Background: The purpose of this study is to analyze the current status and factors of elderly patients’ hospitalization for hip replacement, knee replacement, and general spine surgery. Methods: National health insurance data in 2018 was provided by the National Health Insurance Service. We used multiple regression to analyze factors associated with the medical utilization of hip replacement, knee replacement, and general spine surgery in elderly patients over 65 years old. The dependent variables are the length of stay and total health expenditure. The independent variables are the demographic-social factors (sex, age, region, insurance type, income level) and surgery-related factors (institution type, location of the hospital, surgery classification). Results: The most common factor affecting surgery was the location of medical institutions. Compared with the medical institutions located in metropolitan, the length of stay in rural medical institutions was higher and total health expenditure was lower. The lower quartile of income, the higher the length of stay and total health expenditure. In addition, the variables of age, type of health insurance, and type of medical institution were statistically significant. Conclusion In this study, we confirmed the effect of sociodemographic factors and medical institution factors on the Healthcare Utilization of spinal and joint surgery.

PURPOSE: To demonstrate the effectiveness of the conservative treatment which was introduced to the extraarticular triplane fractures of the distal tibia. MATERIALS AND METHODS: We reviewed radiographs and medical records of eight patients with extraarticular triplane fractures of the tibia. Four patients were treated with closed reduction and internal fixation and the others with closed reduction and plaster. RESULTS: In all patients, the union of fractures was obtained. Although the physes were closed early, there was no angular deformity or leg length discrepancy. CONCLUSION: In case of extraarticular triplane fracture, except for open fracture or failure of closed reduction, conservative treatment yield good result.
Child* ; Congenital Abnormalities ; Fractures, Open ; Humans ; Leg ; Medical Records ; Tibia*

PURPOSE: Due to their high success rate, sling operations have recently been widely performed for stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite the encouraging short-term results of the sling surgery using anterior vaginal wall, the long-term results have been shown not to be as good as those in short-term studies. This study was designed to investigate the long term results of a Raz's anterior vaginal wall sling (AVWS), and to determine factors contributing to patients' satisfaction. MATERIALS AND METHODS: An outcome-based study was conducted on 77 patients who had undergone an AVWS performed by the same surgeon. Patients were preoperatively evaluated for their history, by physical examination, standardized symptom questionnaires and urodynamic studies. Patients with a follow-up of at least 1-year were assessed by the parameters of voiding symptoms and subjective satisfaction from the postoperative questionnaires. RESULTS: Of the 62 patients (81%) available for long term follow-up, 43 (69.4%) were currently satisfied with the urinary status, 35 (56.5%) were dry all the time, 12 (19.4%) were occasionally wet, but the severity had improved, 15 (24.1%) had not improved or had worsened. A review of the charts of the 15 failures revealed all of them were postoperatively urgent. Late complications occurred in 4 patients; 1 had recurrent cystocele and 3 had dyspareunia. De novo urge incontinence occurred in 5 patients. CONCLUSIONS: The stress incontinence was cured, or improved, in 75.8% of the patients after a follow-up of at least 1-year. The satisfaction of patients was closely associated with the presence, or resolution, of postoperative urgency or urge incontinence.
Cystocele ; Dyspareunia ; Female ; Follow-Up Studies ; Humans ; Physical Examination ; Surveys and Questionnaires ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: Cryoablation has been used successfully for the local treatment of renal cell carcinoma. Besides local destruction, Cryoablation has an immunogenic nature. In this study, we evaluated the anti-tumor immune response induced by cryoablation in renal cell carcinoma murine model. MATERIALS AND METHODS: Renal cell carcinoma was produced in BALB/c mice by the subcutaneous inoculation of Renca cells in the thigh. After 7 days, the tumors were removed using liquid nitrogen in cryoablation group and bipolar electrocoagulation in electrocautery group. For twelve days after re-inoculation of Renca cells at contralateral thigh, tumor volumes were measured daily to assess the effect against the growth of tumor. The immunocyte levels (T4, T8, B and NK cell) were determined to evaluate immune activity by FACS (Fluorescence activated cell sorter) analysis. The effect of cryoablation to induce apoptosis of tumor was evaluated by TUNEL (Terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling) assay. RESULTS: The tumor volume of cryoablation group was significantly smaller than that of electrocautery group and control (p<0.05). Comparing with control, T cell level was significantly increased after cryoablation (p<0.05), but no group had a significant difference in the levels of B cell and NK cell by FACS analysis. The apoptosis index % of cryoablation group was significantly increased than that of control group (p<0.05) by TUNEL. CONCLUSIONS: Cryoablation could result in the inhibition of re-inoculated tumor growth and induce T cell mediated immune response. The active immune response may be attributed to the apoptosis of tumor after cryoablation.
Allergy and Immunology ; Animals ; Apoptosis ; Carcinoma, Renal Cell* ; Cryosurgery* ; DNA Nucleotidylexotransferase ; Electrocoagulation ; Immunity, Active ; In Situ Nick-End Labeling ; Killer Cells, Natural ; Mice ; Nitrogen ; Thigh ; Tumor Burden

The clinical practice guidelines (CPGs) is made step by step. The evidences that have been published were searched and a group of experts make a consensus based in the evidences. The CPGs in the medical field, where utilizations and interests are increasing, must be confirmed in the management of quality. The Korean Appraisal of Guidelines for Research & Evaluation II (K-AGREE II) tool that helps to manage the quality of CPGs and to develop CPGs was translated by the Steering Committee for Clinical Practice Guideline. It is divided into 6 domains and each domains are independent. It is consisted of 23 items as detail and 2 items for the overall evaluation. Only fifteen CPGs are successfully certified using the K-AGREE II tool in the Korean Medical Guideline Information Center from 2013 and 3 CPGs made by the Korea Urological Association and the associated societies are certified successfully. With the level of certification of CPGs is higher, the Korea Urological Association and the associated societies are also try to develop CPGs that meet their level of certification. The Korean clinical practice guideline for the treatment of prostate cancer developed recently is the evidence of effort.
Certification ; Consensus ; Information Centers ; Korea ; Prostatic Neoplasms ; Quality Improvement ; Urology

Background: Based on the importance of ceasing smoking programs to control the regional disparity of smoking behavior in Korea, this study aims to reveal the variation of smoke rate and determinants of it for 229 provinces. An evaluation of the relative efficiency of the cease smoking program under the consideration of regional characteristics was followed. Methods: The main sources of data are the Korean Statistical Information Service and a national survey on the expenditure of public health centers. Multivariate regression is performed to figure the determinants of regional variation of smoking rate. Based on the result of the regression model, clustering analysis was conducted to group 229 regions by their characteristics. Three clusters were generated. Using data envelopment analysis (DEA), relative efficiency scores are calculated. Results from the pooled model which put 229 provinces in one model to score relative efficiency were compared with the cluster-separated model of each cluster. Results: First, the maximum variation of the smoking rate was 16.9%p. Second, sex ration, the proportion of the elder, and high risk drinking alcohol behavior have a significant role in the regional variation of smoking. Third, the population and proportion of the elder are the main variables for clustering. Fourth, dissimilarity on the results of relative efficiency was found between the pooled model and cluster-separated model, especially for cluster 2. Conclusion This study figured regional variation of smoking rate and its determinants on the regional level. Unconformity of the DEA results between different models implies the issues on regional features when the regional evaluation performed especially on the programs of public health centers.

Purpose: Several studies have associated the serum vitamin D level with total testosterone levels and the prostate volume. Herein, we investigated the effect of vitamin D supplementation on testosterone, prostate, and lower urinary tract symptoms (LUTS) in men. Materials and Methods: Men over 40 years of age diagnosed with a vitamin D deficiency (25[OH]D <20 ng/mL) who received vitamin D supplementation for one year were included in the study and administered 25,000 IU of cholecalciferol every 2 weeks. Prostate ultrasound, uroflowmetry, postvoid residual urine volume measurement, and serological tests (serum testosterone levels, etc.) were performed upon diagnosis and one year later. Participants also answered the International Prostate Symptom Score (IPSS) and Aging Males’ Symptoms Scale (AMS) questionnaires. Results: A significant increase was observed in the vitamin D level following one year of vitamin D supplementation, with a significant decrease in the postvoid residual urine volume, total IPSS score and without a significant change in the prostate volume. Improved psychological subscale score of AMS questionnaire was observed with a statistical significance. Conclusions Vitamin D supplementation suppressed the increase in the prostate volume and improved the LUTS. Although there is no direct effect on serum testosterone levels, vitamin D supplementation helped improve hypogonadal symptoms.

PURPOSE: We investigated the correlations of serum total testosterone (TT) levels with body composition and physical fitness parameters in patients with erectile dysfunction (ED) to know the best exercise for testosterone deficiency. MATERIALS AND METHODS: Eighty-seven ED patients underwent serum TT assessment as well as body composition and basic exercise testing. The bioelectrical impedance analysis was used to assess body composition. Seven types of basic exercise tests were used to determine physical fitness. Correlations between serum TT levels and body composition/physical function parameters were evaluated using partial correlation analyses. A serum TT cut-off value was obtained for the parameters significantly correlated with serum TT levels. RESULTS: The subjects had a mean serum TT level of 342.1 ng/dL. Among the body composition parameters, body and abdominal fat percentages showed statistically significant negative correlations with serum TT levels. Among the basic exercise test parameters, only the cycle ergometer test for cardiorespiratory fitness showed a statistically significant positive correlation with serum TT levels. CONCLUSIONS: Serum TT levels in patients with ED, may be increased by reducing fat percentage and improving cardiorespiratory fitness via aerobic exercise.
Abdominal Fat ; Body Composition ; Electric Impedance ; Erectile Dysfunction* ; Exercise ; Exercise Test ; Humans ; Male ; Physical Fitness ; Testosterone*

PURPOSE: In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. MATERIALS AND METHODS: We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. RESULTS: Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. CONCLUSIONS: Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.
Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Erythropoietin* ; Humans ; Jehovah's Witnesses ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms* ; Retrospective Studies

Cystic dysplasia of the rete testis (CDT) is a very rare congenital benign testicular tumor that is often associated with ipsilateral genitourinary anomalies. It is usually found in the pediatric population and must be differentially diagnosed from a malignant lesion. Here we report the case of a 63-year-old man with a left inguinal hernia who visited our urologic outpatient clinic. Scrotal ultrasonography showed a left direct inguinal hernia in the inguinal area and a well-circumscribed cystic lesion containing multiple minute cysts with echogenic foci occupying almost one-third of the left testicular parenchyma. Testicular tumor markers were within the normal range and a computed tomography scan of the abdomen showed no genitourinary abnormalities. We presumed that the left testicular lesion was malignant, and the patient underwent radical orchiectomy. However, the pathologic examination revealed a CDT. Here we present this case of a 63-year-old man with an inguinal hernia accompanied by multiple cystic lesions on the left testis.
Abdomen ; Adult ; Ambulatory Care Facilities ; Hernia, Inguinal ; Humans ; Middle Aged ; Orchiectomy ; Reference Values ; Rete Testis ; Testicular Neoplasms ; Testis ; Biomarkers, Tumor ; Urogenital Abnormalities