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Very Late Onset of Radiation-induced Complicated Vesicocutaneous Fistula.

Korean Journal of Urological Oncology.2015;13(2):101-104.

Vesicocutaneous fistula (VCF) secondary to radiation therapy is a rare event. There are difficulties in establishing the early diagnosis and choosing the proper management option. We present a very unusual case of postradiotherapy vesicocutaneous fistula which developed more than 30 years later. Temporary urinary diversion was performed because of poor performance status and anatomical condition. However, it failed to achieve spontaneous closure of VCF. It is important to recognize that late onset of radiation induced VCF could develop even after a substantial period of time has lapsed. In addition, conservative treatment appears to be unsuccessful in patient with complicated VCF. Therefore, it must be counselled carefully after a making synthetic judgment based on different individual situation.
Cutaneous Fistula ; Early Diagnosis ; Fistula* ; Humans ; Judgment ; Urinary Diversion

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Silencing of Heat Shock Protein 27 Expression Accelerates Doxazosin-induced Apoptosis in Prostate Cancer Cell Line PC-3.

Soon Cheol SHIN ; Jeong Man CHO ; Jung Yoon KANG ; Tag Keun YOO ; Heeju CHO

Korean Journal of Urological Oncology.2015;13(2):93-100.

PURPOSE: Heat shock proteins (HSPs) are highly expressed during stress responses and cellular adaptation to environmental changes. One such protein is HSP27, a 27kDa protein that prevents cell death induced by many pro-apoptotic agents. Therefore, the aim of this study was to investigate the correlation between HSP27 expression and apoptosis induced by doxazosin treatment in prostate cancer cell line PC-3. MATERIALS AND METHODS: RT-PCR, Western blotting, and immunocytochemical staining were performed to determine whether HSP27 mRNA and protein are expressed in PC-3 cells. Next, to investigate the effects of doxazosin on apoptosis and HSP27 protein expression in PC-3 cells, the cells were stained using a TUNEL kit (to detect apoptotic cells) and with HSP27 antibody (to assess HSP27 protein expression) 6, 12, 24, and 48h after treatment with 25microM doxazosin. In addition, to determine whether HSP27 mRNA interference accelerates doxazosin-induced apoptosis of PC-3, we knocked down HSP27 with siRNA and then evaluated the rate of apoptosis after doxazosin treatment. RESULTS: HSP27 mRNA and protein were expressed in PC-3 cells. Furthermore, HSP27 mRNA and protein levels increased until 12 hours after 25microM doxazosin treatment, whereas the rate of apoptosis did not increased dramatically. After 12 hours, HSP27 expression decreased and then apoptosis was accelerated. In addition, siRNA-mediated knockdown of HSP27 induce higher apoptosis rate of PC-3 cells even before 12hrs after doxazosin treatment. CONCLUSIONS: By inhibiting apoptosis, HSP27 expression might play an important role in inhibiting progression to castration-refractory prostate cancer and resistance to anti-cancer treatment.
Apoptosis* ; Blotting, Western ; Cell Death ; Cell Line* ; Doxazosin ; Heat-Shock Proteins* ; Hot Temperature* ; HSP27 Heat-Shock Proteins* ; In Situ Nick-End Labeling ; Prostate* ; Prostatic Neoplasms* ; RNA, Messenger ; RNA, Small Interfering

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Climacturia (Orgasm-associated Incontinence) Following Radical Prostatectomy.

Yun Beom KIM ; Jae Hyun RYU ; Tae Young JUNG ; Duk Yoon KIM ; Hee Ju CHO ; Tag Keun YOO

Korean Journal of Urological Oncology.2015;13(2):85-92.

PURPOSE: Climacturia is involuntary loss of urine during orgasm. The mechanism of climacturia in men who undergo radical prostatectomy (RP) is not fully understood, while deficiency in bladder neck coaptation during orgasm may be the cause. We evaluated the prevalence and risk factors of climacturia after RP. MATERIALS AND METHODS: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from 2002 to 2013 and was able to have a vaginal intercourse postoperatively. RP was conducted using open or robot-assisted approach. We analysed the symptoms of climacturia, relationship between climacturia and several clinical factors. Also, we tried to find factors to predict the presence of climacturia. RESULTS: Total of 123 patients were analyzed in this study. The median age of the men was 65 year and postoperative follow-up period for the interview was 37 months. Of the total 123 patients, 29 (23.6%) complained of the climacturia. In climacturia group, robot-assisted RP (p=0.018), nerve-sparing (p=0.046) and penile rehabilitation (p=0.012) were significantly less frequent, and more pad were comsumed (p=0.001) compared to non-climacturia group. On multivariable analysis, post-prostatectomy incontinence (PPI) (OR 6.49, p=0.004) and penile rehabilitation (OR 0.22, p=0.036) were significant factors to predict the presence of climacturia. CONCLUSIONS: Climacturia occurs in more than 20% patients who were potent enough after RP in our study. PPI and penile rehabilitation were positive and negative factor to predict an occurrence of climacturia, respectively. Therefore, in addition to PPI and erectile dysfunction, patients must be informed of this complication before undergoing RP.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Neck ; Orgasm ; Prevalence ; Prostatectomy* ; Prostatic Neoplasms ; Rehabilitation ; Retrospective Studies ; Risk Factors ; Urinary Bladder ; Urinary Incontinence

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The Internalization of Bacillus Calmette-Guerin (BCG) in Bladder Cancer Cells May be Inhibited by Human beta-defensin 3.

Song Won LIM ; In Ho CHANG ; Tae Hyoung KIM ; Soon Chul MYUNG ; Kyung Do KIM ; Young Tae MOON ; Jin Wook KIM ; Byung Hoon CHI

Korean Journal of Urological Oncology.2015;13(2):75-84.

PURPOSE: To investigate whether secretion of human beta-defensin 3 (HBD-3) is induced by bacillus Calmette-Guerin (BCG) and to determine whether HBD-3 affects BCG internalization in bladder cancer cells. MATERIALS AND METHODS: RTPCR analysis was used to determine whether HBD-3 mRNA increases after incubation with BCG. HBD-3 proteins in 5637 and T24 human bladder cancer cell lines were assayed by ELISA. The internalization rate was evaluated by double immunofluorescence assay and confocal microscopy to test the optimal dose of HBD-3 for BCG internalization. We also investigated the difference in internalization rates and cell viability between recombinant HBD-3 protein, anti-HBD-3 antibody, and HBD-3 plus anti-HBD-3 antibody pretreatments. RESULTS: BCG induced HBD-3 mRNA expression and HBD-3 production dose and time-dependently in bladder cancer cells and affected BCG internalization. Pretreatment with recombinant HBD-3 protein lowered internalization of BCG dose-dependently. Moreover, anti-HBD-3 antibody prevented the effect of HBD-3 on BCG internalization in bladder cancer cells. The internalization rate of BCG pretreated with anti-HBD-3 antibody was higher than that in the control. The BCG internalization rate in cells pretreated with anti-HBD-3 antibody plus recombinant HBD-3 protein was higher than that in the control. BCG decreased bladder cancer cell viability, and anti-HBD-3 antibody prevented the inhibitory role of HBD-3 on the anti-proliferative effects of M. bovis BCG in bladder cancer cells. CONCLUSIONS: Bladder cancer cells produce HBD-3 when they are infected by BCG to defend themselves against BCG internalization, which plays an important role during the initiation and propagation of the immunotherapeutic response in bladder cancer cells.
Bacillus* ; Cell Line ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Fluorescent Antibody Technique ; Humans* ; Microscopy, Confocal ; Mycobacterium bovis ; RNA, Messenger ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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Treatment of MIBC - Neoadjuvant Chemotherapy: New Standard of Care.

Whi An KWON ; Ho Kyung SEO

Korean Journal of Urological Oncology.2015;13(2):66-74.

The standard management for patients with muscle invasive bladder cancer (MIBC) involves radical cystectomy and pelvic lymph node dissection. Although this treatment may be curative, a large proportion of patients will develop recurrence and will ultimately die of metastatic disease. Prospective, randomized clinical trial data demonstrate a survival advantage for those patients who receive neoadjuvant chemotherapy (NAC) prior to radical cystectomy and this concept was confirmed by meta-analysis. The administration of cisplatin-based combination NAC has consistently demonstrated a survival benefit of 5%. The pathologic downstaging is used as a surrogate end point. The efficacy of NAC for MIBC was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), with complete response rates (pT0) as high as 38%. Dose dense M-VAC (DDMAVC) is preferred over standard MVAC, and gemcitabine/cisplatin is a reasonable alternative to standard M-VAC for NAC. In Korea, while NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
Biomarkers ; Cisplatin ; Cystectomy ; Doxorubicin ; Drug Therapy* ; Humans ; Korea ; Lymph Node Excision ; Methotrexate ; Neoadjuvant Therapy ; Prospective Studies ; Recurrence ; Standard of Care* ; Urinary Bladder Neoplasms ; Vinblastine

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Clinical Utility of Novel Biomarkers in the Era of Active Surveillance of Prostate Cancer.

Jeong Hyun KIM

Korean Journal of Urological Oncology.2015;13(2):58-65.

Active surveillance (AS) is an alternative to initial radical treatment for men with low-risk localized prostate cancer (PCa). Current AS criteria for selection and follow-up incorrectly exclude some patients eligible for AS and misclassify some who actually harbour significant disease. It is crucial what will serve as the best parameter to correctly identify tumors that progress to a more aggressive phenotype so as not to miss the window of curability. There is an unmet need for a noninvasive biomarker test that can provide a higher degree of specificity for detecting aggressive disease than currently available clinical tools. Several biomarkers are now being actively investigated as novel tools to improve PCa risk assessments. Prostate-specific antigen (PSA) isoform [-2]proPSA and its derivatives, percentage of [-2]proPSA to free PSA (%[-2]proPSA) and Prostate Health Index (PHI), have higher accuracy than the currently used PSA and other PSA derivatives for predicting PCa detection and aggressiveness. In the AS program, %[-2]proPSA and PHI showed improved predictive value for an unfavorable biopsy conversion at annual surveillance biopsy. Although prostate cancer antigen 3 (PCA3) was limited in predicting aggressive cancer, PCA3 and TMPRSS2:ERG also had additional independent predictive value for predicting PCa. However, the roles of PCA3 and TMPRSS2:ERG in risk assessment during AS need to be tested in additional multi-institutional studies. Tissue biomarkers also showed promising ability to predict disease progression. Although the biopsy-based tissue biomarkers provide additional prognostic information over existing clinical tools, further validation studies are also needed to provide robust evidence.
Biomarkers* ; Biopsy ; Disease Progression ; Follow-Up Studies ; Humans ; Male ; Passive Cutaneous Anaphylaxis ; Phenotype ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Risk Assessment ; Sensitivity and Specificity

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Epidemiology and Treatment Patterns of Urologic Cancers in Korea.

Kyo Chul KOO ; Byung Ha CHUNG

Korean Journal of Urological Oncology.2015;13(2):51-57.

Prostate, kidney, and bladder cancers are the three most prevalent urologic cancers in the Korean population. Throughout the last decade, there has been an upsurge in the incidence and prevalence of prostate and kidney cancers, along with a marked improvement in survival. A stage migration has been observed towards early detection of localized cancers, and accordingly, the landscape of urologic cancer treatment in Korea has been characterized by an exponential increase in the number of patients receiving surgery with curative intent. Herein, a substantial proportion of surgeries were performed using minimally-invasive methods, especially robot-assisted surgery. Current management strategies of urologic cancers in Korea are mostly based on evidences provided by international guidelines. There is prompt adoption and clinical application of novel systemic agents for advanced stage cancer, and surgical and oncological outcomes are comparable to those of Western reports. Multidisciplinary treatment options are available for various cancers at different stages. At the same time, treatment decisions are influenced by the availability of health-care resources, which is regulated by the National Health Insurance policy guidelines. Accumulating information on characteristics of urologic cancers in Korean patients demonstrates that Korean patients harbor more aggressive prostate cancer features compared to Western men. Due to the racial disparity in features of certain cancers, the optimal management strategy specific for the Korean population is yet to be validated. A comprehensive national cancer database may help to identify risk factors, select sequential strategies, and to assess survival outcome of Korean urologic cancer patients.
Epidemiology* ; Humans ; Incidence ; Kidney ; Kidney Neoplasms ; Korea* ; Male ; National Health Programs ; Prevalence ; Prostate ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder Neoplasms ; Urologic Neoplasms*

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Sangjun YOO ; In Gab JEONG

Korean Journal of Urological Oncology.2015;13(2):43-50.

In spite of multidisciplinary treatment, about 70% of lymph node (LN) positive bladder cancer reported to be recurred within 5-year after radical cystectomy and pelvic lymphadenectomy although considerable number of patients survived for a long period without adjuvant treatment after surgery. Current TNM nodal staging system doesn't account for this survival differences. In this regard, several LN-related parameters were developed to predict prognosis of LN positive bladder cancer. In this article, we will state the controversies on current TNM nodal staging system for bladder cancer. In addition, we will review the accuracy of imaging studies to predict LN metastasis before surgery and impact of several surgical and pathologic LN-related parameters, such as extent of lymphadenectomy, number of removed LNs, number of metastatic LNs, LN density, extracapsular extension of LN, on prognosis of LN positive bladder cancer. Moreover, we will review the value of adjuvant chemotherapy on LN positive bladder cancer.
Chemotherapy, Adjuvant ; Cystectomy ; Drug Therapy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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Collecting Duct Carcinoma (Bellini Duct Carcinoma) Presented as a Renal Cyst.

Hyun Jin JUNG ; Hoon Kyu OH ; Hong Seok SHIN

Korean Journal of Urological Oncology.2017;15(3):187-191. doi:10.22465/kjuo.2017.15.3.187

Renal cysts are frequently seen in the general population. Most small simple renal cysts are managed by conservative treatment. A renal cell carcinoma (RCC) presenting as a renal cyst is extremely uncommon, and collecting duct carcinoma is a rare type of RCC. This report describes a collecting duct carcinoma initially presnted as a renal cyst. The patient was a 52-year-old man who had been diagnosed with a renal cyst in the left lower pole 8 years earlier but was not regularly follow-up. He presented with left flank pain and gross hematuria. Computed tomography revealed a heterogeneous enhanced mass in the left lower pole and multiple para-aortic lymph nodes. He underwent radical nephrectomy and lymph nodes dissection which confirmed collecting duct carcinoma with sarcomatoid differentiation.
Carcinoma, Renal Cell* ; Flank Pain ; Follow-Up Studies ; Hematuria ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy

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Poloxamer 407 Hydrogels for Intravesical Instillation to Mouse Bladder: Gel-Forming Capacity and Retention Performance.

Sang Hyun KIM ; Sung Rae KIM ; Ho Yub YOON ; In Ho CHANG ; Young Mi WHANG ; Min Ji CHO ; Myeong Joo KIM ; Soo Yeon KIM ; Sang Jin LEE ; Young Wook CHOI

Korean Journal of Urological Oncology.2017;15(3):178-186. doi:10.22465/kjuo.2017.15.3.178

PURPOSE: Poloxamer 407 (P407) thermo-sensitive hydrogel formulations were developed to enhance the retention time in the urinary bladder after intravesical instillation. MATERIALS AND METHODS: P407 hydrogels (P407Gels) containing 0.2 w/w% fluorescein isothiocyanate dextran (FD, MW 4 kDa) as a fluorescent probe were prepared by the cold method with different concentrations of the polymer (20, 25, and 30 w/w%). The gel-forming capacities were characterized in terms of gelation temperature (G-Temp), gelation time (G-Time), and gel duration (G-Dur). Homogenous dispersion of the probe throughout the hydrogel was observed by using fluorescence microscopy. The in vitro bladder simulation model was established to evaluate the retention and drug release properties. P407Gels in the solution state were administered to nude mice via urinary instillation, and the in vivo retention behavior of P407Gels was visualized by using an in vivo imaging system (IVIS). RESULTS: P407Gels showed a thermo-reversible phase transition at 4℃ (refrigerated; sol) and 37℃ (body temperature; gel). The G-Temp, G-Time, and G-Dur of FD-free P407Gels were approximately 10℃–20℃, 12–30 seconds, and 12–35 hours, respectively, and were not altered by the addition of FD. Fluorescence imaging showed that FD was spread homogenously in the gelled P407 solution. In a bladder simulation model, even after repeated periodic filling-emptying cycles, the hydrogel formulation displayed excellent retention with continuous release of the probe over 8 hours. The FD release from P407Gels and the erosion of the gel, both of which followed zero-order kinetics, had a linear relationship (r²=0.988). IVIS demonstrated that the intravesical retention time of P407Gels was over 4 hours, which was longer than that of the FD solution ( < 1 hour), even though periodic urination occurred in the mice. CONCLUSIONS: FD release from P407Gels was erosion-controlled. P407Gels represent a promising system to enhance intravesical retention with extended drug delivery.
Administration, Intravesical* ; Animals ; Dextrans ; Drug Liberation ; Fluorescein ; Hydrogel* ; Hydrogels* ; In Vitro Techniques ; Kinetics ; Methods ; Mice* ; Mice, Nude ; Microscopy, Fluorescence ; Optical Imaging ; Phase Transition ; Poloxamer* ; Polymers ; Urinary Bladder* ; Urination

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