Purpose: This study aimed to evaluate the relationship between prostate volume and lower urinary symptom (LUTS) in subjects undergoing health checkup and to know the usefulness of TRUS in health screening.
Materials and Methods: The study was conducted in 883 men aged ≥20 years who underwent TRUS for health screening. All participants had filled in the international prostate symptom score (IPSS) and were tested for prostate-specific antigen; prostate volume, central gland volume, and transitional zone index were measured using TRUS. We analyzed the differences in the IPSS by prostate volume and differences in prostate volume by severity of LUTS and correlation between prostate volume and each component of IPSS.
Results: There were differences in the total IPSS, storage score, and voiding score between the subjects with prostate volumes of ≥30 mL or not (p=0.027, p=0.037, and p=0.029, respectively). However, the differences were found only for urgency and weak stream. The volume of the severe symptom group was bigger than those of the mild and moderate symptom groups (p=0.002 and p=0.014). The correlation between prostate volume and IPSS was significant only for the between the central volume and nocturia (r=0.112, p＜0.01).
Conclusions The relationship between prostate volume and urinary symptoms showed significant but low correlation and found only in some components. For the accurate diagnosis, it would be more useful to accompany various voiding-related surveys in addition to TRUS during health screening. (Korean J Urol Oncol 2020;18:53-60)

PURPOSE: To explore the effect of bi-parametric MRI-ultrasound (MR/US) fusion prostate biopsy on the detection of overall cancer and significant prostate cancer (sPCa). MATERIALS AND METHODS: We examined 140 patients with suspected prostate cancer lesions on MRI from August 2016 to March 2018. All patients had undergone 3T pre-biopsy bi-parametric (T2 weighted and diffusion-weighted) prostate MRI (bpMRI), and their MRI images were evaluated with Prostate Imaging Reporting and Data System (PI-RADS) version 2.0. MR/US fusion targeted prostate biopsy was performed for lesions with a PI-RADS score ≥3 before systemic biopsy. The results of targeted and systemic biopsy were evaluated in regards to detection rate according to PI-RADS score. RESULTS: Of the patients (mean age=67.2 years, mean prostate-specific antigen level=8.1 ng/mL), 66 (47.1%) and 37 (26.4%) patients were diagnosed with cancer and significant prostate cancer, respectively. The rate of positive targeted biopsy increased with higher PI-RADS score (3: 40.4%, 4: 56.7%, 5: 90.0%). The proportion of significant prostate cancer among positive target lesions was 65.3% (32/49). CONCLUSION: bpMRI is a feasible tool with which to identify sPCa. MR/US fusion biopsy, rather than systemic biopsy, can help identify sPCa. We recommend using supplemental tools to increase prostate cancer detection in patients with PI-RADS 3 lesions.
Biopsy ; Diffusion ; Humans ; Image-Guided Biopsy ; Information Systems ; Magnetic Resonance Imaging ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Ultrasonography

PURPOSE: To analyze the clinical parameters correlated with early recovery of urinary continence after radical prostatectomy, with a focus on urethral mobility during pelvic contraction at catheter removal. METHODS: We prospectively analyzed 67 patients who underwent prostatectomy for prostate cancer at Jeju National University Hospital from January 2015 to June 2018. At the time of catheter removal, a cystography was performed in 67 men (median age, 65 years; range, 55–76 years) who had undergone robot-assisted laparoscopic prostatectomy. The vertical length of bladder neck movement between relaxing and contracting the pelvic muscles was measured. The correlation between the rate of continence recovery and the length of urethral movement was also assessed. All participants were divided into 2 groups according to the length of bladder neck elevation. Group 1 had ≥0.6 cm of elevation, while group 2 demonstrated <0.6 cm of elevation. RESULTS: A reverse correlation existed between the length of urethral movement and the recovery rate of urinary continence (r=–0.488, P<0.001). The optimal cutoff value for length of urethral movement was found to be 0.6 cm among patients (area under the curve, 0.703). A statistically significant difference was observed between group 1 (length≥0.6 cm) and group 2 (<0.6 cm) (P<0.05). Multivariate regression analysis showed that urethral movement predicted the postoperative urinary incontinence. CONCLUSIONS: The extent of bladder neck elevation after robot-assisted laparoscopic prostatectomy, which can be easily evaluated using cystography, may be a good predictor of the recovery of urinary continence.
Catheters ; Humans ; Male ; Muscles ; Neck ; Prospective Studies ; Prostatectomy ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Incontinence

PURPOSE: Recently, intrinsic sphincter deficiency (ISD) has been identified as one important factor in the outcome of stress urinary incontinence (SUI) related surgery. Clinical factors that can predict ISD are uncommon. The aim of this study was to determine predictive clinical factors for ISD in female patients with SUI. METHODS: The patients were classified into 3 groups according to the value of Valsalva leak point pressure (VLPP)>90 cm H₂O (anatomical incontinence, AI), between 61 and 90 cm H₂O (equivocal, EV), and <60 cm H₂O (ISD). All groups underwent a full examination, history evaluation, physical examination, uroflowmetry, and complete urodynamic study. Univariate analysis was performed by chi-square or t-test for categorical variables, respectively. A multivariate study was performed by Pearson correlation analysis in order to get clinical predictors of VLPP<60 cm H₂O. Statistical significance was set at P<0.05. RESULTS: There were 3 groups with a total of 189 patients: 56 patients (AI, 29.7%), 64 patients (EV, 33.8%), and 69 patients (ISD, 36.5%). The univariate analysis revealed a significant difference associated with maximal urethral closing pressure (P=0.03) and Stamey classification (P=0.006) between ISD and AI. The more severe the urinary symptom grade, the higher the frequency of ISD. However, the multivariate analysis showed the independent predictor of ISD is only present in grades II and III symptoms in the Stamey classification (P=0.001). CONCLUSIONS: It was found that the more severe the symptoms of urinary incontinence, the higher the possibility of ISD. In other words, the degree of urinary incontinence was found to be one relevant clinical factor in predicting ISD. This finding may help in evaluating and identifying the appropriate surgical technique for EV. Currently, absolute cutoff value to diagnose ISD has not yet been determined. More research is needed to identify clinical factors that can predict ISD.
Classification ; Female ; Humans ; Multivariate Analysis ; Physical Examination ; Urethra ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: Incidence of cancer has been increasing each years. The incidence of genitourinary cancer are also being increased. We aim to describe the time trends in genitourinary cancer incidence in Jeju province. MATERIALS AND METHODS: Age-standardized rates for incidence of genitourinary tract cancer in Korea and world standard population were calculated using the databases from the Jeju Cancer Rigistry from 1999 to 2012. RESULTS: Cancer incidence in Jeju was increased approximately 2-fold from 1217 cases 1999 to 2376 cases in 1999. Prostate cancer occurred most frequently followed by bladder tumor, and kidney cancer in 2012. In the prostate cancer, incidence was increasing every year from 18 cases in 1999 to 110 cases in 2012. Age-standardized incidence rate (ASR) was approximately four time increased, from 3.0 cases in 1999 and 11.2 cases in 2012. Incidence of bladder cancer were 43 cases in 1999 and 27 cases in 2012, ASR of bladder cancer was increased from 5.0 cases in 1999 to 7.5 cases in 2012. Kidney cancer showed constantly reducing the incidence. Peak is 60 cases in 2009 and recent incidence was 37 cases in 2012. There was no significant change in the incidence of testicular cancer, ureter cancer, renal pelvis cancer from 1999 to 2012. CONCLUSIONS: Incidence of cancer has been increasing in Jeju, similar to other area In Korea. Prostate cancer is the most common urological cancer in Jeju province, and kidney cancer incidence is recently decreasing. We should try to prevent genitourinary tract cancer caused obesity and smoking.
Incidence* ; Kidney Neoplasms ; Kidney Pelvis ; Korea ; Obesity ; Prostatic Neoplasms ; Smoke ; Smoking ; Testicular Neoplasms ; Ureteral Neoplasms ; Urinary Bladder Neoplasms ; Urogenital Neoplasms* ; Urologic Neoplasms

Epidermal cysts are commonly encountered, slow-growing superficial cysts in the hair-bearing areas of the body, and are usually discovered in the second and fourth decades of life. These cysts tend to be superficial, meaning that they can be easily found by ultrasound and digital palpation at a moderate degree of growth. However, we found a huge testicular cyst that went undetected until old age. In this report, we describe the interesting case of a patient in whom the right testis was totally replaced with an epidermal cyst. The cyst was found by ultrasonography and further evaluated with magnetic resonance imaging. We performed orchiectomy under the impression of an epidermal cyst. The pathologic report confirmed this clinical impression. Over 24 months of follow-up, we did not find any recurrence of a growing mass on the testis.
Aged, 80 and over ; Epidermal Cyst* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Orchiectomy ; Palpation ; Recurrence ; Testicular Neoplasms ; Testis* ; Ultrasonography

PURPOSE: To examine the possibility of reducing the number of cores per prostate biopsy in elderly patients with high levels of prostate-specific antigen (PSA) without significantly lowering the detection rate of prostate cancer. MATERIALS AND METHODS: Two hundreds sixteen men with PSA levels >20 ng/mL who underwent prostate biopsies from May 2009 to April 2013 were retrospectively reviewed. With the help of magnetic resonance imaging (MRI), the laterality of the dominant tumor burden in patients was determined. The results of targeted biopsies were compared with those of conventional biopsy procedures. RESULTS: The mean age and PSA level were 79.5 years and 81.3 ng/mL, respectively, and the overall diagnostic rate of sextant biopsies was 81.9% (177/216). MRI was able to show the tumor burden in 189 of the 216 patients. The detection rate of transrectal ultrasonography (TRUS)-guided targeted biopsies was 87.3% (165/189). Detection rates were comparable with conventional biopsies (81.9% [177/216]) (p=0.23). Of the 177 men in whom the results of the sextant biopsy were positive, 12 men (6.8%) with PSA levels <29 ng/mL did not have any cancer cells according to targeted biopsies. However, all other patients were diagnosed with prostate cancer using the abovementioned techniques. CONCLUSIONS: We believe that TRUS-guided targeted biopsies of the prostate in elderly men with high PSA levels could reduce the number of unnecessary cores per biopsy. However, a risk of detection loss remains. Therefore, we recommend that at least a sextant biopsy should be performed, even in elderly patients, in order to detect prostate cancer.
Aged* ; Biopsy* ; Humans ; Magnetic Resonance Imaging* ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Retrospective Studies ; Tumor Burden ; Ultrasonography

PURPOSE: Accurately measuring urinary urgency is important for diagnosing overactive bladder (OAB) and quantifying improvements in treatment outcome. Various methods have been recommended for evaluating urinary urgency, but these methods assess individual perceptions and preferences. To overcome the subjectivity in measuring urinary urgency, we evaluated the relationship between uroflowmetric parameters and urinary urgency in women with OAB. METHODS: Consecutive female patients with lower urinary tract symptoms (n=110) were prospectively enrolled in this study between April 2011 and September 2012. Individuals with a history of using medications that are known to affect bladder function were excluded. All enrolled patients completed uroflowmetry with a delayed time to voiding (T2V). After urination was completed, patients were asked whether they experienced any urinary hesitancy or urgency at that time. RESULTS: The mean patient age was 56.1 years; 70 out of 110 patients reported some degree of urinary urgency. T2V decreased with increased urgency. Several uroflowmetric parameters were observed to have a significant correlation with urinary urgency. T2V had a meaningful correlation coefficient for individuals with urgency, regardless of the voided volume. There was no significant correlation between the presence of urinary hesitancy and T2V. CONCLUSIONS: We believe that T2V would be a complementary tool for diagnosing and determining the degree of urinary urgency in women with OAB.
Female ; Humans ; Lower Urinary Tract Symptoms ; Prospective Studies ; Treatment Outcome ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urination* ; Urodynamics

Gastrointestinal stromal tumors (GISTs) are an unusual and heterogeneous group of spindle cell tumors that can also appear on the exterior of the gastrointestinal tract (extra-GISTs). Despite the fact that extra-GISTs or large rectal GISTs can lead to the clinical impression of a prostatic mass, these tumors are, in general, excluded in the differential diagnosis of spindle cell tumors observed on prostate needle biopsy. Here, we present, in detail, a case of an extra-GIST identified on prostatic biopsy; the tumor was previously believed to be a primary prostatic stromal sarcoma in the differential diagnosis. Every investigator should check for KIT (CD117) in immunohistochemical staining to rule out an extra-GIST prior to diagnosing a solitary prostatic tumor, specialized prostatic stromal tumor, or leiomyosarcoma on prostate needle biopsy.
Biopsy ; Biopsy, Needle ; Diagnosis* ; Diagnosis, Differential ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Leiomyosarcoma ; Prostate ; Research Personnel ; Sarcoma

PURPOSE: We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. MATERIALS AND METHODS: Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. RESULTS: Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. CONCLUSION: Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.
Catheterization/*instrumentation/methods ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Length of Stay ; Male ; Postoperative Care ; Postoperative Complications/epidemiology ; Postoperative Period ; Retrospective Studies ; *Urinary Catheters ; Vesico-Ureteral Reflux/surgery