PURPOSE: We assessed the impact of pelvic lymphadenectomy on the survival of patients who had undergone radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed 107 patients who underwent radical cystectomy for transitional cell carcinoma of the bladder between January 1991 and December 2000. We preoperatively excluded patients with evidence of pelvic lymphadenopathy and distant metastases from the study. Among 107 patients, 61 patients (Group A) underwent pelvic lymphadenectomy while 46 patients (Group B) did not. The clinicopathological parameters were not significantly different in the two groups. RESULTS: In group A, 12 patients (19.6%) were found to have pelvic node metastases. Five-year overall survival and recurrence-free survival rates were 68% and 75% for Group A, respectively. In group B, 5-year overall survival and recurrence-free survival rates were 36% and 56%, respectively. Multivariate analysis revealed that T stage (p=0.004) and lymphadenectomy (p=0.044) were significant prognostic factors for survival. CONCLUSIONS: The overall survival rates between the two groups were significantly different. Our findings suggested that lymphadenectomy may improve the prognosis of patients who underwent radical cystectomy for transitional cell carcinoma of the bladder.
Carcinoma, Transitional Cell* ; Cystectomy* ; Humans ; Lymph Node Excision* ; Lymphatic Diseases ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: We analyzed the impact of transurethral resection of the bladder (TUR-B) in patients with bladder cancer, in whom a subsequent cystectomy was performed. MATERIALS AND METHODS: We reviewed the records of 93 patients, with clinical stage T2 or less transitional cell carcinomas of the bladder that underwent a radical cystectomy at our institute. Before the radical cystectomy, TUR-B was performed for diagnostic and therapeutic purposes in all patients. We used the term "complete TUR" for the following procedures. No residual tumors were found after the TUR endoscopically, also, muscle layer should be present in the TUR specimens and no gross residual tumors were found in the cystectomy specimens by the pathologist. RESULTS: Eleven (26.8%) of the 41 patients with superficial bladder cancer had no evidence of residual tumors. Of the 19 patients with superficial bladder cancer that underwent complete TUR-B, 10 (52.6%) had no residual tumors. For the invasive tumors, 10 (19.2%) of the 52 patients that had a T2 stage disease had no residual tumors, and 10 (29.4%) of the 34 patients with a T2 stage disease, who underwent complete TUR-B, had no residual tumors. In the 38 patients with superficial bladder cancer, 17 (44.7%) changed to a higher stage. Of the 17 patients who underwent complete TUR-B, 3 (17.7%) changed to a higher stage. Among the patients with a T2 stage disease, those with the pT0 stage had a better survival than those with the pT2 stage with residual tumors (p=0.04). CONCLUSIONS: The completeness of TUR-B is important in evaluating residual tumors after a previous TUR-B in those patients with both superficial and invasive bladder cancers.
Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Neoplasm, Residual* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We investigated libido and sexual life satisfaction of middle-aged couples in Seoul. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The questionnaires asking about erectile function, sexual performance, sexual life satisfaction, and libido were administered by trained interviewers. RESULTS: Interviews were completed for 1,356 couples(66.7%). The prevalence of severe and moderate loss of libido in the men was 29%. Decrease of libido correlated with increasing age. Higher scores on the erection scale of the O'Leary sexual function questionnaire were closely correlated with greater libido. In sexual function self-assessment, most male subjects did not complain of libido(53.8%), erection(61.7%), or ejaculation(63.8%) difficulties. Most couples(50.3% of the male and 53% of the female subjects) expressed satisfied with their sexual lives. Higher scores on the erection scale correlated with an increase in sexual satisfaction of both men and women. Fewer than half of the female subjects(40.4%) answered that they had 'no' or 'low' sexual interest. Younger age and more education were correlated with greater sexual interest. CONCLUSIONS: With increasing age, middle-aged couples living in Seoul showed a decrease in libido, sexual function, and sexual interest. However, satisfaction with their sexual life was high in general.
Aged ; Education ; Epidemiology ; Family Characteristics* ; Female ; Humans ; Libido ; Male ; Prevalence ; Surveys and Questionnaires ; Self-Assessment ; Seoul*

PURPOSE: Information on sexual function including the prevalence of erectile dysfunction, the severity of erectile dysfunction and the risk factors associated with it, from population-based sampled couples in Seoul, Korea was examined. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The total number of study subjects where sufficient answers were obtained was 1,356. The questionnaire included questions on erectile function, sexual performance, and sex life. RESULTS: The combined prevalence of mild, moderate and severe erectile dysfunction was 84.3%. This correlated well with the score on the erection scale of the O'Leary sexual function inventory. The prevalence of severe erectile dysfunction was 11.8%, which increased from 1.0% in subject aged from 40 years to 68.5% in 70 years. The prevalence of self-reported erectile dysfunction was 12.0%. The subjects' age was most strongly associated with erectile dysfunction. After adjusting for age, a higher probability of erectile dysfunction directly correlated with diabetes, hypertension, heart disease, cigarette smoking, and low level of education. CONCLUSIONS: The population-based epidemiological data showed that male erectile dysfunction is quite common and impacts on quality of life of men.
Aged ; Education ; Epidemiology ; Erectile Dysfunction ; Family Characteristics ; Heart Diseases ; Humans ; Hypertension ; Korea ; Male ; Prevalence* ; Quality of Life ; Surveys and Questionnaires* ; Risk Factors ; Seoul* ; Smoking

PURPOSE: We tried to determine the prevalence of LUTS and to measure the impact of these symptoms on quality of life (QOL), and to reevaluate the validity of I-PSS in Korea. MATERIALS AND METHODS: A total of 1,356 men ranging from 40 to 79 years old living in Seoul metropolitan area was selected by stepwise random sampling and surveyed with questionnaire including I-PSS. Several risk factors were analyzed to assess the relevance with lower urinary tract symptoms. RESULTS: About 16% had moderate-to-severe LUTS, as assessed by I-PSS more than 7. The prevalence of moderate-to-severe LUTS increased significantly with age (p<0.01); 10%, 16%, 29%, and 45% in the age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years respectively. The most prevalent symptoms were weak stream and nocturia. QOL decreased as urinary symptom severity increased; 5%, 52%, 78% of the men with I-PSS 0 to 7, 8 to 19, and 20 to 35 had poor QOL as assessed by QOL indices more than 2, respectively. A good correlation was found between the total symptom score and the quality of life score that was included in the I-PSS. CONCLUSIONS: Moderate to severe LUTS of elderly men above 40 years old in Seoul metropolitan area are relatively common, and more people suffer from the LUTS as they get older. New modified I-PSS system in Korean elderly men according to the importance of individual symptom in the established I-PSS, will be beneficial in the management of the lower tract symptom associated with BPH.
Adult* ; Aged* ; Epidemiologic Studies ; Humans ; Korea ; Lower Urinary Tract Symptoms* ; Male ; Nocturia ; Prevalence ; Prostate* ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; Rivers ; Seoul*

OBJECTIVES: To determine the prevalence of prostatitis symptoms in the general population by questionnaire survey and to measure the effect of prostatitis symptoms on quality of life(QOL). MATERIALS AND METHODS: A cross sectional community-based epidemiologic study was performed on 2,034 men, living in the Seoul metropolitan area using stepwise random sampling. Out of 2,034 interviewees, 1,356 men who were older than 40 and provided sufficient information were selected for this study. The questionnaires were completed by well trained interviewers. Contents of the questionnaires included demographic data, the Prostatitis Symptom Index(PSI), the International Prostate Symptom Score(IPSS), a general health questionnaire section and a sexual health questionnaire section. The PSI was composed of a sum of the scores from three questions about dysuria, penile pain and perineal pain and it ranged 0 to 12. Incidence of prostatitis symptoms was defined by a score of 4 or more and the reference group was defined as consisting of those with a score of 3 or less. The rate of incidence of prostatitis symptoms was assessed according to age and the difference of QOL between the prostatitis symptoms group and the reference group. RESULTS: The overall positive rate of prostatitis symptoms measured by the PSI, in men older than 40, living in the Seoul metropolitan area, was 4.5%(61/1,356), adjusted to 4.8% by the relative proportion of this age group in the general population of the Seoul metropolitan area as compared to Korea and the World. The proportion of the group with prostatitis symptoms assessed by the PSI did not increase with age although the proportion of participants with moderate to severe lower urinary tract symptoms (LUTS) did increase with age. The group with prostatitis symptoms suffered from a much greater incidence of LUTS compared to the reference group (p<0.05). The QOL scores of the IPSS, and the general health and sexual health status of the group with prostatitis symptoms, were worse than those of the reference group.(p<0.05). CONCLUSIONS: The positive rate of prostatitis symptoms in men older than 40, living in the Seoul metropolitan area, was 4.8% and it didn't increase with age. The general QOL of the group with prostatitis symptoms was much worse than that of the reference group.
Dysuria ; Epidemiologic Studies ; Humans ; Incidence ; Korea ; Lower Urinary Tract Symptoms ; Male ; Prevalence ; Prostate ; Prostatitis* ; Quality of Life* ; Surveys and Questionnaires ; Reproductive Health ; Seoul

PURPOSE: We reviewed clinical characteristics and prognostic factors in testicular germ cell tumor in adults. MATERIALS AND METHODS: We reviewed the records of 42 patients with testicular germ cell tumors managed at Seoul National University Hospital between January 1985 and May 1997. Patients were followed regularly to determine clinical outcome with tumor markers, chest X-ray and abdominal CT. Mean follow-up was 5.75 years ranging from 3months to 238months. RESULTS: Painless testiscular enlargement(86%) was the most common presenting symptom and history of cryptorchidism was noted in 6 patients. Among 21 seminoma patients, 11 were stage I, 9 were stage II, and 1 was unknown and among 21 nonseminomatous germ cell tumor(NSGCT) patients, 14 were stage I, 1 was stage II, 5 were stage III, and 1 was unknown. Of the 11 patients with stage I seminoma, there was no recurrence in 7 patients who received retroperitoneal low-dose radiation therapy after orchiectomy, but 2(50%) of 4 patients who had surveillance after orchiectomy, showed relapse at retroperitoneal lymph nodes. One of 3 patients who had elevated level of serum beta-HCG at initial presentation showed tumor relapse at retroperitoneal lymph node. Among 11 patients with stage I NSGCT under surveillance after radical orchiectomy, 7 patients(63.6%) had relapse. Vascular invasion of tumor was noted in orchiectomy specimens in 3 cases of the 7 relapsed cases compared to no vascular invasion in 4 non-relapsed cases. Also, 4 of 7 patients with elevation of tumor marker resulted in relapse. Although primary pathologic stage T2 was noted in 2 patients with clinical stage I NSGCT, no recurrence occurred after adjuvant combined chemotherapy. Fifteen patients with stage II or stage III were treated with systemic combination chemotherapy after radical orchiectomy and 7 of these patients had residual retroperitoneal mass. Of these patients, salvage chemotherpy was done in 2 patients, salvage RPLND and salvage chemotherapy with RPLND was performed in 1 patient respectively. Of the patients with stage II or III, One patient with stage IIB seminoma died despite of salvage chemotherapy with RPLND. The remaining 3 patients with residual mass were followed regulary without further treatment. They had no evidence of recurrence which was evaluated by tumor marker, chest X-ray and abdominal CT. The marked reduction of residual mass after adjuvant therapy were found in this group. The overall survival rate in total patients was 98% at 5.75 years from initial diagnosis. CONCLUSIONS: Adjuvant low-dose radiation therapy after radical orchiectomy was recommended to reduce recurrence rates in stage I seminoma. The vascular invasion, pre-orchiectomy elevation of tumor markers, or pathologic T2 or more stage were risk factors for relapse in stage I NSGCT. In advanced staged germ cell tumor, high survival rate was achieved by cis-platin based combination chemotherapy. Especially, in the patients with marked reduction of tumor mass after chemotherapy, close surveillance might be adequate in stead of second look operation for the retroperitoneal mass. Irrelevant of its histopathologic finding and stage, the testicular germ cell tumor showed excellent therapeutic end-results. Further studies should be directed at developing therapeutic modalities that could achieve better therapeutic results with least therapeutic complication and sequelae.
Adult* ; Cryptorchidism ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Follow-Up Studies ; Germ Cells* ; Humans ; Lymph Nodes ; Male ; Neoplasms, Germ Cell and Embryonal* ; Orchiectomy ; Recurrence* ; Risk Factors* ; Seminoma ; Seoul ; Survival Rate ; Testis ; Thorax ; Tomography, X-Ray Computed ; Biomarkers, Tumor

PURPOSE: Prostate-specific antigen(PSA) exist in serum in two major immunodetectable molecular forms: free PSA, and complexed PSA(PSA- alpha-1-antichymotrypsin). Total PSA represents the sum of the free and complexedorms. Preliminary investigations have illustrated the potential benefits of using percent free PSA to enhance the utility of PSA in distinguishing benign prostate disease from prostate cancer. Our study was undertaken to define the effectiveness of precent free PSA in the early detection of prostate cancer and to determine appropriate cutoff points for percent free PSA in Korea when total PSA level is normal or mildly elevated so as to eliminate negative biopsies. MATERIALS AND METHODS: Patient samples consisted of 24 histologically confirmed primary cancer, 83 men with untreated benign prostate disease histologically confirmed by negative sextant biopsies, and 29 men with normal digital rectal examination and PSA values less than 4.0ng/ml. Total PSA and free PSA levels were determined using PSA-RIACT and FPSA-RIACT kit(Cis Bio International, France), respectively. Percent free PSA was calculated for all patients. Within the range of 2.5-20.0ng/ml, receiver operating curve(ROC) was generated and utilized to evaluate cutpoints for percent free PSA to be used in clinical practice. RESULTS: When all subjects were included, both total PSA and percent free PSA significantly discriminated patients with prostate cancer from patients with benign histologic conditions(p=0.0003 and p=0.0001, respectively). However, in men with total PSA values between 2.5 and 20.0ng/ml, the percent free PSA significantly discriminated patients with prostate cancer from patients with benign conditions(p=0.001), whereas the total PSA did not(p=0.14). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the percent free PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. Within the range of 2.5-20.0ng/ml, the cutoff point for percent free PSA was 20. CONCLUSIONS: Measurement of percent free PSA enhance the ability to discriminate prostate cancer from benign histologic condition while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 2.5 and 20.0ng/ml.
Biopsy ; Digital Rectal Examination ; Humans ; Korea ; Male ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity

PURPOSE: To develope the bacillus Calmette-Guerin(BCG) antitumor component therapy which could reduce the adverse effect of intravesical BCG therapy, we investigated the effect of the fractions of BCG on the immune responses of mouse and compared with whole BCG. MATERIALS AND METHODS: Seven fractions, 4(fraction 1, 2, 3, 4) from BCG cell wall and 1 (fraction 7) front BCG cytoplasm and 2(fraction 5, 6) mixed, were collected by multiple ultrasonification and centrifugation of BCG solution and the difference of each fraction was confirmed by spectrophotometric absorbance. Change of lymphokine killer(LAK), natural killer(NK) and tumor cell dependent cytotoxic(TCDC) activities of mouse spleen cells were investigated by 51Cr releasing assay and proportion of T cell subset in mouse spleen and peritoneal lymhocytes were investigated by flow cytometric analyses using monoclonal antibodies to mouse CD4, CD8 and CD2S cells. RESULTS: In LAK and NK activities, fraction 1, 2 and 3 showed similar results with whole BCG. In TCDC activity, the all 7 fraction showed lower activities compared with BCG. In T cell subset analyses, similar results were found in fraction 1, 2 and 3 compared with whole BCG. CONCLUSIONS: We could suggest that the antitumor activity of BCG seems to be mediated by some component in cell wall. Further investigations which could elucidate these findings should be necessary.
Animals ; Antibodies, Monoclonal ; Bacillus* ; Cell Wall ; Centrifugation ; Cytoplasm ; Immunity, Cellular* ; Mice* ; Mycobacterium bovis ; Spleen ; Urinary Bladder Neoplasms

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.
Alprostadil ; Education ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Humans ; Male ; Papaverine ; Phentolamine