PURPOSE: Since the first description of multiple primary malignant neoplasms(MPNs) by Billroth, numerous studies concerning MPNs have been reported. We analyzed variable characteristics of MPNs in urologic tumor patients and try to offer useful clinical informations. MATERIALS AND METHODS: From January 1994 to September 1998, we have treated 1,230 patients who had at least one primary urologic cancer; 459 transitional cell carcinomas, 366 renal cell carcinomas, 325 prostatic cancers, 128 others. Among those patients, 99 patients(8.0%) had genitourinary multiple primary neoplasms(GU-MPNs). We reviewed the medical and pathologic records of these 99 patients with GU-MPNs. RESULTS: The incidence of MPNs was especially high in patients with renal cell carcinoma and bladder cancer than any other GU tract cancers. Renal cell carcinoma plus gastrointestinal malignancy and urothelial cancer plus cervix cancer were common combinations of MPNs in this study. Incidences of counterpart cancers were similar to the ranks of relative frequency of cancers in Korea except genitourinary cancers that were more common than the relative frequency of their own. 55 cases were synchronous and mean diagnostic interval was one month and eleven days. 36 cases of 44 metachronous MPNs developed within 5 years after the diagnosis of the first tumor. In synchronous MPNs, 29 second tumors(52.7%) were diagnosed by staging workup or during operation of the first tumor and 34 second tumors(77.3%) of metachronous MPNs were diagnosed by their own symptoms. CONCLUSIONS: Due to the improvements in the techniques for diagnosis and treatment of cancer and the prolonged average life span, occurrence of MPNs is no longer rare. Therefore importance of early diagnosis of MPNs is increasing. We recommend to keep in mind the possibility of MPNs especially in RCC and bladder cancers. We think further study is needed to delimitate the risk factors of MPNs.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Early Diagnosis ; Humans ; Incidence ; Korea ; Neoplasms, Multiple Primary* ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder Neoplasms ; Urogenital Neoplasms ; Urologic Neoplasms ; Uterine Cervical Neoplasms

PURPOSE: The international index of erectile function(IIEF) is a multidimensional scale for assessment of erectile function and detecting treatment-related changes in patients with erectile dysfunction. It was developed by Dr. Rosen in 1997 and composed of 15-item questionnaire of five relevant domains of sexual function(that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction). The IIEF currently is available in more than 30 languages for use in multinational clinical trials, and demonstrates adequate sensitivity and specificity for detecting treatment-related changes in erectile function in patients with erectile dysfunction. For application of the IIEF to Korean, it is inevitable to demonstrate the reliability and validity of Korean version of IIEF, since the cultural background is one of the most important factors which often results in misinterpretation of the questionnaire. MATERIALS AND METHODS: From May 13th to July 20th 1998, a total of 39 patients aged over 30 who visited Andrology Clinic with the complaint of erectile dysfunction were enrolled for the patient group and 40 age-matched volunteers who visited the Department of Family Medicine without erectile dysfunction were enrolled for a control group. Self administered questionnaire survey was performed with linguistically valid Korean version of IIEF for all study subjects and was repeated with the inteval of 10-25 days(between the first and second survey). The results were analyzed statistically by PC-SAS version 6.12. RESULTS: Two separate aspects of scale reliability were evaluated, namely, internal consistency and test-retest repeatability. Internal consistency(Cronbach`s alpha) was computed separately for the five domains in patient and control group. Responses in overall satisfaction was highly consistent with alpha value of 0.96. A satisfactory degree of consistency also was observed for items in the other domains(alpha values greater than 0.70). Test-retest repeatability was assessed by computing correlations between the domain score and total scale scores at the first and the second survey. There was no significant difference in the domain scores and total scale scores between the first and the second survey; nevertheless, test-retest repeatability was relatively low for the orgasmic function(r=0.67) and intercourse satisfaction(r=0.70) domains. Relatively high correlations were observed for the other domains(r value of 0.73 to 0.85), as well as for the total scale scores(r=0.88)(p<0.01). To demonstrate validity, domain scores were compared with the monthly frequency of sexual intercourse(convergent validity) and with scales that measure occupational satisfaction(divergent validity). Siginificant positive correlations were observed between the monthly frequency of sexual intercourse and subscale scores for all five domains. In contrast, none of the correlations between domain scores and measure of occupational satisfaction reached statistical significance. Discriminant validity was assessed by comparing the responses for patients with erectile dysfunction with control group by repeated measures ANOVA. Highly significant differences were observed between the patients with erectile dysfunction and age-matched controls. CONCLUSIONS: Based on the results of this study, the Korean version of IIEF was verified in its reliability and validity. This can be used as a brief and reliable self-administered scale for assessing erectile function and for detecting treatment-related changes in patients with erectile dysfunction. Furthermore, this can be used as universal and objective scale in multinational clinical trial and research field.
Andrology ; Coitus ; Erectile Dysfunction ; Humans ; Male ; Orgasm ; Surveys and Questionnaires ; Reproducibility of Results ; Sensitivity and Specificity ; Volunteers ; Weights and Measures