Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men and it may be accompanied with significant problems in the quality of life. Histological changes of BPH is starting at the age of 35, and there is induced in 60% of 60-year-old men, 80% of 80-year-old men, in 50% of the patient group may lead to lower urinary tract symptoms (LUTS). A 74-year-old man with huge BPH visited outpatient clinic with severe LUTS of an year duration. He was diagnosed with BPH 11 years ago and underwent transurethral resection of prostate twice. However, the prostate grew up to remarkable size again, which lead to the bladder outlet obstruction (BOO) and renal failure. There is no report for huge BPH (above 300 g) in Korea, we report a case with huge prostate size that is measured 330 g and treated with suprapubic open prostatectomy.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Humans ; Korea ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Quality of Life ; Renal Insufficiency ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction

Recent studies of Carbonic anhydrase IX (CAIX) expression and clinical significance in renal cell carcinoma (RCC) have given rise to disagreements in the usefulness of CAIX as a prognostic factor. The purpose of this study was to evaluate the association between CAIX expression and clinical factors in RCC. The medical record of 172 RCC patients in hospital (from January 1999 and December 2007) were reviewed retrospectively. Patients were divided into a high expression group (109 cases) and low expression group (63 cases) according to their degree of CAIX expression. We evaluated the association between CAIX expression and age, body mass index (BMI), type of renal neoplasm, tumor stage, nuclear grade, metastasis after surgery and tumor-specific survival rate. The mean age of the high expression group and the low expression group were 56 years and 54 years respectively. The mean BMI of the high expression group and the low expression group were 24.2 kg/m2 and 24.5 kg/m2 respectively. Comparing the difference between clear cell RCC and non clear cell RCC, CAIX was significantly more expressed in clear cell RCC. There was no significant differences between high expression clear cell RCC and low expression clear cell RCC according to age, BMI, nuclear grade, metastasis after surgery and tumor-specific survival rate (p=0.237, p=0.802, p=0.382, p=0.551). However, in clear cell RCC, CAIX expression was significantly more expressed in patients with higher T or N stages (p=0.015, p=0.033). CAIX was significantly higher expressed in clear cell RCC and was significantly lower expressed in patients with higher T stage or N stage.
Body Mass Index ; Carbon* ; Carbonic Anhydrases* ; Carcinoma, Renal Cell* ; Humans ; Kidney Neoplasms ; Medical Records ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies ; Survival Rate

PURPOSE: This study was conducted to describe our early experience with active surveillance (AS). MATERIALS AND METHODS: Between January 2008 and December 2012, 35 patients were treated with AS. Selection criteria included the following: Gleason score < or =6 with single positive core, clinical stage < or =T1c, prostate-specific antigen (PSA) < or =10 ng/mL, and unremarkable imaging results. On patient follow-up, we regularly measured PSA (every 3-6 months) and performed prostate biopsies (after 1 and 3 years). RESULTS: In the first year of follow-up, prostate biopsies were performed in 25 patients (13 patients, negative for cancer; 7 patients, Gleason score of 6 without progression; 5 patients, progression, treated with radical prostatectomy [RP]). In the third year of follow-up, prostate biopsies were performed in five patients (two patients, negative for cancer; one patient, Gleason score of 6 without progression; two patients, progression, treated with RP). Seven patients discontinued AS because of increased anxiety, and three patients were lost to follow-up. Overall, seven patients (28%) who experienced progression had a mean PSA doubling time (DT) of 7.54 years. Six patients had a PSA DT of more than 3 years, whereas one had a PSA DT of less than 3 years. This study was limited by its small sample size and short follow-up period. CONCLUSIONS: PSA kinetics did not correlate with progression, which suggests that regular biopsies should still be performed. AS is an available treatment option for patients with a low risk of prostate cancer but should only be used in carefully selected patients.
Anxiety ; Biopsy ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Kinetics ; Lost to Follow-Up ; Neoplasm Grading ; Patient Selection ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Sample Size ; Watchful Waiting

PURPOSE: The utility of the expression of glucose-regulated protein 78 (GRP78) in the evaluation of prognosis depends on the type of tumor. Hence, we aimed to examine the impact of expression of GRP78 and Bcl-2, which are used in the existing prognostic evaluation of ureter tumors, in the evaluation of recurrence and survival rates of ureter tumors. MATERIALS AND METHODS: In 53 patients who had undergone radical nephroureterectomy for a ureter tumor from March 2002 to March 2012, age, sex, T stage, nuclear grade, bladder recurrence, and survival rate were analyzed at the time of the patient's surgery depending on the extent of immunohistochemical expression of GRP78 and Bcl-2. RESULTS: GRP78 was overexpressed in 25 patients (47.2%). When GRP78 was overexpressed, there was a high T stage (p=0.001) and nuclear grade (p=0.007) and a lot of bladder recurrence (40.0%, p=0.034). Bcl-2 was overexpressed in 16 patients (30.1%), and there were no significant associations with any risk factors (p>0.05, respectively). In the multivariate analysis regarding bladder recurrence, the recurrence rate was higher with higher pT stage (p=0.048) and when GRP78 (p=0.033) was overexpressed. In the Kaplan-Meier survival analysis, although the survival rate was significantly lower in the group in which GRP78 was overexpressed (p=0.03), there was no correlation between Bcl-2 overexpression and survival rate (p=0.07). CONCLUSIONS: Patients with ureter tumors who had overexpression of GRP78 had a high T stage and nuclear grade, a lot of bladder recurrence, and a low survival rate. Therefore, if GRP78 is overexpressed in ureter tumor patients, active postoperative follow-up should be carried out.
Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate ; Ureter ; Urinary Bladder

PURPOSE: A ureter obstruction caused by a ureteral stone results in inflammatory changes in the proximal submucosal layer and prevents the spontaneous passage of the ureteral stone. Accordingly, we analyzed the relationship between the spontaneous passage rates of ureteral stones less than 8 mm in size and serum C-reactive protein (CRP) levels and neutrophil percentages. MATERIALS AND METHODS: A total of 187 patients who were diagnosed with ureteral stones less than 8 mm in size and were managed consecutively at Keimyung University Dongsan Medical Center from January 2001 to January 2011 were retrospectively analyzed. Ureteral stone removal was defined as no ureteral stone shown in an imaging test without any treatment for 8 weeks after diagnosis. The patients were divided into three groups according to the levels of serum CRP and into two groups according to neutrophil percentage. The associations between these factors and ureteral stone passage rates were then examined. RESULTS: The ureteral stone passage rates of the low serum CRP level group, the medium serum CRP level group, and the high serum CRP level group were 94.1% (159/169), 70% (7/10), and 50.0% (4/8), respectively. The passage rates of ureteral stones in the group with a normal neutrophil percentage and in the group with a higher neutrophil percentage were 94.5% (121/128) and 83.1% (49/59), respectively (p=0.011). CONCLUSIONS: Measuring serum CRP levels and neutrophil percentages in patients with small ureteral stones of less than 8 mm is useful in predicting whether the stone will be spontaneously passed. When the serum CRP level and neutrophil percentage of a patient are high, aggressive treatment such as extracorporeal shock wave lithotripsy should be considered.
C-Reactive Protein ; Humans ; Lithotripsy ; Neutrophils ; Retrospective Studies ; Ureter ; Ureterolithiasis

PURPOSE: We compared the effects of alpha-adrenergic receptor blocker (alpha-blocker) monotherapy with those of combination therapy with alpha-blocker and 5-alpha-reductase inhibitor (5-ARI) on benign prostatic hyperplasia (BPH) progression for over 10 years. MATERIALS AND METHODS: A total of 620 patients with BPH who received alpha-blocker monotherapy (alpha-blocker group, n=368) or combination therapy (combination group, n=252) as their initial treatment were enrolled from January 1989 to June 2000. The incidences of acute urinary retention (AUR) and BPH-related surgery were compared between the two groups. Incidences stratified by follow-up period, prostate-specific antigen (PSA), and prostate volume (PV) were compared between the two groups. RESULTS: The incidence of AUR was 13.6% (50/368) in the alpha-blocker group and 2.8% (7/252) in the combination group (p<0.001). A total of 8.4% (31/368) and 3.2% (8/252) of patients underwent BPH-related surgery in the alpha-blocker and combination groups, respectively (p=0.008). According to the follow-up period, the incidence of AUR was significantly decreased in combination group. However, the incidence of BPH-related surgery was significantly reduced after 7 years of combination therapy. Cutoff levels of PSA and PV for reducing the incidences of AUR and BPH-related surgery were 2.0 ng/ml and 35 g, respectively (p<0.001). CONCLUSIONS: Long-term combination therapy with alpha-blocker and 5-ARI can suppress the progression of BPH more efficiently than alpha-blocker monotherapy. For patients with BPH with PSA >2.0 ng/ml or PV >35 ml, combination therapy promises a better effect for reducing the risk of BPH progression.
5-alpha Reductase Inhibitors ; Adrenergic alpha-1 Receptor Antagonists ; Follow-Up Studies ; Humans ; Incidence ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Urinary Retention

PURPOSE: We analyzed the impact of immediate intravesical mitomycin C instillation after transurethral resection of the bladder (TURB) on tumor recurrence and progression in patients with periodic mitomycin C instillation. MATERIALS AND METHODS: Between June 2000 and June 2006, a retrospective study was performed in a total of 115 patients with primary bladder tumors receiving a 6-week course of mitomycin C instillation after TURB. The patients were assigned to two groups: 53 patients in the immediate mitomycin C (I-MMC) group were treated by immediate instillation of mitomycin C after TURB and periodic instillation (6 times, 1 time per week), and 62 patients in the MMC group received only periodic instillation. Tumor recurrence and progression were compared in the two groups. RESULTS: During the mean follow-up period of 46.5 months in the I-MMC group and 47.2 months in the MMC group, early recurrence (within 1 year) occurred in 6 of 53 patients (11.3%) in the I-MMC group and in 18 of 62 patients (29.0%) in the MMC group (p<0.02). Although a significantly lower early recurrence rate was observed in the I-MMC group, this difference was not significant for recurrence within 2 or 3 years or for total recurrence. Progression was not significantly different between the two groups regarding the early and total period. CONCLUSIONS: Our study confirmed the positive effect of a single, immediate mitomycin C instillation in patients with non-muscle-invasive bladder tumors who received periodic mitomycin C instillation. This benefit was limited to early recurrence and was not maintained with long-term follow-up. This approach can be an alternative to periodic mitomycin C instillation without immediate instillation.
Administration, Intravesical ; Follow-Up Studies ; Humans ; Mitomycin ; Recurrence ; Retrospective Studies ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: We investigated the correlations between the expression of claudin-1 and claudin-7 in clear cell renal cell carcinoma (clear cell RCC) and clinical parameters. MATERIALS AND METHODS: The subjects of this study were 119 patients with confirmed clear cell RCC between January 2000 and December 2007. Their RCC tissues were immunohistochemically stained for claudin-1 and claudin-7. The correlations between the expression of claudin and parameters such as sex, age, body mass index (BMI), tumor size, TNM stage, Furhman nuclear grade, postoperative distant metastasis, and cancer-specific survival were analyzed. RESULTS: Among the total 119 subjects, claudin-1 was expressed in 18 (15.1%) and claudin- 7 in 31 (26.1%). Claudin-1 was expressed in patients who were older (p=0.007), who had a greater tumor size (p=0.001), who had a higher pathologic T stage (p=0.009), who had preoperative distant metastasis (p=0.035), and who had a higher Furhman nuclear grade (p=0.004). Claudin-7 was expressed only in patients who had a higher Furhman nuclear grade (p=0.031). The risk of postoperative distant metastasis was associated with the expression of claudin-1 (p<0.001) but not with the expression of claudin-7 (p=0.668). The expression of claudin-1 and -7 was not associated with cancer-specific survival (p>0.05). CONCLUSIONS: In clear cell RCC, claudin-1 was expressed in patients who were older and who had a greater tumor size, who had higher T or M stages, and who had a higher Furhman nuclear grade. The expression of claudin-1 was associated with a higher risk of postoperative distant metastasis.
Body Mass Index ; Carcinoma, Renal Cell ; Claudin-1 ; Humans ; Neoplasm Metastasis

PURPOSE: We evaluated the long-term effects of loxoprofen on nocturia in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between January 2006 and December 2008, 40 BPH patients with 2 or more episodes of nocturia received an alpha-blocker, 5-alpha reductase inhibitor, and a single dose of 60 mg of loxoprofen at night before sleep for 12 months (Group I). During the same period, 38 BPH patients selected as the control group received an alpha-blocker and 5-alpha reductase inhibitor (Group II). Patients were reevaluated after 3, 6, and 12 months of treatment by the number of nocturia episodes and side effects. RESULTS: After 3 months of treatment, the number of nocturia episodes decreased significantly compared with baseline in both group I and group II (1.9+/-0.7, 2.1+/-0.7, respectively, p<0.05). The degree of decrease in nocturia was significantly different between the groups (-1.5+/-0.9, -1.1+/-0.9, respectively, p=0.034). After 6 and 12 months, the number of nocturia episodes decreased significantly compared with baseline in both group I and group II (p<0.05), but the degree of decrease was not significantly different between the groups (p>0.05). After 6 and 12 months of treatment in group I, treatment-emergent adverse events, including 5 cases of gastric discomfort (12.5%), 3 cases of leg edema (7.5%), and 1 case of decreased urine volume (2.5%), occurred in 9 of the 40 (22.5%) patients. CONCLUSIONS: Loxoprofen can be an effective treatment for patients with nocturia secondary to BPH in the short term. Long-term use of loxoprofen is not recommended because of the side effects.
Edema ; Humans ; Leg ; Nocturia ; Oxidoreductases ; Phenylpropionates ; Prostatic Hyperplasia ; Sodium

PURPOSE: This study was performed to investigate the relationship between cyclooxygenase-2 (COX-2) expression and apoptosis/angiogenesis in inflammatory and noninflammatory benign prostatic hyperplasia (BPH) and prostate cancer (PC). MATERIALS AND METHODS: This study involved 64 BPH and 57 PC patients. The BPH histopathologies were classified by the presence of chronic inflammation as follows: noninflammatory BPH (NI-BPH; n=23) and inflammatory BPH (I-BPH; n=41). The association between the expression of COX-2, expression of Bcl-2, the apoptotic index (AI), expression of vascular endothelial growth factor (VEGF), and microvascular density (MVD) in the prostate was investigated. RESULTS: An overexpression of COX-2, Bcl-2, and VEGF was observed in cases of PC compared with cases of BPH. In PC, the AI was lower and MVD was higher than in BPH. In NI-BPH, I-BPH, and PC, the overexpression of COX-2, Bcl-2, and VEGF gradually increased. The AI was high in I-BPH, but did not differ significantly between the NI-BPH and I-BPH groups or between the NI-BPH and PC groups. MVD was significantly high in PC, but no significant difference was found between NI-BPH and I-BPH. A significant correlation was shown between the overexpression of COX-2 and Bcl-2, and COX-2 and VEGF. However, the AI was not correlated with the overexpression of COX-2 or Bcl-2. MVD was correlated with the overexpression of COX-2 and VEGF. CONCLUSIONS: COX-2 overexpression in PC is correlated with a decrease in apoptosis and an increase in angiogenesis. Chronic inflammation in BPH causes an overexpression of COX-2, which induces the increased expression of Bcl-2 and VEGF. It is likely that chronic inflammation plays a role in the intermediate step of carcinogenesis in the prostate.
Apoptosis ; Cyclooxygenase 2 ; Humans ; Inflammation ; Prostate ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Vascular Endothelial Growth Factor A