PURPOSE: This study was conducted to evaluate prognostic factors and cancer-specific survival (CSS) in a cohort of 41 patients with urachal carcinoma by use of a Bayesian model-averaging approach. MATERIALS AND METHODS: Our cohort included 41 patients with urachal carcinoma who underwent extended partial cystectomy, total cystectomy, transurethral resection, chemotherapy, or radiotherapy at a single institute. All patients were classified by both the Sheldon and the Mayo staging systems according to histopathologic reports and preoperative radiologic findings. Kaplan-Meier survival curves and Cox proportional-hazards regression models were carried out to investigate prognostic factors, and a Bayesian model-averaging approach was performed to confirm the significance of each variable by using posterior probabilities. RESULTS: The mean age of the patients was 49.88+/-13.80 years and the male-to-female ratio was 24:17. The median follow-up was 5.42 years (interquartile range, 2.8-8.4 years). Five- and 10-year CSS rates were 55.9% and 43.4%, respectively. Lower Sheldon (p=0.004) and Mayo (p<0.001) stage, mucinous adenocarcinoma (p=0.005), and larger tumor size (p=0.023) were significant predictors of high survival probability on the basis of a log-rank test. By use of the Bayesian model-averaging approach, higher Mayo stage and larger tumor size were significant predictors of cancer-specific mortality in urachal carcinoma. CONCLUSIONS: The Mayo staging system might be more effective than the Sheldon staging system. In addition, the multivariate analyses suggested that tumor size may be a prognostic factor for urachal carcinoma.
Adult ; Bayes Theorem ; Carcinoma/*pathology/*therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Treatment Outcome ; Urinary Bladder Neoplasms/*pathology/*therapy

PURPOSE: This study was conducted to evaluate prognostic factors and cancer-specific survival (CSS) in a cohort of 41 patients with urachal carcinoma by use of a Bayesian model-averaging approach. MATERIALS AND METHODS: Our cohort included 41 patients with urachal carcinoma who underwent extended partial cystectomy, total cystectomy, transurethral resection, chemotherapy, or radiotherapy at a single institute. All patients were classified by both the Sheldon and the Mayo staging systems according to histopathologic reports and preoperative radiologic findings. Kaplan-Meier survival curves and Cox proportional-hazards regression models were carried out to investigate prognostic factors, and a Bayesian model-averaging approach was performed to confirm the significance of each variable by using posterior probabilities. RESULTS: The mean age of the patients was 49.88+/-13.80 years and the male-to-female ratio was 24:17. The median follow-up was 5.42 years (interquartile range, 2.8-8.4 years). Five- and 10-year CSS rates were 55.9% and 43.4%, respectively. Lower Sheldon (p=0.004) and Mayo (p<0.001) stage, mucinous adenocarcinoma (p=0.005), and larger tumor size (p=0.023) were significant predictors of high survival probability on the basis of a log-rank test. By use of the Bayesian model-averaging approach, higher Mayo stage and larger tumor size were significant predictors of cancer-specific mortality in urachal carcinoma. CONCLUSIONS: The Mayo staging system might be more effective than the Sheldon staging system. In addition, the multivariate analyses suggested that tumor size may be a prognostic factor for urachal carcinoma.
Adult ; Bayes Theorem ; Carcinoma/*pathology/*therapy ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Treatment Outcome ; Urinary Bladder Neoplasms/*pathology/*therapy

PURPOSE: This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). MATERIALS AND METHODS: Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. RESULTS: The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791+/-240,757, 2,024,246+/-674,859 (p=0.998), 3,603,557+/-870,333 (p<0.01), and 8,021,902+/-330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627+/-231,957, 1,798,127+/-645,602 (p=0.634), 3,039,769+/-711,792 (p<0.01), and 899,668+/-323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163+/-24,581, 226,119+/-215,009, 563,788+/-487,798 (p<0.01), and 7,122,234+/-56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. CONCLUSIONS: VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.
Anesthesia ; Carcinoma, Renal Cell ; Costs and Cost Analysis ; Fees and Charges ; Fees, Medical ; Humans ; Laparotomy ; Medically Uninsured ; Nephrectomy ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative

PURPOSE: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution. MATERIALS AND METHODS: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases. RESULTS: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma. CONCLUSIONS: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.
Adrenalectomy ; Cystectomy ; Follow-Up Studies ; Gloves, Surgical ; Humans ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time ; Orchiectomy ; Postoperative Complications ; Prospective Studies ; Robotics ; Surgical Procedures, Minimally Invasive ; Ureter ; Urologic Diseases

It is important to identify and to test serologically active antigens, so as to devise a cocktail of the best antigens or peptides. We searched for antigens that have serodiagnostic utility using two-dimensional fractionation of sonic extracts from Mycobacterium tuberculosis and probing with pools of sera from healthy subjects and patients with tuberculosis (TB). Reactive protein spots with patient sera were identified by tandem mass spectrometry. Three proteins, Rv0652, Rv2626c, and Rv3418c, which have not previously been described as serologic targets, were identified. Rv0652 protein among them was expressed in Escherichia coli and serum IgG antibodies against this antigen were measured in 150 patients with pulmonary TB and in 115 healthy subjects. The sensitivity and specificity were 39% and 92%, respectively. These results suggest that a newly identified protein, Rv0652 may be a valuable candidate to be included in a cocktail test kit for TB diagnosis.
Antibodies ; Escherichia coli ; Humans ; Immunoglobulin G ; Mycobacterium ; Mycobacterium tuberculosis ; Peptides ; Proteins ; Sensitivity and Specificity ; Tandem Mass Spectrometry ; Tuberculosis

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.
Abscess ; Aminoglycosides ; Anti-Bacterial Agents ; Diagnosis ; Dysuria ; Fever ; Follow-Up Studies ; Hematuria ; Humans ; Incidence ; Korea ; Massage ; Patient Admission ; Prostate ; Prostate-Specific Antigen ; Prostatitis* ; Pyuria ; Retrospective Studies ; Urinalysis

PURPOSE: The incidence of prostate cancer is increasing in Korea, but compared with western counties, the incidence is relatively low. The detection rate of prostate cancer, according to the serum prostate-specific antigen (PSA) level, is reportedly different in Korean men, but this remains to be confirmed. We retrospectively reviewed the data of prostate biopsies, and evaluated the detection rate of prostate cancer from biopsies, according to the serum PSA level in Korean men. MATERIALS AND METHODS: We retrospectively reviewed the results of 2,422 Korean men who had undergone prostate biopsies at 12 medical centers. Prostate biopsies were performed in cases of high PSA levels, greater than 4ng/ml, or abnormal findings on digital rectal examination. RESULTS: Of the 2,422 men, 39.7% had a positive biopsy. With PSA levels between 4 and 10ng/ml, the detection rate of prostate cancer was 15.9%. This rate was similar to that of the Japanese (15.8%), but quite different from that of American men (25%). With PSA levels above 10ng/ml, 59.5% of men had a positive biopsy. For PSA levels > or= 4ng/ml and > or= 10ng/ml, the detection rates were 42.1 and 59.5%, respectively. CONCLUSIONS: When the serum PSA levels were divided into 4 subdivisions (4.0-10.0, 10.0-20.0 and 20.0-100.0ng/ml and more than 100.0ng/ml), the detection rates were 15.9, 34.1, 66.2 and 93.8%, respectively.
Asian Continental Ancestry Group ; Biopsy ; Digital Rectal Examination ; Humans ; Incidence ; Korea ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Retrospective Studies

PURPOSE: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen (PSA) levels, where the initial biopsies were negative for cancer. MATERIALS AND METHODS: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218 (29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104 (19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26 (4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. RESULTS: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result (12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients (p<0.05). CONCLUSIONS: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patients.
Biopsy* ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Reference Values ; Ultrasonography

PURPOSE: We evaluated the clinical characteristics of the patients with urachal cancer, and we also analyzed their prognosis. MATERIALS AND METHODS: Medical records for 14 patients who were diagnosed with urachal cancer during the last fifteen years were retrospectively analyzed in regards to their clinical characteristics. Survival probabilities of 26 patients, 14 of whom were at our institute and 12 of whom were previously reported in the Korean Journal of Urology, were estimated using Kaplan-Meier curves. RESULTS: The incidence of urachal cancer was 1.2% of all primary bladder malignancies seen at our institute. The most common presenting symptom was gross hematuria (71.4%), and other symptoms included suprapubic pain or mass (28.6%), frequency or residual urine sensation (14.3%) and mucusuria (7.1%). We performed surgical resection on 12 patients, partial cystectomy on 8 patients, total cystectomy on 3 patients and pelvic exenteration on 1 patient. Histologic examination revealed 13 mucinous adenocarcinomas and 1 adenosquamous cell carcinomas. The surgical margins were free of tumor in 10 (83.3%) patients. 9 patients were classified as stage IIIA and 1, 2, 1, and 1 patients were classified as stage IIIB, IIIC, IIID and IVB, respectively. The overall survival rates (n=26) were 71.1% at 2 years and 45.1% at 5 years. The survival probabilities in the partial cystectomy group (n=16) were 100.0% and 61.4% at 2 and 5 years respectively, and 60.0% and 40.0% at 2 and 5 years, respectively, in the total cystectomy group (n=6). There was no significant difference between the two groups (p>0.05). CONCLUSIONS: Urachal cancer is rare, and its incidence was 0.4% of all primary bladder malignancies reported in Korea. Generally, the prognosis is unfavorable because early diagnosis is difficult and local invasions, distant metastasis and recurrences frequently develop. However, we would expect a more favorable prognosis if proper surgical resection following the correct preoperative diagnosis is performed. In addition, partial cystectomy would be a good treatment if negative surgical margins were ensured.
Adenocarcinoma, Mucinous ; Cystectomy ; Diagnosis ; Early Diagnosis ; Hematuria ; Humans ; Incidence ; Korea ; Medical Records ; Neoplasm Metastasis ; Pelvic Exenteration ; Prognosis* ; Recurrence ; Retrospective Studies ; Sensation ; Survival Rate ; Urachus ; Urinary Bladder ; Urology

PURPOSE: We evaluated the clinical characteristics of the patients with urachal cancer, and we also analyzed their prognosis. MATERIALS AND METHODS: Medical records for 14 patients who were diagnosed with urachal cancer during the last fifteen years were retrospectively analyzed in regards to their clinical characteristics. Survival probabilities of 26 patients, 14 of whom were at our institute and 12 of whom were previously reported in the Korean Journal of Urology, were estimated using Kaplan-Meier curves. RESULTS: The incidence of urachal cancer was 1.2% of all primary bladder malignancies seen at our institute. The most common presenting symptom was gross hematuria (71.4%), and other symptoms included suprapubic pain or mass (28.6%), frequency or residual urine sensation (14.3%) and mucusuria (7.1%). We performed surgical resection on 12 patients, partial cystectomy on 8 patients, total cystectomy on 3 patients and pelvic exenteration on 1 patient. Histologic examination revealed 13 mucinous adenocarcinomas and 1 adenosquamous cell carcinomas. The surgical margins were free of tumor in 10 (83.3%) patients. 9 patients were classified as stage IIIA and 1, 2, 1, and 1 patients were classified as stage IIIB, IIIC, IIID and IVB, respectively. The overall survival rates (n=26) were 71.1% at 2 years and 45.1% at 5 years. The survival probabilities in the partial cystectomy group (n=16) were 100.0% and 61.4% at 2 and 5 years respectively, and 60.0% and 40.0% at 2 and 5 years, respectively, in the total cystectomy group (n=6). There was no significant difference between the two groups (p>0.05). CONCLUSIONS: Urachal cancer is rare, and its incidence was 0.4% of all primary bladder malignancies reported in Korea. Generally, the prognosis is unfavorable because early diagnosis is difficult and local invasions, distant metastasis and recurrences frequently develop. However, we would expect a more favorable prognosis if proper surgical resection following the correct preoperative diagnosis is performed. In addition, partial cystectomy would be a good treatment if negative surgical margins were ensured.
Adenocarcinoma, Mucinous ; Cystectomy ; Diagnosis ; Early Diagnosis ; Hematuria ; Humans ; Incidence ; Korea ; Medical Records ; Neoplasm Metastasis ; Pelvic Exenteration ; Prognosis* ; Recurrence ; Retrospective Studies ; Sensation ; Survival Rate ; Urachus ; Urinary Bladder ; Urology