Purpose: Prostate cancer ranks as the second most common cancer in men globally, representing a significant cause of cancer-related mortality. Metastasis, the spread of cancer cells from the primary site to distant organs, remains a major challenge in managing prostate cancer. Pyruvate dehydrogenase kinase 4 (PDK4) is implicated in the regulation of aerobic glycolysis, emerging as a potential player in various cancers. However, its role in prostate cancer remains unclear. This study aims to analyze PDK4 expression in prostate cancer cells and human samples, and to explore the gene's clinical significance. Materials and Methods: PDK4 expression was detected in cell lines and human tissue samples. Migration ability was analyzed using Matrigel-coated invasion chambers. Human samples were obtained from the Kyungpook National University Chilgok Hospital. Results: PDK4 expression was elevated in prostate cancer cell lines compared to normal prostate cells, with particularly high levels in DU145 and LnCap cell lines. PDK4 knockdown in these cell lines suppressed their invasion ability, indicating a potential role of PDK4 in prostate cancer metastasis. Furthermore, our results revealed alterations in epithelial-mesenchymal transition markers and downstream signaling molecules following PDK4 suppression, suggesting its involvement in the modulation of invasion-related pathways. Furthermore, PDK4 expression was increased in prostate cancer tissues, especially in castration-resistant prostate cancer, compared to normal prostate tissues, with PSA and PDK4 expression showing a significantly positive correlation. Conclusions PDK4 expression in prostate cancer is associated with tumor invasion and castration status. Further validation is needed to demonstrate its effectiveness as a therapeutic target.

Purpose: Oligoprogressive lesions are observed in a subset of patients who progress to castration-resistant prostate cancer (CRPC), while other lesions remain controlled by systemic therapy. This study evaluates the impact of progression-directed therapy (PDT) on these oligoprogressive lesions. Materials and Methods: This retrospective study included 40 patients diagnosed with oligoprogressive CRPC. PDT was performed for treating all progressive sites using radiotherapy. Fifteen patients received PDT using radiotherapy for all progressive sites (PDT group) while 25 had additional first-line systemic treatments (non-PDT group). In PDT group, 7 patients underwent PDT and unchanged systemic therapy (PDT-A group) and 8 patients underwent PDT with additional new line of systemic therapy on CRPC (PDT-B group). The Kaplan–Meier method was used to assess treatment outcomes. Results: The prostate specific antigen (PSA) nadir was significantly lower in PDT group compare to non-PDT group (p=0.007). A 50% PSA decline and complete PSA decline were observed in 13 patients (86.7%) and 10 patients (66.7%) of PDT group and in 18 patients (72.0%) and 11 patients (44.0%) of non-PDT group, respectively. The PSA-progression free survival of PDT-B group was significantly longer than non-PDT group. The median time to failure of first-line systemic therapy on CRPC was 30.2 months in patients in PDT group and 14.9 months in non-PDT group (p=0.014). PDT-B group showed a significantly longer time to progression than non-PDT group (p=0.025). Minimal PDT-related adverse events were observed. Conclusions PDT can delay progression of disease and enhance treatment efficacy with acceptable tolerability in oligoprogressive CRPC.

Purpose: This study examined the effects of residual fragments (RF) on the patient-reported quality of life (QOL) after kidney stone surgery, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using the Korean version of the Wisconsin Stone Quality of Life Questionnaire (K-WISQOL). Materials and Methods: The medical records of 156 patients who underwent RIRS or PCNL and completed the preoperative and postoperative K-WISQOL from January 2021 to September 2023 were analyzed retrospectively. The patients were divided into RIRS and PCNL groups by the surgical method. The participants completed the K-WISQOL within four weeks before and after treatment. The patients’ baseline characteristics, surgical outcomes, and K-WISQOL scores were compared according to the presence of RF in each surgical group. Results: Of the 156 patients, 95 underwent RIRS, and 61 underwent PCNL. In the RIRS group, the patients’ baseline characteristics and surgical outcomes were similar in the stone-free (SF) and RF subgroups. The changes in all K-WISQOL domain scores and total scores were similar in the two subgroups. In the PCNL group, the RF subgroup had a significantly higher proportion of staghorn stones, a significantly larger mean stone diameter and significantly longer operation time than those of the SF subgroup. But, the changes in all K-WISQOL domain scores and total scores were not significantly different between the two subgroups, as observed in the RIRS group. Conclusions This study showed that the presence of RFs after endoscopic kidney surgery did not affect the short-term patient-reported QOL regardless of the surgical methods.

Purpose: This study conducted an epidemiological investigation of Pseudomonas aeruginosa urinary tract infections (UTIs) following cystoscopy at Chilgok Kyungpook National University Hospital. Materials and Methods: From May 16 to July 15, 2022, among 353 patients who underwent cystoscopy, 6 patients reported febrile UTIs following cystoscopy. They were admitted to the urology department of the hospital after visiting the Emergency Department. P. aeruginosa was found in the urine cultures of 4 of the 6 hospitalized patients. During the epidemiological investigation, no changes were observed in factors such as the reprocessing procedures for endoscopic equipment. Therefore, microbiological tests were performed using environmental samples derived from the endoscopic equipment and cleaning process. Results: P. aeruginosa was identified in a dual-enzymatic detergent (EmPower) used during the endoscope cleaning process. After changing the disinfectant and cleaning process, no further bacterial growth was observed in subsequent microbiological tests. Conclusions This study highlights the potential of cystoscopes to serve as reservoirs for bacteria due to inadequate cleaning during the disinfection process. To minimize the risk of infections following cystoscopy, it is important to pay close attention to the reprocessing and cleaning of cystoscopes.

Purpose: This study examined the effects of residual fragments (RF) on the patient-reported quality of life (QOL) after kidney stone surgery, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using the Korean version of the Wisconsin Stone Quality of Life Questionnaire (K-WISQOL). Materials and Methods: The medical records of 156 patients who underwent RIRS or PCNL and completed the preoperative and postoperative K-WISQOL from January 2021 to September 2023 were analyzed retrospectively. The patients were divided into RIRS and PCNL groups by the surgical method. The participants completed the K-WISQOL within four weeks before and after treatment. The patients’ baseline characteristics, surgical outcomes, and K-WISQOL scores were compared according to the presence of RF in each surgical group. Results: Of the 156 patients, 95 underwent RIRS, and 61 underwent PCNL. In the RIRS group, the patients’ baseline characteristics and surgical outcomes were similar in the stone-free (SF) and RF subgroups. The changes in all K-WISQOL domain scores and total scores were similar in the two subgroups. In the PCNL group, the RF subgroup had a significantly higher proportion of staghorn stones, a significantly larger mean stone diameter and significantly longer operation time than those of the SF subgroup. But, the changes in all K-WISQOL domain scores and total scores were not significantly different between the two subgroups, as observed in the RIRS group. Conclusions This study showed that the presence of RFs after endoscopic kidney surgery did not affect the short-term patient-reported QOL regardless of the surgical methods.

Purpose: This study conducted an epidemiological investigation of Pseudomonas aeruginosa urinary tract infections (UTIs) following cystoscopy at Chilgok Kyungpook National University Hospital. Materials and Methods: From May 16 to July 15, 2022, among 353 patients who underwent cystoscopy, 6 patients reported febrile UTIs following cystoscopy. They were admitted to the urology department of the hospital after visiting the Emergency Department. P. aeruginosa was found in the urine cultures of 4 of the 6 hospitalized patients. During the epidemiological investigation, no changes were observed in factors such as the reprocessing procedures for endoscopic equipment. Therefore, microbiological tests were performed using environmental samples derived from the endoscopic equipment and cleaning process. Results: P. aeruginosa was identified in a dual-enzymatic detergent (EmPower) used during the endoscope cleaning process. After changing the disinfectant and cleaning process, no further bacterial growth was observed in subsequent microbiological tests. Conclusions This study highlights the potential of cystoscopes to serve as reservoirs for bacteria due to inadequate cleaning during the disinfection process. To minimize the risk of infections following cystoscopy, it is important to pay close attention to the reprocessing and cleaning of cystoscopes.

Purpose: This study examined the effects of residual fragments (RF) on the patient-reported quality of life (QOL) after kidney stone surgery, such as retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), using the Korean version of the Wisconsin Stone Quality of Life Questionnaire (K-WISQOL). Materials and Methods: The medical records of 156 patients who underwent RIRS or PCNL and completed the preoperative and postoperative K-WISQOL from January 2021 to September 2023 were analyzed retrospectively. The patients were divided into RIRS and PCNL groups by the surgical method. The participants completed the K-WISQOL within four weeks before and after treatment. The patients’ baseline characteristics, surgical outcomes, and K-WISQOL scores were compared according to the presence of RF in each surgical group. Results: Of the 156 patients, 95 underwent RIRS, and 61 underwent PCNL. In the RIRS group, the patients’ baseline characteristics and surgical outcomes were similar in the stone-free (SF) and RF subgroups. The changes in all K-WISQOL domain scores and total scores were similar in the two subgroups. In the PCNL group, the RF subgroup had a significantly higher proportion of staghorn stones, a significantly larger mean stone diameter and significantly longer operation time than those of the SF subgroup. But, the changes in all K-WISQOL domain scores and total scores were not significantly different between the two subgroups, as observed in the RIRS group. Conclusions This study showed that the presence of RFs after endoscopic kidney surgery did not affect the short-term patient-reported QOL regardless of the surgical methods.

Purpose: This study conducted an epidemiological investigation of Pseudomonas aeruginosa urinary tract infections (UTIs) following cystoscopy at Chilgok Kyungpook National University Hospital. Materials and Methods: From May 16 to July 15, 2022, among 353 patients who underwent cystoscopy, 6 patients reported febrile UTIs following cystoscopy. They were admitted to the urology department of the hospital after visiting the Emergency Department. P. aeruginosa was found in the urine cultures of 4 of the 6 hospitalized patients. During the epidemiological investigation, no changes were observed in factors such as the reprocessing procedures for endoscopic equipment. Therefore, microbiological tests were performed using environmental samples derived from the endoscopic equipment and cleaning process. Results: P. aeruginosa was identified in a dual-enzymatic detergent (EmPower) used during the endoscope cleaning process. After changing the disinfectant and cleaning process, no further bacterial growth was observed in subsequent microbiological tests. Conclusions This study highlights the potential of cystoscopes to serve as reservoirs for bacteria due to inadequate cleaning during the disinfection process. To minimize the risk of infections following cystoscopy, it is important to pay close attention to the reprocessing and cleaning of cystoscopes.

Purpose: We prospectively compared the diagnostic accuracy of kidney dynamic computed tomography (KDCT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasonography (CEUS) for the assessment of small renal mass (SRM) (≤4 cm). Materials and Methods: Seventy-six patients with SRM (mean age, 58.4±13.1 years) who underwent renal biopsy (n=11) or nephrectomy (partial or radical) (n=65) were enrolled. All patients underwent KDCT, MRI, and CEUS before renal biopsy or nephrectomy. Results: The mean maximal tumor size was 21.0±9.8 mm. The mean R.E.N.A.L nephrometry score was 7.0±1.7. Fifty-six patients had renal cell carcinoma (RCC) (clear cell, 42; papillary, 7; chromophobe, 5; succinate dehydrogenase deficient, 1; unspecified RCC, 1). Twenty patients had a benign tumor (angiomyolipoma, 11; oncocytoma, 3; others, 6). Clinicopathologic variables were comparable in RCC and benign groups. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of KDCT were 89.3%, 10.0%, 73.5%, and 25.0%, respectively. The sensitivity, specificity, PPV, and NPV of MRI were 89.3%, 10.0%, 73.5%, and 25.0%, respectively. The sensitivity, specificity, PPV, and NPV of CEUS were 85.7%, 50.0%, 82.8%, and 55.6%, respectively. The diagnostic accuracy of KDCT, MRI, and CEUS were 68.4%, 68.4%, and 76.3%, respectively. In a subgroup analysis based on clinical tumor size of 10 mm and 20 mm, CEUS also showed the highest diagnostic accuracy. Conclusions CEUS had the highest specificity, PPV, and NPV and may help improve the assessment of SRM.

Purpose: We compared the surgical outcomes of radical nephrectomy (RN) and partial nephrectomy (PN) in adult patients with clinical T2 stage (cT2) renal cell carcinoma (RCC) by utilizing data from the Korean Renal Cell Carcinoma (KORCC) database. Materials and Methods: We retrospectively analyzed adult patients with cT2 RCC from 8 tertiary hospitals who were registered in the KORCC between 2003 and 2023. Patients with a solitary kidney or bilateral tumors were excluded. The patient cohort was divided into RN and PN arms, and propensity score matching (PSM) was conducted with a 1:3 ratio. Perioperative and survival outcomes were compared between arms. Results: After PSM, the PN and RN arms included 44 and 132 patients, respectively. No significant differences were observed in baseline characteristics, apart from laterality, following PSM. Regarding perioperative outcomes, complications of Clavien-Dindo classification grade III or higher (11.4%, p<0.001) and urological complications (9.1%, p=0.045) were more common in the PN arm than in the RN arm. Postoperative renal function was superior in the PN arm, whereas the incidence of de novo chronic kidney disease (CKD) at 6 months was higher among the recipients of RN (37.6%, p<0.001). Pathological examination indicated a higher pathological T stage in the RN arm. Overall, cancer-specific, and recurrence-free survival rates did not differ significantly between arms. Based on Cox regression analysis, the use of PN was not a significant predictor of recurrence-free survival (hazard ratio, 0.675; p=0.474). Conclusions In cT2 RCC, PN was associated with a lower incidence of de novo CKD than RN. No significant differences in survival outcomes were noted. PN may represent a viable alternative to RN for certain patients with cT2 RCC. Further research is warranted to explore the management of advanced RCC.