplete emptying: non-severe group (n=147, 69.7%) and severe group (n=64, 30.3%). The severe group showed longer time to maximum flow rate (Qmax) and greater total overactive bladder symptom score (OABSS). No differences in age, PVR volume, and diagnosis of overactive bladder (OAB) were found between the 2 severity groups. Multivariable analysis identified the severity of the feeling of incomplete emptying to be significantly associated with time to Qmax and minimum volume of voids. Time to Qmax was identified as a significant predictor of severe symptoms in women with OAB. In addition, the feeling of incomplete emptying, total OABSS, and minimum volume of voids were significantly associated with quality of life. Conclusions Female patients with the feeling of incomplete emptying who have insignificant PVR volume exhibited severe voiding symptoms and low quality of life. The treatment strategy should be focused on improving the minimum volume of voids and shortening the time to Qmax.

No abstract available.
Atrial Fibrillation* ; Heart* ; Thoracic Surgery*

PURPOSE: Stone size and location are generally considered the most important factors associated with spontaneous ureter stone passage (SSP). Several parameters related to inflammatory changes have been identified as predictors associated with SSP. Our aim was to investigate the predictive role of neutrophil-to-lymphocyte ratio (NLR) for SSP. MATERIALS AND METHODS: A retrospective review was performed on 131 patients who were referred to the urology outpatient clinic and diagnosed with unilateral ureteral stones at our emergency department between July 2016 and December 2016. The presence of ureteral stones was confirmed with non-contrast-enhanced computed tomography (NCCT) for all patients. SSP was confirmed with either the patient collecting the stone during urination or by NCCT performed at 3 weeks from the first stone episode. Physical examination, urinalysis, complete blood count, serum chemistry and inflammatory markers, plain radiographs, and NCCT at initial presentation were reviewed to analyze predictors of future SSP. RESULTS: Of 113 patients included for analysis, 90 (79.6%) passed their stones spontaneously. The SSP rates within 3 weeks according to the stone's size (5–10 mm and ≤5 mm) were 62.2% and 88.2%, respectively. A lower stone location [odds ratio (OR), 11.54; p=0.001], smaller stone size (≤5 mm) (OR, 8.16; p=0.001), and NLR (<2.3) (OR, 9.03; p=0.003) were independent predictors of SSP. CONCLUSION: Low NLR (<2.3) may predict SSP in patients with ureter stones ×1.0 cm in size. Our results suggest that ureteral inflammation plays an important role in SSP. Early intervention may be considered for patients presenting with high NLR (≥2.3).
Ambulatory Care Facilities ; Blood Cell Count ; Calculi ; Chemistry ; Early Intervention (Education) ; Emergency Service, Hospital ; Humans ; Inflammation ; Physical Examination ; Prognosis ; Retrospective Studies ; Ureter* ; Urinalysis ; Urinary Calculi ; Urination ; Urology

PURPOSE: Postoperative urinary retention (POUR) is a common complication after spinal surgery. However, no clear definition of POUR currently exists, and no studies have evaluated the management of POUR. We aimed to investigate the prognostic factors for eventual POUR-free status in spinal surgery patients. METHODS: The records of patients who received a urologic consultation for POUR from January 2015 to December 2016 were reviewed. POUR-free status was defined as a voiding volume (VV) >100 mL and a VV ratio >50%. Patients with an indwelling Foley catheter and those with any postoperative complications were excluded. The patients were divided into 2 groups according to the primary management method (Foley catheterization [FC] or intermittent catheterization [IC]). RESULTS: In total, 205 patients (median age, 70.6 years) were evaluated. Significant prognostic factors for eventual POUR-free status were intraoperative FC, previous spinal surgery, operative level (L3–5), lumbar fusion, and total volume (TV) at the time of POUR. Bladder training and medication did not reduce the time to POUR-free status. In patients who underwent FC, the duration of indwelling FC was a significant prognostic factor for POUR-free status. In a subanalysis, the TV (≥500 mL) and VV ratio at the time of POUR were significant prognostic factors for POUR-free status after primary management. Among the patients who achieved a POUR-free status, 8 (6.4%) experienced recurrent POUR. The VV ratio (<62.0%) was the only predictor of recurrent POUR. CONCLUSIONS: The criterion of POUR-free status is useful after spinal surgery. IC and FC were similar in their efficacy for the management of these patients.
Catheterization ; Catheters ; Humans ; Methods ; Postoperative Complications ; Postoperative Period ; Urinary Bladder ; Urinary Catheterization ; Urinary Retention*

Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging (MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI. Materials and Methods: Between January 2017 and September 2020, 585 patients suspected with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI-targeted biopsy using an image-based fusion program was performed in addition to the 12- core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and patients who underwent target biopsy alone (n=7) were excluded. Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age, 68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%]; nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2% (150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density was a significant factor for presence of visible lesions, prostate cancer, and significant prostate cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm3 was identified as the significant cutoff value for predicting positive target biopsy in groups with negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using systematic biopsy. Conclusions To maximize cancer detection rates, both targeted and systematic biopsies should be implemented. PSA density was identified as a useful factor for recommending prebiopsy MRI to patients suspected with prostate cancer.

Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging (MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI. Materials and Methods: Between January 2017 and September 2020, 585 patients suspected with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI-targeted biopsy using an image-based fusion program was performed in addition to the 12- core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and patients who underwent target biopsy alone (n=7) were excluded. Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age, 68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%]; nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2% (150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density was a significant factor for presence of visible lesions, prostate cancer, and significant prostate cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm3 was identified as the significant cutoff value for predicting positive target biopsy in groups with negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using systematic biopsy. Conclusions To maximize cancer detection rates, both targeted and systematic biopsies should be implemented. PSA density was identified as a useful factor for recommending prebiopsy MRI to patients suspected with prostate cancer.

Purpose: This study assessed the outcomes of microsurgical testicular sperm extraction (mTESE) and potential preoperative predictors of sperm retrieval (SR) in patients with non-obstructive azoospermia (NOA). Materials and Methods: Clinical data of 111 NOA patients who underwent mTESE was reviewed retrospectively. Baseline patient characteristics, including age, body mass index (BMI), testicular volumes, and preoperative endocrine levels, such as testosterone (T), follicle-stimulating hormone (FSH), serum-luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), FSH/LH ratio along with T/LH ratio, were analyzed. After categorizing the patients into two groups based on SR success or failure, logistic regression analysis was performed to identify the preoperative predictors of successful SR. Results: Sixty-eight patients had successful SR (61.3%), whereas 43 patients (38.7%) showed negative results. Failed SR group had elevated serum FSH and LH levels, whereas successful SR patients had a significantly larger testicular volume (p<0.001). Moreover, the successful group had a higher T/LH ratio (p<0.001). Multivariate logistic analysis showed that the T/LH ratio, serum FSH levels, and bilateral testicular volumes were significantly associated with successful sperm extraction. Conclusion In addition to traditional predictors, such as testicular volume and preoperative FSH levels, the T/LH ratio is a potential independent predictor of successful SR in infertile patients with NOA.

PURPOSE: Postoperative ileus (POI) is common following bowel resection for radical cystectomy with ileal conduit (RCIC). We investigated perioperative factors associated with prolonged POI following RCIC, with specific focus on opioid-based analgesic dosage. MATERIALS AND METHODS: From March 2007 to January 2013, 78 open RCICs and 26 robot-assisted RCICs performed for bladder carcinoma were identified with adjustment for age, gender, American Society of Anesthesiologists grade, and body mass index (BMI). Perioperative records including operative time, intraoperative fluid excess, estimated blood loss, lymph node yield, and opioid analgesic dose were obtained to assess their associations with time to passage of flatus, tolerable oral diet, and length of hospital stay (LOS). Prior to general anaesthesia, patients received epidural patient-controlled analgesia (PCA) consisted of fentanyl with its dose adjusted for BMI. Postoperatively, single intravenous injections of tramadol were applied according to patient desire. RESULTS: Multivariate analyses revealed cumulative dosages of both PCA fentanyl and tramadol injections as independent predictors of POI. According to surgical modality, linear regression analyses revealed cumulative dosages of PCA fentanyl and tramadol injections to be positively associated with time to first passage of flatus, tolerable diet, and LOS in the open RCIC group. In the robot-assisted RCIC group, only tramadol dose was associated with time to flatus and tolerable diet. Compared to open RCIC, robot-assisted RCIC yielded shorter days to diet and LOS; however, it failed to shorten days to first flatus. CONCLUSION: Reducing opioid-based analgesics shortens the duration of POI. The utilization of the robotic system may confer additional benefit.
Aged ; Analgesics, Opioid/*administration & dosage/therapeutic use ; Carcinoma/*surgery ; Cystectomy/*adverse effects ; Dose-Response Relationship, Drug ; Female ; Humans ; Ileus/*epidemiology ; Length of Stay ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Robotic Surgical Procedures/adverse effects ; Time Factors ; Tramadol/*administration & dosage/therapeutic use ; Treatment Outcome ; Urinary Bladder Neoplasms/*surgery ; Urinary Diversion/*adverse effects