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Controlling Legal Risk for Effective Hospital Management.

Hyun Jun PARK ; Duk Young CHO ; Yong Sug PARK ; Sun Wook KIM ; Jae Hong PARK ; Nam Cheol PARK

The World Journal of Men's Health.2016;34(1):56-63. doi:10.5534/wjmh.2016.34.1.56

PURPOSE: To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. MATERIALS AND METHODS: This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. RESULTS: Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). CONCLUSIONS: Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital.
Busan ; Compliance ; Dissent and Disputes ; Financial Management, Hospital ; Health Personnel ; Humans ; Male ; Malpractice ; Medical Errors ; Medical Records ; Negotiating ; Retrospective Studies ; Risk Factors

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Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate.

Dong Yeub HAM ; Woo Suk CHOI ; Sang Hoon SONG ; Young Joon AHN ; Hyoung Keun PARK ; Hyeong Gon KIM ; Hwancheol SON

The World Journal of Men's Health.2016;34(1):47-55. doi:10.5534/wjmh.2016.34.1.47

PURPOSE: The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC) presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP). MATERIALS AND METHODS: A multimedia IC (M-IC) presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20) or the M-IC group (n=20). The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15) to evaluate objective understanding, and questionnaires on subjective understanding (range, 0~10) and satisfaction (range, 0~10) using a visual analogue scale. RESULTS: Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332) or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122); however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033). After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. CONCLUSIONS: M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself.
Education ; Humans ; Informed Consent* ; Male ; Multimedia* ; Prospective Studies* ; Prostate* ; Prostatic Hyperplasia ; Surgical Procedures, Operative ; Volatilization*

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The Efficacy of Medical Treatment of Peyronie's Disease: Potassium Para-Aminobenzoate Monotherapy vs. Combination Therapy with Tamoxifen, L-Carnitine, and Phosphodiesterase Type 5 Inhibitor.

Tae Yong PARK ; Hyeong Guk JEONG ; Jong Jin PARK ; Ji Yun CHAE ; Jong Wook KIM ; Mi Mi OH ; Hong Seok PARK ; Je Jong KIM ; Du Geon MOON

The World Journal of Men's Health.2016;34(1):40-46. doi:10.5534/wjmh.2016.34.1.40

PURPOSE: This study was designed to evaluate the efficacy of medical treatment of Peyronie's disease. MATERIALS AND METHODS: A total of 109 patients with Peyronie's disease who had been treated from January 2011 to December 2014 were retrospectively reviewed in this study. Forty-four patients (Group 1) were treated with 12 mg of potassium para-aminobenzoate daily. Sixty-five patients (Group 2) were treated with combination therapy: tamoxifen (20 mg) and acetyl-L-carnitine (300 mg) twice daily in addition to a phosphodiesterase type 5 inhibitor. Ability to perform sexual intercourse, pain during erection, size of plaque, and penile curvature angle were assessed. RESULTS: In Group 1, 30 of 44 patients (68.2%) discontinued treatment within 12 weeks, while 5 patients (7.7%) in Group 2 discontinued treatment. Pain during erection and plaque size were improved in both groups but showed no statistical difference due to the high dropout rate in Group 1. In both groups, penile curvature was improved, but demonstrated no statistical difference between the treatment groups. However, combination therapy demonstrated a better response rate in patients whose penile curvature angle was less than 30° (44.4% vs. 79.1%, p=0.048). The rate of successful sexual intercourse was significantly higher in Group 2 (42.8% vs. 78.3%, p=0.034). The number of patients who underwent surgical correction despite medical treatment was significantly higher in Group 1 (35.7% vs. 13.3%, p=0.048). CONCLUSIONS: Early medical combination therapy in Peyronie's disease may present better results in patients whose curvature angle is less than 30°.
4-Aminobenzoic Acid ; Acetylcarnitine ; Carnitine* ; Coitus ; Drug Therapy, Combination ; Humans ; Male ; Patient Dropouts ; Penile Induration* ; Potassium* ; Retrospective Studies ; Tamoxifen*

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Book Review: Modern Oriental Phytotherapy in Sexul Medicine.

Sae Woong KIM

The World Journal of Men's Health.2015;33(1):42-43. doi:10.5534/wjmh.2015.33.1.42

No abstract available.
Phytotherapy*

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Electrocautery Resection, Shaving with a Scalpel, and Podophyllin: a Combination Therapy for Giant Condyloma Acuminatum.

Hamed AKHAVIZADEGAN

The World Journal of Men's Health.2015;33(1):39-41. doi:10.5534/wjmh.2015.33.1.39

Giant condyloma acuminatum (also known as Buschke-Lowenstein tumor) is a rare disease, for which the treatment of choice is still controversial. In the case described in this report, we used a combination of electrocautery and a surgical scalpel to resect a huge genital wart, followed by long-term local treatment with podophyllin. This procedure was relatively fast, easy to perform, involved minimal bleeding, and did not result in any complications. Moreover, combination therapy enabled us to avoid deep resection of the lesion and consequently, sexual function was preserved completely.
Buschke-Lowenstein Tumor* ; Condylomata Acuminata ; Electrocoagulation* ; Hemorrhage ; Podophyllin* ; Rare Diseases ; Warts

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Spontaneous Corpus Cavernosum Abscess in a Healthy Man Using Long-Term Androgenic Anabolic Steroids.

Emre TUZEL

The World Journal of Men's Health.2015;33(1):36-38. doi:10.5534/wjmh.2015.33.1.36

Abscess formation of the corpus cavernosum is very rare. Here, we report a case of long-term anabolic androgenic steroid (AAS) abuse that is suspected to have facilitated the development of a corpus cavernosum abscess in a healthy bodybuilder. Cultures obtained from the abscess contained Staphylococcus epidermidis, a microorganism that almost exclusively affects immunocompromised patients. Therefore, prompt drainage of pus from cavernosal bodies should be the primary aim of the treatment. This case illustrates the potential danger of AAS suppressing the immune system and causing a serious infection.
Abscess* ; Anabolic Agents ; Drainage ; Immune System ; Immunocompromised Host ; Staphylococcus epidermidis ; Steroids* ; Suppuration

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Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy.

Ja Yoon KU ; Hong Koo HA

The World Journal of Men's Health.2015;33(1):30-35. doi:10.5534/wjmh.2015.33.1.30

PURPOSE: Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. MATERIALS AND METHODS: A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. RESULTS: Mean operation time and length of hospital stay for RARP and LRP were 145.5+/-43.6 minutes and 118.1+/-39.1 minutes, and 6.4+/-0.9 days and 6.6+/-1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). CONCLUSIONS: Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.
Coitus ; Cystectomy ; Humans ; Laparoscopy ; Learning Curve* ; Length of Stay ; Nephrectomy ; Prostatectomy* ; Prostatic Neoplasms ; Robotics ; Treatment Outcome

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Protective Effect of Administered Rolipram against Radiation-Induced Testicular Injury in Mice.

Wan LEE ; Yeonghoon SON ; Hyosun JANG ; Min Ji BAE ; Jungki KIM ; Dongil KANG ; Joong Sun KIM

The World Journal of Men's Health.2015;33(1):20-29. doi:10.5534/wjmh.2015.33.1.20

PURPOSE: Pelvic irradiation for the treatment of cancer can affect normal cells, such as the rapidly proliferating spermatogenic cells of the testis, leading to infertility, a common post-irradiation problem. The present study investigated the radioprotective effect of rolipram, a specific phosphodiesterase type-IV inhibitor known to increase the expression and phosphorylation of the cyclic adenosine monophosphate response element-binding protein (CREB), a key factor for spermatogenesis, with the testicular system against pelvic irradiation. MATERIALS AND METHODS: Male C57BL/6 mice were treated with pelvic irradiation (2 Gy) and rolipram, alone or in combination, and were sacrificed at 12 hours and 35 days after irradiation. RESULTS: Rolipram protected germ cells from radiation-induced apoptosis at 12 hours after irradiation and significantly increased testis weight compared with irradiation controls at 35 days. Rolipram also ameliorated radiation-induced testicular morphological changes, such as changes in seminiferous tubular diameter and epithelial height. Additionally, seminiferous tubule repopulation and stem cell survival indices were higher in the rolipram-treated group than in the radiation group. Moreover, rolipram treatment counteracted the radiation-mediated decrease in the sperm count and mobility in the epididymis. CONCLUSIONS: These protective effects of rolipram treatment prior to irradiation may be mediated by the increase in pCREB levels at 12 hours post-irradiation and the attenuated decrease in pCREB levels in the testis at 35 days post-irradiation in the rolipram-treated group. These findings suggest that activation of CREB signaling by rolipram treatment ameliorates the detrimental effects of acute irradiation on testicular dysfunction and the related male reproductive functions in mice.
Adenosine Monophosphate ; Animals ; Apoptosis ; Cyclic AMP Response Element-Binding Protein ; Epididymis ; Germ Cells ; Humans ; Infertility ; Male ; Mice* ; Phosphorylation ; Rolipram* ; Seminiferous Tubules ; Sperm Count ; Spermatogenesis ; Stem Cells ; Testis

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The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate.

Kyu Shik KIM ; Won Sik JEONG ; Sung Yul PARK ; Yong Tae KIM ; Hong Sang MOON

The World Journal of Men's Health.2015;33(1):14-19. doi:10.5534/wjmh.2015.33.1.14

PURPOSE: Dutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Eighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization. RESULTS: Lower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (DeltaHb=0.65+/-1.27 g/dL vs. 1.16+/-0.73 g/dL, 1.30+/-1.00 g/dL vs. 1.86+/-1.05 g/dL respectively, p=0.019, p=0.011; DeltaHct=1.89%+/-3.83% vs. 3.47%+/-2.09%, 3.69%+/-2.95% vs. 5.39%+/-3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95+/-1.02 d vs. 3.92+/-1.14 d, p=0.000), continuous saline bladder irrigation (1.81+/-1.08 d vs. 2.36+/-1.06 d, p=0.016), and hospitalization after TURP (3.95+/-1.09 d vs. 4.76+/-1.19 d, p=0.001) in the dutasteride group. CONCLUSIONS: Preoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.
Dihydrotestosterone ; Hematocrit ; Hemorrhage* ; Hospitalization ; Humans ; Prostate* ; Prostatic Hyperplasia ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Catheters ; Dutasteride

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Semen Analysis in Cancer Patients Referred for Sperm Cryopreservation before Chemotherapy over a 15-Year Period in Korea.

Ja Yoon KU ; Nam Cheol PARK ; Tae Gyeong JEON ; Hyun Jun PARK

The World Journal of Men's Health.2015;33(1):8-13. doi:10.5534/wjmh.2015.33.1.8

PURPOSE: This study evaluated the demographics and semen parameters of males with cancer who banked their sperm prior to chemotherapy. MATERIALS AND METHODS: This is a retrospective study of 66 cases referred for sperm banking prior to initiation of chemotherapy over a 15-year period (1999~2014). Patients who had previously received cancer treatment including chemotherapy or radiotherapy were not included in this study. RESULTS: We studied a total of 66 cancer patients referred for cryopreservation of sperm prior to chemotherapy. The mean age of the patients at the time of banking was 32.0+/-7.9 years (range, 19~58 years). The types of cancer were testicular cancer (31 cases, 47.0%), non-Hodgkin's disease (10 cases, 15.1%), Hodgkin's disease (5 cases, 7.6%), leukemia (8 cases, 12.1%), gastrointestinal malignancy (5 cases, 7.6%), and musculoskeletal malignancy (5 cases, 7.6%). There were significant differences in sperm concentration and viability among the various types of cancer, but no significant difference in semen volume or sperm motility and morphology. CONCLUSIONS: In this study we found that sperm quality could decrease even before chemotherapy. Because chemotherapy can also negatively affect spermatogenesis, sperm cryopreservation prior to treatment should be strongly recommended for cancer patients of reproductive age.
Cryopreservation* ; Demography ; Drug Therapy* ; Hodgkin Disease ; Humans ; Infertility, Male ; Korea ; Leukemia ; Male ; Radiotherapy ; Retrospective Studies ; Semen ; Semen Analysis* ; Sperm Banks ; Sperm Motility ; Spermatogenesis ; Spermatozoa* ; Testicular Neoplasms

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