PURPOSE: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. RESULTS: Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06+/-2.56 and 11.81+/-2.87 mm, and prostatic urethral lengths were 36.39+/-6.15 and 37.45+/-7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25+/-0.06 and 0.24+/-0.06, and prostatic-posterior urethral length ratios were 0.75+/-0.06 and 0.76+/-0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. CONCLUSIONS: The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.
Humans ; Laparoscopy ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Urinary Incontinence ; Urodynamics

The aims of this study were to estimate daily intake of macrominerals from beverages, liquid teas, and liquid coffees and to evaluate their potential health risks for Korean children and adolescents (1-to 19 years old). Assessment of dietary intake was conducted using the actual level of sodium, calcium, phosphorus, potassium, and magnesium in non-alcoholic beverages and (207 beverages, 19 liquid teas, and 24 liquid coffees) the food consumption amount drawn from "The Fourth Korea National Health and Nutrition Examination Survey (2007-2009)". To estimate the dietary intake of non-alcoholic beverages, 6,082 children and adolescents (Scenario I) were compared with 1,704 non-alcoholic beverage consumption subjects among them (Scenario II). Calculation of the estimated daily intake of macrominerals was based on point estimates and probabilistic estimates. The values of probabilistic macromineral intake, which is a Monte-Carlo approach considering probabilistic density functions of variables, were presented using the probabilistic model. The level of safety for macrominerals was evaluated by comparison with population nutrient intake goal (Goal, 2.0 g/day) for sodium, tolerable upper intake level (UL) for calcium (2,500 mg/day) and phosphorus (3,000-3,500 mg/day) set by the Korean Nutrition Society (Dietary Reference Intakes for Koreans, KDRI). For total children and adolescents (Scenario I), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 7.93, 10.92, 6.73, 23.41, and 1.11, and 95th percentile daily intake of those was, respectively, 28.02, 44.86, 27.43, 98.14, and 3.87 mg/day. For consumers-only (Scenario II), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 19.10, 25.77, 15.83, 56.56, and 2.86 mg/day, and 95th percentile daily intake of those was, respectively, 62.67, 101.95, 62.09, 227.92, and 8.67 mg/day. For Scenarios I.II, sodium, calcium, and phosphorus did not have a mean an 95th percentile intake that met or exceeded the 5% of Goal and UL.
Adolescent ; Beverages ; Calcium ; Child ; Humans ; Korea ; Magnesium ; Models, Statistical ; Nutrition Surveys ; Phosphorus ; Potassium ; Sodium ; Tea

A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.
Aged ; Anxiety ; Arrhythmias, Cardiac ; Delayed Diagnosis ; Delirium ; Depression ; Early Diagnosis ; Fever ; Humans ; Hydrocortisone ; Hyperthyroidism ; Iodides ; Lethargy ; Meningism ; Parkinson Disease ; Precipitating Factors ; Thyroid Crisis ; Thyroid Gland ; Weight Loss

To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged > or =18 yr with mixed nocturia (> or =2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4+/-44.1 to 220.3+/-90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.
Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Antidiuretic Agents/*administration & dosage ; Deamino Arginine Vasopressin/*administration & dosage ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Nocturia/complications/*drug therapy ; Polyuria/complications/*drug therapy ; Prospective Studies ; Questionnaires ; Sleep/drug effects/physiology ; Urinary Bladder/*physiopathology ; Urodynamics/physiology

For the evaluation of the kidney impairment, serum creatinine concentrations or glomerular filtration rates are mainly used, and the conditions of solitary or transplanted kidney and chronic dialysis are also taken into the considerations. Some symptoms and signs of the chronic renal disability in spite of adequate treatment add one additional grade. For evaluating bladder and urethral impairment, the criteria include voiding symptoms and signs. The patients with urinary diversions have impairment grades depending on the alteration of upper urinary tract function. For penile impairment, the degrees are evaluated using the international index of erectile function, nocturnal penile tumescence and color doppler ultrasonography. For evaluating impairment of other male reproductive organs, functional and anatomical changes of these organs, analysis of the semen or hormones and the state of solitary testis are used as the criteria. For evaluating impairment of female reproductive organs, pregnancy potential, requirement of continuous treatment and the ability of sexual intercourse are used. Also, degree of impairment is modified according to the ages in evaluating female reproductive systems. We have tried to make this evaluation system objective, scientific, and convenient, but still find it leaving much to be desired.
*Disability Evaluation ; Female ; Genitalia, Female/physiopathology ; Genitalia, Male/physiopathology ; Humans ; Kidney Diseases/classification/*diagnosis ; Korea ; Male ; Program Development ; Severity of Illness Index ; Urethral Diseases/classification/*diagnosis ; Urinary Bladder Diseases/classification/*diagnosis ; Urologic Diseases/classification/*diagnosis

PURPOSE: This study was performed to evaluate the relationship of the expressions of clusterin with Ki-67 and the clinicopathological factors and significance of clusterin expression in human renal cell carcinoma (RCC). MATERIALS AND METHODS: Normal kidney (n=26) and RCC tissues (n=111) were obtained from 111 patients who had undergone a radical or partial nephrectomy. The expressions of clusterin and Ki-67 protein were analysed using immunohistochemical staining. The medical records of the patients were retrospectively reviewed to evaluate the clinicopathological factors. RESULTS: In contrast to the clusterin and Ki-67 expressions of 30.8 and 11.5%, respectively in the normal kidney (n=26), those in the RCC tissues were 93.7 and 28.8% (n=111), respectively (p<0.05). In contrast to the normal tissues, Ki-67 staining was significantly correlated with the expression of clusterin in the RCC tissues (p<0.05). The expression level of clusterin protein in the RCC tissues was significantly related to the tumor stage and grade (p<0.05), but not to age, gender or histological cell type (p>0.05). Furthermore, the recurrence-free survival in patients with strong clusterin expression was significantly lower than in those with weak expression (p<0.05). CONCLUSIONS: These findings suggest that clusterin may be involved in the progression of RCC and; therefore, a useful prognostic variable in patients with an RCC.
Carcinoma, Renal Cell* ; Clusterin* ; Humans* ; Ki-67 Antigen ; Kidney ; Medical Records ; Nephrectomy ; Retrospective Studies

Gap junction protein, connexin, is expressed in endothelial cells of vessels, glomerulus, and renin secreting cells of the kidney. The purpose of this study was to investigate the role of gap junction in renin secretion and its underlying mechanisms using As 4.1 cell line, a renin-expressing clonal cell line. Renin release was increased proportionately to incubation time. The specific gap junction inhibitor, 18-beta glycyrrhetinic acid (GA) increased renin release in dose-dependent and time- dependent manners. Heptanol and octanol, gap junction blockers, also increased renin release, which were less potent than GA. GA-stimulated renin release was attenuated by pretreatment of the cells with amiloride, nifedipine, ryanodine, and thapsigargin. GA dose-dependently increased intracellular Ca2+ concentration, which was attenuated by nifedipine, nimodipine, ryanodine, and thapsigargin. However, RP-cAMP, chelerythrine, tyrphostin A23, or phenylarsine oxide did not induced any significant change in GA-stimulated increase of intracellular Ca2+ concentration. These results suggest that gap junction plays an important role on the regulation of renin release and intracellular Ca2+ concentration in As 4.1 cells.
Amiloride ; Calcium* ; Cell Line* ; Connexins ; Endothelial Cells ; Gap Junctions* ; Glycyrrhetinic Acid ; Heptanol ; Kidney ; Nifedipine ; Nimodipine ; Renin* ; Ryanodine ; Thapsigargin

The present study was performed to investigate the dynamics of Cu,ZnSOD and MnSOD expression following courses of reperfusion after repetitive ischemic preconditioning on the left rectus femoris muscle of Spraque-Dawley rats. Nine or thirty five weeks-old rats were subjected to three, six and ten cycles of ischemic preconditioning that was 5 min ischemia and 5 min reperfusion at the left common iliac artery. Left rectus femoris muscle was isolated 0, 3, 6, 24 and 72 hours of reperfusion after ischemic preconditioning and assayed by immunohistochemical staining with anti-Cu,ZnSOD and anti-MnSOD antibodies. The results were as follows; The immunoreactivities of Cu,ZnSOD and MnSOD were increased in the repectitive three and six cycles of ischemic preconditioning. However, after the repetitive ten cycles of ischemic preconditioning, the Cu,ZnSOD immunoreactivities were decreased in the nine weeks-old rats while MnSOD immunoreactivities were decreased in thirty five weeks-old rats. These findings suggest that severe damayes result from decrease of Cu,ZnSOD in nine weeks-old rats and decrease of MnSOD in thirty five weeks-old rats after ten cycles of ischemic preconditioning.
Animals ; Antibodies ; Iliac Artery ; Ischemia ; Ischemic Preconditioning* ; Muscles* ; Quadriceps Muscle* ; Rats* ; Reperfusion