The rapid response system (RRS) is an innovative system designed for in-hospital, at-risk patients but underutilization of the RRS generally results in unexpected cardiopulmonary arrests. We implemented an extended RRS (E-RRS) that was triggered by actively screening at-risk patients prior to calls from primary medical attendants. These patients were identified from laboratory data, emergency consults, and step-down units. A four-member rapid response team was assembled that included an ICU staff, and the team visited the patients more than twice per day for evaluation, triage, and treatment of the patients with evidence of acute physiological decline. The goal was to provide this treatment before the team received a call from the patient's primary physician. We sought to describe the effectiveness of the E-RRS at preventing sudden and unexpected arrests and in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screened by the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRS activations of simple consultations for invasive procedures. After E-RRS implementation, the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality rate was reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with a reduction in the in-hospital code and mortality rates.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Education, Professional ; Female ; Heart Arrest/mortality ; *Hospital Mortality ; *Hospital Rapid Response Team ; Hospitals, University ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Young Adult

Castleman's disease is a rare benign lymphoproliferative disorder that frequently affects lymph nodes of the mediastinal thorax and the neck. It very rarely affects the renal sinus. We report a case of Castleman's disease arising in the renal sinus in a 64-year-old man. The patient visited the hospital with the chief complaint of hematuria. Abdominal computed tomography revealed a homogeneous mass in the sinus of the left kidney, radiologically interpreted as a malignant urothelial tumor. Subsequently, nephroureterectomy was performed, after which microscopic examination of the specimen revealed a diffuse lymphoproliferative lesion with reactive lymphoid follicles of various sizes and prominent plasma cell infiltration of interfollicular spaces, highlighted by immunohistochemical staining for CD138. The lesion was diagnosed as Castleman's disease of the plasma cell type. Although preoperative diagnosis of Castleman's disease is difficult and the incidence is exceedingly rare, it should be considered in the differential diagnosis of renal sinus tumors.
Diagnosis, Differential ; Giant Lymph Node Hyperplasia ; Hematuria ; Humans ; Incidence ; Kidney ; Lymph Nodes ; Lymphoproliferative Disorders ; Middle Aged ; Neck ; Plasma Cells ; Thorax

PURPOSE: This study was conducted to analyze the clinical characteristics and treatments of patients with genitourinary tuberculosis (GUTB) over the past 10 years. MATERIALS AND METHODS: The study population comprised 101 patients who were diagnosed with GUTB and hospitalized from January 2000 to December 2009. Acid-fast bacilli (AFB) smear, urine tuberculosis culture, urine tuberculosis polymerase chain reaction (PCR), intravenous urography, cystoscopy, and histopathologic findings were used for patient selection. Yearly proportion, gender, patient distribution according to age, history of tuberculosis, and presence of other organ tuberculosis were analyzed. RESULTS: The patients hospitalized with GUTB counted for 0.9% of all patients admitted to the department of urology. The sex ratio was 1:1.53 (male:female), and the patients' mean age was 45.57+/-12.55 years (range, 19-81 years). Among the patients, there was one immunocompromised patient. A total of 22 patients (21.8%) had a medical history of tuberculosis, mostly pulmonary tuberculosis (90.9%). The sensitivity of AFB stain, tuberculosis culture, and PCR was 41.6%, 55.4%, 33.7%, respectively. A total of 54 patients required additional surgical treatment: 30 cases of nephrectomy, 8 cases of epididymectomy, 8 cases of ureteral stent, 5 cases of nephrostomy, 1 case of ureterectomy, 1 case of augmentation cystoplasty, and 1 case of transurethral resection of prostate. CONCLUSIONS: The frequency of GUTB tended to decrease progressively. However, GUTB is still a threat to public health. There was no previous history of tuberculosis in two-thirds of the cases of GUTB and more than half of them required further surgical treatment.
Cystoscopy ; Humans ; Immunocompromised Host ; Nephrectomy ; Patient Selection ; Polymerase Chain Reaction ; Prevalence ; Public Health ; Sex Ratio ; Stents ; Tuberculosis ; Tuberculosis, Pulmonary ; Tuberculosis, Urogenital ; Ureter ; Urography ; Urology

PURPOSE: The aim of this study was to evaluate the efficacy of a daily dose of tadalafil 5 mg as well as its safety for the cardiovascular system in men with erectile dysfunction. MATERIALS AND METHODS: This study included a total of 162 men who were administered a daily dose of tadalafil 5 mg between April and December of 2009. A total of 127 men completed the 8-week clinical trial. The International Index of Erectile Function (IIEF)-5, blood pressure, and heart rate were measured before treatment with tadalafil (V1) and 4 (V2) and 8 weeks (V3) after treatment with tadalafil. Adverse effects were assessed at V1, V2, and V3. In cases in which the International Prostate Symptom Score (IPSS) was > or =8 at V1, maximal flow rate (Qmax) and postvoid residual volume (PVR) were measured. RESULTS: The IIEF-5 values were 11.25+/-3.18, 14.56+/-3.79, and 16.91+/-3.56 at V1, V2, and V3, respectively, with significant improvement (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). The IPSS values were 10.59+/-5.56, 9.07+/-6.06, and 8.15+/-6.10 at V1, V2, and V3, respectively, and the differences were statistically significant (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). There were no significant differences in blood pressure or heart rate. Adverse effects were observed in 7 men (5.51%) at V2 and in 5 men (3.94%) at V3. CONCLUSIONS: Tadalafil 5 mg administered once-a-day may be effective in improving erectile function. Adverse effects on the cardiovascular system may be minimal. In addition, it is believed that this may also be effective in improving voiding symptoms.
Blood Pressure ; Carbolines ; Cardiovascular System ; Erectile Dysfunction ; Heart Rate ; Humans ; Male ; Prospective Studies ; Prostate ; Residual Volume ; Treatment Outcome ; Tadalafil

PURPOSE: We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field. MATERIALS AND METHODS: From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis(R) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach. RESULTS: Mean patient age was 54.8 years. Mean operative time was 171.2+/-109.1 minutes. Mean estimated blood loss was 265.0+/-395.5 ml. Mean incision length was 3.2+/-1.4 cm. Mean length of hospitalization was 5.2+/-2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively. CONCLUSIONS: In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery.
Gloves, Surgical ; Hospitalization ; Humans ; Ileus ; Laparoscopy ; Medical Records ; Nephrectomy ; Operative Time ; Pain Measurement ; Retrospective Studies ; Surgical Instruments ; Urinary Bladder ; Urology

PURPOSE: In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. MATERIALS AND METHODS: Two men and two women with a mean age of 51.5+/-9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0 degrees robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. RESULTS: The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. CONCLUSIONS: Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.
Cystadenoma ; Cystectomy ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Operative Time ; Polyglactin 910 ; Robotics ; Running ; Sutures ; Urachal Cyst ; Urachus ; Urinary Bladder ; Urinary Catheters

PURPOSE: We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. MATERIALS AND METHODS: From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. RESULTS: The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5+/-14.0 ng/ml and 9.1+/-5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). CONCLUSIONS: BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.
Biopsy ; Biopsy, Needle ; Digital Rectal Examination ; Early Diagnosis ; Humans ; Lower Urinary Tract Symptoms ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Retrospective Studies ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction

PURPOSE: We performed this study to investigate the predictive factors that are related to recovery from acute urinary retention after non-urogenital surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of 160 patients who were referred to the department of urology because of lasting acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2006. Patients were divided into two groups: a transient retention group, which included patients who recovered voiding capability after urinary catheterization for 7 days, and the unresponsive retention group, which included patients who did not recover voiding capability. Surgical factors, patient factors, use of patient-controlled analgesia (PCA), amount of residual urine, and medications during catheterization were analyzed. RESULTS: In the chi-square analysis, gender (female, p=0.006), age (> or=60 years old, p<0.001), preoperative voiding difficulty (p=0.028), comorbidity with hypertension (p=0.001), diabetes mellitus (p=0.003), location of surgery (pelvic cavity, p=0.005), amount of intraoperative fluid (> or =4,000 ml, p=0.002), and intraoperative indwelling of Foley catheter (p=0.026) were found to differ significantly between the two groups. In the multivariate logistic regression analysis, gender (female, p=0.002; OR=5.6), age (> or=60 years old, p=0.001; OR=5.9), hypertension (p=0.049; OR=2.6), location of surgery (pelvic cavity, p<0.001; OR=20.125), and amount of intraoperative fluid (> or =4,000 ml, p=0.001; OR=8.5) were found to increase the risk of unresponsive urinary retention. The residual urine volume of the unresponsive urinary retention group was larger than that of the transient urinary retention group (741+/-306 ml vs. 614+/-222 ml, p=0.003). CONCLUSIONS: Use of a preoperative indwelling catheter and careful management of urination is necessary to prevent unresponsive urinary retention in patients with risk factors such as female gender, old age, hypertension, surgery in the pelvic cavity, and a large amount of intraoperative fluid injection.
Analgesia, Patient-Controlled ; Catheterization ; Catheters ; Catheters, Indwelling ; Comorbidity ; Diabetes Mellitus ; Female ; Humans ; Hypertension ; Logistic Models ; Postoperative Care ; Retention (Psychology) ; Retrospective Studies ; Risk Factors ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention ; Urination ; Urology

PURPOSE: Recent studies have reported the association between metabolic syndrome and benign prostatic hyperplasia. This study was conducted to evaluate the relation between metabolic syndrome and prostate-specific antigen (PSA). MATERIALS AND METHODS: From January 2004 to December 2007, a total of 4,115 male outpatients (aged 40 to 79 years) who visited the health care center at our medical center were examined. Eligible men were classified according to the presence or absence of metabolic syndrome and the number of components of the metabolic syndrome. The association between the sum of metabolic syndrome components and PSA level was evaluated. The association between each metabolic syndrome component and PSA level was also evaluated. RESULTS: The PSA level of metabolic syndrome patients was lower than that of the control group (p=0.022). An increased number of metabolic syndrome components was significantly associated with a linear, decreasing trend in PSA levels (p-trend=0.040). When a Pearson's correlation was performed, only obesity was inversely associated with PSA level in the metabolic syndrome group. There was no significant factor that was related to having a PSA level greater than or equal to 2.5 ng/ml. CONCLUSIONS: Metabolic syndrome should be considered as a factor associated with reduced PSA levels. If the patient with metabolic syndrome is obese, the PSA cutoff value should be lower than 4 ng/ml.
Delivery of Health Care ; Humans ; Male ; Metabolic Syndrome X ; Obesity ; Outpatients ; Prostate-Specific Antigen ; Prostatic Hyperplasia

PURPOSE: Elderly men are often troubled by lower urinary tract symptoms (LUTS), including frequency, urgency, incontinence and nocturia. Especially, nocturia is one of the frequently complained about urologic symptoms and this can be combined with sleep disorders. We investigated the prevalence and risk factors for nocturia in males who participated in a prostate examination survey. MATERIALS AND METHODS: A total of 7,299 men participated in a prostate examination survey from March 2003 to December 2006; these men were given an International Prostate Symptom Score(IPSS) and they underwent transrectal ultrasonography of the prostate. The prevalence of nocturia and its associated factors, which included age, the IPSS severity, the prostate volume and the place of residence, were evaluated. RESULTS: Among the men who were evaluated, 23.4% reported voiding once per night and 68% reported voiding twice or more per night. The severe IPSS group revealed a significantly higher nocturia score compared to the mild and moderate IPSS group. While the nocturia score and the other LUTS score increased significantly with age, only the nocturia score increased significantly with age in each of the IPSS severity groups. The nocturia score increased significantly with a prostate volume >or=30g. Men living in Seoul showed a significantly lower nocturia score than that for men living in other areas. Multiple logistic regression analysis also indicated that an older age, a severe IPSS score, the country of residence were the independent risk factors. Multiple regression analysis revealed the nocturia score to have the highest correlation with the quality of life. CONCLUSIONS: For Korean males, the prevalence of nocturia >or=2 is 68% and the incidence of nocturia increased significantly according to age, the IPSS severity, the prostate volume and the place of residence.
Aged ; Humans ; Hypogonadism ; Incidence ; Logistic Models ; Lower Urinary Tract Symptoms ; Male ; Mitochondrial Diseases ; Nocturia ; Ophthalmoplegia ; Prevalence ; Prostate ; Risk Factors ; Sleep Wake Disorders