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Foerster B, Abufaraj M, Matin SF, Azizi M, Gupta M, Li WM, Seisen T, Clinton T, Xylinas E, Mir MC, Schweitzer D, Mari A, Kimura S, Bandini M, Mathieu R, Ku JH, Marcq G, Guruli G, Grabbert M, Czech AK, Muilwijk T, Pycha A, D'Andrea D, Petros FG, Spiess PE, Bivalacqua T, Wu WJ, Rouprêt M, Krabbe LM, Hendricksen K, Egawa S, Briganti A, Moschini M, Graffeille V, Kassouf W, Autorino R, Heidenreich A, Chlosta P, Joniau S, Soria F, Pierorazio PM, Shariat SF. Pretreatment Risk Stratification for Endoscopic Kidney-sparing Surgery in Upper Tract Urothelial Carcinoma: An International Collaborative Study. Eur Urol 2021; 80:507-515. [PMID: 34023164 DOI: 10.1016/j.eururo.2021.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several groups have proposed features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC). OBJECTIVE To evaluate standard risk stratification features, develop an optimal model to identify ≥pT2/N+ stage at radical nephroureterectomy (RNU), and compare it with the existing unvalidated models. DESIGN, SETTING, AND PARTICIPANTS This was a collaborative retrospective study that included 1214 patients who underwent ureterorenoscopy with biopsy followed by RNU for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed multiple imputation of chained equations for missing data and multivariable logistic regression analysis with a stepwise selection algorithm to create the optimal predictive model. The area under the curve and a decision curve analysis were used to compare the models. RESULTS AND LIMITATIONS Overall, 659 (54.3%) and 555 (45.7%) patients had ≤pT1N0/Nx and ≥pT2/N+ disease, respectively. In the multivariable logistic regression analysis of our model, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.0-1.03, p = 0.013), high-grade biopsy (OR 1.81, 95% CI 1.37-2.40, p < 0.001), biopsy cT1+ staging (OR 3.23, 95% CI 1.93-5.41, p < 0.001), preoperative hydronephrosis (OR 1.37 95% CI 1.04-1.80, p = 0.024), tumor size (OR 1.09, 95% CI 1.01-1.17, p = 0.029), invasion on imaging (OR 5.10, 95% CI 3.32-7.81, p < 0.001), and sessile architecture (OR 2.31, 95% CI 1.58-3.36, p < 0.001) were significantly associated with ≥pT2/pN+ disease. Compared with the existing models, our model had the highest performance accuracy (75% vs 66-71%) and an additional clinical net reduction (four per 100 patients). CONCLUSIONS Our proposed risk-stratification model predicts the risk of harboring ≥pT2/N+ UTUC with reliable accuracy and a clinical net benefit outperforming the current risk-stratification models. PATIENT SUMMARY We developed a risk stratification model to better identify patients for endoscopic kidney-sparing surgery in upper tract urothelial carcinoma.
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Affiliation(s)
- Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, Division of Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Quebec, Canada
| | - Mohit Gupta
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Thomas Seisen
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - M Carmen Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Donald Schweitzer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Ja H Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Gautier Marcq
- Division of Urology, McGill University Health Center, McGill University, Montreal, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | | | - Markus Grabbert
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Armin Pycha
- Department of Urology, Provincial Hospital of Bozen, Bozen, Italy; Medical School, Sigmund Freud University, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Firas G Petros
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity Bivalacqua
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Morgan Rouprêt
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Wassim Kassouf
- Division of Urology, McGill University Health Center, McGill University, Montreal, Canada
| | | | - Axel Heidenreich
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Phillip M Pierorazio
- Brady Urological Institute and Department of Urology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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Marcq G, Foerster B, Abufaraj M, Matin SF, Azizi M, Gupta M, Li WM, Seisen T, Clinton T, Xylinas E, Mir MC, Schweitzer D, Mari A, Kimura S, Bandini M, Mathieu R, Ku JH, Guruli G, Grabbert M, Czech AK, Muilwijk T, Pycha A, D'Andrea D, Petros FG, Spiess PE, Bivalacqua T, Wu WJ, Rouprêt M, Krabbe LM, Hendricksen K, Egawa S, Briganti A, Moschini M, Graffeille V, Autorino R, John P, Heidenreich A, Chlosta P, Joniau S, Soria F, Pierorazio PM, Shariat SF, Kassouf W. Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study. Eur Urol Focus 2021; 8:491-497. [PMID: 33773965 DOI: 10.1016/j.euf.2021.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories. OBJECTIVE To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective study including 1214 patients from 21 centers who underwent ureterorenoscopy (URS) with biopsy followed by radical nephroureterectomy (RNU) for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multivariate logistic regression analysis identified predictors of muscle invasion (≥pT2) at RNU. The Youden index was used to identify cutoff points. RESULTS AND LIMITATIONS A total of 811 patients (67%) were male and the median age was 71 yr (interquartile range 63-77). The presence of non-organ-confined disease on preoperative imaging (p < 0.0001), sessile tumor (p < 0.0001), hydronephrosis (p = 0.0003), high-grade cytology (p = 0.0043), or biopsy (p = 0.0174) and higher age at diagnosis (p = 0.029) were independently associated with ≥pT2 at RNU. Tumor size was significantly associated with ≥pT2 disease only in univariate analysis with a cutoff of 2 cm. Tumor size and all significant categorical variables defined the high-risk category. Tumor multifocality and a history of radical cystectomy help to dichotomize between low-risk and intermediate-risk categories. The odds ratio for muscle invasion were 5.5 (95% confidence interval [CI] 1.3-24.0; p = 0.023) for intermediate risk versus low risk, and 12.7 (95% CI 3.0-54.5; p = 0.0006) for high risk versus low risk. Limitations include the retrospective design and selection bias (all patients underwent RNU). CONCLUSIONS Patients with low-risk UTUC represent ideal candidates for KSS, while some patients with intermediate-risk UTUC may also be considered. This classification needs further prospective validation and may help stratification in clinical trial design. PATIENT SUMMARY We investigated factors predicting stage 2 or greater cancer of the upper urinary tract at the time of surgery for ureter and kidney removal and designed a new risk stratification. Patients with low or intermediate risk may be eligible for kidney-sparing surgery with close follow-up. Our classification scheme needs further validation based on cancer outcomes.
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Affiliation(s)
- Gautier Marcq
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, Division of Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
| | - Mohit Gupta
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Thomas Seisen
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris Descartes University, Paris, France
| | - M Carmen Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Donald Schweitzer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Marco Bandini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Ja H Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Georgi Guruli
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Markus Grabbert
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Armin Pycha
- Department of Urology, Provincial Hospital of Bozen, Bozen, Italy; Medical School, Sigmund Freud University, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Firas G Petros
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity Bivalacqua
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Morgan Rouprêt
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia John
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Phillip M Pierorazio
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada.
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D’Andrea D, Foerster B, Matin SF, Ku JH, Muilwijk T, Monteiro LL, Liao R, Petros FG, Spiess PE, Bivalacqua TJ, Hendricksen K, van Rhijn BW, Shabsigh A, Briganti A, Joniau S, Kassouf W, Pierorazio PM, Margulis V, Necchi A, Shariat SF. Impact of Sex on Response to Neoadjuvant Chemotherapy in Patients with Upper-tract Urothelial Cancer. EUR UROL SUPPL 2020; 19:16-19. [PMID: 34337449 PMCID: PMC8317786 DOI: 10.1016/j.euros.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- David D’Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Surena F. Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ja H. Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Leonardo L. Monteiro
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Ross Liao
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Firas G. Petros
- Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity J. Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W.G. van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Phillip M. Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- Corresponding author. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel.: +43 1 404002615; Fax: +43 1 404002332.
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Foerster B, Petros F, Seisen T, Xylinas E, Kimura S, Monteiro LL, Azizi M, Bandini M, Clinton T, Hendricksen K, Ku JH, Grabbert M, Czech AK, Mathieu R, Muilwijk T, Anele U, Matin SF, Krabbe LM, Rouprêt M, Briganti A, Heidenreich A, Pycha A, Autorino R, Egawa S, Chlosta P, Spiess PE, Joniau S, Kassouf W, Shariat SF. MP18-13 VALIDATION OF EAU GUIDELINE’S PRETREATMENT RISK STRATIFICATION PARAMETERS IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Foerster B, Matin SF, Gupta M, Schweitzer D, Clinton T, Kimura S, Bandini M, Ku JH, Muilwijk T, Monteiro LL, Abufaraj M, Petros F, Bivalacqua TJ, Hendricksen K, Krabbe LM, Egawa S, Briganti A, Joniau S, Kassouf W, Pierorazio PM, van Rhijn BW, Margulis V, Necchi A, Shariat SF. MP18-02 EFFICACY OF PREOPERATIVE CHEMOTHERAPY ON OUTCOMES OF HIGH-RISK UPPER TRACT UROTHELIAL CARCINOMA (UTUC). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Truong B, Rich-Garg N, Ehst BD, Deodhar AA, Ku JH, Vakil-Gilani K, Danve A, Blauvelt A. Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis. Clin Cosmet Investig Dermatol 2015; 8:563-9. [PMID: 26622188 PMCID: PMC4639475 DOI: 10.2147/ccid.s90270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Innovation What is already known about the topic: psoriasis (PsO) is a common skin disease with major impact on quality of life (QoL). Patient-reported data on QoL from large number of PsO patients with and without psoriatic arthritis (PsA) are limited. What this study adds: In a large cohort referred to a university psoriasis center, patients with PsO and concomitant PsA (~30% in this group) had greater degrees of skin and nail involvement and experienced greater negative impacts on QoL. Despite large numbers of patients with moderate-to-severe disease, use of systemic therapy by community practitioners was uncommon. Background PsO and PsA are common diseases that have marked adverse impacts on QoL. The disease features and patient-reported QoL data comparing PsO and PsA patients are limited. Objective To identify and compare demographics, clinical disease characteristics, and QoL scores in a large cohort of PsO patients with and without PsA. Methods All PsO patients seen in a psoriasis specialty clinic, named the Center of Excellence for Psoriasis and Psoriatic Arthritis, were enrolled in an observational cohort. Demographic, QoL, and clinical data were collected from patient-reported questionnaires and from physical examinations performed by Center of Excellence for Psoriasis and Psoriatic Arthritis dermatologists and a rheumatologists. Cross sectional descriptive data were collected and comparisons between patients with PsO alone and those with concomitant PsA are presented. Results A total of 568 patients were enrolled in the database. Mean age of PsO onset was 28 years and mean disease duration was 18 years. Those with family history had an earlier onset of PsO by ~7 years. Mean body surface area involvement with PsO was 14%. Mean body mass index was 30.7. Prevalence of PsA was 29.8%. PsA patients had a higher mean body surface area compared to patients with PsO alone (16.7% vs 13.4%, P<0.05), higher prevalence of psoriatic nail changes (54.4% vs 36%, P<0.0002), and worse QoL scores as assessed by the Short Form-12 (67 vs 52, P<0.00001), Psoriasis Quality of Life-12 questionnaire (62 vs 71, P<0.01), and Routine Assessment of Patient Index Data 3 (2.3 vs 4.7, P<0.01). Strikingly, 49% of patients with PsO had never received any systemic therapy. Conclusion These data highlight that PsO has marked negative impacts on QoL, while those patients with concomitant PsA are affected to a much greater degree. Despite large numbers of patients presenting with moderate-to-severe disease, use of systemic therapy for both PsO and PsA was uncommon.
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Affiliation(s)
- B Truong
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - N Rich-Garg
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - B D Ehst
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - A A Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - J H Ku
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - K Vakil-Gilani
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - A Danve
- Division of Arthritis and Rheumatic Diseases, Oregon Health and Science University, Portland, OR, USA
| | - A Blauvelt
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA ; Oregon Medical Research Center, Portland, OR, USA
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Ku JH, Kang M, Kim HS, Jeong CW, Kwak C, Kim HH. The prognostic value of pretreatment of systemic inflammatory responses in patients with urothelial carcinoma undergoing radical cystectomy. Br J Cancer 2015; 112:461-7. [PMID: 25584490 PMCID: PMC4453653 DOI: 10.1038/bjc.2014.631] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/06/2014] [Accepted: 11/30/2014] [Indexed: 12/12/2022] Open
Abstract
Background: Systemic inflammatory response (SIR) is important in the relationship between the tumour, the host, and outcome in cancer patients. However, limited data exist regarding the prognostic significance of SIR in bladder cancer. We investigate the utility of pretreatment SIR in patients with urothelial carcinoma undergoing radical cystectomy. Methods: The study cohort consisted of 419 patients with a median follow-up of 37.7 months. The SIRs used for each described prognostic nomogram are consistent with previously published data: C-reactive protein, albumin, white cell count, neutrophil count, lymphocyte count, and platelet count. Primary end point was disease-specific survival (DSS) and overall survival (OS) after surgery. Cox regression models were used to determine the time to disease-specific and overall mortality. Multivariate regression coefficients of the predictors were used to develop nomograms for predicting 5-year DSS and OS probability. Results: Multivariate Cox regression analyses revealed that albumin, lymphocyte count, and platelet count were significantly associated with a significantly increased risk for death from bladder cancer. The nomograms including each index were developed to predict the probability of 5-year DSS and OS after radical cystectomy. The C statistics were 77.8% and 77.3%, respectively, and exceeded the 2002 AJCC (72.0% and 70.3%, respectively). In the decision curve analyses, the nomograms including SIR demonstrated higher net benefit gains compared with the models without SIR. Conclusions: Cellular components of SIR have better prognostic values compared with acute-phase protein in patients undergoing radical cystectomy for bladder cancer.
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Affiliation(s)
- J H Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - M Kang
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - H S Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - C W Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - C Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - H H Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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8
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Kim M, Song SH, Ku JH, Kim HJ, Paick JS. Pilot study of the clinical efficacy of ejaculatory hood sparing technique for ejaculation preservation in Holmium laser enucleation of the prostate. Int J Impot Res 2014; 27:20-4. [PMID: 25007827 DOI: 10.1038/ijir.2014.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 04/14/2014] [Accepted: 06/06/2014] [Indexed: 01/12/2023]
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9
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Garg N, Truong B, Ku JH, Devere TS, Ehst BD, Blauvelt A, Deodhar AA. A novel, short, and simple screening questionnaire can suggest presence of psoriatic arthritis in psoriasis patients in a dermatology clinic. Clin Rheumatol 2014; 34:1745-51. [PMID: 24827874 DOI: 10.1007/s10067-014-2658-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
Delaying diagnosis of psoriatic arthritis (PsA) can lead to poor quality of life and disability. The purpose of this study is to identify simple questions for dermatologists to screen psoriasis patients for psoriatic arthritis. Data regarding psoriasis and arthritis were prospectively collected by a questionnaire from all psoriasis patients. Patients with joint-related symptoms were assessed by a rheumatologist for the presence of PsA. Retrospectively, the sensitivity and specificity, positive and negative predictive values, likelihood ratios, and posttest probabilities of various screening questions were calculated to identify the best combination of parameters. Of 517 patients seen in dermatology clinic, 117 (22.63 %) were found to have PsA. Four screening questions ("Do you have a history of joint pain or swelling?" "Do you have stiffness in the morning?" "Have you had X-rays taken of your joints?" "Do you have PsA?") with psoriatic nail changes demonstrated high sensitivity and specificity for predicting PsA. A cutoff of three out of these five parameters correctly classified patients with and without PsA with 86.9 % sensitivity, 71.3 % specificity, 53 % positive predictive value (PPV), 93.6 % negative predictive value (NPV), and area under the curve (AUC) of 0.87. Likelihood ratios for individual parameters varied between1.6 and 3.7, and with a combination of certain parameters, the posttest probability of PsA was 76 %. This is a preliminary data on a potential screening questionnaire which can help dermatologists quickly screen for PsA. All patients not having evaluated by a rheumatologist could have led to underdiagnosis of PsA and potential misclassification. Psoriasis patients seen at a specialty clinic may introduce a referral bias.
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Affiliation(s)
- N Garg
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP09, Portland, OR, 97239, USA.
| | - B Truong
- Oregon Health & Science University, Portland, OR, USA.
| | - J H Ku
- Oregon Health & Science University, Portland, OR, USA.
| | - T S Devere
- Kaiser Foundation Hospital, Honolulu, HI, USA.
| | - B D Ehst
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.
| | - A Blauvelt
- Oregon Health & Science University, Portland, OR, USA.
| | - A A Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP09, Portland, OR, 97239, USA.
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10
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Affiliation(s)
- Kyungtae Ko
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
| | - Young H. Park
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
| | - Jeong W. Lee
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
| | - Ja H. Ku
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
| | - Cheol Kwak
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
| | - Hyeon H. Kim
- Department of Urology; Seoul National University College of Medicine; Seoul; Korea
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11
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Abstract
OBJECTIVE To investigate the effects of survivin gene RNA interference on cell growth and the cell cycle in the human bladder cancer cell line T24. MATERIALS AND METHODS A small interfering RNA (siRNA) targeting survivin was transfected into T24 cells using a liposome approach. Reverse transcription-polymerase chain reaction and Western blot analysis were used to examine survivin gene expression in T24 cells. Cells densities were determined by haematocytometer counts and flow cytometry was used for cell cycle analysis. Caspase-3 activity was quantified. RESULTS After treatment with survivin siRNA, the survivin gene expression in T24 cells was almost completely absent. The survivin siRNA treatment caused a profound decrease in survivin protein, which was correlated with a decrease in cell growth, G2/M arrest, and an increase in the fraction of cells undergoing apoptosis. The inhibition of survivin expression increased caspase-3 activity in T24 cells, which led to apoptosis. CONCLUSIONS RNA interference can efficiently suppress survivin expression in T24 cells. Targeting survivin by siRNA may be a promising approach to block proliferation of bladder cancer cells and may provide a suitable adjuvant therapy for treatment of bladder cancer.
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Affiliation(s)
- Ja H Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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12
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Kim HH, Cho SY, Park DS, Kwak C, Lee SE, Ku JH. WITHDRAWN: Prognostic factors of biochemical recurrence after radical prostatectomy in Korean men with high-risk prostate cancer. Eur J Surg Oncol 2007:S0748-7983(07)00550-1. [PMID: 17983725 DOI: 10.1016/j.ejso.2007.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
Abstract
This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.
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Affiliation(s)
- H H Kim
- Department of Urology, Seoul National University Hospital, 28, Yongon Dong, Jongno Ku, Seoul 110-744, Republic of Korea
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Song YS, Lee HJ, Park IH, Kim WK, Ku JH, Kim SU. Potential differentiation of human mesenchymal stem cell transplanted in rat corpus cavernosum toward endothelial or smooth muscle cells. Int J Impot Res 2007; 19:378-85. [PMID: 17460699 DOI: 10.1038/sj.ijir.3901539] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
One of the causes of erectile dysfunction (ED) is the damaged penile cavernous smooth muscle cells (SMCs) and sinus endothelial cells (ECs). To investigate the feasibility of applying immortalized human mesenchymal stem cells (MSCs) to penile cavernous ECs or SMCs repair in the treatment of ED, the in vivo potential differentiation of the immortalized human MSCs toward penile cavernous endothelial or smooth muscle was investigated. One clone of immortalized human bone marrow mesenchymal stem cell line B10 cells via retroviral vector encoding v-myc were transplanted into the cavernosum of the Sprague-Dawley rats and harvested 2 weeks later. The expression of CD31, von Willebrand factor (vWF), smooth muscle cell actin (SMA), calponin and desmin was determined immunohistochemically in rat penile cavernosum. Multipotency of B10 to adipogenic, osteogenic or chondrogenic differentiation was found. Expression of EC specific markers (CD31 or vWF protein) and expression of SMC specific markers (calponin, SMA or desmin protein) were demonstrated in grafted B10 cells. When human MSCs were transplanted into the penile cavernosum, they have the potential to differentiate toward ECs or SMCs. Human MSCs may be a good candidate in the treatment of penile cavernosum injury.
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Affiliation(s)
- Y S Song
- Department of Urology, Soonchunhyang School of Medicine, Seoul, Korea
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14
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Shim HB, Kim YD, Jung TY, Lee JK, Ku JH. Prostate-specific antigen and prostate volume in Korean men with spinal cord injury: a case–control study. Spinal Cord 2007; 46:11-5. [PMID: 17387315 DOI: 10.1038/sj.sc.3102051] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, cross-sectional, case-control study. SETTING Outpatient department in Seoul, Korea. OBJECTIVES To assess prostate volume and serum prostate-specific antigen (PSA) levels in Korean men with spinal cord injury (SCI). METHODS A total of 31 SCI patients with ages ranging between 45 and 81 years old (median age, 58 years) were studied. Thirty-one age-matched individuals without SCI were enrolled in the study as controls. We tested PSA levels and performed transrectal ultrasonographies on all enrolled patients. Of the patients with SCI, 20 were evaluated for testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels. RESULTS Serum PSA levels and prostate volume parameters in the two groups had similar values: the median (5th-95th percentiles) serum PSA level was 1.56 ng/ml (0.12-9.77) for SCI patients and 1.04 ng/ml (0.50-2.98) for controls (P=0.481), whereas the median (5th-95th percentiles) prostate volume was 18.33 ml (10.16-76.78) for SCI patients and 20.80 ml (14.23-41.22) for controls (P=0.072). No significant differences were found when serum PSA levels and prostate volumes were compared according to SCI patient injury characteristics. Testosterone levels were lower than the normal range in 7 SCI patients (35%), LH was higher than the normal range in 10 SCI patients (20%), and FSH was higher than the normal range in eight SCI patients (40%). We observed an age-related increase in FSH levels (r=0.634, P=0.004), although hormone levels did not correlate with serum PSA levels and prostate volume parameters. CONCLUSIONS According to our results, serum PSA levels and prostate volume in Korean SCI patients are not different from those in uninjured men and are not affected by injury characteristics.
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Affiliation(s)
- H B Shim
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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15
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Abstract
We report a pelvic liposarcoma originating from the left spermatic cord that recurred following inadequate excision. In our case, the tumor was resected without performing orchiectomy previously. The patient was managed by laparoscopic resection, before undergoing radical orchiectomy in the left inguinal region. To our knowledge, no case of laparoscopic resection for the recurrent liposarcoma has been described. In addition, the present case serves to demonstrate that radical orchiectomy with wide excision is needed for paratesticular tumor.
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Affiliation(s)
- Hong B Shim
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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16
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Ku JH, Kwak C. Metastasectomy plus immunotherapy compared with immunotherapy alone in metastatic renal cell carcinoma. Clin Oncol (R Coll Radiol) 2007; 19:164-5. [PMID: 17355116 DOI: 10.1016/j.clon.2006.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Shim HB, Lee SE, Park HK, Ku JH. Digital rectal examination as a prostate cancer-screening method in a country with a low incidence of prostate cancer. Prostate Cancer Prostatic Dis 2007; 10:250-5. [PMID: 17297501 DOI: 10.1038/sj.pcan.4500944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of this study was to evaluate the value of using digital rectal examination (DRE) for prostate cancer diagnosis in an Asian population. Patients with serum prostate-specific antigen (PSA) levels ranging from 2.5 to 19.9 ng/ml underwent transrectal ultrasonography-guided prostate biopsies. Patients were divided into two groups: the normal DRE group (n=721) and the abnormal DRE group (n=192). The cancer detection rate was higher in the abnormal DRE group (47.4%) than in the normal DRE group (23.0%) (P<0.001). However, the detection rates in these two groups were not significantly different in men 45-59 years old as well as in men with low PSA levels (2.5-3.9 ng/ml). In all subjects, the areas under the receiver operating characteristic curves for positive biopsies were 60.0% (95% confidence interval (CI), 55.7-64.3%, P<0.001). However, in the subgroup analysis, the predictive power of the DRE was not significant in men 45-59 years old. In addition, DREs of patients with low PSA levels had no discriminative ability. The pathological features of the prostate biopsies were not significantly different between the two groups in subjects 45-59 years old and in subjects with PSA levels from 2.5 to 3.9 ng/ml. Our data indicate that DREs increase the probability of cancer detection. However, our findings also raise the question, 'Are DREs really useful for cancer detection in younger men and men with low PSA levels in the Asian population?'
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Affiliation(s)
- H B Shim
- Department of Urology, Seoul Veterans Hospital, 6-2 Doonchon dong, Kangdong ku, Seoul 134-791, Korea
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18
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Shim HB, Lee JK, Jung TY, Ku JH. Serum prostate-specific antigen as a predictor of prostate volume in Korean men with lower urinary tract symptoms. Prostate Cancer Prostatic Dis 2007; 10:143-8. [PMID: 17199133 DOI: 10.1038/sj.pcan.4500937] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the study was to assess the utility of prostate-specific antigen (PSA) as a predictor of prostate volume indexes (total prostate volume (TPV), transition zone volume and transition zone index) in Korean men with lower urinary tract symptoms (LUTS). From September 2003 to April 2006, 3431 patients with LUTS were included in the study; they had a median age of 63.8 years, a median prostate volume of 22.6 ml and a median serum PSA of 1.04 ng/ml. Men with a baseline PSA of >10 ng/ml were excluded, to reduce the likelihood of including occult prostate cancer. Prostate volume indexes and serum PSA levels had an age-dependent log-linear relationship. Receiver operating characteristic curve analysis showed that PSA had good predictive value for various prostate volume indexes thresholds. The approximate age-specific criteria for detecting men with a TPV of >40 ml are PSA levels of 1.20, 1.44 and 1.72 ng/ml for men with LUTS in their sixth, seventh and eighth decades, respectively. The results show that serum PSA identifies Korean men with large prostates reasonably well. Korean men may produce and/or release more PSA per unit prostate volume than white men. The cutoffs for PSA and prostate volume to response to LUTS therapy should be determined in this population.
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Affiliation(s)
- H B Shim
- Department of Urology, Seoul Veterans Hospital, Seoul, South Korea
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19
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Ku JH, Yeo WG, Kwon TG, Kim HH. Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumors: analysis of surgical aspects based on histological types. Int J Urol 2006; 12:1015-21. [PMID: 16409602 DOI: 10.1111/j.1442-2042.2005.01203.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate whether hormonal functions of the tumor influence the operative results of laparoscopic adrenalectomy, and to analyse the clinical outcomes in patients with various hormonally active adrenal tumors. METHODS Clinical and pathological records of 68 patients were reviewed. The average age of patients was 40 years (range 20-75); 39 were women and 29 men. For the comparison, patients were divided into the non-functioning tumor group (n = 22) and the functioning tumor group (n = 46). RESULTS All laparoscopic adrenalectomies were finished successfully, and no open surgery was necessary. The median operative time and blood loss in the two groups were similar; however, in subgroup analysis, operative time for pheochromocytoma was significantly longer than that for non-functioning tumor (P = 0.044). No difference was noted in intra- and postoperative data between the groups. Of the 22 patients with aldosteronoma, 18 (81.8%) became normotensive and no longer required postoperative blood pressure medications. Adrenalectomy led to an overall reduction in the median number of antihypertensive medications (P < 0.001). All patients with Cushing adenoma had resolution or improvement of the signs and symptoms during follow-up periods. There was no evidence of biochemical or clinical recurrence in any patient with pheochromocytoma. CONCLUSION The results of this retrospective review document that laparoscopic adrenalectomy is a safe and effective treatment for functioning as well as non-functioning adrenal tumors, although endocrinologic features may play a significant role.
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Affiliation(s)
- Ja H Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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20
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Paick JS, Lee SC, Ku JH. More effects of extracorporeal magnetic innervation and terazosin therapy than terazosin therapy alone for non-inflammatory chronic pelvic pain syndrome: a pilot study. Prostate Cancer Prostatic Dis 2006; 9:261-5. [PMID: 16683008 DOI: 10.1038/sj.pcan.4500881] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to evaluate whether extracorporeal magnetic innervation (ExMI) combined with alpha-blocker therapy is more effective than alpha-blocker monotherapy for patients with non-inflammatory chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS), category IIIB. Patients were randomized to either terazosin monotherapy (group 1, n=21) or terazosin combined with ExMI therapy (group 2, n=19). Patients in group 2 had 12 treatment sessions of ExMI twice a week during 6 weeks. None of the patients experienced any side effects from treatment. The changes in each domain of the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) measured on week 6 were not significantly different between the groups. However, the difference (median, 25-75th percentiles) between the two groups in total NIH-CPSI scores was -4 (-11.5, -2) for group 1 and -12 (-17.3, -2.3) for group 2, respectively (P=0.047). At 6 weeks, 47.6% (10 of 21) of group 1 had a >25% decrease in total NIH-CPSI compared with 78.9% (15 of 19) of group 2 (P=0.041). Also, more patients in group 2 (78.9%) were rated as responders with a 6-point decrease in NIH-CPSI compared with group 1 (47.6%) (P=0.041). The early results suggest that ExMI combined with alpha-blocker therapy has better effect than alpha-blocker monotherapy for the treatment of CP/CPPS.
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Affiliation(s)
- J-S Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
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21
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Song YS, Song ES, Lee KH, Park YH, Shin WC, Ku JH. Sleep-related nocturnal erections and erections during midazolam-induced sedation in healthy young men. Int J Impot Res 2006; 18:522-6. [PMID: 16541116 DOI: 10.1038/sj.ijir.3901463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study was performed to evaluate the characteristics of penile erection during midazolam-induced sedation after nocturnal sleep deprivation (NSD) and to determine the effect of NSD on erectile episodes in healthy, sexually functional young men. This procedure might possibly prove to be a brief office-based method of assessing whether erectile dysfunction is psychogenic or biogenic. Nineteen volunteers between the ages of 20 and 29 years participated in this study. We measured the morning penile erection after midazolam (3-5 mg) administration intravenously and all subjects completed 42 tests. Of 42 test, 28 tests revealed erectile episodes, whereas no erectile episodes were observed in 14 tests. Nocturnal sleep deprivation rate was significantly higher in tests with erectile episodes than in tests without erectile episode (P=0.030). Test order or duration of test was not different between two test results. Number of erectile episodes (r=0.374, P=0.015), tip radial rigidity (r=0.412, P=0.007), base radial rigidity (r=0.366, P=0.017) and tip tumescence (r=0.447, P=0.003) correlated with the degree of NSD. When we determined whether NSD was discriminative with regard to erectile episodes, the area under the receiver operating characteristic curve was calculated at 0.705 (95% confidence interval, 0.527-0.883; P=0.032) for the possibility of erectile episodes. Nocturnal sleep deprivation might recover the inhibited rapid eye movement sleep during midazolam-induced sedation. Our findings suggest that erection monitoring during midazolam-induced sedation after NSD may be convenient. However, validation of midazolam-induced morning penile tumescence monitoring with a large population is mandatory.
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Affiliation(s)
- Y S Song
- Department of Urology, Soonchunhyang School of Medicine, Seoul, Korea
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22
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Abstract
In addition to androgen, autonomic nerves may be involved in prostatic function. As patients with spinal cord injury (SCI) have impaired innervation of the prostate, the prostate volume and prostate-specific antigen (PSA) level in patients with SCI may be different from those of healthy men. Experiments in rats with SCI indicate that neurogenic factors play an important role in prostate growth and function but the same phenomena may not occur in men with SCI because the current animal models differ from clinical results in humans in several respects. Although many of studies indicate the importance of intact peripheral innervation on the secretory function of the prostate, the effect of more central denervation such as occurs in complete SCI at the cervical, thoracic, or lumbar levels on prostatic function is unclear. In addition, the impact of central nervous system injury on prostatic secretory activity, and consequently on serum PSA levels, is also not clear. Furthermore, the impact of hormonal changes on prostate cancer development and prognosis observed in patients with SCI may also be affected by the level of injury and patient age at the time of injury, which have not been studied. In this article, we review prostate activity and prostate cancer in SCI and discuss how they may relate to neurogenic factors.
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Affiliation(s)
- H B Shim
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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23
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Oh SJ, Shin HI, Paik NJ, Yoo T, Ku JH. Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury. Spinal Cord 2006; 44:757-62. [PMID: 16432529 DOI: 10.1038/sj.sc.3101903] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective, cross-sectional study, based on cases of spinal cord injury (SCI). SETTING Three outpatient medical departments in Seoul, Korea. OBJECTIVES To assess depressive symptoms in patients on clean intermittent catheterization after SCI. METHODS In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18-75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI). RESULTS For patients and controls, the average total BDI scores were 20.3+/-1.0 and 11.4+/-0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42-10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67-12.81, P=0.003) of depression than those who were able to perform self-catheterization. CONCLUSIONS The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.
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Affiliation(s)
- S-J Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis. Spinal Cord 2005; 44:165-9. [PMID: 16151451 DOI: 10.1038/sj.sc.3101825] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective study, based on cases of spinal cord injury (SCI). OBJECTIVES To establish hazard ratios for risk of epididymo-orchitis in SCI. SETTING South Korea. METHODS A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003. RESULTS The average age at which the lesion occurred was 24.8 years old (range, 18-53). The average time since SCI was 16.9 years (range, 1-37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P=0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P=0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26-38.53; P=0.026); however, a history of urethral stricture lost statistical significance (P=0.074). For other variables, no positive association with epididymo-orchitis was observed. CONCLUSIONS In this study, CIC was an independent risk factor for the development of epididymo-orchitis in patients with SCI. In addition, our findings suggest that urethral stricture may be a contributing factor for the development of epididymo-orchitis in these patients. Correct instructions about CIC are of utmost importance.
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Affiliation(s)
- J H Ku
- Department of Urology, Seoul Veterans Hospital, Seoul, Republic of Korea
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Kim SW, Ku JH, Paick JS. 32: Practices for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Nationwide Postal Survey of Urologists in South Korea. J Urol 2005. [DOI: 10.1016/s0022-5347(18)34297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
OBJECTIVE To determine whether diurnal voiding patterns predict nocturia in patients with lower urinary tract symptoms (LUTS), as few studies have evaluated the association between diurnal and nocturnal voiding patterns. PATIENTS AND METHODS We prospectively analysed the frequency-volume charts (FVCs) of consecutive patients with LUTS. At the initial visit patients had a detailed clinical evaluation and subsequently were requested to complete a 72-h FVC. In all, 104 (41 men and 63 women, mean age 63 years, range 50-83) were included in the primary analyses. Associations between daytime variables and nocturia were described using maximum likelihood estimates of the relative risk and by 95% confidence intervals (CIs) based on logistic regression models. RESULTS When at least one night-time void was used to define nocturia the multivariate logistic model showed a negative association of mean daytime voided volume with nocturia (P = 0.001). The odds ratio for nocturia decreased with this variable to 0.98 (95% CI 0.96-0.99). When 'voiding at least twice per night' was used to define nocturia only the number of daytime voids was positively related to nocturia (odds ratio 1.22; 95% CI 1.01-1.48; P= 0.040). CONCLUSION Nocturia may be associated with diurnal voiding patterns; these results also suggest that the causes of nocturia of one or of two or more voids may differ. This highlights the role of bladder function in more severe forms of nocturia.
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Affiliation(s)
- J H Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
A case is reported of anuria and urinary ascites secondary to bilateral ureteropelvic obstruction by fungal balls. Management consisted of bilateral nephrostomy drainage with local irrigation with amphotericin B, and systemic antifungal treatment without surgery. Aspiration by paracentesis was performed for the urinary ascites and continuous drainage through an 8 Fr pig tail catheter for the urinoma. The literature on renal fungus balls in neonates and infants is reviewed.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Seoul, Korea.
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Ku JH, Ahn HC, Kim ME, Lee NK, Park YH. Contralateral hernias or hydroceles in men with unilateral diseases. Acta Paediatr 2003; 92:640-641. [PMID: 12839303 DOI: 10.1080/08035350310011687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
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Abstract
OBJECTIVES To assess the prevalence of circumcision in South Korean young men dwelling in the community, investigate attitudes and perspectives about circumcision, and how they perceive physician involvement in the decision process. METHODS Between May and November 2001, this cross sectional survey was performed. Of 27 202 men aged 20 years dwelling in the community of Choong-chung South Province, 2700 were randomly selected at a 10.0% sampling fraction after a sampling process by census district and a total of 1742 (64.5%) agreed to participate in the study. These subjects completed self administered questionnaires and we included 1674 men (a response rate 62.0%) in the study. RESULTS The overall proportion of circumcised was 1306 (78.0%) and an additional 192 (11.5%) wished to be circumcised later. Circumcision was carried out mostly during their elementary and middle school years. Of men circumcised, the decision whether to circumcise was most often made by their parents. Of the subjects, 75.0% believed that circumcision is necessary, while 2.9% believed it to be unnecessary. Among those who believed circumcision to be necessary, the most common reason was to improve penile hygiene (89.1%). CONCLUSIONS Our results indicate a positive attitude toward circumcision in South Korean men, linking it with hygienic practices. Circumcision in South Korea depends on the perpetuation of cultural beliefs that support it.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Seoul, Korea.
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Abstract
OBJECTIVE To take a different perspective in assessing young men with chronic prostatitis-like symptoms, this study was designed since few prospective studies are available to survey a population of young men. MATERIAL AND METHODS One hundred and fifty men aged 20 years dwelling in the community were randomly selected. Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index and the selfreported scores for pain and urinary symptoms were used to identify chronic prostatitis-like symptoms. The psychological methods used were the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Bem Sex Role Inventory. A total of 87 men (a response rate 58%) completed self-administered questionnaires. RESULTS As the scores for pain and urinary symptoms increased, those for depression increased (p < 0.001 and p = 0.01, respectively). However, the mean scores for state and trait anxiety were not different according to the scores for pain and urinary symptoms. The mean masculinity scores were not different according to the scores for pain but those were significantly different according to the scores of urinary symptoms (p = 0.042). The mean femininity scores were not different according to the scores of pain and urinary symptoms. CONCLUSIONS Our findings suggest that psychological factors, especially depression and weak masculine identity may be associated with an early stage of chronic prostatitis-like symptoms. Young men with chronic prostatitis-like symptoms also have psychological problems.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Taejeon, Korea.
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Abstract
OBJECTIVE To investigate the factors influencing testicular volume in young men in the community. SUBJECTS AND METHODS Between May and November 2001, 2700 men aged 20 years and dwelling in the community were randomly selected at a 10% sampling fraction after a sampling process by census district; 2080 men agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. After excluding those with testicular diseases the study comprised 1792 men. RESULTS There were significant but weak correlations between testicular volumes and height, body weight and body mass index. In a multivariate model, high environmental temperature was associated with a decreased likelihood (odds ratio, OR, 0.42; 95% confidence interval, CI, 0.29-0.60; P < 0.001) of a paired testicular volume being below the 25th percentile of all participants. The likelihood of a low paired testicular volume varied by area, with a 1.6-fold greater risk in men dwelling in large rural areas than in those in major towns. Increasing height was associated with a decreased likelihood (OR 0.60; 95% CI 0.38-0.96; P = 0.032) and low body weight with an increased likelihood of a low paired testicular volume (OR 2.54; 95% CI 1.57-4.12; P < 0.001). CONCLUSION These results establish that demographic and environmental factors have an effect on testicular size and suggest that body size may be important in determining testicular size in late adolescents.
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Affiliation(s)
- J H Ku
- Departments of Urology, Military Manpower Administration, Seoul, and Soonchunhyang University School of Medicine, Pucheon and Chonan, Korea.
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Lee JM, Kim H, Oh MJ, Ku JH, Jang DP, Kim IY, Kim SI. Development of a virtual speaking simulator using Image Based Rendering. Stud Health Technol Inform 2002; 85:258-60. [PMID: 15458098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The fear of speaking is often cited as the world's most common social phobia. The rapid growth of computer technology has enabled the use of virtual reality (VR) for the treatment of the fear of public speaking. There are two techniques for building virtual environments for the treatment of this fear: a model-based and a movie-based method. Both methods have the weakness that they are unrealistic and not controllable individually. To understand these disadvantages, this paper presents a virtual environment produced with Image Based Rendering (IBR) and a chroma-key simultaneously. IBR enables the creation of realistic virtual environments where the images are stitched panoramically with the photos taken from a digital camera. And the use of chroma-keys puts virtual audience members under individual control in the environment. In addition, real time capture technique is used in constructing the virtual environments enabling spoken interaction between the subject and a therapist or another subject.
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Affiliation(s)
- J M Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
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Abstract
OBJECTIVES To investigate the influence of environmental factors on chronic prostatitis-like symptoms among young men in a community. METHODS Of 28,841 men aged 20 years dwelling in the community, a total of 16,321 men (response rate 56.6%) were included in this study. The National Institutes of Health Chronic Prostatitis Symptom Index was used to identify men with chronic prostatitis-like symptoms. The questionnaire also queried sociodemographic characteristics. The Korean Meteorological Administration provided information on the weather of the community. We determined the risk factors of chronic prostatitis-like symptoms among these environmental factors using univariate and multivariate analyses. RESULTS Six percent of the men were identified as having significant prostatitis-like symptoms (perineal and/or ejaculatory pain and a total pain score of 4 or greater). The univariate logistic regression analysis indicated that education level, average duration of sunlight, and average temperature were risk factors for chronic prostatitis-like symptoms. As these variables increased, the scores of chronic prostatitis-like symptoms decreased. In the multivariate model used, the likelihood of chronic prostatitis-like symptoms varied by the final educational level, with middle school and high school graduates having 1.8 and 1.4-fold higher odds, respectively, than men attending college. In the same model, the average duration of sunlight was also an independent risk factor of chronic prostatitis-like symptoms (odds ratio 0.85; 95% confidence interval 0.77 to 0.95; P = 0.003), but the average temperature lost statistical significance. CONCLUSIONS Our findings suggest that the community-based prevalence of chronic prostatitis-like symptoms may be high in young men. Higher education and a longer time in sunlight were associated with a decreased likelihood of chronic prostatitis-like symptoms.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Taejeon, South Korea
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Ku JH, Song YS, Kim ME, Lee NK, Park YH. Is there a role of radial rigidity in the evaluation of erectile dysfunction? Int J Impot Res 2001; 13:200-4. [PMID: 11494075 DOI: 10.1038/sj.ijir.3900674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2000] [Accepted: 02/26/2001] [Indexed: 11/09/2022]
Abstract
RigiScan has been the most widely utilized device for measuring erectile rigidity. However, the use of the RigiScan in the evaluation of erectile dysfunction has questionable because the RigiScan device does not directly determine axial rigidity. The aim of this study is to clarify that radial rigidity measured by RigiScan reflects the intracorporeal pressure and erectile capability efficiently. From January 1998 to May 1999, a total of 23 patients with erectile dysfunction were involved in the study. They were evaluated by RigiScan and duplex ultrasonography after intracorporeal injection of prostaglandin E1. We investigated the relationship between radial rigidity and the resistance index. The results of radial rigidity were also compared with that of the degree of erection. For the entire group, significant correlations were found between radial rigidity and the resistance index (r=0.680, P<0.001 for tip rigidity; r=0.703, P<0.001 for base rigidity). In addition, for 12 patients whose tip rigidity exceeded 60% and for 10 whose base rigidity exceeded 60%, the correlations between radial rigidity and the resistance index remained (r=0.659, P=0.020 for tip rigidity; r=0.759, P=0.011 for base rigidity). Based on the response determined by patients, radial rigidity represented the degree of erection efficiently. Our findings suggest that RigiScan is a useful diagnostic tool. Radial rigidity represents the intracorporeal pressure efficiently and has an acceptable role in the evaluation of erectile dysfunction.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Teajeon, Korea.
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Jo HJ, Ku JH, Jang DP, Shin MB, Ahn HB, Lee JM, Cho BH, Kim SI. The development of the virtual reality system for the treatment of the fears of public speaking. Stud Health Technol Inform 2001; 81:209-11. [PMID: 11317741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The fear of public speaking is a kind of social phobias. The patients having the fear of public speaking show some symptoms like shame and timidity in the daily personal relationship. They are afraid that the other person would be puzzled, feel insulted, and they also fear that they should be underestimated for their mistakes. For the treatment of the fear of public speaking, the cognitive-behavioral therapy has been generally used. The cognitive-behavioral therapy is the method that makes the patients gradually experience some situations inducing the fears and overcome those at last. Recently, the virtual reality technology has been introduced as an alternative method for providing phobic situations. In this study, we developed the public speaking simulator and the virtual environments for the treatment of the fear of public speaking. The head-mounted display, the head-tracker and the 3 dimensional sound system were used for the immersive virtual environment. The imagery of the virtual environment consists of a seminar room and 8 virtual audiences. The patient will speak in front of these virtual audiences and the therapist can control motions, facial expressions, sounds, and voices of each virtual audience.
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Affiliation(s)
- H J Jo
- Department of Biomedical Engineering, College of Medicine, Hanyang University, Seoul, Korea
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Choi YH, Jang DP, Ku JH, Shin MB, Kim SI. Short-term treatment of acrophobia with virtual reality therapy (VRT): a case report. Cyberpsychol Behav 2001; 4:349-54. [PMID: 11710259 DOI: 10.1089/109493101300210240] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Y H Choi
- Department of Psychiatry, Inje University, Seoul Paik Hospital, Seoul, South Korea.
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Abstract
BACKGROUND Computed tomography (CT) has been the most informative imaging method in renal trauma. Despite the good sensitivity of magnetic resonance imaging (MRI) to the presence of hematoma, edema and ischemia, MRI has not been widely studied in patients with renal trauma. The present study was initiated to evaluate the role of MRI in patients with renal trauma. METHODS Between June 1998 and September 1999, CT and MRI were prospectively performed on 12 patients who suffered from renal trauma and the results reviewed. RESULTS The presence and size of perirenal hematoma could be detected by both CT and MRI. Magnetic resonance imaging could differentiate intrarenal hematoma from perirenal hematoma more accurately, and provided additional information about the hematoma as T1- and T2-weighted MRI were able to determine recent bleeding in the hematoma by regional differences in signal intensity. Magnetic resonance imaging clearly revealed renal fracture with non-viable fragment and detected focal renal laceration that was not detected on CT due to perirenal hematoma associated with renal infarction. However, although MRI had many advantages over CT, it had also major drawbacks, which were that it required longer imaging time and increased the cost. CONCLUSIONS Magnetic resonance imaging may be useful in renal trauma. However, it is suggested that MRI should be limited to carefully selected patients, such as those with severe renal injury or equivocal findings on CT.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Taejeon, Seoul, Korea.
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Abstract
We surveyed the prevalence of chronic prostatitis-like symptoms in young men using the National Institutes of Health (NIH) Chronic Prostatitis Symptom Index (CPSI) and determined the clinical validity of the NIH-CPSI among men in the community. Of 29,017 men aged 20 years dwelling in the community, 8,705 men were randomly selected at a 30.0% sampling fraction and a total of 6,940 men (a response rate 79.7%) completed a self-administered questionnaire. Six percent reported having pain or discomfort in more than one area . About 5% did not feel that the bladder emptied fully after urinating more than 1 time in 5 and 10.5% had to urinate again within 2 h more than 1 time in 5. As the scores for pain or discomfort increased, those for urinary symptoms and impact on quality of life increased (P < 0.001; Armitage test). As the scores for urinary symptoms increased, those for pain or discomfort and impact on quality of life also increased (P < 0.001; Armitage test). The community-based prevalence of chronic prostatitis-like symptoms were found to be high in young men as well as in older men. Our findings indicate that men with pain or urinary symptoms experience a negative impact on their quality of life and the NIH-CPSI provides a valid measure for the general population.
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Affiliation(s)
- J H Ku
- Military Manpower Administration, Taejeon, Korea.
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Abstract
A case of infected hydrocele in a neonate is presented. We describe this unusual condition, and discuss the diagnosis, pathophysiology and treatment.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Taejeon, Korea
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Abstract
OBJECTIVE To assess the results of the excision, plication and internal drainage techniques for hydrocele repair. PATIENTS AND METHODS Between January 1990 and June 1998, 132 patients (mean age 54.36 years, range 16-83) underwent repair for idiopathic hydrocele using one of three techniques (excision, eversion/plication or internal drainage); the complication and recurrence rates of each technique were evaluated. RESULTS The excisional technique resulted in the highest complication rate (81%) and the internal drainage technique the lowest (7%). Postoperative scrotal oedema occurred in 74% of patients after plication and this was the highest rate among the techniques (P < 0.001). Differences in the rates of wound infection and haematoma among the three techniques were not statistically significant. The internal drainage technique had the highest recurrence rate (85%) and the excisional technique the lowest (1.3%; P < 0.001). CONCLUSIONS Although useful, the internal drainage technique has a high recurrence rate and we suggest abandoning its use for hydrocele repair. The present results suggest that plication is better than excision, causing fewer complications, and better than internal drainage, as the results are more favourable.
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Affiliation(s)
- J H Ku
- Department of Urology, Military Manpower Administration, Taejon, Korea.
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Abstract
PURPOSE Perineal ectopic testis is seen very rarely and here we report on two patients with perineal ectopic testis. METHODS/RESULTS We experienced two cases of perineal ectopic testis on which orchiopexies to the corresponding hemiscrotums were performed. CONCLUSIONS On surgical exploration, the gubernaculum testes were found to lie fixed to the perineum.
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Affiliation(s)
- J H Ku
- Department of Urology, Soonchunhyang University Medical School, Chonan, Korea
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Abstract
We analyzed the peripheral blood of patients with gastrointestinal tract cancer at different stages to assess the presence of carcinoembryonic antigen (CEA) mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR), which we used as an indicator for micrometastatic malignant cells. A total of 35 gastric, 24 colorectal, 4 esophageal and 4 biliary tract cancer patients and nine normal healthy subjects were studied. No CEA mRNA was detected in the nine normal healthy volunteers. CEA mRNA was detected in 100% (10/10) of metastatic, 33.3% (3/9) of early gastric cancer (EGC), and 18.8% (3/16) resectable gastric cancer patients, respectively. In colorectal cancer, 55.6% (5/9) of metastatic cancers were positive for CEA mRNA, and 26.7% (4/15) Duke stage B/C showed positive. One patient with stage III gastric cancer who was negative CEA mRNA initially and turned positive during follow-up, developed multiple bone metastasis one month later. Another stage III patient, who was positive for CEA mRNA, preoperatively revealed early relapse in two months. These results suggest that the identification of circulating tumor cells using RT-PCR for the detection of CEA mRNA is feasible and this analysis may be a promising tool for early detection of micrometastatic circulating malignant cells in patients with gastrointestinal tract cancer.
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Affiliation(s)
- Y H Noh
- Department of Biochemistry, Kunkuk University, College of Medicine, Chungju, Korea
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Abstract
OBJECTIVE To evaluate the effect of interferon-alpha2B on mumps orchitis, often caused by postpubertal mumps and which can result in permanent testicular atrophy. PATIENTS AND METHODS The study included 21 patients with mumps orchitis, treated between May 1990 and June 1997. Patients were randomly assigned into two groups: in group 1, 13 patients received therapy with interferon-alpha2B (3 x 10(6) IU per day) and group 2 did not, acting as controls. All were evaluated by measurements of testis size, mumps virus titre, hormone level and semen analysis. RESULTS In group 1, the patients' symptoms resolved within 2-3 days and the volume of the testes returned to normal within 11 days; there was no testicular atrophy in any patient during the follow-up. However, asthenospermia continued to be detected in four patients (unilateral in two, bilateral in two). In group 2, the patients' symptoms resolved within 5-6 days and the volume of the testes returned to normal within 10 days; testes atrophied in three patients (unilateral in two, bilateral in one) during the follow-up. Asthenospermia continued in four patients (unilateral in two, bilateral in two). CONCLUSION These results suggest that treatment with systemic interferon-alpha2B is effective in preventing testicular atrophy when combined with standard symptomatic treatment.
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Affiliation(s)
- J H Ku
- Department of Urology, Soonchunhyang University of Medicine, Chonan, Korea
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Abstract
OBJECTIVES The molecular mechanisms that regulate cardiomyocyte cell cycle and terminal differentiation in humans remain largely unknown. To determine which cyclins, cyclin dependent kinases (CDKs) and cyclin kinase inhibitors (CKIs) are important for cardiomyocyte proliferation, we have examined protein levels of cyclins, CDKs and CKIs during normal atrial development in humans. METHODS Atrial tissues were obtained in the fetus from inevitable abortion and in the adult during surgery. Cyclin and CDK proteins were determined by Western blot analysis. CDK activities were determined by phosphorylation amount using specific substrate. RESULTS Most cyclins and CDKs were high during the fetal period and their levels decreased at different rates during the adult period. While the protein levels of cyclin D1, cyclin D3, CDK4, CDK6 and CDK2 were still detectable in adult atria, the protein levels of cyclin E, cyclin A, cyclin B, cdc2 and PCNA were not detectable. Interestingly, p27KIP1 protein increased markedly in the adult period, while p21CIP1 protein in atria was detectable only in the fetal period. While the activities of CDK6, CDK2 and cdc2 decreased markedly, the activity of CDK4 did not change from the fetal period to the adult period. CONCLUSION These findings indicate that marked reduction of protein levels and activities of cyclins and CDKs, and marked induction of p27KIP1 in atria, are associated with the withdrawal of cardiac cell cycle in adult humans.
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Affiliation(s)
- W H Kim
- Department of Obstetrics and Gynecology, Chonbuk National University Medical School, Chonju, Korea
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Ku JH, Nemanich RJ. Surface electronic structure of clean and hydrogen-chemisorbed SixGe1-x alloy surfaces. Phys Rev B Condens Matter 1996; 54:14102-14110. [PMID: 9985333 DOI: 10.1103/physrevb.54.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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