Dongtan Sacred Heart Hospital

Hwaseong, South Korea

Dongtan Sacred Heart Hospital

Hwaseong, South Korea

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Choo M.S.,Dongtan Sacred Heart Hospital | Kim M.,Asan Medical Center | Ku J.H.,Seoul National University | Kwak C.,Seoul National University | And 2 more authors.
Annals of Surgical Oncology | Year: 2017

Background: We evaluated the effect of the extent of pelvic lymph node dissection (PLND) on oncological and functional outcomes in patients with intermediate- to high-risk prostate cancer (PCa) by conducting a systematic review and meta-analysis. Methods: Two independent researchers performed a systematic review of radical prostatectomy (RP) with extended PLND (ePLND), and RP with standard (sPLND) or limited PLND (lPLND) in patients with PCa using the PubMed, EMBASE, and Cochrane Library databases and using the terms ‘prostatectomy’, ‘lymph node excision’, and ‘prostatic neoplasm’. The primary outcome was biochemical-free survival, which was analyzed by extracting survival data from the published Kaplan–Meier (KM) curves. In addition, we obtained summarized survival curves by reconstructing the KM data. Secondary outcomes of the recovery of erection and continence were also analyzed. Results: Nine studies involving over 1554 patients were included, one of which was a randomized controlled trial. The pooled analysis showed a significant difference in biochemical recurrence between ePLND and sPLND (hazard ratio 0.71, 95% confidence interval 0.56–0.90, p = 0.005), with no significant between-study heterogeneity (I2 = 37%). From the summary survival curves, it can be observed that the curves for the two groups diverged more and more as a function of time. From the analyses of functional outcomes including only three studies, no statistically significant differences in the recovery of erectile function and continence were observed. No evidence of significant publication bias was found. Conclusions: In patients with PCa, ePLND could be an oncological benefit; however, a functional compromise cannot be determined. © 2017 Society of Surgical Oncology


PubMed | Dongtan Sacred Heart Hospital, Boramae Medical Center, Gachon University, Dongguk University and Seoul National University
Type: Journal Article | Journal: International neurourology journal | Year: 2014

To identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding.We identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding).The mean prostate volume was 65.131.5 mL, and the mean prostate-specific antigen (PSA) level was 3.693.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 oclock positions in the proximal prostate. The average number of bleeding arteries was 12.17.9 per procedure, and 1.931.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels.During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 oclock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.


PubMed | Soonchunhyang University, Ajou University, Korea University, Chungbuk National University and 3 more.
Type: Journal Article | Journal: Gut and liver | Year: 2015

Various anatomical features of the biliary tree affect ability to remove difficult common bile duct (CBD) stones. In this study, we evaluated the clinical characteristics and outcomes of the endoscopic treatment of stones in stemware-shaped CBDs.Thirty-four patients with a stone and a stemware-shaped CBD who were treated at different tertiary referral centers from January 2008 to December 2012 were studied retrospectively. When stone removal failed, percutaneous or direct peroral cholangioscopic lithotripsy, endoscopic retrograde biliary drainage, or surgery was performed as a second-line procedure.The overall success rate of the first-line procedure was 41.2%. Five of the 34 patients (14.7%) experienced procedure-related complications. No procedure-related mortality occurred. Mechanical lithotripsy was required to completely remove stones in 13 patients (38.2%). Conversion to a second-line procedure was required in 20 patients (58.8%). Mechanical lithotripsy was needed in 75% and 66.7% of those with a stone size of <1 cm or 1 cm, respectively. Stone recurrence occurred in two patients (9.1%) after 6 months and 27 months, respectively.The endoscopic treatment of stones in a stemware-shaped CBD is challenging. The careful assessment of difficult CBD stones is required before endoscopic procedures.


Kang M.,Seoul National University | Kim M.,Seoul National University | Choo M.S.,Dongtan Sacred Heart Hospital | Bae J.,Dongguk University | And 3 more authors.
Urology | Year: 2014

Objective To ascertain the association of cystourethroscopic findings of bladder neck elevation with urodynamic bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS-BPH). Materials and Methods Study subjects were 646 consecutive men aged >40 years diagnosed with LUTS-BPH at Seoul National University Hospital from December 2005 through January 2012. We collected the International Prostatic Symptom Score, serum prostate-specific antigen levels, prostate volume measured by transrectal ultrasonography, uroflowmetry with postvoid residual volume, and urodynamics with a pressure flow study. We examined the degree of lateral lobe protrusion of prostate, bladder neck elevation degree (BNE-D), and bladder neck elevation angle (BNE-A) under a cystourethroscopic examination. Results When we examined BNE by cystourethroscope, the mean BNE-A was 26.1°. Higher BNE-D was strongly positively correlated with BNE-A, but neither was associated with the degree of lateral lobe protrusion of prostate. Patients with higher BNE-A (≥35°) had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). BNE-A was positively correlated with BOO index (r = 0.186). However, we identified only total prostate volume (odds ratio [OR], 1.036), maximal flow rate (Qmax; OR, 0.843), and detrusor pressure at Qmax (PdetQmax; OR, 1.278) as significant predictors of BOO in the multivariate analysis. Conclusion In sum, patients with higher BNE-A (≥35°) by cystourethroscope had higher BOO index and more obstructed voiding patterns than those with lower BNE-A (<35°). Moreover, both BNE-D and BNE-A were positively correlated with BOO index. Thus, cystourethroscopic findings of BNE status can be helpful to predict urodynamic BOO in the patients with LUTS-BPH. © 2014 Elsevier Inc.


PubMed | Seoul National University, Gachon University, Chungbuk National University, Yonsei University and 5 more.
Type: Journal Article | Journal: PloS one | Year: 2016

Gestational hypertensive diseases (GHD) and gestational diabetes mellitus (GDM) increase the risk of cardiovascular disease (CVD) later in life. However, the association between gestational medical diseases and familial history of CVD has not been investigated to date. In the present study, we examined the association between familial history of CVD and GHD or GDM via reliable questionnaires in a large cohort of registered nurses.The Korean Nurses Survey was conducted through a web-based computer-assisted self-interview, which was developed through consultation with cardiologists, gynecologists, and statisticians. We enrolled a total of 9,989 female registered nurses who reliably answered the questionnaires including family history of premature CVD (FHpCVD), hypertension (FHH), and diabetes mellitus (FHDM) based on their medical knowledge. Either multivariable logistic regression analysis or generalized estimation equation was used to clarify the effect of positive family histories on GHD and GDM in subjects or at each repeated pregnancy in an individual.In this survey, 3,695 subjects had at least 1 pregnancy and 8,783 cumulative pregnancies. Among them, 247 interviewees (6.3%) experienced GHD and 120 (3.1%) experienced GDM. In a multivariable analysis adjusted for age, obstetric, and gynecologic variables, age at the first pregnancy over 35 years (adjusted OR 1.61, 95% CI 1.02-2.43) and FHpCVD (adjusted OR 1.60, 95% CI 1.16-2.22) were risk factors for GHD in individuals, whereas FHH was not. FHDM and history of infertility therapy were risk factors for GDM in individuals (adjusted OR 2.68, 95% CI 1.86-3.86; 1.84, 95% CI 1.05-3.23, respectively). In any repeated pregnancies in an individual, age at the current pregnancy and at the first pregnancy, and FHpCVD were risk factors for GHD, while age at the current pregnancy, history of infertility therapy, and FHDM were risk factors for GDM.The FHpCVD and FHDM are significantly associated with GHD and GDM, respectively. Meticulous family histories should be obtained, and women with family histories of these conditions should be carefully monitored during pregnancy.


Choo M.S.,Dongtan Sacred Heart Hospital | Jeong C.W.,Seoul National University | Kwak C.,Seoul National University | Kim H.H.,Seoul National University | Ku J.H.,Seoul National University
Clinical Genitourinary Cancer | Year: 2015

Background The aim of the present study was to evaluate the effect of differences between the sexes on the prognosis of urothelial carcinoma after adjusting for other factors by using propensity score matching. Patients and Methods Between 2000 and 2011, 678 consecutive patients who had undergone radical cystectomy or radical nephroureterectomy for urothelial carcinoma were enrolled in this study. Propensity score methodology was used to adjust for selection bias with 10 and 12 perioperative variables for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). By a 2:1 male-to-female patient matching ratio, we selected 38 and 66 pairs of patients with UCB and UTUC. Results The number of male patients was 573 (84.5%), and there were 105 female patients (15.5%). The mean follow-up was 55.5 ± 38.4 months. There were no significant differences in the perioperative variables of age, pathologic T (pT) stage, grade, lymphovascular invasion (LVI), and concomitant carcinoma in situ (CIS) between the sexes. Neither cancer-specific survival (CSS) or overall survival (OS) was associated with sex in a multivariate Cox proportional hazard model. In propensity score matching analysis, female sex was not an independent risk factor for CSS and OS in urothelial carcinoma. In patients with UCB, body mass index (BMI) and pT stage were independently associated with CCS. For the patients with UTUC, age, pT stage, LVI, adjuvant chemotherapy, bladder cuffing, and location were significantly correlated. Conclusion After adjusting for other risk factors with propensity score matching, female sex may not be an independent risk factor in prognosis for urothelial carcinoma (UC). © 2015 Elsevier Inc. All rights reserved.


Kang M.,Seoul National University | Kim M.,Asan Medical Center | Choo M.S.,Dongtan Sacred Heart Hospital | Paick J.-S.,Seoul National University | Oh S.-J.,Seoul National University
Urology | Year: 2016

Objective To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size. Materials and Methods We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (≤30 mL), moderately enlarged (31-80 mL), and large prostate (≥81 mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings. Results Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r = 0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate. Conclusion BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates. © 2016 Elsevier Inc. All rights reserved.


PubMed | Dongtan Sacred Heart Hospital and Seoul National University
Type: Journal Article | Journal: Clinical genitourinary cancer | Year: 2015

The aim of the present study was to evaluate the effect of differences between the sexes on the prognosis of urothelial carcinoma after adjusting for other factors by using propensity score matching.Between 2000 and 2011, 678 consecutive patients who had undergone radical cystectomy or radical nephroureterectomy for urothelial carcinoma were enrolled in this study. Propensity score methodology was used to adjust for selection bias with 10 and 12 perioperative variables for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC). By a 2:1 male-to-female patient matching ratio, we selected 38 and 66 pairs of patients with UCB and UTUC.The number of male patients was 573 (84.5%), and there were 105 female patients (15.5%). The mean follow-up was 55.5 38.4 months. There were no significant differences in the perioperative variables of age, pathologic T (pT) stage, grade, lymphovascular invasion (LVI), and concomitant carcinoma in situ (CIS) between the sexes. Neither cancer-specific survival (CSS) or overall survival (OS) was associated with sex in a multivariate Cox proportional hazard model. In propensity score matching analysis, female sex was not an independent risk factor for CSS and OS in urothelial carcinoma. In patients with UCB, body mass index (BMI) and pT stage were independently associated with CCS. For the patients with UTUC, age, pT stage, LVI, adjuvant chemotherapy, bladder cuffing, and location were significantly correlated.After adjusting for other risk factors with propensity score matching, female sex may not be an independent risk factor in prognosis for urothelial carcinoma (UC).


PubMed | Dongtan Sacred Heart Hospital, Asan Medical Center and Seoul National University
Type: | Journal: Urology | Year: 2016

To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size.We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (30mL), moderately enlarged (31-80mL), and large prostate (81mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings.Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r = 0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate.BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates.


PubMed | Dongtan Sacred Heart Hospital and Hanyang University
Type: Journal Article | Journal: Academic radiology | Year: 2014

To propose a useful computed tomography (CT) criterion, the diameter with compression (DWC), especially in appendices with borderline diameters.We retrospectively collected 216 patients with visible appendices on CT after clinicopathologic confirmation of appendicitis. Each CT criterion of appendicitis was evaluated by an experienced abdominal radiologist: maximal outer diameter (MOD), DWC, mural thickness and enhancement, periappendiceal infiltration, and appendicolith. DWC is the expected diameter after deduction of the intraluminal compressible contents such as air and feces. All the CT criteria were compared in the appendicitis and nonappendicitis group.The areas under the receiver operating characteristic curve (AUC) of the MOD and the DWC were 0.967 and 0.973, respectively. The optimal cutoff value was 8.2mm for the MOD and 6.6mm for the DWC. Twenty-five of the 80 appendicitis patients (31.2%) and 62 of the 136 nonappendicitis patients (45.6%) had MODs between 5.7mm and 9.8mm in the overlap between the two groups. In this overlap, the AUC of the MODs declined sharply to 0.767, whereas the AUC of the DWCs remained 0.923. Use of the criterion of DWC >6.6mm yielded a sensitivity of 84.0%, a specificity of 88.7%, and an accuracy of 87.4%. There were no other criteria with both sensitivity and specificity >80% in the range of overlap.The proposed CT criterion of the DWC is not affected by normal distension or periappendiceal inflammation but only by true appendicitis. Therefore, DWC can improve the diagnostic performance of appendicitis regardless of the MOD.

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