PURPOSE: Increasing clinical importance is being placed on the role of differential renal function (DRF) for the management of congenital ureteropelvic junction obstructions. Supranormal DRF of a hydronephrotic kidney, on a renal scan, is hypothesized to be due to an increase in single nephron filtration or nephron volume. However, the etiology of this paradoxical phenomenon still remains to be elucidated. We studied the histopathological changes of hydronephrotic kidneys with a supranormal DRF. MATERIALS AND METHODS: 35 children with unilateral congenital hydronephrosis and supranormal DRF (>55%), on preoperative renal scans, who had undergone pyeloplasty, were retrospectively evaluated. There were 3 female and 32 male patients. The mean age at the time of the operation was 12.6 months, ranging from 0.1 to 144 months. Needle biopsies, from 3 different sites at the lower pole of the kidney, were performed during surgery. To evaluate the presence of glomerular hypertrophy, the maximal planar area of the glomeruli was measured under light microscopy. Tissue samples were obtained in same manner from kidneys with no history of urinary tract disease on autopsy, and used as controls. The mean glomerular areas of the patient and control groups were plotted according to the patient's age. RESULTS: The mean glomerular area in the patient group was smaller than in the control group, with the exception of 4 patients. According to the logistical regression, the probability of larger renal glomeruli increased with decreasing DRF (p=0.1155). CONCLUSIONS: The glomerular area of a hydronephrotic kidney, with a supranormal renal function on a renal scan, was not significantly larger than the normal controls. Therefore, we believe that the theory of increased nephron volume as a cause of a supranormal DRF can be excluded.
Autopsy ; Biopsy, Needle ; Child ; Female ; Filtration ; Humans ; Hydronephrosis ; Hypertrophy* ; Kidney ; Male ; Microscopy ; Nephrons ; Retrospective Studies ; Urologic Diseases

PURPOSE: Increasing clinical importance is being placed on the role of differential renal function (DRF) for the management of congenital ureteropelvic junction obstructions. Supranormal DRF of a hydronephrotic kidney, on a renal scan, is hypothesized to be due to an increase in single nephron filtration or nephron volume. However, the etiology of this paradoxical phenomenon still remains to be elucidated. We studied the histopathological changes of hydronephrotic kidneys with a supranormal DRF. MATERIALS AND METHODS: 35 children with unilateral congenital hydronephrosis and supranormal DRF (>55%), on preoperative renal scans, who had undergone pyeloplasty, were retrospectively evaluated. There were 3 female and 32 male patients. The mean age at the time of the operation was 12.6 months, ranging from 0.1 to 144 months. Needle biopsies, from 3 different sites at the lower pole of the kidney, were performed during surgery. To evaluate the presence of glomerular hypertrophy, the maximal planar area of the glomeruli was measured under light microscopy. Tissue samples were obtained in same manner from kidneys with no history of urinary tract disease on autopsy, and used as controls. The mean glomerular areas of the patient and control groups were plotted according to the patient's age. RESULTS: The mean glomerular area in the patient group was smaller than in the control group, with the exception of 4 patients. According to the logistical regression, the probability of larger renal glomeruli increased with decreasing DRF (p=0.1155). CONCLUSIONS: The glomerular area of a hydronephrotic kidney, with a supranormal renal function on a renal scan, was not significantly larger than the normal controls. Therefore, we believe that the theory of increased nephron volume as a cause of a supranormal DRF can be excluded.
Autopsy ; Biopsy, Needle ; Child ; Female ; Filtration ; Humans ; Hydronephrosis ; Hypertrophy* ; Kidney ; Male ; Microscopy ; Nephrons ; Retrospective Studies ; Urologic Diseases

Purpose: To evaluate the incidence and pattern of recurrence after surgery in patients with organ-confined renal cell carcinoma (RCC) to establish an appropriate follow-up plan. Materials and Methods: In this retrospective study, we evaluated data from 2960 patients who underwent radical or partial nephrectomy for stage 1 or 2 RCC. We investigated the location of first recurrence and recurrence-free survival (RFS) by plotting Kaplan–Meier curves and analyzed the associated variables using Cox regression analysis. Results: During a median follow-up of 59 months, the 10-year RFS rates were 94.5%, 75.0%, and 57.9%, for T1a, T1b, and T2 RCC, respectively. A total of 211 patients experienced recurrence: 67 after 5 years, and 14 after 10 years. The most common sites of the first recurrence were the lungs, bones, and contralateral kidneys. Male sex, older age, higher pathologic T stage, higher nuclear grade, clear-cell RCC, and presence of differentiation were associated with recurrence. Among patients followed up for more than 60 months, higher pathologic T stage and grade, as well as clear cell RCC were predictors of RFS. Conclusion Late recurrence after surgery is common in patients with organ-confined RCC, with recurrence occurring even after 10 years. Consequently, long-term follow-up, of perhaps 10 years or more, including imaging studies of the abdomen, lungs, and bone, should be considered for the early detection of recurrence.

Purpose: To evaluate the incidence and pattern of recurrence after surgery in patients with organ-confined renal cell carcinoma (RCC) to establish an appropriate follow-up plan. Materials and Methods: In this retrospective study, we evaluated data from 2960 patients who underwent radical or partial nephrectomy for stage 1 or 2 RCC. We investigated the location of first recurrence and recurrence-free survival (RFS) by plotting Kaplan–Meier curves and analyzed the associated variables using Cox regression analysis. Results: During a median follow-up of 59 months, the 10-year RFS rates were 94.5%, 75.0%, and 57.9%, for T1a, T1b, and T2 RCC, respectively. A total of 211 patients experienced recurrence: 67 after 5 years, and 14 after 10 years. The most common sites of the first recurrence were the lungs, bones, and contralateral kidneys. Male sex, older age, higher pathologic T stage, higher nuclear grade, clear-cell RCC, and presence of differentiation were associated with recurrence. Among patients followed up for more than 60 months, higher pathologic T stage and grade, as well as clear cell RCC were predictors of RFS. Conclusion Late recurrence after surgery is common in patients with organ-confined RCC, with recurrence occurring even after 10 years. Consequently, long-term follow-up, of perhaps 10 years or more, including imaging studies of the abdomen, lungs, and bone, should be considered for the early detection of recurrence.

Purpose: To evaluate the incidence and pattern of recurrence after surgery in patients with organ-confined renal cell carcinoma (RCC) to establish an appropriate follow-up plan. Materials and Methods: In this retrospective study, we evaluated data from 2960 patients who underwent radical or partial nephrectomy for stage 1 or 2 RCC. We investigated the location of first recurrence and recurrence-free survival (RFS) by plotting Kaplan–Meier curves and analyzed the associated variables using Cox regression analysis. Results: During a median follow-up of 59 months, the 10-year RFS rates were 94.5%, 75.0%, and 57.9%, for T1a, T1b, and T2 RCC, respectively. A total of 211 patients experienced recurrence: 67 after 5 years, and 14 after 10 years. The most common sites of the first recurrence were the lungs, bones, and contralateral kidneys. Male sex, older age, higher pathologic T stage, higher nuclear grade, clear-cell RCC, and presence of differentiation were associated with recurrence. Among patients followed up for more than 60 months, higher pathologic T stage and grade, as well as clear cell RCC were predictors of RFS. Conclusion Late recurrence after surgery is common in patients with organ-confined RCC, with recurrence occurring even after 10 years. Consequently, long-term follow-up, of perhaps 10 years or more, including imaging studies of the abdomen, lungs, and bone, should be considered for the early detection of recurrence.

Purpose: Mirabegron, the first-in-class beta-3 agonist, is the mainstay medication for overactive bladder (OAB). The aim of this study was to investigate the efficacy and safety of generic drugs of mirabegron (Mirabek® ) in adults diagnosed with OAB through a multicenter, prospective, non-interventional observational study. Materials and Methods: Adult patients with OAB prescribed Mirabek® SR Tab. 50 mg for the first time were recruited from hospitals between September 2021 and September 2022. Participants underwent baseline registration followed by two follow-ups at 4-and 8-week intervals. Data on demographics, medical history, OAB symptoms, vital signs, medication administration, and adverse events were collected. Results: Among 1,714 patients, Mirabek® SR Tab. 50 mg effectively improved OAB symptoms over an 8-week treatment period, with significant differences in symptom improvement between baseline and both 4- and 8-week time points as well as between 4 weeks and 8 weeks. The incidence rate of adverse events was 0.70%; most cases were mild with no severe reactions. Conclusions This study demonstrated that Mirabek® , a generic drug of betmiga, is an effective and safe treatment option for adults with OAB. Furthermore, the introduction of generic drug reduced the costs of prescription drugs and expanded the opportunity for many patients to access mirabegron.

Purpose: To evaluate the incidence and pattern of recurrence after surgery in patients with organ-confined renal cell carcinoma (RCC) to establish an appropriate follow-up plan. Materials and Methods: In this retrospective study, we evaluated data from 2960 patients who underwent radical or partial nephrectomy for stage 1 or 2 RCC. We investigated the location of first recurrence and recurrence-free survival (RFS) by plotting Kaplan–Meier curves and analyzed the associated variables using Cox regression analysis. Results: During a median follow-up of 59 months, the 10-year RFS rates were 94.5%, 75.0%, and 57.9%, for T1a, T1b, and T2 RCC, respectively. A total of 211 patients experienced recurrence: 67 after 5 years, and 14 after 10 years. The most common sites of the first recurrence were the lungs, bones, and contralateral kidneys. Male sex, older age, higher pathologic T stage, higher nuclear grade, clear-cell RCC, and presence of differentiation were associated with recurrence. Among patients followed up for more than 60 months, higher pathologic T stage and grade, as well as clear cell RCC were predictors of RFS. Conclusion Late recurrence after surgery is common in patients with organ-confined RCC, with recurrence occurring even after 10 years. Consequently, long-term follow-up, of perhaps 10 years or more, including imaging studies of the abdomen, lungs, and bone, should be considered for the early detection of recurrence.

Purpose: To evaluate the incidence and pattern of recurrence after surgery in patients with organ-confined renal cell carcinoma (RCC) to establish an appropriate follow-up plan. Materials and Methods: In this retrospective study, we evaluated data from 2960 patients who underwent radical or partial nephrectomy for stage 1 or 2 RCC. We investigated the location of first recurrence and recurrence-free survival (RFS) by plotting Kaplan–Meier curves and analyzed the associated variables using Cox regression analysis. Results: During a median follow-up of 59 months, the 10-year RFS rates were 94.5%, 75.0%, and 57.9%, for T1a, T1b, and T2 RCC, respectively. A total of 211 patients experienced recurrence: 67 after 5 years, and 14 after 10 years. The most common sites of the first recurrence were the lungs, bones, and contralateral kidneys. Male sex, older age, higher pathologic T stage, higher nuclear grade, clear-cell RCC, and presence of differentiation were associated with recurrence. Among patients followed up for more than 60 months, higher pathologic T stage and grade, as well as clear cell RCC were predictors of RFS. Conclusion Late recurrence after surgery is common in patients with organ-confined RCC, with recurrence occurring even after 10 years. Consequently, long-term follow-up, of perhaps 10 years or more, including imaging studies of the abdomen, lungs, and bone, should be considered for the early detection of recurrence.

BACKGROUND: The isolated lung model is a very useful model in investigation of hypoxic pulmonary vasoconstriction (HPV), and angiotensin II is extensively used in this model. But the exact role of angiotensin II in HPV is not clear in the isolated rabbit lung. Thus we were concerned about the role of angiotensin II in the blood-perfused rabbit lung. METHODS: New Zealand white rabbits (n = 28) lungs were isolated and perfused with a constant pulmonary perfusate flow; acid-base status and temperature were maintained at constant levels. Deoxyglucose (DOG group, n = 7), angiotension II and deoxyglucose (AG-DOG group, n = 7), calcium (CA group, n = 7), angiotensin II and calcium (AG-CA group, n = 7) were administered, and then hypoxic responses were measured. Three ratios were calculated and compared (P alpha: ratio of hypoxic response to pulmonary arterial pressure at normoxia, P beta: ratio of hypoxic response to baseline hypoxic response, P gamma: ratio of pulmonary arterial pressure at hypoxia to pulmonary arterial pressure at baseline). RESULTS: Angiotensin II increased the pulmonary arterial pressure by 14%, and increased HPV. Baseline pulmonary pressure was increased in the AG-DOG group and in the AG-CA group (P<0.05). P gamma significantly increased in the AG-DOG and AG-CA groups (P<0.05). The first HPV increased but the second HPV decreased in the AG-DOG group (P alpha: P<0.05) and in the AG-CA group. P beta showed no difference between groups. CONCLUSIONS: Angiotensin II resulted in an increase of pulmonary arterial pressure in the isolated rabbit lung. One may misinterpret this as an potentiation of HPV, but HPV was not changed by angiotensin II. Therefore we deny the necessity for angiotensin II in the isolated rabbit lung model.
Angiotensin II* ; Angiotensins* ; Anoxia ; Arterial Pressure ; Calcium ; Deoxyglucose ; Lung* ; Rabbits ; Vasoconstriction*

PURPOSE: We investigated the safety and efficacy of transurethral resection of the prostate(TURP) in benign prostatic hyperplasia(BPH) more than 60cc by single surgeon for the relief of infravesical obstruction. MATERIALS AND METHODS: We evaluated 211 patients treated with TURP in BPH with large prostate by single surgeon. Each group was divided by prostate volume(group 1; 60-69.9, group 2; 70-79.9, group 3; 80-89.9, group 4; 90-99.9, group 5; >100cc of prostate volume). Various parameters such as International Prostate Symptom Score(IPSS), maximal flow rate(Qmax.), postvoid residual volume(PVR), prostate volume, adenoma volume, resection time, resection prostate volume, irrigation fluid volume and complications were evaluated and compared. RESULTS: Age of each group was not significantly different. Prostate volume, adenoma volume, resection time, Resection volume, irrigation volume of each groups were different significantly. But, resection volume/resection time and irrigation volume/resection time were not different significantly. Mean resection volume/resection time was 1.34g/min, and mean irrigation volume/resection time was 315.8ml/min. And intraoperative and postoperative complications of each group were not different. Mean postoperative change of Hb was 2.0+/-1.1g/dl. Postoperative parameters(IPSS, Qmax, PVR) were improved significantly. Only 2 patients needed transfusion in group 5. No urinary incontinence and TUR syndrome in each group was observed. CONCLUSIONS: TURP by experienced surgeon is a safe and effective treatment in BPH patients with large prostates for relief of infravesical obstruction.
Adenoma