Objectives: Very limited previous research has investigated the utility weights of prostate-related diseases in the general population in Korea. The purpose of this study was to calculate the utility of prostate-related health states in the Korean general public using the standard gamble (SG) method. Methods: Seven health states for hypothetical prostate cancers, 1 for benign prostate hyperplasia, and 1 for erectile dysfunction were developed based on patient education material and previous publications. In total, 460 responses from the Korean general population were used to analyze the utility of prostate-related health states. Computer-assisted personal interviews were conducted, and utility values were measured using a visual analogue scale (VAS) and SG. Mean utility values were calculated for each prostate-related health state. Results: The mean utility values of prostate cancer derived from SG ranged from 0.281 (metastatic castration-refractory prostate cancer) to 0.779 (localized prostate cancer requiring prostatectomy). The utility value of benign prostate hyperplasia was 0.871, and that of erectile dysfunction was 0.812. The utility values obtained using the SG method in all conditions were higher than the values obtained by VAS. There were no significant demographic variables affecting utility values in multivariate analysis. Conclusions Our findings might be useful for economic evaluation and utility calculation of screening and interventions for prostate-related conditions in the general population.

We evaluated the long-term results of feminizing genital reconstruction in patients with genital ambiguity with high vaginal confluence. The medical records of 10 consecutive patients with ambiguous genitalia and high vaginal confluence who underwent feminizing genital reconstruction from 1996 to 2007 were reviewed. Seven patients had congenital adrenal hyperplasia, one had mixed gonadal dysgenesis, one had partial androgen insensitivity, and one had 5-alpha reductase deficiency syndrome. Median age at operation was 21 months (range, 2-47 months). Median follow up was 7.7 yr. Of the six patients who underwent feminizing genital reconstruction with the Gonzalez method, three had good results. Of the other three patients, one had a urethrovaginal fistula and underwent fistula repair 9 yr after, one had distal vaginal stenosis and underwent revision vaginoplasty 9 yr after, and one had a urethrovaginal fistula and urethral stricture. The patient with urogenital mobilization had persistent urogenital sinus. Feminizing genitoplasty using the Gonzalez method showed good long-term results in patients with ambiguous genitalia and Congenital adrenal hyperplasia. The procedure is less invasive than other approaches and results in excellent cosmetic outcomes; and complications can be corrected by relatively simple procedures.
Child, Preschool ; Disorders of Sex Development/*surgery ; Female ; Feminization/*surgery ; Follow-Up Studies ; Humans ; Infant ; Male ; Penis/abnormalities ; *Reconstructive Surgical Procedures ; Urethral Stricture/surgery ; Urogenital System/surgery ; Vagina/*surgery

PURPOSE: We report our experiences of nerve and seminal sparing cystectomy to improve of daytime and nighttime urinary continence and sexual function in patients requiring a radical cystoprostatectomy. MATERIALS AND METHODS: Between December 1999 and December 2003, the data from 17 patients who underwent a nerve and seminal sparing cystectomy were compared with those from 18 patients who underwent a radical cystoprostatectomy for a malignant neoplasm of the bladder. No patient had erectile dysfunction or voiding problems prior to surgery. All patients had organ-confined tumors (stage Ta-2N0M0). The mean ages and follow- up periods were 54.4 years and 16.1 months for the study group and 59.4 years and 17.9 months for the control group. RESULTS: The rates of potency, daytime continence and night-time continence were 93.8, 100 and 81.3%, respectively, in the patients who underwent nerve and seminal sparing cystectomy, and 0, 94.4 and 50%, respectively in those who underwent radical cystoprostatectomy. Within 3 days of the Foley catheter removal, 31 and 19% had daytime and nighttime continence, respectively, in those who underwent nerve and seminal sparing cystectomy. CONCLUSIONS: In patients with considerable concern relating to sexual activity, and in those anxious about loss of urinary continence after radical cystoprostatectomy, a nerve and seminal sparing cystectomy can be used, which elevates the quality of life via preservation of physiological voiding and normal sexual function with oncological safety if patients are selected carefully.
Catheters ; Cystectomy* ; Erectile Dysfunction ; Humans ; Male ; Quality of Life ; Sexual Behavior ; Sexuality ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Incontinence

We report the clinical experiences of three patients with posterior urethral valve(PUV) who underwent fetal intervention. Vesico-amniotic shunts were installed under ultrasonographic guidance at the gestational age of 13, 20, and 21 weeks, respectively. Although the vesico-amniotic shunts migrated over the months, renal change was prevented. Two patients remained in good health with normal renal function at follow-up at 8 and 24 months, while one patient with renal dysplasia died due to sepsis at the age of 3 months. We suggest that fetal intervention for patients with PUV is meaningful if the candidates for intervention can be carefully selected.
Fetus ; Follow-Up Studies ; Gestational Age ; Humans ; Sepsis ; Treatment Outcome ; Urethral Obstruction

Rhabdoid tumor of the kidney (RTK) is a rare malignancy in infancy. Central nervous system involvement in RTK is already known. However, solitary spinal metastasis in RTK has been hardly reported. The authors report a case of metastatic RTK to spine causing paraplegia in an 8-month-old girl. Since the patient was young, the diagnosis of spine metastasis was delayed until paraplegia was seen after radical nephrectomy. Thorough neurological examination should be performed for early diagnosis of spinal metastasis in young patients with RTK. If there are any abnormal signs in neurologic examination, magnetic resonance images of brain and spine are recommended.
Brain ; Central Nervous System ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Infant* ; Kidney* ; Neoplasm Metastasis ; Nephrectomy ; Neurologic Examination ; Paraplegia ; Rhabdoid Tumor* ; Spine*

PURPOSE: The goal of this study was to investigate the association between hypercholesterolemia and the time required for progression to castration-resistant prostate cancer (CRPC) in patients who have undergone androgen deprivation therapy (ADT). MATERIALS AND METHODS: Data from 154 patients with prostate cancer between 2005 and 2012 were reviewed retrospectively. ADT was employed as a treatment modality for these patients either due to multiple bone metastases at the time of diagnosis or due to old age in combination with other morbidities. Serum cholesterol levels and statin use were reviewed. We analyzed the factors associated with the development of CRPC after ADT treatment. The mean follow-up period was 34.8 months. RESULTS: The mean age of the patients was 71.3 years old and their mean prostate-specific antigen level was 141.8±212.6 ng/mL. Their mean cholesterol level was 175.9±37.7 mg/dL, and 14 patients (9.1%) were statin users. CRPC developed in 44 patients (28.6%), and the mean duration from ADT treatment to CRPC was 24.1 months. In a multivariate analysis, hypercholesterolemia was associated with the development of CRPC (hazard ratio [HR]=1.017, p<0.001), depending on clinical T stage (p=0.005) and the presence of bone metastasis (p<0.001). A subanalysis showed that hypercholesterolemia was associated with the development of CRPC in patients with bone metastasis (HR=1.032, p<0.001), but not in patients without bone metastasis. CONCLUSIONS: Hypercholesterolemia may be associated with the development of CRPC after ADT in patients with bone metastasis. Further studies with longer follow-up periods and larger samples are needed to validate this finding.
Cholesterol ; Diagnosis ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Retrospective Studies

PURPOSE: To evaluate the impact of temporary internal ureteral stents on the surgical outcomes of dismembered pyeloplasty in children. MATERIALS AND METHODS: The medical records of 70 children (76 renal units) who underwent dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction at at Asan Medical Center between January 2005 and December 2010 were retrospectively reviewed. We classified the renal units into the stented group (22 renal units) and the nonstented group (54 renal units). Fifty-four of 70 patients were male and their mean age was 2.2+/-3.8 years old. The mean follow-up period was 29.6+/-16.8 months. RESULTS: Sixty-four children had unilateral UPJ obstruction. The mean stent duration was 31.9 days. As shown by evaluation of radiologic images, there were no significant differences between the stented group and the nonstented group during the follow-up period (p>0.05). The mean preoperative and postoperative anteroposterior pelvic diameters (APPDs) of the nonstented group were 31.3 mm and 15.1 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 3.9 and 2.9, respectively (p=0.037). The mean preoperative and postoperative APPDs of the stented group were 36.4 mm and 15.6 mm, respectively (p<0.001). The preoperative and postoperative grades of hydronephrosis were 4 and 3.1, respectively (p<0.001). Repeat obstruction was shown in 4 subjects as a postoperative complication (5.7%). Two children from each group had recurrent UPJ obstruction, with percentages of 3.7% and 9%, respectively (p=0.575). CONCLUSIONS: In a comparison of nonstented and stented groups during pediatric dismembered pyeloplasty for UPJ obstruction, no significant differences were found in the resolution of hydronephrosis or overall postoperative complications.
Child ; Follow-Up Studies ; Humans ; Hydronephrosis ; Male ; Medical Records ; Postoperative Complications ; Retrospective Studies ; Stents ; Ureter ; Ureteral Obstruction

PURPOSE: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms. MATERIALS AND METHODS: The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic 99mTc-MAG3 renal scan was performed 4 months after the surgery. RESULTS: Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF. CONCLUSIONS: The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes.
Child ; Follow-Up Studies ; Humans ; Hydronephrosis ; Technetium Tc 99m Mertiatide ; Ureteral Obstruction

PURPOSE: In this prospective study, the immediate postoperative changes of hydronephrosis, following pyeloplasty in children with a unilateral ureteropelvic junction obstruction, were evaluated. MATERIALS AND METHODS: The study population consisted of 30 patients with a unilateral ureteropelvic junction obstruction, who underwent open pyeloplasty between September 1997 and December 2003. The serial changes of hydronephrosis in children with consecutive ultrasonography were evaluated at 1, 4 and 10 months after the pyeloplasty. Diuretic renograms were performed before and 4 months after the surgery. RESULTS: Of the thirty patients in whom ultrasonography was serially performed at 1, 4 and 10 months following pyeloplasty, improvements of the hydronephrosis were shown in 20, 66 and 80%, respectively. Of the 24 patients who showed no improvement of the hydronephrosis at 1 month after the pyeloplasty, 18 had improved at 10 months. Two patients underwent a reoperation at 4 and 5 months after the pyeloplasty, respectively. One had persistent severe hydronephrosis and a urinary tract infection, and the other persistent hydronephrosis and a decreased differential renal function on follow-up studies. There was no significant difference between the patients with and without improvements of the hydronephrosis at 4 months after the pyeloplasty in terms of the preoperative factors. CONCLUSIONS: Hydronephrosis can persist following pyeloplasty, but improve with time. Patients with persistent or aggravated hydronephrosis following pyeloplasty can be observed, as long as there is no deterioration in the renal function or a urinary tract infection. No conclusion, with regard to a reoperation, can be drawn from isolated persistent hydronephrosis found during ultrasonography.
Child* ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Prospective Studies ; Reoperation ; Ultrasonography ; Urinary Tract Infections

PURPOSE: To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy. MATERIALS AND METHODS: The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins. RESULTS: Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy. CONCLUSION: Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.
Adolescent ; Adult ; Angiography ; Child ; Humans ; Male ; Spermatic Cord/radiography/surgery ; Urogenital Surgical Procedures ; Varicocele/*radiography/*surgery ; Young Adult