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1 2015 년도대한비뇨기과학회통합학술대회 The Korean Urological Congress and Expo: 2015 KUCE 일자 : 2015년 4월 11일 ( 토 ) ~ 12일 ( 일 ) 장소 : 부산벡스코 (BEXCO) Program Abstracts Book The Korean Urological Association

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3 2015 KUCE 대한비뇨기과학회통합학술대회 Contents 인사말 V 임원명단 VI 초록심사위원명단 VIII Program IX - 전체일정표 X 년 4월 11일 ( 토 ) XII 년 4월 12일 ( 일 ) XV 학회장안내도 XVII 부스배치도 / 의료기기및의료품전시회사 XVIII Abstracts 1 특별강좌 17 Poster Session 29 전공의연수강좌 87 Index Author Index Keyword Index 146 온라인전공의수첩설명회 :20 ~ 09:40 부산 BEXCO 강의실 C ( ) KUCE 전공의연수강좌 :40 ~ 12:00 부산 BEXCO 강의실 C ( ) 학술위원회워크샵 :00 ~ 13:00 부산 BEXCO 강의실 (206-1) KJU 워크샵 "KJU 심사길라잡이 " :10 ~ 14:00 부산 BEXCO 강의실 C ( ) KUCE 특별강좌 :00 ~ 15:00 부산 BEXCO 강의실 A (205) 수련실태조사위원보수교육 :20 ~ 15:10 부산 BEXCO 강의실 B ( 통합 ) 2014 년대한비뇨기과학회-아스텔라스공동연구결과발표회 :00 ~ 14:20 부산 BEXCO 강의실 C ( ) 연구위원회워크샵 :20 ~ 16:20 부산 BEXCO 강의실 C ( ) 2015 KUCE 정기평의원회 :00 ~ 18:00 부산 BEXCO 1층 ( ) 수련병원과장회의 :00 ~ 09:00 부산 BEXCO 강의실 B ( 통합 ) 미래전략위원회워크샵 :00 ~ 10:30 부산 BEXCO 강의실 C ( ) 보험정책워크샵 :00 ~ 12:00 부산 BEXCO 강의실 A (205) 지도전문의교육 ( 학회주최 ) :00 ~ 12:00 부산 BEXCO 강의실 B ( 통합 ) III

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5 인사말 존경하는대한비뇨기과학회회원여러분 활기차고향그러운봄날, 항도부산에서여러분들을다시만나게되어대단히기쁘게생각합니다. 회원여러분의희생과학회에대한애정으로우리는지난해전공의의정원을파격적으로감축하는총정원제를스스로도입하였고, 학회는위기를오히려기회로삼으려고보험관련협상을적극적으로임하고있는한편, 우리의영역을강화하기위한여러사업들을진행하고있습니다. 미약하나마전공의충원율에서도의미있는향상이있었습니다. 비뇨기과를감싸고있던그어두움의장막이서서히거두어지길고대합니다. 금년있었던대한의학회총회에서대한비뇨기과학회는대한의학회에가입된 158개의회원학회들중만점으로최우수학회로인정받아수상을하기도하였습니다. KUCE를비롯한비뇨기과학회에서진행되는모든학술대회와행사에회원여러분의적극적인참여와지지가있었기때문이라고생각합니다. 올해로다섯번째를맞는 KUCE는전문의와전공의교육과정을묶은효율적인교육의공간이자비뇨기과의하나됨을이루기에부족함이없는공간이될것입니다. 부디각분과학회에서준비한학술적축제를즐기시고, 더불어회원들에게실질적인도움이되도록학회가야심차게준비한특별강좌와보험정책워크샵, 그리고연구위원회와미래전략위원회의위크샵을통해어려운시기를헤쳐나갈지혜를모으는유익한교류의시간이되었으면합니다. 행사를준비해주신모든위원님들께깊이감사드리며, 회원여러분의활발한참여를기대합니다 년 4 월 대한비뇨기과학회회장주명수 V

6 임원명단 회장주명수 명예회장 이춘용 직전회장 부회장 ( 비뇨기과의사회 ) 한상원 신명식 부회장 ( 보험 )/ 보험정책사업단장 이영구 국제교류사업단장성경탁 미래전략사업단장이형래 총무이사이규성 보험이사민승기 기획이사곽철 연구이사이지열 학술이사홍준혁 수련이사이상돈 고시이사김준철 국제교류이사김장환 법제이사조원열 재무이사박홍석 홍보이사서주태 정보이사김대경 간행이사권동득 대외협력이사권태균 개원발전이사어홍선 Editor in Chief, KJU 박광성 진료지침개발위원회양상국 부총무고영휘 부총무정병창 재단사무국장윤석중 재단사무부국장정인갑 평의원회 강주호 ( 안동성소병원 ) 박광성 ( 전남대학교병원 ) 이정구 ( 고려의대안암병원 ) 고영휘 ( 영남대학교병원 ) 박용진 ( 박비뇨기과 ) 이정주 ( 부산대학교병원 ) 고우진 ( 국민건강보험공단일산병원 ) 박종관 ( 전북대학교병원 ) 이정훈 ( 새봄비뇨기과 ) 곽철 ( 서울대학교병원 ) 박홍석 ( 고려의대구로병원 ) 이종복 ( 국립중앙의료원 ) 권동득 ( 화순전남대학교병원 ) 변석수 ( 분당서울대학교병원 ) 이지열 ( 가톨릭의대서울성모병원 ) 권태균 ( 경북대학교병원 ) 서주태 ( 관동의대제일병원 ) 이택 ( 인하대학교병원 ) 김광진 ( 연세원주기독병원 ) 성경탁 ( 동아대학교병원 ) 이형래 ( 강동경희대학교병원 ) 김대경 ( 을지대학교병원 ) 성도환 ( 인하대학교병원 ) 장석흔 ( 분당제생병원 ) 김덕윤 ( 대구가톨릭대학교병원 ) 성인기 ( 성비뇨기과의원 ) 전상현 ( 울산대병원 ) 김세웅 ( 가톨릭의대서울성모병원 ) 송기학 ( 충남대학교병원 ) 전성수 ( 성균관의대삼성서울병원 ) 김영식 ( 국민건강보험공단일산병원 ) 송병주 ( 한솔비뇨기과 ) 정병창 ( 성균관의대삼성서울병원 ) 김용태 ( 한양대학교병원 ) 송윤섭 ( 순천향대학교병원 ) 정병하 ( 연세의대영동세브란스병원 ) 김장환 ( 연세의대신촌세브란스병원 ) 송재만 ( 연세원주기독병원 ) 정재용 ( 인제의대서울백병원 ) 김종현 ( 미즈메디병원 ) 신동길 ( 부산대학교병원 ) 정재일 ( 인제의대부산백병원 ) 김준철 ( 가톨릭의대부천성모병원 ) 신명식 ( 명비뇨기과 ) 정태영 ( 중앙보훈병원 ) 김태형 ( 중앙대학교병원 ) 양상국 ( 건국대학교충주병원 ) 정희창 ( 영남대학교병원 ) 김현우 ( 가톨릭의대성바오로병원 ) 어홍선 ( 어비뇨기과 ) 조원열 ( 동아대학교병원 ) 김현회 ( 서울대학교병원 ) 오승준 ( 서울대학교병원 ) 조진선 ( 한림의대평촌성심병원 ) 김형곤 ( 건국대학교병원 ) 유정우 ( 타워비뇨기과 ) 주관중 ( 성균관의대강북삼성병원 ) 김형지 ( 단국대학교병원 ) 윤석중 ( 충북대학교병원 ) 주명수 ( 울산의대서울아산병원 ) 김형진 ( 전북대학교병원 ) 이경섭 ( 동국의대경주병원 ) 천준 ( 고려의대안암병원 ) 김홍섭 ( 건국의대충주병원 ) 이규성 ( 성균관의대삼성서울병원 ) 최성 ( 고신대학교병원 ) 나용길 ( 충남대학교병원 ) 이동수 ( 고려에이스비뇨기과 ) 최영득 ( 연세의대신촌세브란스병원 ) 노준 ( 조선대학교병원 ) 이동현 ( 이화의대목동병원 ) 최종보 ( 아주대학교병원 ) 류동수 ( 성균관의대삼성창원병원 ) 이동환 ( 가톨릭의대인천성모병원 ) 한상원 ( 연세의대신촌세브란스병원 ) 명순철 ( 중앙대학교병원 ) 이상곤 ( 한림의대춘천성심병원 ) 한창희 ( 가톨릭의대의정부성모병원 ) 문두건 ( 고려의대구로병원 ) 이상돈 ( 양산부산대학교병원 ) 허정식 ( 제주대학교병원 ) 민권식 ( 인제의대부산백병원 ) 이선주 ( 경희대학교병원 ) 현재석 ( 경상대학교병원 ) 민승기 ( 국립경찰병원 ) 이영구 ( 한림의대강남성심병원 ) 홍준혁 ( 울산의대서울아산병원 ) 이상 87명성명가, 나, 순 VI

7 지회 세부전공학회 강원지회장 송재만 대한남성과학회장 김세웅 대구경북지회장 김덕윤 대한비뇨기종양학회장 김형진 대전충청지회장 박용진 소아비뇨기과학회장 조원열 부산경남지회장 성인기 대한배뇨장애요실금학회장 김준철 서울지회장 정재용 내비뇨기과학회장 권태균 인천경기지회장 이동환 전립선학회장 정재일 제주지회장 허정식 요로생식기감염학회장 이선주 호남지회장 박광성 비뇨기초음파학회장 이경섭 기초의학연구회장 이규성 대한비뇨기과의사회 신명식 요로생식기손상재건연구회장 송기학 노인비뇨기요양연구회장 김형지 감사 인사위원회 김영곤, 김천일 위원장 : 주명수위원 : 신명식, 이규성, 조원열, 박홍석, 김영곤, 김천일, 정태영, 이택, 정병창 총무위원회 위원장 : 이규성 위원 : 윤석중, 정인갑, 고영휘, 정병창 보험위원회 위원장 : 민승기 간사 : 조영삼 위원 : 김상진, 김성식, 김영식, 류동수, 박민구, 박성열, 박형근, 방우진, 손환철, 양승옥, 오진규, 이용성, 이용식, 이창호, 장영섭, 정하범, 조정호, 주관중, 최우석, 최훈, 한준현, 한창희 국제교류위원회 위원장 : 김장환 간사 : 홍성규 위원 : 구교철, 김계환, 김태환, 김진욱, 김홍욱, 송채린 기획위원회 위원장 : 곽철 간사 : 정창욱 위원 : 김형준, 나웅, 두진경, 백승, 소민우, 송상훈, 전성수, 정진우, 조성용, 화정석 연구위원회 위원장 : 이지열 간사 : 변석수 위원 : 강택원, 류지간, 박용현, 이승욱, 이승주, 이효석, 전황균, 홍성후 학술위원회 위원장 : 홍준혁 간사 : 구자현 위원 : 김선옥, 김선일, 김수동, 박승철, 박현준, 백민기, 백성현, 서성일, 송상훈, 유은상, 이민호, 이상철, 임동훈, 임영재, 정영범, 정재영, 조민철, 하홍구, 한웅규 수련위원회 위원장 : 이상돈 간사 : 정재민 위원 : 김기호, 김명기, 박관진, 박재영, 서호경, 손정환, 우승효, 이승환, 정승일, 하유신 고시위원회 위원장 : 김준철 간사 : 최종보 위원 : 강석호, 박관진, 신동길, 유창희, 이동현, 이창호, 조강수, 한덕현, 한창희, 홍범식, 황의창 법제위원회 위원장 : 조원열 간사 : 김태효 위원 : 강성구, 김성철, 김장한, 노준화, 도성훈, 문경현, 박흥재, 우승효, 이동현, 조인창 재무위원회 위원장 : 박홍석 간사 : 윤종현 위원 : 김은탁, 박성우, 유호송, 윤석중, 이승환, 정인갑, 함원식 홍보위원회 위원장 : 서주태 간사 : 배재현 위원 : 김수진, 김재헌, 김종욱, 김현우, 문기혁, 양상국, 어홍선, 오철영, 윤하나, 이동기, 장인호, 정경진, 정재홍, 최경화, 황진철 정보위원회 위원장 : 김대경 간사 : 조대연 위원 : 조문기, 서영진, 유동훈, 이상욱, 이재환, 이승배, 정홍 간행위원회 위원장 : 권동득 간사 : 정호석 위원 : 강동일, 고준성, 김두상, 김성철, 김태남, 김태범, 박성진, 여정균, 오미미, 유은상, 이신영, 임재성, 정병수 대외협력위원회 위원장 : 권태균 간사 : 유창희 위원 : 박성찬, 박재홍, 박진성, 송승훈, 이성호, 하윤석, 황진철 개원발전위원회 위원장 : 어홍선 간사 : 노중석 위원 : 김용우, 김진호, 노세경, 박병대, 정기욱 보험정책사업단 단장 : 이영구 간사 : 한준현 1 보건정책대응기획위원회 위원장 : 김태형 / 간사 : 박민구 / 위원 : 정태영, 조규선, 장인호, 조강수, 김용준 2 의협 / 심평원대책위원회 위원장 : 주관중 / 위원 : 김영식, 조정호, 이용석, 오진규, 최우석 국제교류사업단 단장 : 성경탁 미래전략사업단 단장 : 이형래 간사 : 백성현 1 비뇨배상연구회 위원장 : 허정식 / 간사 : 박경기 / 위원 : 유현욱, 하홍구, 손환철, 유구한, 최석환, 한덕현 2 병원위원회 위원장 : 김종현 / 간사 : 윤종민 / 위원 : 이웅희, 김용수, 강주호, 정한수, 이준민, 김성주 3 진료영역회복창출위원회 위원장 : 이승주 / 간사 : 방우진 / 위원 : 박현준, 이민호, 유영근 KJU 위원장 : 박광성 간사 : 양대열 위원 : 강석호, 강정윤, 강택원, 구자현, 권태균, 김계환, 김대경, 김원재, 나군호, 류지간, 명순철, 박현준, 서일영, 손환철, 양상국, 오승준, 유호송, 윤석중, 이규성, 이승욱, 이승주, 이원기, 이지열, 이혜영, 전승현, 전황균, 조원열, 최종보, 한웅규, 홍성규, 홍준혁 진료지침위원회 위원장 : 양상국 간사 : 문경현 위원 : 김기호, 김재헌, 김태범, 김희열, 류지간, 양승옥, 여정균, 유은상, 이승욱, 장영섭, 정재민, 정재흥, 조강수, 최우석, 이영숙, 이신영 VII

8 초록심사위원명단 홍준혁 구자현 김선옥 김선일 김수동 박승철 박현준 백민기 백성현 서성일 송상훈 유은상 이민호 이상철 임동훈 임영재 정영범 정재영 조민철 하홍구 한웅규 2015 년도제 67 차학술대회안내 2015년도제67차대한비뇨기과학회학술대회는 2015년 11월18일부터 20일까지 The.K Hotel Seoul에서개최합니다 년도제 67 차대한비뇨기과학회학술대회 일자 : 2015년 11월 18일 ( 금 )~20일( 일 ) 장소 : The-K Hotel Seoul VIII

9 2015년도대한비뇨기과학회통합학술대회 2015 KUCE Program

10 2015 년 4 월 11 일 ( 토 ) 강의실 A (205호) 강의실 B ( 통합 ) 강의실 C ( ) 07:30-09:00 등록 (2층 main lobby) 09:00-09:20 개회식및전시장개장식 09:20-09:40 온라인전공의수첩설명회대한 Endourology 학회강좌요로생식기손상재건연구회강좌 09:40-10:40 전공의연수강좌 10:40-12:00 대한전립선학회강좌 대한비뇨기초음파학회강좌 ( 고시설명회포함 ) 12:00-13:00 중식 - 3층전시장 ( 그랜드볼룸 ) KJU 워크샵 "KJU 심사길라잡이 " 13:00-14:00 기초의학연구회강좌 (12:10-14:00) 대한요로생식기감염학회강좌 2014년아스텔라스연구사업 (13:00-14:20) 결과발표회 (14:00-14:20) KUCE 특별강좌좌장 : 주명수 ( 대한비뇨기과학회회장 ) 진료지침평가위원의역할과중요성 연구위원회워크샵 Ⅰ 14:00-15:00 연자 : 장성구 Meet the basic and clinical 수련실태조사위원 ( 경희의대, 대한의학회부회장 ) experts. 보수교육좌장 : 이지열 ( 가톨릭의대 ), (14:20-15:10) 좌장 : 윤하나 ( 이화의대 ) 변석수 ( 서울의대 ) Nationwide Survey of (14:20-15:40) Work-Life Balance of Women Urologists in Japan 연자 : Sayuri Takahashi (Tokyo Univ) 15:00-15:20 Coffee Break 15:00-18: KUCE 정기평의원회 [1층 ( 호)] 15:20-16:40 대한배뇨장애요실금학회강좌 대한소아비뇨기과학회강좌 연구위원회워크샵 Ⅱ Meet the basic and clinical experts. 좌장 : 이지열 ( 가톨릭의대 ), 변석수 ( 서울의대 ) (15:40-16:20) 16:40-18:00 대한비뇨기종양학회강좌 대한남성과학회강좌 X

11 2015 년 4 월 12 일 ( 일 ) 강의실 A (205호) 강의실 B ( 통합 ) 강의실 C ( ) 08:00-09:00 등록 / Booth Visit 수련병원과장회의 203호 09:00-10:30 미래전략위원회워크샵 ( 진행 : 이형래 보험정책워크샵 지도전문의교육 미래전략사업단장 ) 10:30-10:40 ( 진행 : 민승기보험이사 ) ( 진행 : 이상돈수련이사 ) Coffee Break 10:40-12:00 대한비뇨기과의사회강좌 XI

12 2015 년 4 월 11 일 ( 토 ) 강의실 A (205 호 ) 강의실 B ( 통합 ) 강의실 C ( ) 07:30-09:00 등록 (2 층 main lobby) 09:00-09:20 개회식및전시장개장식 09:20-09:40 09:40-10:40 10:40-12:00 대한 Endourology 학회강좌 Surgical tips to be included in standard technique 좌장 : 전승현 ( 경희의대 ), 서일영 ( 원광의대 ) 1. Hemostatic materials 조혁진 ( 가톨릭의대 ) 2. Narrow band imaging 정재영 ( 국립암센터 ) 3. Laser TURP 박승철 ( 원광의대 ) 4. Stent for urinary obstruction 김택상 ( 고신의대 ) 5. Retrograde intrarenal surgery 한덕현 ( 성균관의대 ) 대한전립선학회강좌 좌장 : 유탁근 ( 을지의대 ) 1. Beneficial Effect of Statins on Prostate Cancer: Myth or Real? 김성철 ( 인제의대 ) 2. Metastasis: Where Are You From? Role of Lethal Clone in Primary Cancer of Prostate 윤석중 ( 충북의대 ) 3. Personalized Medicine for BPH: Is It Possible? 한준현 ( 한림의대 ) 4. Trichomonas Vaginalis Infection and Prostate Diseases 이승주 ( 가톨릭의대 ) 요로생식기손상재건연구회강좌 New horizons in urologic reconstructive surgery 좌장 : 송기학 ( 충남의대 ) 1. Urotrauma: AUA guideline 2014 심지성 ( 고려의대 ) 2. Penoscrotal reconstruction from the viewpoint of PS surgeon 이근철 ( 동아의대성형외과 ) 3. Surgical skill for urethroplasty 김수웅 ( 서울의대 ) 4. Biomaterial for reconstruction 신정욱 ( 인제대의용공학과 ) 대한비뇨기초음파학회강좌 Basic Approach to Ultrasound for Urologists 좌장 : 김태형 ( 중앙의대 ), 이경섭 ( 동국의대 ) 1. How to Handle Ultrasound Machine 정승은 ( 가톨릭의대영상의학과 ) 2. Prostate Ultrasonography 박성윤 ( 연세의대영상의학과 ) 3. Kidney Ultrasonography 김상윤 ( 서울의대영상의학과 ) 4. 초음파인증제도소개강택원 ( 전남의대 ) Q & A 온라인전공의수첩설명회 전공의연수강좌 전공의를향한학회장메시지주명수대한비뇨기과학회장 전공의연수강좌 (1) 좌장 : 이상돈 ( 부산의대 ) 1. 비뇨기과수술후수액요법의원칙하유신 ( 가톨릭의대 ) 2. 비뇨기과수술후상처합병증의관리이승환 ( 연세의대 ) 3. 비뇨기계통증의단계적관리정승일 ( 전남의대 ) 전공의연수강좌 (2) 좌장 : 박관진 ( 서울의대 ) 1. 외상외응급실환자의관리손정환 ( 분당제생병원 ) 2. 비뇨기계선천기형의해법정재민 ( 부산의대 ) 3. 전공의가알아야할 UDS 판독법김명기 ( 전북의대 ) 고시정책소개 김준철고시위원장 Special Lecture 좌장 : 김청수 ( 울산의대 ) Prostate and I : What Have I Learned From Robotic Surgery? 이상은 ( 서울의대 ) XII

13 강의실 A (205 호 ) 강의실 B ( 통합 ) 강의실 C ( ) 12:00-13:00 중식 - 3 층전시장 ( 그랜드볼룸 ) KJU 워크샵 "KJU 심사길라잡이 " (12:10-14:00) 13:00-14:00 기초의학연구회강좌기초연구입문좌장 : 류지간 ( 인하의대 ) 1. 신진연구자의입장에서정부연구비수주방법 ) 한웅규 ( 연세의대 ) 2. 기초연구논문작성법 : 표와그림을중심으로정병창 ( 성균관의대 ) 대한요로생식기감염학회강좌 (13:00 14:20) Current issue in TRUS Guided Prostate Biopsy 좌장 : 이선주 ( 경희의대 ), 나용길 ( 충남의대 ) 1. TRUS Biopsy Infection & Antibiotic Resistance 황의창 ( 전남의대 ) 2. Antibiotic Prophylaxis for Transrectal Prostate Biopsy 김기호 ( 동국의대 ) 3. Non-Antibiotic Prophylaxis for Transrectal Prostate Biopsy 장인호 ( 중앙의대 ) 4. Treatment for infectious complication 유구한 ( 경희의대 ) 2014 년아스텔라스연구사업결과발표회 (14:00-14:20) KUCE 특별강좌 연구위원회워크샵 Ⅰ 좌장 : 주명수 ( 대한비뇨기과학회회장 ) (14:20-15:40) [ 기초의학 ] 진료지침평가위원의역할과중요성연자 : 장성구 ( 경희의대, 대한의학회부회장 ) Meet the basic and clinical experts. 좌장 : 이지열 ( 가톨릭의대 ), 14:00-15:00 좌장 : 윤하나 ( 이화의대 ) Nationwide Survey of Work-Life Balance of Women Urologists in Japan 연자 : Sayuri Takahashi (Tokyo Univ) 수련실태조사위원보수교육 (14:20-15:10) 변석수 ( 서울의대 ) 1. How to promote my research work? 김원재 ( 충북의대 ) 2. 비뇨기과의사가할만한중개연구서준규 ( 인하의대 ) 3. 연구중심병원과연구자로서비뇨기과의사의역할김청수 ( 울산의대 ) 15:00-15:20 Coffee Break 15:00-18: KUCE 정기평의원회 [1 층 ( 호 )] XIII

14 강의실 A (205 호 ) 강의실 B ( 통합 ) 강의실 C ( ) 15:20-16:40 16:40-18:00 대한배뇨장애요실금학회강좌 Debate in MUS 좌장 : 김하영 ( 한림의대 ) 1. Urethral hypermobility: Is it still important in patient with SUI 이상욱 ( 강원의대 ) 2. Single incision sling: current status(role) in treatment of SUI 이성호 ( 한림의대 ) MUS in special situation 좌장 : 정희종 ( 원광의대 ) 1. MUS in patient with ISD 서영진 ( 동국의대 ) 2. MUS in patient with POP 이영숙 ( 성균관의대 ) 3. MUS in patient with recurred SUI 신동길 ( 부산의대 ) 4. MUS in patient with detrusor underactivity 이창호 ( 순천향의대 ) 5. MUS in patient with obesity, chronic cough etc. 김수진 ( 가톨릭의대 ) 대한비뇨기종양학회강좌 Radical nephroureterectomy for upper urinary tract cancer: video-guided step-by-step approach 좌장 : 김형진 ( 전북의대 ) 1. Open 김선일 ( 아주의대 ) 2. Laparoscopic 정창욱 ( 서울의대 ) 3. Robot-assisted laparoscopic 박성열 ( 한양의대 ) Case discussion 좌장 : 김형진 ( 전북의대 ) 패널김선일 ( 아주의대 ), 박성열 ( 한양의대 ), 정창욱 ( 서울의대 ) 대한소아비뇨기과학회강좌 Practical issues in the management of nocturnal enuresis: thoughts from young pediatric urologists 좌장 : 김건석 ( 울산의대 ) 1. Diagnostics that should not be missed 정재민 ( 부산의대 ) 2. Interpretation of noninvasive tests: how to get relevant information for invasive tests, management and follow-up 김성철 ( 인제의대 ) 3. My follow-up strategies: evidences and reality 임영재 ( 연세의대 ) 4. Refractory enuresis: my interpretation and reaction 송상훈 ( 울산의대 ) Case discussion 좌장 : 김건석 ( 울산의대 ) 패널정재민 ( 부산의대 ), 임영재 ( 연세의대 ), 송상훈 ( 울산의대 ) 대한남성과학회강좌 Round Table Meeting on Late onset hypogonadism; most frequently debating topics 좌장 : 김세웅 ( 가톨릭의대 ), 이성원 ( 성균관의대 ) 1. 남성갱년기증후군의가장신뢰할만한진단지표는? 박현준 ( 부산의대 ) 2. 남성호르몬이저하된무증상환자, 치료해야하는가? 김진욱 ( 중앙의대 ) 3. 남성호르몬보충요법의목표설정, 증상개선 vs 정상호르몬수치? 이원기 ( 한림의대 ) 4. 가장효율적인남성호르몬제제의선택은? 허정식 ( 제주의대 ) 5. 남성호르몬보충요법, 심혈관계에대한안전성은? 박민구 ( 인제의대 ) 패널양대열 ( 한림의대 ), 문두건 ( 고려의대 ), 양상국 ( 건국의대 ) 손환철 ( 서울의대 ), 류지간 ( 인하의대 ), 이승욱 ( 한양의대 ) 연구위원회워크샵 Ⅱ (15:40-16:20) Meet the basic and clinical experts. 좌장 : 이지열 ( 가톨릭의대 ), 변석수 ( 서울의대 ) 1. 임상연구의설계이승욱 ( 한양의대 ) 2. 공동연구자로부터배운임상시험이경호 ( 서울의대영상의학과 ) XIV

15 2015 년 4 월 12 일 ( 일 ) 강의실 A (205 호 ) 강의실 B ( 통합 ) 강의실 C ( ) 08:00-09:00 등록 / Booth Visit 수련병원과장회의 203 호 09:00-10:30 보험정책워크샵 ( 진행 : 민승기보험이사 ) Opening Remark 이영구대한비뇨기과학회부회장 / 보험정책사업단장 ( 한림의대 ) 주명수대한비뇨기과학회회장 ( 울산의대 ) Session I : 보험급여삭감사례분석및보험청구 Know-how & tips (9:10-09:50) 좌장 : 신명식대한비뇨기과학회부회장 1. 발표 1 : 의원사례중심조정호대한비뇨기과의사회보험이사 ( 골드만비뇨기과 ) 2. 발표 2 : 병원 / 종합병원사례중심민승기대한비뇨기과학회보험이사 ( 국립경찰병원 ) 질의및응답 지도전문의교육 ( 진행 : 이상돈수련이사 ) 1. 연차별수련목표및수련내용손정환 ( 분당제생병원 ) 2. 공통수련과정운영제도의현주소및비뇨기과학회의방향이상돈 ( 부산의대 ) 3. 수련교육프로그램의효과적인평가방법정승일 ( 전남의대 ) 4. 비뇨기과전문의자격취득요건및자격시험하유신 ( 가톨릭의대 ) 미래전략위원회워크샵 ( 진행 : 이형래미래전략사업단장 ) 좌장 : 이형래 ( 미래전략사업단단장, 경희의대 ) 진료영역회복및창출위원회세션 1. 비뇨기과의새로운영역 - 남성비만 / 체형 / 탈모이승주 ( 가톨릭의대 ) 2. Androgenic alopecia, in the view of urology 유영근 ( 포헤어모발이식센터 ) 비뇨배상연구회세션 1. 비뇨기계의료배상의목적허정식 ( 제주의대 ) 2. 비뇨기계의료배상의실례박경기 ( 제주의대 ) Discussion 병원위원회세션 2 차의료기관에서비뇨기과활성화방안김용수 ( 청주한국병원 ) Discussion 10:30-10:40 Session Il : 대한의사협회보험정책 (09:50-10:45) 좌장 : 연준흠대한의사협회보험이사 1. 발표 1 : 상대가치점수의개념및개정방향 Coffee Break 대한비뇨기과의사회강좌 Another way of ED treatment ; ESWT 김선우좌장 : 이윤수대한의사협회보험연구팀장 ( 이윤수조성완비뇨기과 ) 2. 발표 2 : 보헙급여기준변경절차백영기 1. ESWT ; physics and basic 10:40-12:00 대한의사협회보험급여팀장 mechanisms 3. 발표 3: 대한의사협회보험정책현재석 ( 경상의대 ) ( 비뇨기과지원정책포함 ) 2. Clinical trial of ESWT ; pros 김기성정경우 ( 스마일정경우비뇨기과 ) 대한의사협회보험정책팀장 3. Clinical trial of ESWT ; cons 질의및응답이민종 ( 골드만비뇨기과 ) panel discussion XV

16 강의실 A (205 호 ) 강의실 B ( 통합 ) 강의실 C ( ) Session IIl : 국가건강보험정책방향 (11:00-12:20) 좌장 : 이영구대한비뇨기과학회부회장 ( 한림의대 ) 1. 발표 1 : KDRG 개정방향및추진현황김애련심평원분류체계실분류개발부장 2. 발표 2 : 상대가치 2 차개정작업진행현황공진선심평원분류체계실상대가치개발부장 3. 발표 3 : 2015 년건강보험정책방향손영래보건복지부보험급여과장질의응답및토의 XVI

17 학회장안내도 XVII

18 부스배치도 XVIII

19 업체명부스번호업체명부스번호 한국아스텔라스제약 ( 주 ) 45, 46 금청약품주식회사 28 종근당 43, 44 대웅제약 6 JW 중외제약 39, 40 바드코리아 ( 주 ) 8 한국엠에스디 ( 유 ) 37, 38 박스터코리아 16 GSK ( 글락소스미스클라인 ) 29, 30 신한생명 ( 주 ) pb 자산운용본부 2 층 Foyer 한국얀센 54, 55 아스트라제네카 32 SK 케미칼 52, 53 아시안메디칼 18 동국제약 56, 57 엘리어헬스케어주식회사 14 동아에스티 35, 36 올림푸스한국 13 제일약품 ( 주 ) 50, 51 의림메디아 9 한국릴리 41, 42 인튜이티브서지컬 19 한국노바티스 1, 2 일양약품 5 한국페링제약 48,49 제이텍바이오젠 22 한미약품 3, 4 주 ) 한국팜비오 25 ( 주 ) 한독 27 주식회사코엠상사 20 ( 주 ) 소구 15 칼스톨츠엔도스코피코리아 ( 유 ) 12 ( 주 ) 솔빛메디칼 17 하이메드 ( 주 ) 26 ( 주 ) 씨엘팜 24 한국다케다제약 7 ( 주 ) 에스엠허스 23 한국화이자제약 33 ( 주 ) 엠큐브테크놀로지 21 한국화이자제약 34 ( 주 ) 지인씨앤티 11 한국엘러간 Coloplast 10 Sanofi 31 XIX

20 의료기기및의료품전시회사 번호업체명전시및주취급품목전화팩스담당자 1 ( 주 ) 한독자트랄 XL 최희승 2 ( 주 ) 소구 Camera system URS 김민수 3 ( 주 ) 솔빛메디칼 UVENTA Metal Stent 손명식부장 4 ( 주 ) 씨엘팜 비닉스뉴페질헤모라민 박준영 5 ( 주 ) 에스엠허스 Self Catheterization Set Foley Balloon Catheter Nephrostomy Catheter 박민선 6 ( 주 ) 엠큐브테크놀로지 CubeScan BioCon-700 BioCon-2000w CubeFlow 강승구 7 ( 주 ) 지인씨앤티 Flow master Uroflow 곽정훈 8 ( 주 ) 한국얀센자이티가 정승호 9 Coloplast 자가도뇨카테터 SpeediCath Conveen leg bag 정은정 10 GSK ( 글락소스미스클라인 ) 아보다트 (Avodart) 임윤자 11 JW 중외제약 트루패스제피드피나스타 유선옥 12 SK 케미칼 엠빅스에스오젝스 함봉호 13 금청약품주식회사카티젤겔 이호빈 14 대웅제약루피어 유정철 15 동국제약 16 동아에스티 로렐린데포데스민정 플리바스자이데나 고은미 윤지욱 17 바드코리아 ( 주 ) X-Forece InLay Optima HighFlex 김예리 XX

21 번호업체명전시및주취급품목전화팩스담당자 18 박스터코리아플로실 (Floseal) 이민경 19 신한생명 ( 주 ) pb 자산운용본부금융저축플랜 이종환 20 아스트라제네카졸라덱스 박동규 21 아시안메디칼 AMS 700 IPP AUS 800 SPHINCTER GreenKight HPS Laser 김윤규 22 엘리어헬스케어주식회사 NMP 안세현 23 올림푸스한국 3D IMAGING Cystoscope ureteroscope 박원호 24 의림메디아 CT 김정범 25 인튜이티브서지컬다빈치로봇수술기 강효정 26 일양약품 하이트린하이네콜일양실데나필 정완교 27 제이텍바이오젠 예나스테론젤미론프로퍼틸 이경환 28 제일약품 ( 주 ) 비유피 -4 포르테라알프존 원혜림 29 종근당 유리토스펜폴 김애진 30 ( 주 ) 한국팜비오게그론 정소영 31 주식회사코엠상사비뇨기과레이저 박대진 32 칼스톨츠엔도스코피코리아 ( 유 ) Telescope Endoscopy Camerasystem Laparoscopy instrument 고봉준 33 하이메드 ( 주 ) Urodynamic System Urodynamic Table System Uroflowmetry 김신형 34 한국릴리 35 한국노바티스 시알리스악세론 보트리엔트아피니토 윤홍석 박장호 36 한국다케다제약루프린 함서윤 XXI

22 번호업체명전시및주취급품목전화팩스담당자 37 한국아스텔라스제약 ( 주 ) 하루날베시케어엑스탄디, 베타미가 박은희 38 한국엘러간 Botox 한국엠에스디 ( 유 ) 프로스카안드리올 정우용 40 한국페링제약미니린 박주영 41 한국화이자제약토비애즈 이미나 42 한국화이자제약수텐 1 부스 한국화이자제약 43 한미약품 44 Sanofi 가딕스팔팔 Taxotere Jevtana 김명준 임원택 XXII

23 2015년도대한비뇨기과학회통합학술대회 2015 KUCE Abstracts

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25 2015 년 4 월 11 일 ( 토 ) 09:20~10:40 강의실 A (205 호 ) 대한 Endourology 학회강좌 : Surgical tips to be included in standard technique 좌장 : 전승현 ( 경희의대 ), 서일영 ( 원광의대 ) Hemostatic materials 조혁진 ( 가톨릭의대 ) Narrow band imaging 정재영 ( 국립암센터 ) Laser TURP 박승철 ( 원광의대 ) Stent for urinary obstruction 김택상 ( 고신의대 ) Retrograde intrarenal surgery 한덕현 ( 성균관의대 ) 2015 년 4 월 11 일 ( 토 ) 10:40~12:00 강의실 A (205 호 ) 대한전립선학회강좌 좌장 : 유탁근 ( 을지의대 ) Beneficial Effect of Statins on Prostate Cancer: Myth or Real? 김성철 ( 인제의대 ) Metastasis: Where Are You From? Role of Lethal Clone in Primary Cancer of Prostate 윤석중 ( 충북의대 ) Personalized Medicine for BPH: Is It Possible? 한준현 ( 한림의대 ) Trichomonas Vaginalis Infection and Prostate Diseases 이승주 ( 가톨릭의대 ) Special Lecture 좌장 : 김청수 ( 울산의대 ) Prostate and I : What Have I Learned From Robotic Surgery? 이상은 ( 서울의대 ) 2015 년 4 월 11 일 ( 토 ) 13:00~14:00 강의실 A (205 호 ) 기초의학연구회강좌 : 기초연구입문 좌장 : 류지간 ( 인하의대 ) 신진연구자의입장에서정부연구비수주방법한웅규 ( 연세의대 ) 기초연구논문작성법 : 표와그림을중심으로정병창 ( 성균관의대 ) 3

26 2015 년 4 월 11 일 ( 토 ) 14:00~15:00 강의실 A (205 호 ) KUCE 특별강좌강좌 좌장 : 주명수 ( 대한비뇨기과학회회장 ) 진료지침평가위원의역할과중요성장성구 ( 경희의대, 대한의학회부회장 ) 좌장 : 윤하나 ( 이화의대 ) Nationwide Survey of Work-Life Balance of Women Urologists in Japan Sayuri Takahashi (Tokyo Univ) 2015 년 4 월 11 일 ( 토 ) 15:20~16:40 강의실 A (205 호 ) 대한배뇨장애요실금학회강좌 Debate in MUS 좌장 : 김하영 ( 한림의대 ) Urethral hypermobility: Is it still important in patient with SUI 이상욱 ( 강원의대 ) Single incision sling: current status(role) in treatment of SUI 이성호 ( 한림의대 ) MUS in special situation 좌장 : 정희종 ( 원광의대 ) MUS in patient with ISD 서영진 ( 동국의대 ) MUS in patient with POP 이영숙 ( 성균관의대 ) MUS in patient with recurred SUI 신동길 ( 부산의대 ) MUS in patient with detrusor underactivity 이창호 ( 순천향의대 ) MUS in patient with obesity, chronic cough etc. 김수진 ( 가톨릭의대 ) 2015 년 4 월 11 일 ( 토 ) 16:40~18:00 강의실 A (205 호 ) 대한비뇨기종양학회강좌 : Radical nephroureterectomy for upper urinary tract cancer: video-guided step-by-step approach 좌장 : 김형진 ( 전북의대 ) Open 김선일 ( 아주의대 ) Laparoscopic 정창욱 ( 서울의대 ) Robot-assisted laparoscopic 박성열 ( 한양의대 ) Case discussion 좌장 : 김형진 ( 전북의대 ) 패널 김선일 ( 아주의대 ), 박성열 ( 한양의대 ), 정창욱 ( 서울의대 ) 4

27 2015 년 4 월 11 일 ( 토 ) 09:20~10:40 강의실 B ( 통합 ) 요로생식기손상재건연구회강좌 : New horizons in urologic reconstructive surgery 좌장 : 송기학 ( 충남의대 ) Urotrauma: AUA guideline 2014 심지성 ( 고려의대 ) Penoscrotal reconstruction from the viewpoint of PS surgeon 이근철 ( 동아대성형외과 ) Surgical skill for urethroplasty 김수웅 ( 서울의대 ) Biomaterial for reconstruction 신정욱 ( 인제대의용공학과 ) 2015 년 4 월 11 일 ( 토 ) 10:40~12:00 강의실 B ( 통합 ) 대한비뇨기초음파학회강좌 : Basic Approach to Ultrasound for Urologists 좌장 : 김태형 ( 중앙의대 ), 이경섭 ( 동국의대 ) How to Handle Ultrasound Machine 정승은 ( 가톨릭의대영상의학과 ) Prostate Ultrasonography 박성윤 ( 연세의대영상의학과 ) Kidney Ultrasonography 김상윤 ( 서울의대영상의학과 ) 초음파인증제도소개 강택원 ( 전남의대 ) Q & A 2015 년 4 월 11 일 ( 토 ) 13:00~14:20 강의실 B ( 통합 ) 대한요로생식기감염학회강좌 : Current issue in TRUS Guided Prostate Biopsy 좌장 : 이선주 ( 경희의대 ), 나용길 ( 충남의대 ) TRUS Biopsy Infection & Antibiotic Resistance 황의창 ( 전남의대 ) Antibiotic Prophylaxis for Transrectal Prostate Biopsy 김기호 ( 동국의대 ) Non-Antibiotic Prophylaxis for Transrectal Prostate Biopsy 장인호 ( 중앙의대 ) Treatment for infectious complication 유구한 ( 경희의대 ) 5

28 2015 년 4 월 11 일 ( 토 ) 15:20~16:40 강의실 B ( 통합 ) 대한소아비뇨기과학회강좌 : Practical issues in the management of nocturnal enuresis: thoughts from young pediatric urologists 좌장 : 김건석 ( 울산의대 ) Diagnostics that should not be missed 정재민 ( 부산의대 ) Interpretation of noninvasive tests: how to get relevant information for invasive tests, management and follow-up 김성철 ( 인제의대 ) My follow-up strategies: evidences and reality 임영재 ( 연세의대 ) Refractory enuresis: my interpretation and reaction 송상훈 ( 울산의대 ) Case discussion 좌장 : 김건석 ( 울산의대 ) 패널 정재민 ( 부산의대 ), 임영재 ( 연세의대 ), 송상훈 ( 울산의대 ) 2015 년 4 월 11 일 ( 토 ) 16:40~18:00 강의실 B ( 통합 ) 대한남성과학회강좌 : Round Table Meeting on Late onset hypogonadism; most frequently debating topics 좌장 : 김세웅 ( 가톨릭의대 ), 이성원 ( 성균관의대 ) 남성갱년기증후군의가장신뢰할만한진단지표는? 박현준 ( 부산의대 ) 남성호르몬이저하된무증상환자, 치료해야하는가? 김진욱 ( 중앙의대 ) 남성호르몬보충요법의목표설정, 증상개선 vs 정상호르몬수치? 이원기 ( 한림의대 ) 가장효율적인남성호르몬제제의선택은? 허정식 ( 제주의대 ) 남성호르몬보충요법, 심혈관계에대한안전성은? 박민구 ( 인제의대 ) 2015 년 4 월 11 일 ( 토 ) 09:40~12:00 강의실 C ( ) 전공의연수강좌 전공의를향한학회장메시지주명수 ( 대한비뇨기과학회장 ) 전공의연수강좌 1 좌장 : 이상돈 ( 부산의대 ) 비뇨기과수술후수액요법의원칙 하유신 ( 가톨릭의대 ) 비뇨기과수술후상처합병증의관리 이승환 ( 연세의대 ) 비뇨기계통증의단계적관리 정승일 ( 전남의대 ) 6

29 전공의연수강좌 2 좌장 : 박관진 ( 서울의대 ) 외상외응급실환자의관리 손정환 ( 분당제생병원 ) 비뇨기계선천기형의해법 정재민 ( 부산의대 ) 전공의가알아야할 UDS 판독법 김명기 ( 전북의대 ) 고시정책소개김준철 ( 고시위원장 ) 2015 년 4 월 11 일 ( 토 ) 14:20~15:40 강의실 C ( ) 연구위원회워크샵 I [ 기초의학 ] : Meet the basic and clinical experts 좌장 : 이지열 ( 가톨릭의대 ), 변석수 ( 서울의대 ) How to promote my research work? 김원재 ( 충북의대 ) 비뇨기과의사가할만한중개연구 서준규 ( 인하의대 ) 연구중심병원과연구자로서비뇨기과의사의역할 김청수 ( 울산의대 ) 2015 년 4 월 11 일 ( 토 ) 15:40~16:20 강의실 C ( ) 연구위원회워크샵 II : Meet the basic and clinical experts 좌장 : 이지열 ( 가톨릭의대 ), 변석수 ( 서울의대 ) 임상연구의설계이승욱 ( 한양의대 ) 공동연구자로부터배운임상시험이경호 ( 서울의대영상의학과 ) 7

30 2015 년 4 월 12 일 ( 일 ) 09:00~12:00 강의실 A (205 호 ) 보험정책워크샵 진행 : 민승기보험이사 Opening Remark 이영구대한비뇨기과학회부회장 / 보험정책사업단장 ( 한림의대 ) 주명수대한비뇨기과학회회장 ( 울산의대 ) Session I : 보험급여삭감사례분석및보험청구 Know-how & tips (09:10-09:50) 좌장 : 신명식 ( 대한비뇨기과학회부회장 ) 발표 1. 의원사례중심 조정호 ( 대한비뇨기과의사회보험이사, 골드만비뇨기과 ) 발표 2. 병원 / 종합병원사례중심 민승기 ( 대한비뇨기과학회보험이사, 국립경찰병원 ) 질의및응답 Session Il : 대한의사협회보험정책 (09:50-10:45) 좌장 : 연준흠 ( 대한의사협회보험이사 ) 발표 1. 상대가치점수의개념및개정방향 김선우 ( 대한의사협회보험연구팀장 ) 발표 2. 보헙급여기준변경절차 백영기 ( 대한의사협회보험급여팀장 ) 발표 3. 대한의사협회보험정책 ( 비뇨기과지원정책포함 ) 김기성 ( 대한의사협회보험정책팀장 ) 질의및응답 Session IIl : 국가건강보험정책방향 (11:00-12:20) 좌장 : 이영구 ( 대한비뇨기과학회부회장, 한림의대 ) 발표 1. KDRG 개정방향및추진현황 김애련 ( 심평원분류체계실분류개발부장 ) 발표 2. 상대가치 2차개정작업진행현황 공진선 ( 심평원분류체계실상대가치개발부장 ) 발표 년건강보험정책방향 손영래 ( 보건복지부보험급여과장 ) 질의응답및토의 2015 년 4 월 12 일 ( 일 ) 09:00~12:00 강의실 B ( 통합 ) 지도전문의교육 진행 : 이상돈수련이사 연차별수련목표및수련내용 손정환 ( 분당제생병원 ) 공통수련과정운영제도의현주소및비뇨기과학회의방향 이상돈 ( 부산의대 ) 수련교육프로그램의효과적인평가방법 정승일 ( 전남의대 ) 비뇨기과전문의자격취득요건및자격시험 하유신 ( 가톨릭의대 ) 8

31 2015 년 4 월 12 일 ( 일 ) 09:00~10:30 강의실 C ( ) 미래전략위원회워크샵 진행 : 이형래미래전략사업단장 진료영역회복및창출위원회세션 좌장 : 이형래 ( 미래전략사업단단장, 경희의대 ) 비뇨기과의새로운영역 - 남성비만 / 체형 / 탈모이승주 ( 가톨릭의대 ) Androgenic alopecia, in the view of urology 유영근 ( 포헤어모발이식센터 ) 비뇨배상연구회세션 비뇨기계의료배상의목적 허정식 ( 제주의대 ) 비뇨기계의료배상의실례 박경기 ( 제주의대 ) Discussion 병원위원회세션 2 차의료기관에서비뇨기과활성화방안김용수 ( 청주한국병원 ) Discussion 2015 년 4 월 12 일 ( 일 ) 10:40~12:00 강의실 C ( ) 대한비뇨기과의사회강좌 : Another way of ED treatment ; ESWT 좌장 : 이윤수 ( 이윤수조성완비뇨기과 ) ESWT ; physics and basic mechanisms 현재석 ( 경상의대 ) Clinical trial of ESWT ; pros 정경우 ( 스마일정경우비뇨기과 ) Clinical trial of ESWT ; cons 이민종 ( 골드만비뇨기과 ) Panel discussion 9

32 Poster Session 1: Cancer Prostate 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-1 Hormone therapy and the severity of depressive symptoms in patients undergoing treatment for prostate cancer: a single-center study in Korea 김창희, 장현경, 이승규, 정경진, 윤상진, 김계환가천의대길병원비뇨기과 P-2 The Prostate Cancer Detection Rate according to Prostate-Specific Antigen Trend 이영, 최태수, 신용호, 김영빈, 최승권, 유구한, 이동기, 이형래, 민경은경희대학교의과대학비뇨기과학교실 P-3 임상적저 - 중위험등급전립선암환자에서부분냉동치료의최초경험 : 9 명환자의예비조사추적관찰결과김승빈, 윤성구, 태종현, 김재윤, 조석, 편종현, 김형근, 강성구, 이정구, 김제종, 천준, 강석호고려대학교의과대학비뇨기과학교실 P Barbed running suture for urethrovesical anastomosis in robot assisted laparoscopic radical prostatectomy 김수동, 성경탁동아의대비뇨기과학교실 P-5 Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy 이경, 구자윤, 하홍구부산의대비뇨기과학교실 P-6 Evaluation of voiding symptom, urinary incontinence and sexual function after laparoscopic and robot- assisted laparoscopic radical prostatectomy : A Single Institution Experience 이경, 구자윤, 하홍구부산의대비뇨기과학교실 P-7 한국인의저위험전립선암에서의적극적관찰법의새로운적용기준국하림, 김광모, 이정근, 이한솔, 김기범, 김태진, 이인재, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대학교병원비뇨기과 P-8 전립선결석이 PSA 에미치는영향양희조, 김두상, 이창호, 전윤수순천향의대비뇨기과학교실 P-9 Docetaxel chemotherapy for metastatic castration- resistant prostate cancer: Prognostic impact of concurrent androgen-deprivation therapy on survival outcome 구교철, 이광석, 안현규, 나군호, 홍성준, 정병하연세의대비뇨기과학교실 P-10 전립선조직검사환자의통증조절을위한시술전처치방법에따른환자통증정도의평가이창용, 김철성, 노준, 임동훈, 조원진, 백승조선의대비뇨기과학교실 P-11 Diagnostic value of urinary nucleic acid TSPAN13: S100A9 ratio for prostate cancer 이상근, 서성필, 엄춘일, 김예환, 정필두, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재충북의대비뇨기과학교실 10

33 Poster Session 2: Cancer - Others 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-12 Prognostic value of ABO blood group in patients with renal cell carcinoma: single-institution Results from a large cohort Mooyoung Sohn, Jaeyoon Jung, Donghyun Lee, Chunwoo Lee, Dalsan You, In Gab Jeong, Cheryn Song, Taekmin Kwon, Bumsik Hong, Jun Hyuk Hong, Hanjong Ahn, Choung-Soo Kim Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea P-13 Prognostic Significance of Body Mass Index in Patients Undergoing Nephrectomy for Non-metastatic Renal Cell Carcinoma Dae Sung Cho, Sun Il Kim 1, Seol Ho Choo 1, Se Joong Kim 1 Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea Department of Urology, Ajou University School of Medicine, Suwon, Korea 1 P-14 The impact of three-dimensional tumor volume on cancer-specific survival for patients with pt1 clear-cell renal cell carcinoma Wan Song, Sang Eun Lee, Young Hyo Choi, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Hyun Moo Lee, Han Yong Choi, Hwang Gyun Jeon Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea P-15 The possibilities as a prediction tool for cancer research of big data: Comparison of incidence rate of Korean major male and urologic cancers and trend scores 강동혁 1, 권종규 2, 조강수 3, 함원식 3, 최영득 3, 이주용 3 1 양평군보건소, 2 인제의대비뇨기과학교실, 3 연세의대비뇨기과학교실, 비뇨의과학연구소 P-16 투명세포신세포암에서 Notch-1 발현의임상적의의및예후적가치박동재, 강준구, 김상원, 전소영 1, 이준녕, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 김법완경북대학교의학전문대학원비뇨기과학교실, 1 경북대학교의학전문대학원생명의학연구소 P-17 단일센터에서의소신종물에대한신냉동수술의결과태종현, 윤성구, 김승빈, 김재윤, 김형근, 편종현, 조석, 강성구, 이정구, 김제종, 천준, 강석호고려대학교의과대학비뇨기과학교실 P-18 Narrow-band imaging (NBI) 하경요도적방광종양절제술초기경험 : white-light imaging 과의전향적비교연구윤성구, 태종현, 김승빈, 김재윤, 편종현, 김형근, 조석, 강성구, 천준, 이정구, 김제종, 강석호고려대학교의과대학비뇨기과학교실 P-19 Effect of Diagnostic Ureterorenoscopy on the Intravesical Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma 유재호, 나준필, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수성균관의대삼성서울병원비뇨기과학교실 P-20 Diameter-axial-polar nephrometry score predicts renal parenchymal atrophy after robotic partial nephrectomy 강숭구, 김종원, 윤영은, 조영인, 김숙영, 한웅규연세의대비뇨기과학교실 P-21 The impact of preoperative retrograde pyelography before radical nephroureterectomy for upper urinary tract urothelial carcinoma on intravesical tumor recurrence 이권수, 장재윤, 장준보, 김영욱, 최재영, 고영휘, 문기학, 정희창, 송필현영남의대비뇨기과학교실 P-22 T1 병기방광암환자에서 fibroblast growth factor receptor 3 (FGFR3) 의예후적가치서성필, 이상근, 김예환, 엄춘일, 정필두, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재충북의대비뇨기과학교실 11

34 Poster Session 3: LUTS/BPH 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-23 A clinical trial comparing plasmakinetic transurethral enucleation and resection and plasmakinetic transurethral resection of the prostate in patients with benign prostatic hyperplasia more than 80 g. Chang Yong Lee, Won Jin Cho, Seung Baek, Dong Hoon Lim, Joon Nho, Chul Sung Kim Department of Urology, College of Medicine, Chosun University P-24 Urinary retention following holmium laser enucleation of the prostate caused by hematoma of bladder neck Jun Seok Kim, Dong Hoon Yoo, Seong Woon Park, Joon Hwa Noh Department of Urology, Kwangju Christian Hospital, Gwangju, Korea P-25 Relationship between Metabolic Syndrome and Lower Urinary Tract Symptoms: Community-based, Longitudinal, Cohort Study Seong Ho Lee, Min Soo Choo, Jun Hyun Han, Won Ki Lee, Sang Kon Lee Department of Urology, School of Medicine, Hallym University P-26 Efficacy of a vaporization-resection of the prostate median lobe enlargement and vaporization of the lateral lobe for BPH using a 120 W GreenLight HPS laser : The effect on storage symptoms. 허경재, 문형우, 김강섭, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 황태곤, 김세웅 Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea P-27 The correlation of aortic calcification and LUTS Young Jun Moon, Hyung Jun Kim, Jin Bum Kim, Young Seop Chang, Hong Wook Kim Konyang University Hospital P-28 방광출구폐색이없이배뇨근과활동및수축력장애로진단된남성에서홀뮴레이저전립선적출술의효과에대한초기경험유동훈, 노준화, 박성운, 김준석광주기독병원비뇨기과교실 P-29 Early post-operative outcome analysis after Holmium laser enucleation of the prostate (HoLEP) 강석현, 진병수, 정현진, 김덕윤대구가톨릭대학교의과대학비뇨기과학교실 P-30 남성에서연령에따른배뇨근기능의변화 : 방광출구폐색및신경인성방광이없는환자군에서평가이한솔, 김기범, 이정근, 이영익, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대병원비뇨기과 P-31 배뇨근수축력저하로진단된환자들의임상적치료패턴 Detrusor underactivity: treatment patterns in the real practice 김광모, 국하림, 이한솔, 김기범, 송병도, 김태진, 이인재, 이정근, 조정기, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대병원비뇨기과학교실 P-32 Efficacy of alfuzosin according to sympathetic activity 심강희, 박성곤, 김태우, 추설호, 정병하 1, 이성운 2, 박종관 3, 박광성 4, 천준 5, 이경섭 6, 김형지 7, 성도환 8, 오승준 9, 김세웅 10, 이지열 10, 최종보아주의대비뇨기과학교실, 연세의대비뇨기과학교실 1, 성균관의대비뇨기과학교실 2, 전북의대비뇨기과학교실 3, 전남의대비뇨기과학교실 4, 고려의대비뇨기과학교실 5, 동국의대비뇨기과학교실 6, 단국의대비뇨기과학교실 7, 인하의대비뇨기과학교실 8, 서울의대비뇨기과학교실 9, 카톨릭의대비뇨기과학교실 10 12

35 P-33 당뇨병환자에서전립선비대증과경동맥내중막두께의연관성 Correlation between prostate volume and intima- media thickness (IMT) of carotid artery in diabetic benign prostatic hyperplasia 이창민, 허지혜 1, 임정수 1, 강태욱, 양승훈, 채윤병 2, 정현철, 김광진, 송재만, 정재흥연세대학교원주의과대학비뇨기과학교실, 내과학교실 1, 청주성모병원비뇨기과 2 P-34 Limited correlation between presumed circle area ratio (PCAR) and the severity of lower urinary tract symptom (LUTS) in Korean male 이권수, 장재윤, 장준보, 김영욱, 최재영, 고영휘, 송필현, 문기학, 정희창영남의대비뇨기과학교실 P-35 Outcomes and complications of transurethral resection of prostate in patients with history of acute urinary retention Yang heon Jo, Ho Seok Jeong, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 P-36 Changes in muscarinic and ErbB2 receptor expression in a rat model of partial bladder outlet obstruction. 이충렬, 김영호, 박종목, 신주현, 임재성, 송기학, 나용길, 설종구충남의대비뇨기과학교실 P-37 페이퍼타올을이용한배뇨후점적의이환율및정량적평가연구김마태, 정경화, 고경태, 이원기, 이성호, 김하영, 김성용, 양대열한림대학교의과대학비뇨기과학교실 Poster Session 4: Incontinence, Female Urology and Neurourology 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-38 Systematic review and meta-analysis of intravesical hyaluronic acid instillation for interstitial cystitis/ painful bladder syndrome Chang yong Lee, Seung Baek, Dong Hoon Lim, Joon Nho, Chul Sung Kim, Won Jin Cho Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, South Korea P-39 하부요로증상이있는남성에서방광수축력저하의예측인자로서악력검사의의미함동엽, 김지원, 최우석, 최재경 1, 정성진 2, 백성현, 노용수, 김형곤, 박형근건국대학교병원비뇨기과학교실, 건국대학교병원가정의학과교실 1, 분당서울대병원비뇨기과학교실 2 P-40 폐쇄공테잎삽입술시행시동시에시행하는골반수술이미치는영향비교안창, 전태용, 배정범, 조민철, 이해원, 이광수동국의대비뇨기과학교실 P-41 Effectiveness and Safety of Mirabegron (Adrenergic beta-3 Receptor Agonists) ; Who will benefit from "Mirabegron"? 손희서, 김명주, 김지유, 전유정, 문수영, 허지은, Troya, 김장환연세대학교의과대학비뇨기과학교실 P-42 Expression and Membrane Translocation of Aquaporin 2 (AQP2) and Vasopressin v1a (AVP-v1a) Receptor After Pelvic Nerve Stimulation in the Urinary bladder Sun woo kim, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 13

36 P-43 Increased Expression of Urothelial Aquaporin-1 in Caveolin-1 Knockout Mice Urinary Bladder Ji won Rhu, Sun-Ouck Kim, Kyung-Aa Cho 1, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 P-44 Methylphenidate and Its Effects on Lower Urinary Tract: Assessing cystometrogram in Rats with Hyperactivity Disorder 정하범, 조성태, 최돈경, 김기경, 이영구, 김계환 1 한림의대비뇨기과학교실, 가천의대비뇨기과학교실 1 Poster Session 5: Stone & Endourology 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-45 Is URS helpful for small ureter stones sized around 5mm? Byung Soo Jin, Seok Hyun Kang, Hyun Jin Jung, Duk Yoon Kim Department of Urology, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea P-46 상부요로결석에서 tamsulosin 제제를이용한기대요법의효용성최태수, 김동수, 이영, 신용호, 김영빈, 최승권, 이동기, 민경은, 전승현, 이형래, 유구한경희의대비뇨기과학교실 P-47 10mm 이상의크기가큰상부요관결석에대한 Laser lithotriptor 를이용한경성요관경하배석술과복강경하요관절석술의비교김연주, 김재수, 권준범, 조성룡, 이윤형대구파티마병원비뇨기과 P-48 경주에서요로결석의계절에따른유병률비교박동진, 유정우, 서영진, 이경섭, 권세윤, 김기호동국대학교경주병원비뇨기과 P-49 요석에대한다파장 Nd:YAG 레이저의파쇄효과배민호, 박창후, 조영삼, 박흥재, 권칠훈, 주관중성균관의대비뇨기과학교실 P-50 Comparison of post-operative safety profile in tubeless percutaneous nephrolithotomy according to type of sealant 박준형, 정현우, 서윤석, 김정준, 한덕현성균관의대삼성서울병원비뇨기과학교실 P-51 Predictive factors and treatment outcomes of steinstrasse following extracorporeal shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis 한장희, 최재혁, 정두용, 강호원 1, 조강수, 함원식, 최영득, 이주용연세의대비뇨기과학교실, 비뇨의과학연구소, 1 충북의대비뇨기과학교실 P-52 The discrimination on the baseline surgical proficiency of virtual simulator manifests in time-consuming exercises: the predictive validity using a urethrovesical anastomosis model 장준보, 장재윤, 이권수, 김영욱, 최재영, 송필현, 문기학, 정희창, 고영휘 영남의대비뇨기과학교실 P-53 Association between the presence of baseline microscopic hematuria and the composition of ureteral urolithiasis 장재윤, 장준보, 이권수, 김영욱, 고영휘, 송필현, 문기학, 정희창, 최재영영남의대비뇨기과학교실 14

37 P-54 The significance of non-enhanced compute tomography for renal colic has been overestimated in absence of pyuria 장인호, 김진욱, 김태형, 명순철, 문영태, 김경도중앙의대비뇨기과학교실 P-55 Daily Mean Temperature affects Urolithiasis Presentation in Seoul: A Time-series Analysis 장인호, 김진욱, 김태형, 명순철, 문영태, 김경도중앙의대비뇨기과학교실 Poster Session 6: Infertility & Sexual Dysfunction 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-56 Ameliorative Effects of Urechis Unicintus Against Erectile Dysfunction in a Streptozotocin Induced Diabetic Rat 문형우, 허경재, 김강섭, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 황태곤, 김세웅 Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea P-57 Long-term survival and current patient satisfaction on the inflatable penile prosthesis as a treatment of medical refractory erectile dysfunction 김영욱, 장재윤, 장준보, 이권수, 최재영, 고영휘, 송필현, 정희창, 문기학영남의대비뇨기과학교실 P-58 Expression of Tight Junction Proteins in Rat Vagina Sang Un Yim, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Poster Session 7: Pediatrics 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-59 Cumulative Sum Analysis of Learning Curve for Endoscopic Dextranomer/hyaluronic acid Injection in Vesicoureteral Reflux 김상운, 지병훈, 이용승, 임영재, 한상원연세대학교의과대학비뇨기과학교실 P-60 Is it necessary to repeat the uroflowmetry in children? 김상운, 지병훈, 이용승, 임영재, 한상원연세대학교의과대학비뇨기과학교실 15

38 Poster Session 8: Trauma, Infection and Others 2015 년 4 월 11 일 ( 토 ) ~ 12 일 ( 일 ) E-poster P-61 Clinical Evaluation of Renal Trauma Chang yong Lee, Seung Baik, Dong hoon Lim, Chul sung Kim, Won jin Cho, Joon Rho Department of Urology, Chosun University College of Medicine, Gwang-Ju, Korea P-62 Modified laparoscopic intravesical nonrefluxing ureteral reimplantation with psoas hitch using a submucosal tunneling 김창희, 김주호, 노주환, 김계환, 윤상진, 정한가천의대길병원비뇨기과 P-63 탈세포돼지방광점막하층과자가요도조직결합지지체를이용한요도협착동물모델에서요도재건우명진, 이유진, 김진우, 전소영 1, 이준녕, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 김법완경북대학교의학전문대학원비뇨기과학교실, 1 경북대학교의학전문대학원생명의학연구소 P-64 초음파유도경직장전립선생검에서국소리도카인젤의효용성김순기, 김유석, 조인창, 민승기경찰병원비뇨기과 P-65 Modified Glasgow Prognostic Score as a prognostic factor for septic shock in obstructive acute pyelonephritis Dae Ji Kim, Chae Hong Lim, Seok Heun Jang, Jeong Hwan Son, Jae Won Lee, Dae Sung Cho Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea P-66 The Increased Expression of Transient Receptor Potential Vanilloid-4 (TRPV4) in Cyclophosphamide- Induced Inflammatory Cystitis Tea joo Park, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 P-67 Steroid cream (hydrocortisone propionate butyrate 0.1%) for the treatment of phimosis in boys Young ho Seo, Seheon Jung, Hosuck Chung, Sun-Ouck Kim, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 P-68 Urethral injury and autocastration caused by genital self-mutilation in nonpsychotic heterosexual males: A case report 김성대, 박경기, 김영주, 허정식제주대의학전문대학원비뇨기과학교실 P-69 항균펩타이드방출도뇨관에의한최소억제농도에관한연구김진욱, 장인호, 김태형, 명순철, 문영태, 김경도중앙의대비뇨기과학교실

39 2015년도대한비뇨기과학회통합학술대회 2015 KUCE 특별강좌

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41 The Korean Urological Congress and Expo: 2015 KUCE 대한의학회연구센터임상진료지침평가위원의역할 장성구 경희대학교의과대학비뇨기과학교실대한의학회부회장대한의학회임상진료지침연구사업단단장 19

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49 The Korean Urological Congress and Expo: 2015 KUCE Nationwide Survey of Work-Life Balance of Women Urologists in Japan Sayuri Takahashi Gender Equality Committee, Japanese Urological Association, Department of Urology, Tokyo University In Japan, the number of women urologists has been rapidly growing over the past few years owing to the increasing proportion of female medical students. According to the Ministry of Health, Labor and Welfare, the ratio of women urologists in Japan was only 3.5% in According to data provided by the Japan Urological Association (JUA), the ratio reached 4.8% in The board of JUA founded the Society of Female Urologists in Japan (SFUJ) in 2006 with the goal of increasing the number of women urologists and providing them with overall support. The primary members of SFUJ were all women. For the sake of the further expanded activity, Gender Equality Committee including four male doctors was organized in 2014 after dissolution of SFUJ. We are working to resolve gender-related issues. One of the activity, we performed nationwide surveys of work-life balance of women urologists twice. Here, we will introduce a part of analysis of the survey. Purpose This study examines the change of gender discrimination against women urologists in the last 4 years. Methods An anonymous survey was mailed to all female members of the Japanese Urological Association in 2010 and The total numbers of respondents were 171 of all 378 female members (45%) in 2010 and 233 of 476 (47%) in The respondents were divided into two groups: with or without children. Results 64 (37%) in 2010 and 100 (43%) in 2014 reported having children. 14% in 2010 and 5% in 2014 of women without children and 4.7% in 2010 and 4% in 2014 of women with children experienced discrimination. 2.8% in 2010 and 6% in 2014 of women without children and 14% in 2010 and 8% in 2014 of women with children answered that they experienced discrimination, but felt it was tolerable. 15% in 2010 and 8% in 2014 (without children) and 14% in 2010 and 5% in 2014 (with children) experienced stress due to sexual harassment. 27

50 2015 년도대한비뇨기과학회통합학술대회 Conclusions Women without children suffered from more gender discrimination in 2010 than women with children. Discrimination and sexual harassment dramatically decreased in the last 4 years. The increased rate of women doctors in urology may have contributed to the improvement. 28

51 2015년도대한비뇨기과학회통합학술대회 2015 KUCE Poster Session

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53 Poster Session 1 E-poster Cancer Prostate

54 2015 년도대한비뇨기과학회통합학술대회 P-1 Hormone therapy and the severity of depressive symptoms in patients undergoing treatment for prostate cancer: a single-center study in Korea 김창희, 장현경, 이승규, 정경진, 윤상진, 김계환가천의대길병원비뇨기과 Purpose: Although hormone therapy is commonly employed for advanced prostate cancer, patients receiving hormone therapy frequently develop depressive episodes. This study was designed to search for possible relationships between hormone therapy and the severity of depressive symptoms in patients who were diagnosed with depression during hormone therapy for prostate cancer. Methods: The analysis included 12 men who were diagnosed with depression while they underwent hormone therapy for prostate cancer. The study cohort was stratified into patients who received bicalutamide monotherapy (n = 4) and goserelin monotherapy (n = 8). Geriatric Depression Scale (GDS) scores, serum testosterone levels, and other parameters were evaluated and compared between the two groups. Results: The mean GDS score was 24 (range: 16 30) in the overall cohort, 16 (range: 16 17) in the bicalutamide monotherapy group, and 27 (range: 23 30) in the goserelin monotherapy group. Accordingly, the goserelin monotherapy group had a higher mean GDS score. Serum testosterone level was the only serological finding that differed between the two groups. Serum testosterone decreased to the castrate level after the administration of goserelin monotherapy. In contrast, changes in serum testosterone were marginal after the administration of bicalutamide monotherapy. Conclusions: Anti-androgen agents and luteinizing hormone-releasing hormone (LHRH) agonists affect the level of serum testosterone through distinct mechanisms of action. As compared with other hormonal therapies, LHRH agonists-based treatment is thought to confer a higher risk of depressive symptoms. Thus, when administering LHRH agonists for prostate cancer treatment, clinicians should pay closer attention to the constellation of depressive symptoms that patients may experience. Close attention to depression may mitigate or prevent reductions in quality of life. P-2 The Prostate Cancer Detection Rate according to Prostate-Specific Antigen Trend 이영, 최태수, 신용호, 김영빈, 최승권, 유구한, 이동기, 이형래, 민경은경희대학교의과대학비뇨기과학교실 Purpose: 미국의 NCCN 의가이드라인 (2005 년 ) 의권고사항에따라, 최근미국뿐아니라국내에서도전립선생검에필요한 PSA 의절단치를 2.5ng/ml 로낮추는경향을보이고있다. 본연구는기존의절단치인 4.0ng/ml 보다낮은 PSA 수치의환자에서전립선생검을시행하였을때발견되는전립선암의진단율을조사하여국내에서절단치를낮추는것이전립선암의진단및치료에유효한지에대해알아보고자한다. Materials and Methods: 2006년 6월부터 2014년 6월까지본원에서전립선생검을시행한환자의 PSA 수치와조직검사결과수집한뒤후향적으로분석하였다. 9년간총 233명의환자들이전립선생검을시행받았으며이들을전립선생검일기준 1주일이내에측정한 PSA 수치에따라세군으로나누었고, PSA 수치 4미만인군에서 5a-reductase 를복용중이던환자는연구에서제외하였다. PSA 수치가 10 이상인군은 79명 ( 전체의 34.90%), 4이상 10미만인군은 115명 ( 전체의 49.36%), PSA 수치 4미만은군은 39명 ( 전체의 16.74%) 이었다. Results: 전립선생검을시행받은 233 명의환자들중 78명이전립선암으로진단되었다. PSA 수치가 10이상인 79명중 48 명, PSA 수치가 4~10 인 115 명중 26명, PSA 수치 4미만인 39명중 4명이전립선암으로진단되었고, 진단율은각군별순서대로 60.76%, 22.61%, 10.26% 이었다. PSA 수치가 4 미만인환자들은과거의 PSA수치가높았던경우 (19건 ), 신체검진및영상검사에서의심소견이관찰된경우 (13 건 ), PSA 수치가기준치에근접한경우 (7건) 에전립선조직검사를시행받았다. Conclusions: 많은연구들이 4.0ng/mL 에서 2.5ng/mL 로낮추는것이전립선암의진단및치료에이점이있다고얘기하고있다. 실제, PSA 수치 4미만에서전립선생검을시행받은환자에서전립선암이진단될확률은 10-20% ( 최고 27.48%) 로알려져있다. 이번연구에서국내기준 PSA 수치별진단율을비교한결과, 앞선연구들과크게다르지않다는점을알수있었다. 국내에서전립선암의유병률증가하고있다는점을고려하여절단치를낮춰서적용하는것이전립선암의진단및치료에도움이될것이라생각된다. Keywords: 전립선생검, 전립선암, 전립선항원수치 Keywords: 우울증, 테스토스테론, 황체형성호르몬방출호르몬 32

55 The Korean Urological Congress and Expo: 2015 KUCE P-3 임상적저-중위험등급전립선암환자에서부분냉동치료의최초경험 : 9명환자의예비조사추적관찰결과 김승빈, 윤성구, 태종현, 김재윤, 조석, 편종현, 김형근, 강성구, 이정구, 김제종, 천준, 강석호고려대학교의과대학비뇨기과학교실 목적 : 저중위험도전립선암에서부분냉동치료를시행한그초기경험을보고하였으며, 그추적관찰결과를다시보고하고자한다. 대상및방법 : 2012 년 11월부터 2014 년 1월까지전립선암으로진단된환자중임상적으로한쪽엽에국한되고, PSA 20이하, Gleason 점수 7이하, 임상적병기 T1에서 T2b 인저-중위험등급환자 9명을대상으로하였다. 냉동치료는전신마취하아르곤 / 헬륨가스시스템을사용하여전립선암이진단된한쪽엽을전부포함하는형태로 2번의냉동-해동주기가시행되었다. 주기동안, 요도가온장치를사용하여요도의손상을방지하였고, 온도센서를전립선첨부, Denonviliers fascia 그리고실제냉동부위에삽입하여온도를측정하였다. 환자들에게수술전 EORTC QLQ-C30, IIEF5, IPSS 를확인하고, 수술이후 3개월에한번외래를내원하여동일검사를통해술후합병증여부를조사하였으며, 술후 6개월경과후경직장전립선조직검사를시행하였다. 결과 : 환자들의평균나이는 71.67(63-80) 세였고, 평균추적관찰기간은 10.22(4-20) 개월이었다. 술전임상적병기는 T1c 가 7명, T2a 가 2명이었으며, Gleason score 는 9명모두 6(3+3) 이었으며, 전립선특이항원은평균 6.14, 전립선용적은평균 이었다. 왼쪽이 6명, 오른쪽이 3명이었고, 저등급 7 명, 중등급 2명이었다. 술전시행한 IIEF5 의평균은 이었고, 술전 IPSS score 의평균은 12.89, 삶의질점수평균은 3.44 이었다. 6개월후경직장조직검사를시행한환자는 6명이었으며, 2명에서양성을보였다. 한명은반대측에 Gleason score 6(3+3) 으로현재호르몬치료중이며, 다른한명은동측에 Gleason score 6(3+3) 의양성소견을보였으며환자의선택으로방사선치료를보였으며환자의선택으로방사선치료를보였으며환자의선택으로방사선치료를시행하였다. 결론 : 아직까지도대상환자수가적고, 추적관찰기간이짧지만, 현재까지의결과에서부분냉동치료는국내환자를대상으로하였을때, 종양학적으로크게위험도를높이지않으면서발기부전이나요실금의합병증발생은낮은방법으로근치적전립선절제술을피하고적극적감시를원치않는환자의치료로적절하게시행될수있을것으로기대된다. Keywords: 저중위험도, 전립선암, 부분냉동치료 P Barbed running suture for urethrovesical anastomosis in robot assisted laparoscopic radical prostatectomy 김수동, 성경탁동아의대비뇨기과학교실 Purpose: We compared polyglyconate double arm suture and barbed running sutures during urethrovesial anastomosis (UVA) in Robot assisted laparoscopic radical prostatectomy (RRP). Materials and Methods: A total of 42 consecutive patients underwent Robot assisted laparoscopic radical prostatectomy for prostate cancer. We did a UVA by two layer repair technique and posterior reconstruction was performed in all the patients by 3-0 polyglyconate double arm suture. We divided two groups, in the first 20 patients, the running UVA was performed using double arm 3-0 polyglyconate suture (Group 1). In the other 22 patients, the running UVA was performed with the 3-0 barbed suture (Group 2). Results: The mean UVA time was 37 and 24 minutes in group 1 and 2, respectively (p <0.001). But, there were no statistically significant difference in catheterization time, length of hospital stay. In group 1 and 2, one patient and 3 patients showed mild urine leakage in cystography at postoperative 7days. Overall continence rate at post operation 3months and 6months, there was no statistically significant difference between group 1 and 2 (89% and 94%). Conclusions: We consider that even beginners use of barbed suture for UVA during RRP is associated with a significantly shorter operative time maintaining a proper suturing tension compared with standard double arm suture. Keywords: barbed suture, urethrovesical anastomosis P-5 Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy 이경, 구자윤, 하홍구부산의대비뇨기과학교실 Purpose: Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted intrafascial radical prostatectomy (RARP), few comparative Results with laparoscopic intrafascial radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. Materials and Methods: A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since We evaluated operative 33

56 2015 년도대한비뇨기과학회통합학술대회 (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Results: Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 min and 118.1±39.1 min, and 6.4±0.9 days and 6.6±1.1 days, respectively (P = and P = 0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 h). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (P = 0.578). At postoperative 3 months, sexual intercourse was reported in 14% and 12%, and pad-free continence in 96% and 81% in patients with RARP and LRP, respectively (P = and P = 0.012). Conclusion: Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP. Keywords: 전립선신생물, 전립선적출술, 로봇 P-6 Evaluation of voiding symptom, urinary incontinence and sexual function after laparoscopic and robotassisted laparoscopic radical prostatectomy : A Single Institution Experience 이경, 구자윤, 하홍구부산의대비뇨기과학교실 Objective: To analyze of the voiding symptom and urinary incontinence (UI), after laparoscopic(lrp) and robotassisted laparoscopic radical prostatectomy (RALP). Patients and Methods: Between Jan, 2008and Jul, 2014, 740 patients received radical prostatectomy by a single surgeon; among them, 579received LRP and 68 received RALP. The patients were evaluated recovery of incontinence through 24 hour pad test,the International Prostate Symptom Score (IPSS) and International Index of Erectile function (IIEF) in 1, 3, 6 and 12 months after surgery. Results: In totality, the recovery of incontinence was similar to 12 month after surgery. However, The RALP restored incontinence sooner than those in the ORP group in 1, 3 month and 6 month after surgery (P <0.001, P <0.001 and P=0.037) (figure1). A comparison of time to recovery of incontinence by cox regression analyses showed LRP vs RALP group were uniquely meaningful contributing factor (P=0.011). Over all, The RALP had lower IPSS total scores than LRP group, and showed the significant difference between LRP and RALP group in 6 months after surgery (P=0.004). When divided by voiding part and storage part, there was by far the most distinctin storage part to postoperative 6 months. Also, Patients in the RALP group had significantly better IIEF scores at 1 (P=0.005), 3 (P=0.001), 6 (0.002) and 12 (P=0.049) months. Conclusions: The RALP tended towards get back urinary continence earlier than LRP group, also voiding symptom and sexual function recovered more quickly RALP than in LRP group. Keywords: 요실금, 배뇨증상, 로봇 P-7 한국인의저위험전립선암에서의적극적관찰법의새로운적용기준 국하림, 김광모, 이정근, 이한솔, 김기범, 김태진, 이인재, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대학교병원비뇨기과 Purpose: 저위험전립선암환자에서적극적관찰법 (active surveillance) 이새로운치료방침으로각광받고있지만, 어떠한환자를적극적관찰의대상으로포함시킬것인지에대해서는이견이있다. 여러연구의적극적관찰법의기준이한국인의저위험전립선암에서도적절한지확인해보고자하였다. Materials and Methods: 2006년 1월부터 2014년 6월까지국소전립선암으로근치적전립선적출술을시행받은 1988 명의환자를대상으로 EAU 기준, Dall Era, van As, Soloway, Klotz, Tosoian, Adamy, Bul 등의연구에서의적극적관찰법의적용기준의적절성에대해후향적연구를시행하였다. 각기준의저위험전립선암환자군에서적극적관찰법의기준을적용시술후 Gleason score upgrading 정도를비교분석하였다. D Amico 저위험전립선암환자에서임상적병기, PSA, PSA mass ratio, 조직검사양성코어수, 양성코어에서의암의비율등의임상병리학적인자들을이용하여 Gleason score upgrading 에대한다중회귀분석을시행하였다. Results: EAU 기준, Dall Era, van As, Soloway, Klotz, Tosoian, Adamy, Bul 등의기준에해당하는환자는각각 141 명, 279명, 944명, 304명, 504명, 187명, 491명, 341명이었고, 각각의대상군에서 Gleason score upgrading 율은각각 67.4% (95/141), 55.6% (155/279), 51.2% (485/944), 56.3% (171/304), 65.0% (327/504), 50.8% (95/187), 64.8% (318/491), 56.9% (194/341) 였다. 663 명의 D Amico 저위험전립선암환자군대상으로시행한다중회귀분석에서나이 (OR 1.059, p <0.001), PSA mass ratio (OR , p <0.001), 조직검사양성코어수 (OR 1.270, p = 0.002), 양성코어에서의암의비율 (OR 1.017, p = 0.002) 가술후 Gleason score upgrading에영향을주는인 34

57 The Korean Urological Congress and Expo: 2015 KUCE 자로확인되었다. 본기관의새로운적극적관찰법의기준 ( 임상적병기 T1c 이하, Gleason score 6 이하, PSA 10ng/ml 미만, PSA mass ratio 0.4ug/ml 미만, 조직검사양성코어수 1개, 양성코어에서의암의비율 20% 이하 ) 를적용할경우, 39.3% (33/84) 의 Gleason score upgrading률을보였다. Conclusion: 서구의여러적극적관찰법의기준을한국인에적용한결과, 많은저위험전립선암환자에서 Gleason score upgrading 이확인되었다. 한국인경우, 저위험전립선암에서적극적관찰법을고려할때는서구의기준과다른새로운적용기준을고려해야한다. Keywords: prostate cancer, active surveillance, upgrading P-8 전립선결석이 PSA에미치는영향양희조, 김두상, 이창호, 전윤수순천향의대비뇨기과학교실 Introduction: 전립선결석은전립선초음파시행중흔하게발견되나임상적의의에대해서는많이알려져있지않다. 저자들은전립선결석이 PSA, free PSA 에미치는영향에대해알아보았다. Materials and Methods: PSA가 10nd/ml 이하로전립선조직검사에서전립선비대증으로확인된 236 명의환자를대상으로하였다. 환자들은조직검사전 PSA 와 free PSA 를확인하였고전립선조직검사시행시경직장전립선초음파 (TRUS) 를시행하여전립선용적, 전립선결석의여부를확인하여결석여부에따른차이를비교하였다 Results: 전립선결석은 142명 (60.2%) 에서발견되었다. 환자의나이, 전립선용적, PSA 는두군에서차이가나타나지않았으나 free PSA 는전립선결석이있는군에서유의하게높게나타났다 (p=0.03). PSA density 도차이를보이지않았으나 (p=0.621) percent of free PSA (%fpsa) 는전립선결석이발견된군에서더높게나타났다 (p=0.027). 고령 (60세이상 ) 에서는 PSA 수치가높고 (p=0.05), 전립선용적은크게 (p<0.01) 관찰되었으며 stone 이발견되는경우가많았으나통계학적차이는보이지않았다 (p=0.156). Conclusion: 전립선결석이있는환자에서결석이없는환자에비해 free PSA 관련수치가높게나타났다. PSA 및 free PSA 를해석시전립선결석에따른임상적판단이필요할것으로생각된다. Keywords: prostate, PSA, stone P-9 Docetaxel chemotherapy for metastatic castrationresistant prostate cancer: Prognostic impact of concurrent androgen-deprivation therapy on survival outcome 구교철, 이광석, 안현규, 나군호, 홍성준, 정병하연세의대비뇨기과학교실 Purpose: Docetaxel chemotherapy (DTX) improves cancerspecific survival (CSS) of men with metastatic castration-resistant prostate cancer (mcrpc). Considering the potential existence of androgen receptors that remain active at this stage of the disease, we aimed to assess the impact of combined use of androgen deprivation therapy (ADT) with DTX for mcrpc. Methods: We performed a single-institutional retrospective analysis of consecutive mcrpc patients who received either DTX alone (n = 25) or DTX + ADT (n = 54) between August 2008 and February All patients received DTX dosed 75 mg/m 2 every 3 weeks for at least 6 cycles. CT imaging and bone scans were performed every 3 cycles of DTX. Predictive factors were investigated for radiologic progression-free survival (rpfs) and CSS. Multivariate analyses were performed to control for baseline and on-treatment differences between groups. Results: Median rpfs and CSS from initiation of DTX were 8 (IQR ) months and 17 (IQR ) months, respectively. Both groups had comparable age, comorbidities, pretreatment PSA, stage and grade, extent of metastasis, previous ADT period, number of DTX cycles, and PSA response to DTX. The use of DTX + ADT revealed to be associated with improved rpfs (HR = 0.331, 95% CI ; p = 0.044); however, was not associated with improvement in CSS. On univariate analyses, PSA response, hemoglobin, and neutrophil-to-lymphocyte ratio (NLR) at initiation of DTX were associated with CSS. In multivariate analyses, only NLR remained significant for cancer-specific mortality (HR = 1.294, 95% CI , p = 0.020). Conclusions: In patients with mcrpc, the combined use of ADT with DTX improved rpfs; however, did not show 35

58 2015 년도대한비뇨기과학회통합학술대회 efficacy for CSS. Rather, pretreatment high NLR was associated with a lower risk of CSS. Keywords: 남성호르몬박탈요법, 전립선암, 항암화학요법 P-10 전립선조직검사환자의통증조절을위한시술전처치방법에따른환자통증정도의평가 이창용, 김철성, 노준, 임동훈, 조원진, 백승조선의대비뇨기과학교실 목적 : 전립선조직검사는전립선암을진단하는데필수적이며개원가및대학병원비뇨기과에서가장많이시행하는시술중하나이다. 본연구에서는전립선조직검사전마약성진통제또는비마약성진통제사용에따른두군의조직검사후환자통증정도평가를통해통증조절효과를비교분석하였다. 대상및방법 : 2013 년 12월부터 2014 년 12월까지본원에서전립선조직검사를시행한 204 명을대상으로하였다. 조직검사는 12 core 로동일한숙련된시술자에의해시행되었으며두군모두시술전에통증전처치를시행하였다. 1군은마약성진통제 (Pethidine 25mg) 을근육주사한 99명으로 2군은비마약성진통제 (Tramadol 100mg 정맥내주사와함께 Acetaminophen 650mg 2T 경구복용 ) 를동시에시행한 105 명으로각각분류하였다. 통증평가는통증분석 (10-point Visual analogue scale: VAS) 을통해분석하였으며환자의나이, 전립선의크기 (Prostate volume:cc), PSA 수치를고려하여두군을분석하였다결과 : 전체 124명의환자를 1군과 2군으로분류하였고평균나이는 66.8 세군에따른평균나이는각각 66.2, 67.5 였고전립선의크기는각각 36.6cc, 45,4cc, PSA 는각각 6.1, 5.2 였다. 두군의전립선조직검사후에 VAS 는 3.58, 3.34 로양군간의통증유의한차이가없었다. 결론 : 전립선조직검사전마약성진통제또는비마약성진통제사용에따른두군의조직검사후환자통증정도는유의한차이를보이지않았다. 마약성진통제의경우개원가에서는마약류관리및처리가어려워시술과관리의편의를고려한다면전립선조직검사시비미약성진통제의사용을고려할수있으리라생각된다. P-11 Diagnostic value of urinary nucleic acid TSPAN13: S100A9 ratio for prostate cancer 이상근, 서성필, 엄춘일, 김예환, 정필두, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재충북의대비뇨기과학교실 Background: Circulating cell-free nucleic acid-based biomarkers in body fluids becomes a topic of high interest. We explored whether urinary nucleic acid extracted from urine could be used as diagnostic markers in prostate cancer (CaP) Materials and Methods: Total 95 urines and 234 prostate tissues from patients with CaP and benign prostatic hyperplasia (BPH) were used in the study. Candidate urinary nucleic acid genes were selected from urinary nucleic acid pilot study and validated in test set. By use of real-time quantitative polymerase chain reaction (qpcr), the levels of urinary nucleic acid and tissue mrna expression were measured and evaluated. Results: As a result of pilot study, the ratios of TSPAN13: S100A9 were selected to evaluate diagnostic value of urinary nucleic acid in CaP (P = 0.037). Then, the ratios of TSPAN13:S100A9 were confirmed in tissue mrna levels, which were significantly higher in CaP than in BPH (P <0.001). In validation study of urinary nucleic acid, the ratios of urinary TSPAN13:S100A9 nucleic acid were higher in CaP cases than in BPH controls and represented statistically significant (P = 0.013) Conclusion: The ratios of TSPAN13:S100A9 levels are significantly higher in CaP cases than in BPH controls both in tissue mrna expression levels and in urinary nucleic acid levels. Therefore, the ratio of urinary TSPAN13:S100A9 nucleic acid levels could be used as a suitable biomarker of CaP diagnosis and showed a new approach of finding diagnostic biomarkers in CaP. Keywords: Prostate cancer, cell-free nucleic acid, urine Keywords: 전립선조직검사, 통증조절, 비마약성진통제 36

59 Poster Session 2 E-poster Cancer - Others

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61 The Korean Urological Congress and Expo: 2015 KUCE P-12 Prognostic value of ABO blood group in patients with renal cell carcinoma: single-institution Results from a large cohort Mooyoung Sohn, Jaeyoon Jung, Donghyun Lee, Chunwoo Lee, Dalsan You, In Gab Jeong, Cheryn Song, Taekmin Kwon, Bumsik Hong, Jun Hyuk Hong, Hanjong Ahn, Choung-Soo Kim Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objectives: To evaluate the association between ABO blood group and prognosis in patients with renal cell carcinoma (RCC) undergoing surgery. Materials and Methods: A review of the nephrectomy database of the Asan Medical Center identified 3,172 consecutive patients who underwent nephrectomy for RCC between 1997 and Patients were followed up for a median 60.2 months (interquartile range, months). Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were calculated by the Kaplan- Meier method and compared using the log-rank test. A Cox proportional hazards regression model was used to estimate the prognostic significance of each variable. Results: Of these 3,172 patients, 915 (28.8%), 1,057 (33.7%), 860 (26.7%) and 340 (10.8%) were blood types O, A, B and AB, respectively. ABO blood group was not associated with age, sex, operation method, American Society of Anesthesiologists physical status classification, histologic subtype, or pathological TNM stage. The 5 year OS rates in patients with blood types O, A, B, and AB were 86.0%, 86.8%, 86.6%, and 88.6%, respectively, and the 10 year OS rates were 78.7%, 78.6%, 79.1%, and 76.9%, respectively (P = 0.990). ABO blood group was not significantly associated with RFS (P = 0.921) or CSS (P = 0.808). Univariable and multivariable analyses showed that ABO blood group was not a significant prognostic factor of RFS, CSS, or OS. Conclusions: Our study found that ABO blood group is not associated with survival outcomes and is not prognostic factor in patients who underwent surgery for RCC. Keywords: ABO 혈액형, 신장암, 예후 P-13 Prognostic Significance of Body Mass Index in Patients Undergoing Nephrectomy for Non-metastatic Renal Cell Carcinoma Dae Sung Cho, Sun Il Kim 1, Seol Ho Choo 1, Se Joong Kim 1 Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea Department of Urology, Ajou University School of Medicine, Suwon, Korea 1 Purpose: The aim of this study was to evaluate the impact of body mass index (BMI) on survival in patients with non-metastatic renal cell carcinoma (RCC) treated with radical or partial nephrectomy. Materials and Methods: Between June 1994 and July 2012, 469 patients with RCC underwent radical or partial nephrectomy at two hospitals. Among these patients, 21 patients with lymph node or distant metastasis were excluded. Thus, the medical records of the remaining 448 patients (302 men and 146 women, mean age of 55.9 years) were retrospectively reviewed. The median follow-up duration was 44 months (range 4 to 215 months). The patients were classified into 3 groups according to their BMI based on the Asia-Pacific criteria for obesity: normal (18.5 to <23 kg/m2), overweight (23 to <25 kg/m2), and obese ( 25 kg/m2). The prognostic significance of various clinicopathological variables including BMI was analyzed using univariate and multivariate analysis. Results: Of the total 448 patients, 168 patients (37.5%) were categorized as normal, 112 (25.0%) as overweight, and 168 (37.5%) as obese. Forty-six patients (10.3%) developed local recurrence or distant metastasis and 20 patients (4.5%) died of disease during the follow-up period. In the univariate analysis, BMI, tumor size, T stage, Fuhrman s nuclear grade, coagulative tumor necrosis, and lymphovascular invasion were significant predictors of recurrence-free survival. Also, BMI, tumor size, T stage, Fuhrman s nuclear grade, and lymphovascular invasion were significant predictors of cancerspecific survival. In the multivariate analysis, BMI (p=0.010), tumor size (p=0.009), T stage (p<0.001), Fuhrman s nuclear grade (p=0.006), and lymphovascular invasion (p=0.001) were independent predictors of recurrence-free survival. Also, BMI (p=0.012), tumor size (p=0.004), T stage (p=0.028), and lymphovascular invasion (p=0.013) were independent predictors of cancer-specific survival. Conclusions: Our Results suggest that BMI is an independent prognostic factor for recurrence-free and cancer-specific survival in patients with non-metastatic RCC treated with radical or partial nephrectomy. These findings indicate that BMI could be an effective tool for predicting recurrence or survival in patients undergoing nephrectomy for non-metastatic RCC. Keywords: Body mass index, Nephrectomy, Renal cell carcinoma 39

62 2015 년도대한비뇨기과학회통합학술대회 P-14 The impact of three-dimensional tumor volume on cancer-specific survival for patients with pt1 clear-cell renal cell carcinoma Wan Song, Sang Eun Lee, Young Hyo Choi, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Hyun Moo Lee, Han Yong Choi, Hwang Gyun Jeon Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: To evaluate the impact of three-dimensional tumor volume on cancer-specific survival for patients with pt1 clear- cell renal cell carcinoma (ccrcc). Materials and Methods: We reviewed a prospectively maintained database of 917 patients who underwent radical nephrectomy or nephron-sparing surgery for unilateral, pt1 ccrcc, including 654 pt1a and 263 pt1b patients, between April 1997 and December Three- dimensional tumor volume was measured using specialized volumetric software on cross-sectional computed tomography (CT) images of a preoperative venous phase. Kaplan-Meier and Cox regression analyses were carried out. Results: The median age was 54 years with a follow-up of 60.8 months. Median tumor size and volume were 3.2 cm and 17.4 cm3, respectively. Of 917 patients, 54 (5.9%) had died, including 32 patients with ccrcc (9 patients in pt1a and 23 patients in pt1b). On multivariate analysis, tumor size >3.2 cm and tumor volume >17.4 cm3 were associated with cancer-specific death in pt1 ccrcc patients. When stratified by pt1a/pt1b status and analyzed on median splits, tumor size >2.5 cm was associated with cancer-specific death but not tumor volume >9.5 cm3 in pt1a patients. However, in pt1b patients, tumor volume >62.1 cm3 (P = 0.025, HR: 3.12, 95% CI: ) was highly associated with cancer-specific death but not tumor size >5.0 cm (P = 0.117, HR: 2.04, 95% CI: ). Conclusions: In addition to tumor size, tumor volume is associated with cancer-specific death in pt1 ccrcc patients, particularly in pt1b ccrcc but not in pt1a ccrcc. Keywords: 신장암, 종양크기, 생존률 40

63 The Korean Urological Congress and Expo: 2015 KUCE P-15 The possibilities as a prediction tool for cancer research of big data: Comparison of incidence rate of Korean major male and urologic cancers and trend scores 강동혁 1, 권종규 2, 조강수 3, 함원식 3, 최영득 3, 이주용 3 1 양평군보건소, 2 인제의대비뇨기과학교실, 3 연세의대비뇨기과학교실, 비뇨의과학연구소 Purpose: To examine the trend, and investigated the possibilities as a prediction tool by choosing the trend score about male and urologic cancers have the high incidence rate. Materials and Methods: We selected 5 major male and 3 major urologic cancers for past 3 years (from 2010 to 2012) and examined the incidence rate, and using Naver and Google trend, the rate of cancer incidence was compared with the trend score during the same period. Results: From 2010 to 2012, the greatest occurrence of the cancer to males was the stomach cancer, followed by colon, lung, liver, and prostate cancer. In the urologic field, the prostate cancer was the first one, followed by kidney and bladder cancer. In 2010 to 2012, the Naver trend score was 32 for stomach and colon cancers, 31 for lung cancers, 20 for liver cancers, and 19 for prostate cancers, which index were corresponded with the order of incidence rate. Though the Google trend score for prostate cancer was not found, the average was 9 for stomach cancer, 8 for colon cancer, 6 for lung cancer, 4 for liver cancer, which index were corresponded with the order of incidence rate. In 2013 and 2014, the figure of prostate cancer was grown and exceeded liver cancer. Conclusions: In the trend score, the index of the prostate cancer shows continuing increase, and, from the Results, urologists should recognize the importance of the study on the prostate cancer such as management, prevention, and treatment of the prostate cancer. Keywords: 트렌드분석, 비뇨기암, 남성암 P-16 투명세포신세포암에서 Notch-1 발현의임상적의의및예후적가치 박동재, 강준구, 김상원, 전소영 1, 이준녕, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 김법완경북대학교의학전문대학원비뇨기과학교실, 1 경북대학교의학전문대학원생명의학연구소 목적 : 세포성장, 분화, 고사등을조절함으로써세포의운명을결정적인역할을한다고알려져있는 Notch 경로는다양한종양에서비정상적인발현이보고되고있지만, 투명세포신세포암에서 Notch 경로의역할은명확하게밝혀져있지않다. 이에저자들은 Notch 경로의대표적인수용체인 Notch-1 의발현정도를분석하여투명세포신세포암에서 Notch 경로의역할을알아보고자한다. 대상및방법 : 근치적혹은부분신절제술을시행받고투명세포신세포암으로진단된환자중신세포암조직과정상신장조직이이용가능하였던 49례를대상으로하였다. 신세포암조직및정상신장조직에서발현되는 Notch-1 의발현정도를 real time PCR 를이용하여분석하였다. 신세포암내 Notch-1 의발현정도 (absolute value) 와정상신장조직에비례한신세포암내 Notch-1 의상대발현정도 (relative value) 를의무기록을통해확인한임상적, 병리학적특성에따라비교분석한다. 결과 : 신세포암조직에서 Notch-1 의 mrna 발현은정상신장조직에비해유의하게높은것으로나타났다. 병리학적병기에따른분석에서, 신세포암조직에서 Notch-1 의 mrna 발현은 T1 보다 T2 혹은 T3에서정상신장조직에비해유의하게증가된것으로관찰되었다. 정상신장조직에비례한신세포암조직내 Notch-1 의상대발현정도는병기에따라증가하였고 T1보다 T3에서유의하게증가된것으로관찰되었다. 또한, 상관분석에서 Notch-1 의상대발현정도는종양의크기와양의상관관계가확인되었다. 종양의재발이나종양특이사망이발생한환자에서 Notch-1 의상대발현정도는재발이나사망이없는환자보다높게관찰되지만통계학적유의성은없었다. 결론 : Notch-1 은투명세포신세포암에서발현이증가되고있고병리학적병기가높을수록원발종양의크기가클수록높게발현되었다. 이를통해 Notch 경로는신세포암에서종양의진행과관련성이있는것으로추정되고, 추가적인연구를통해예후인자및표적분자로서의가능성을확인해보아야한다. Keywords: 신세포암, 병기, 종양크기 P-17 단일센터에서의소신종물에대한신냉동수술의결과태종현, 윤성구, 김승빈, 김재윤, 김형근, 편종현, 조석, 강성구, 이정구, 김제종, 천준, 강석호고려대학교의과대학비뇨기과학교실목적 : 소신종물에대한표준치료는부분신절제술이지만, 부분신절제술을시행하기에수술위험도가높은고령이나동반질환이많은환자, 단일신환자, 다발성신종양을가진유전성신질환환자등에서신냉동수술은부분신절제술을대체하여시행되어지고있다. 저자들은본원에서 10년동안시행되었던신냉동수술의추적결과를보고하고자한다. 대상및방법 : 2004 년 8월부터 2014 년 5월까지본원영상검사상신장암으로의심되어신냉동수술을시행받은총 70명 (81 신종물 ) 의환자들에대하여후향적으로조사하였다. 이들중추적관찰이되지않은 1명과신혈관근육지방종 (AML) 에냉동수술을시행하였던 1명을제외한 68명 (79 신종물 ) 의환자들을대상으로하였다. 본원에서신냉동수술의절대적적응증은단일신혹은만성신병증에서발생한신종양, 양측신종양, 유전성다발성신종양이었다. 선택적적응증은 70세이상고령이나 ASA 점수 3점이상, 출혈성경향, 다른종류의동반암이있는환자에서발생한신종물이었다. 41

64 2015 년도대한비뇨기과학회통합학술대회 결과 : 대상환자총 68명 (79신종물) 중초기9명 (13.2%) 의환자는개복으로시행하였고, 이후 59명 (86.8%) 의환자는복강경수술을시행하였다. 평균추적관찰기간은 (3-119) 개월이었고, 환자의평균나이는 62.0 (22-81) 세였다. 신종물의평균크기는 2.25 ( )cm 이었으며, 평균RENAL score는 7 (4-11) 점이었다. 평균수술시간은 194 (85-290) 분이었고, 평균실혈량은 75 (0-300)ml 였으며, 평균재원일수는 6.66 (3-13) 일이었다. 조직검사상총 79개의신종물중 52개 (65.8%) 에서신장암으로진단되었고, 이중 8 개 (15.4%) 에서냉동수술부위의국소재발이관찰되었다. 크기가 4cm 미만이었던총 74개의종양중에서 48개 (64.8%) 에서신장암으로확인되었고, 이들중 4개 (8.3%) 에서국소재발이관찰되었다. 또한, 신종물의크기가 4cm 이상이었던총 5개의종양중에서 4개 (80.0%) 에서신장암으로확인되었고, 이들중 4개 (100.0%) 에서국소재발이관찰되었다. 국소재발환자 8 명중 1 명은다시냉동수술을, 4명은고주파열치료를시행받았고, 이후재발이나전이소견은없었다. 나머지 3명은적극적감시중에있으며, 재발크기의증가나전이소견은없었다. 추적기간중전체 68명의환자들중 1명에서원격전이가발견되었다. 결론 : 4cm이하의소신종물에대한신냉동수술은안전하고효과적인최소침습적치료로확인되었다. 표준치료인부분신절제술에비교하여높은국소재발율을보였으나, 다른신원보존술식을추가적으로시행할경우장기적으로우수한종양학적치료성적을보였다. 적절한환자선택을한다면, 신냉동수술은부분신절제술의대체치료로서유용할것으로사료된다. Keywords: 소신종물, 신냉동수술, 대체치료 P-18 Narrow-band imaging (NBI) 하경요도적방광종양절제술초기경험 : white-light imaging 과의전향적비교연구 윤성구, 태종현, 김승빈, 김재윤, 편종현, 김형근, 조석, 강성구, 천준, 이정구, 김제종, 강석호고려대학교의과대학비뇨기과학교실 목적 : 방광암은일차적으로경요도적절제술로치료되며수술적치료 3개월후많게는 45% 에서재발하는것으로나타난다. 이러한높은조기재발은 undetected lesion의가능성을시사하며이는현재통상적으로사용되는 white-light cystoscopy (WLC) 에서종종작은 mass 나 CIS lesion 을놓치기쉽기때문일것으로추정되고있다. Narrow-band imaging (NBI) cystoscopy 은빛의파장이헤모글로빈에흡수되어 submucosa 의모세혈관이나혈관을잘보이게하여혈관이많은방광종양을정상 mucosa 보다명확하게나타내주므로방광종양의발견율을높일것으로기대된다. 이연구에서기존의 WLC 및 NBI 를이용한 cystoscopy 후방광종양의발견에대한초기경험을기술하고자한다. 방법 : 2013 년 12월부터 2014 년 6월까지본원에서방광내종물로경요도적방광종양절제술이나방광종양조직검사를예정하고있는환자를대상으로하였고, 피험자에게설명문을통해설명하 여, 동의서를작성한지원자만시험에참여하게하였으며난수표를이용한무작위배정을통하여 NBI 시행군의대조군으로기존의 WLC 만시행한 WLC 시행군을두었다. 양군 (NBI 군, WLC군 ) 에서, 각각수술시방광내시경에서발견된종양의개수및조직검사상요로상피암으로진단되는종양의개수에대해서조사하였다. NBI 시행군은기존의 WLC 하에서방광내를면밀히관찰하여종양의개수를확인한후다시 NBI 모드에서추가로종양으로의심되는병변의수를조사한후모두절제하였다. 결과 : 총 42명의환자중 22명은 WLC 군으로, 20명은 NBI 군으로분류하였다. WLC 군에서는 18명이방광암으로진단되었으며, 발견된 39개의종양중에 23개가방광암으로, 14개는 chronic inflammation 으로진단되었다. NBI 군에서는 16명이방광암으로진단되었으며, 59개종양중에 26개가방광암으로, 27개가 chronic inflammation 으로진단되었다. NBI 군에서 NBI mode 에서종양이추가로발견된 10명의환자중 3명이방광암으로진단이되었으며 (30%), NBI mode 에서추가로발견된종양은 23개이며, 그중 2개는 Carcinoma in situ, 2개는 Ta 의결과를보였다 (17.4%). 결론 : NBI 를이용하여추가로발견된종양중방광암으로진단되는경우가 17.4 % 로이는향후추적관찰중방광암재발률을낮출것으로기대된다. 향후추적내시경검사에서양군에서의재발률에대한연구가진행될예정이다. Keywords: NBI, TURBT, bladder cancer P-19 Effect of Diagnostic Ureterorenoscopy on the Intravesical Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma 유재호, 나준필, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수성균관의대삼성서울병원비뇨기과학교실 Object: In upper urinary tract tumors, diagnostic ureterorenoscopy (URS) is the most powerful procedure to confirm Upper tract urothelial cancer (UTUC). However, the URS may increase the risk of intravesical recurrence (IVR). There have been limited reports about the impact of URS on IVR following radical nephroureterectomy (RNU). In this study, we investigate whether diagnostic URS would increase the IVR and be an independent predictor for the IVR. Patients and Methods: The medical records of 630 patients who had RNU with bladder cuff excision due to UTUC were retrospectively reviewed. Diagnostic URS was performed in 282 patients (44.7%). Patients were divided into two groups according to the URS. All patients were followed every 3 4 months for the first year after surgery, every six months from the second to fifth years, and annually thereafter. The Kaplan Meier method was used to calculate survival outcomes and multivariate 42

65 The Korean Urological Congress and Expo: 2015 KUCE analysis was performed to address risk factors for the IVR. Results: The median age was 64 (IQR 56-72) years with follow-up duration of 34.3 ( ) months. Median time from URS to RNU was 16 (0-38) days. In 72 patients, diagnostic URS and following RNU were performed on the same day. The IVR developed in 268 patients (42.5%) at 8.2 ( ) months. The 5-year IVR-free survival rate was 63.6 ± 6.9% and 42.6 ± 8.0% in patients with and without URS, respectively (P <0.001). In multivariate analysis, previous history of bladder tumour, extravesical excision of distal ureter, multifocal tumour, and URS were independent predictors for higher IVR (P <0.05). The IVR rate in patients without manipulation during URS was not different to those with manipulation. The duration from URS to RNU was not associated with IVR (P = 0.799). Conclusions: The diagnostic URS for UTUC was associated with the increased IVR rate following RNU. However, the lessening of interval from URS to RNU or URS without any manipulation could not reduce the IVR rate. Keywords: 요관경하요관조직검사, 신장요관절제술, 방광내재발 P-20 Diameter-axial-polar nephrometry score predicts renal parenchymal atrophy after robotic partial nephrectomy 강숭구, 김종원, 윤영은, 조영인, 김숙영, 한웅규연세의대비뇨기과학교실 Introduction: Preservation of functional renal parenchyma is essential for those who undergoing partial nephrectomy. Renal parenchymal atrophy (RPA) after partial nephrectomy possibly Results from ischemia-reperfusion injury. The present study aimed to verify the association diameter-axial-polar (DAP) nephrometry score and RPA for patients undergoing robotic partial nephrectomy (RPN). Materials and Methods : Present study was conducted to evaluate 136 patients underwent RPN between July 2007 and February Postoperative images obtained at a median of 23.5 months after RPN and RPA was calculated by the ratio of postoperative-to-preoperative parenchymal thickness. Univariable analysis and logistic regression analysis were used for factors associated with RPA after RPN. Results : The median age was 52 (IQR ) years. The median DAP nephrometry score was 6 (IQR 5-6) and median renal parenchymal atrophy was 1.26 (IQR ) %. On the Spearman correlation analysis, RPA was associated with diameter (D) (p = 0.009), axial distance (A) (p = 0.002) and polar distance (P) (p = 0.051). In addition, there was also a correlation between DAP sum score and RPA (r 2 =0.155, p <0.001; Figure 1). As a continuous variable, DAP sum score was associated with severe RPA (> 10%; OR 2.56, p=0.001). On the logistic regression, high DAP sum score (> 5) was a significant predictor of severe RPA (OR 6.0; 95% CI, ; p = 0.025). Conclusion : Diameter axial polar nephrometry predicted RPA in patients who underwent RPN. Thus DAP nephrometry score can be useful for surgical planning or patient counseling before RPN. Keywords: 신세포암, 부분신절제술, 신기능 43

66 2015 년도대한비뇨기과학회통합학술대회 P-21 The impact of preoperative retrograde pyelography before radical nephroureterectomy for upper urinary tract urothelial carcinoma on intravesical tumor recurrence 이권수, 장재윤, 장준보, 김영욱, 최재영, 고영휘, 문기학, 정희창, 송필현영남의대비뇨기과학교실 Purpose: Despite its diagnostic role in identification of upper urinary tract urothelial carcinoma (UUT-UC), approach to ipsilateral ureteral potentially aggravates spread of tumor, as reported in preoperative ureteroscopy before nephroureterectomy. We thus assessed the impact of preoperative retrograde pyelography (RGP) on intravesical recurrence after radical nephroureterectomy for UUT-UC. Materials and Methods: Of a total of 114 patients who underwent nephroureterectomy for UUT-UC from January 2000 to June 2012 in our institution, 72 patients who did not undergo preoperative ureteroscopy were selectively enrolled. Computed tomography and urine cytology as a basic diagnostic modality were performed in all subjects. The impact of preoperative RGP and the other variables (age, sex, operating time, clinicopathological factors, and hematological factors) on intravesical recurrence were analyzed by multivariate Cox regression model. Results: During a mean follow up period of 61.2 months, 32 (44.4%) patients had intravesical recurrence after RNU, and 41 subjects (56.16%) underwent preoperative RGP. The mean duration from preoperative RGP to RNU was 14.2±19.4 days and mean interval of intravesical recurrence was 22.0±23.1 months. Multivariable analysis showed that RGP and pathologic stage over T2 were independent factors for intravesical tumor recurrence (p=0.012 and p=0.036, respectively, Table 1). Regarding the duration from preoperative RGP to RNU, no significant difference was observed between the recurrence group and the non-recurrence group (p>0.05). Conclusions: As with preoperative ureteroscopy, our data demonstrated that preoperative RGP is an independent factor associated with intravesical recurrence of UUT-UC after RNU. 서성필, 이상근, 김예환, 엄춘일, 정필두, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재충북의대비뇨기과학교실 Purpose: Significant clinical heterogeneity remains, particularly for those with pt1 bladder cancer (BC). The aim of the present study was to investigate the value of fibroblast growth factor receptor 3 (FGFR3) mutations and gene expression as a prognostic marker in primary pt1 BC. Materials and Methods: The FGFR3 mutation status was determined by direct sequencing and FGFR3 mrna expression was determined by real-time polymerase chain reaction (RT-PCR) in 120 patients with primary pt1 BC. The Results were compared with clinicopathologic parameters and the prognostic value of FGFR3 was evaluated by Kaplan-Meier analysis and a multivariate logistic regression model. Results: FGFR3 mutations were found in 37/120 pt1 BC (30.8%). FGFR3 mrna expression was significantly higher in FGFR3 mutant BC (P <0.001). FGFR3 wildtype BC and low FGFR3 expression were associated with high grade tumor, cancer progression (all P< 0.05). Kaplan Meier estimates revealed a significant difference in progression free survival depending on the FGFR3 mutation status and FGFR3 expression level (log-rank test, each p< 0.05). Low FGFR3 expression level (odds ratio 4.345, 95% confidence interval , P=0.006) was independent predictor of cancer progression on multivariate logistic regression analysis, but FGFR3 mutation status was not. Conclusion: FGFR3 wild-type BC and low FGFR3 expression were adverse prognosticator in patients with pt1 BC. Therefore, we suggested that FGFR3 mutation status and FGFR3 expression level could be used to more precisely identify subsets of patients with pt1 BC with relatively better and worse prognoses. Keywords: Bladder cancer, FGFR3, Mutation, Expression, Prognosis Keywords: 상부요로상피암, 역행성요로조영술, 재발 P-22 T1 병기방광암환자에서 fibroblast growth factor receptor 3 (FGFR3) 의예후적가치 44

67 Poster Session 3 E-poster LUTS/BPH

68

69 The Korean Urological Congress and Expo: 2015 KUCE P-23 A clinical trial comparing plasmakinetic transurethral enucleation and resection and plasmakinetic transurethral resection of the prostate in patients with benign prostatic hyperplasia more than 80 g. Chang Yong Lee, Won Jin Cho, Seung Baek, Dong Hoon Lim, Joon Nho, Chul Sung Kim Department of Urology, College of Medicine, Chosun University Purpose: We compared the Pre & post-operative clinical outcomes of transurethral enucleation and resection (TUERP) and transurethral resection of the prostate (TURP) for BPH more than 80g Materials and Methods: A retrospective review of 76 patients with BPH larger than 80 g who had done TUERP and TURP from Jan,2011 to Dec,2013, we are compare the efficacy of TUERP and TURP. The parameters included IPSS, QOL score, Qmax, PVR, changes in HGB and serum Na. The postoperative measures such as operative time, resected adenoma weight, resection rate, catheterization time, hospital stay and complications were compared. Results: There were 37 patients with TUERP and 39 patients with TURP performed respectively. IPSS, QOL, Qmax and PVR were significantly improved at 3 months follow up compared with baseline. There were more resected chip weight (54.5±15.7g vs 46.3±15.9g, p= 0.050), Greater resection ratio(82.0±12.9% vs 61.5± 14.8%, P<0.001) were recorded in TUERP group than in TURP group. The postoperative catheterization time and postoperative hospital stay were similar in the 2 groups. Preoperative loss of HGB and serum Na were similar between two groups. The postoperative improvement in QOL and PVR were similar in the 2 groups at 3 months. However, improvement in IPSS,Qmax were significantly better in the TUERP group at 3 months. Conclusions: For large volume BPH, TUERP is associated with greater resection chip weight and resection ratio, better improved IPSS, and Qmax than TURP. Thus, Patients undergoing TUERP seems to be more satisfied with urinary stream than those with TURP Keywords: 전립선, 전립선비대증, 경요도전립선적출술 P-24 Urinary retention following holmium laser enucleation of the prostate caused by hematoma of bladder neck Jun Seok Kim, Dong Hoon Yoo, Seong Woon Park, Joon Hwa Noh Department of Urology, Kwangju Christian Hospital, Gwangju, Korea Sometimes after urethral catheter removal following holmium laser enucleation of the prostate (HoLEP), clinicians encounter urinary retention (UR) resulting in the need for a re-catheterization due to a voiding failure. During HoLEP, it is unavoidable to keep the bladder distended. To avoid a bladder injury during morcellation, it is required to keep the bladder over-distended. Therefore, due to over-distention of the bladder, there is a concern for myogenic injury of the bladder that is responsible for de novo UR, despite a successful relief of a bladder outlet obstruction. Previous studies reported that patient age, history of diabetes, total operative time, and surgical experience were related to de novo postoperative UR after HoLEP. We report a case of de novo UR following HoLEP caused by hematoma of bladder neck. A 64-year-old male visited our urologic clinic 47

70 2015 년도대한비뇨기과학회통합학술대회 because of weak stream, tenesmus, frequency, and nocturia lasting several years. He did not have a specific medical history such as a hypertension, diabetes, and operation. Performed examinations showed the 26 of IPSS, 1.1 ng/ml of PSA, 10 ml/s of Qmax, 103 ml of PVR, and 46 g of estimated prostate weight by TRUS. Despite medical managements during 5 months, his symptoms had not improved and PVR more than 100 ml had been persisted. Therefore, He underwent a HoLEP. Total operative time was 90 minutes (enculeation, 80 minutes; morcellation, 10 minutes). Retrieved tissue weight was 18 g. Foley catheter was removed after postoperative 5 days. Despite a Foley catheter removal, he could not urinate and underwent a re-catheterization. Foley catheter was removed at third day of re-catheterization, however, he failed voiding. We performed a bladder ultrasonography, and ultrasonography showed a 3 cm sized hyperechoic mass in the bladder which was connected the bladder neck. Cystoscopy revealed a flat shaped hematoma attached to bladder neck. The hematoma was removed used by a morcellator. After hematoma removal, he has urinated well. 3.0±8.44, p=0.402, respectively). An increase in the voiding and storage subscores was not significantly different between the two groups (0.72±6.62 vs 1.71±6.18, p=0.250; 1.28±3.6 vs 1.29±3.73, p=0.984; respectively) (Table 1). In the multivariate logistic regression analysis with control for age and life style factors, the risk factors for moderate/severe LUTS were age and erectile dysfunction (p<0.05). However, the presence of the MS did not increase the risk of moderate/severe LUTS (OR=1.09, 95% CI , p=0.748) (Table 2). Conclusions: Our cross-sectional and longitudinal risk factor analyses do not support the hypothesis that the MS is linked to LUTS in Korean men. Keywords: benign prostatic hyperplasia, lower urinary tract symptoms, metabolic syndrome Keywords: Prostatic hyperplasia, Laser therapy, Urinary retention P-25 Relationship between Metabolic Syndrome and Lower Urinary Tract Symptoms: Community-based, Longitudinal, Cohort Study Seong Ho Lee, Min Soo Choo, Jun Hyun Han, Won Ki Lee, Sang Kon Lee Department of Urology, School of Medicine, Hallym University Aim of Study: The aim of the study was to test the hypothesis that the metabolic syndrome (MS) is linked to lower urinary tract symptoms (LUTS) in Korean men. Materials and Methods: This was a longitudinal study that used data collected from 328 men aged years (mean age, 69.7 years) who were randomly selected among 1,520 participants in LUTS was assessed by the International Prostate Symptom Score (IPSS, Korean version). We collected information from 224 (68.3%) men (range, years, mean age, 71.7 years) among the original responders on the biological, medical, psychological, social, lifestyle, and economic factors in Results: The prevalence of the MS was 187/328 (57.0%) in 2004 and 125/224 (55.8%) in 2007 among men, respectively. There was no significantly greater increase in the IPSS in men with the MS than in men without the MS over a 3-year period of time (2.0±9.37 vs 48

71 The Korean Urological Congress and Expo: 2015 KUCE P-26 Efficacy of a vaporization-resection of the prostate median lobe enlargement and vaporization of the lateral lobe for BPH using a 120 W GreenLight HPS laser : The effect on storage symptoms. 허경재, 문형우, 김강섭, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 황태곤, 김세웅 Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea Purpose: GreenLight laser photoselective vaporization of the prostate (PVP) was established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia (BPH). However, it may be difficult to achieve adequate tissue removal from a large prostate, particularly those with an enlarged median lobe. The Purposeof this study was to investigate the feasibility and clinical effect of 120 W GreenLight high-performance system laser vaporization-resection for an enlarged prostate median lobe compared with those of only vaporization. Materials and Methods: A total of 126 patients from January 2010 to January 2014 had an enlarged prostate median lobe and were included in this study. Ninety-six patients underwent vaporization only (VP group) and 30 patients underwent vaporization-resection for an enlarged median lobe (VR group). The clinical outcomes were International Prostate Symptoms Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual urine volume (PVR) assessed at 1, 3, 6, and 12 months postoperatively between the two groups. Results: The parameters were not significantly different preoperatively between the two groups, except PVR. Operative time and laser time were shorter in the VR group than those in the VP group. (74.1 vs min, 46.7 vs min, P = 0.020, 0.013, respectively) and used less energy (218.2 vs KJ, P = 0.025). Improved IPSS values, increased Qmax, and a reduced PVR were seen in the two groups. In particular, improved storage IPSS values were higher at 1 and 3 months in the VR group than those in the VP group (P = 0.030, 0.022, respectively). No significant complications were detected in either group. Conclusions: Median lobe tissue vaporization-resection was complete, and good voiding Results were achieved. Although changes in urinary symptoms were similar between patients who received the two techniques, shorter operating time and lower energy were superior with the vaporization-resection technique. In addition, vaporization-resection may have a beneficial effect on storage symptoms. Keywords: BPH, HPS laser, median lobe P-27 The correlation of aortic calcification and LUTS Young Jun Moon, Hyung Jun Kim, Jin Bum Kim, Young Seop Chang, Hong Wook Kim Konyang University Hospital Introduction and Objective: Recently it was reported that vascular calcification was one of the cause of lower urinary tract symptoms. We studied to evaluate the association between lower urinary tract symptoms of vascular calcification in the abdominal CT using by Agar score. Materials and Methods: The records were obtained from a retrospective database who underwent abdominal CT due abdominal pain, hematuria. Sex, age, height, weight, prostatic size, calcification of aorta and internal iliac artery, amount of subcutaneous fat and visceral fat in the umbilicus level, IPSS, OABSS and uroflowmetry were assessed. Calcification of aorta was estimated from renal artery bifurcation to iliac artery bifurcation level. And internal iliac artery calcification was calculated from bifurcation of iliac artery to bladder. We scanned each subject of 0.5cm interval on the CT scan. The calcification of blood vessels was measured as Agar score using abdominal CT by Aquarius intuition Edition version program. This program has been used in measuring calcification on the coronary artery on cardiac CT in chest pain patients. Results: From June 2012 to May 2014, 58 patients with LUTS were enrolled. Mean age of LUTS patients was 57.5±14.6(25~86)years old. Mean of PSA was 1.2±1.01 ng/dl(0.13~3.47). Mean of prostate size was 34.9±18.45 (19.4~98.8)gm. Aortic calcification significantly correlated with nocturia (p = 0.002), sum of irritative Symptoms (p = 0.019), sum of IPSS (p = 0.026), urgency (p = 0.031) and urgency incontinence (p = 0.394). Urinary symptoms and sign was no correlation with internal iliac calcification and body fat composition. Conclusions: Aortic calcification was correlated with urinary symptoms in the abdominal CT. It is needed further large-scale prospective study for the correlations of symptoms and abdominal aortic calcification in the LUTS patients. Keywords: 대동맥석회화, 하부요로증상 49

72 2015 년도대한비뇨기과학회통합학술대회 P-29 Early post-operative outcome analysis after Holmium laser enucleation of the prostate (HoLEP) 강석현, 진병수, 정현진, 김덕윤대구가톨릭대학교의과대학비뇨기과학교실 P-28 방광출구폐색이없이배뇨근과활동및수축력장애로진단된남성에서홀뮴레이저전립선적출술의효과에대한초기경험 유동훈, 노준화, 박성운, 김준석광주기독병원비뇨기과교실 서론 : 노인남성에서하부요로증상원인의대부분은전립선비대증과과민성방광으로알려져있지만방광출구폐색이없이배출장애와저장장애를동시에호소하는배뇨근과활동및수축력저하 (Detrusor hyperactivity with impaired contractility, DHIC) 인경우약물등의요인에의해급성요폐가발생할위험이높으며이로인해만족할만한치료역시기대하기어렵다. 이에저자들은저명한방광출구폐색이없이 DHIC 로진단된환자에서홀뮴레이저전립선적출술 (Holmium laser enuleation of the prostate, HoLEP) 로최대한전립선조직을제거하고항콜린제투여로치료한경험을보고하고자한다. 대상및방법 : 2014년 2월부터 2014년 12월까지지속적인약물치료에도반복적인요폐, 요절박, 빈뇨, 야간뇨등의하부요로증상이개선되지않은 12명의환자중경직장전립선초음파및방광경검사에서저명한방광출구폐색이없으며요역동학검사에서 DHIC 로진단된 4명의환자를대상으로하였다. 모든환자에서병력청취, 신체검사, 직장수지검사 PSA 를시행하였고술전, 후그리고 3개월간의항콜린제투여후국제전립선증상점수 (IPSS) 및최대요속및주관적인만족도를비교하였다. 결과 : 대상자들의연령, 전립선크기, 혈중 PSA, 제거된전립선조직의평균값은각각 68.5세 (62-72), 22.2g ( ), 1.25ng/ml ( ), 5.4g ( ) 이였다. IPSS 총점수는수술전평균 23 에서수술후 17.5 로감소하였고, 배뇨증상 ( 항목 1,3,5,6) 점수는수술전평균 12.5 에서수술후 10 또저장증상 ( 항목 2,4,7) 점수는수술전평균 10.5 에서수술후 7.5로감소하였다. 3개월간의항콜린제투여후 IPSS 총점수는 14.75, 배뇨증상점수는 8.25 그리고저장증상점수는 6.5 으로모두감소하였다. 최대요속은수술전평균 7.2ml/s 에서수술후 10.25m/s 그리고항콜린제복용후 12.5ml/s 로모두향상되었다. 수술후항콜린제 3개월지난후주관적만족도는만족 2명 (50%), 보통 2명 (50%) 이였다. 결론 : 저명한방광출구폐색없이배출장애와저장장애를모두호소하는 DHIC 환자에서 HoLEP 으로최대한전립선조직을제거한후항콜린제를투여하는방법은총 IPSS 그리고최대요속을개선시켜환자의삶의질을높일수있었다. 하지만모든환자가매우만족할수있는치료법은아니므로수술전환자에게충분한설명이필요할것으로생각된다. Purpose: Holmium laser enaucleation of the prostate (HoLEP) is one of the standard treatment of benign prostatic hyperplasia (BPH) nowadays. In this study, we try to analyze the early recovery of uroflow and International Prostate Symptoms Scale (IPSS) in post-operative one month because most of patients showed gradual improvement in follow-up evaluation. Materials & methods : Prospective analysis of 54 patients who underwent HoLEP was done. Pre-operative & day of catheter removal and one month uroflow, IPSS, QoL were measured Results : The mean age of the patients was 72.1 (±6.78) and mean of prostate volume was 56.8 (±35.29). Max flow rate was increased (p=0.004) and IPSS was decreased (p=0.002) with statistical significancy. Also, QOL was improved significantly (p=0.000). Some patients (n=20) showed decreased max flow rate (mean : 8.5 to 4.9) in catheter removal day but all of them were improved (to 13.5) post-operative 1 month. Conclusion : Although some patients showed decresed uroflow rate in immediate post-operatively, early improvement of voiding parameters were recovered after 1 month post-operatively. And most patients were very satisfied this procedure. So, HoLEP is an effective treatment for the patients with BPH. Keywords: 전립선비대증, 홀뮴레이저 Keywords: DHIC, HoLEP 50

73 The Korean Urological Congress and Expo: 2015 KUCE Filling CMG 에서 MCC 와배뇨근유순도는나이에따른유의한변화가없었다. PFS 에서 PdetQmax 의평균값은 35.3 ± 8.9 cmh2o 이었고나이가 10살증가함에따라 0.96 cmh2o 씩유의한감소를보였다 (p=0.037). BCI 의평균값은 ± 34.0 로, 역시나이가 10살증가함에따라 4.6씩유의한감소를나타냈다 (p=0.008). 결론 : BOO 및신경인성방광이없는남성들에서, PdetQmax 및 BCI 값은나이가증가함에따라유의한감소를나타냈다. 이러한나이에따른배뇨근기능감소의임상적의미에대한추가적인연구가필요할것으로생각된다. Keywords: 요역동학검사, 나이, 남성 P-30 남성에서연령에따른배뇨근기능의변화 : 방광출구폐색및신경인성방광이없는환자군에서평가 이한솔, 김기범, 이정근, 이영익, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대병원비뇨기과 목적 : 배뇨에관련된질환이없더라도나이가듦에따라배뇨근의기능은변화하는것으로보고되었으나, 아직까지이에대한연구는많지않다. 특히, 남성에서는전립선비대증등다른요인으로인해순수한배뇨근의변화를관찰하기는쉽지않다. 저자들은방광출구폐색및신경인성방광이없는남성들에서배뇨근기능이나이에따라어떠한변화를겪는지알아보고자하였다. 대상및방법 : 2003 년 5월부터 2014 년 3월까지하부요로증상으로요역동학검사를시행받은 5,502 명의남성환자들중, 신경인성방광으로진단되었거나의심되는경우, 검사전요폐가있었던경우, 이전에하부요로에해부학적이상이있거나수술적치료를받은경우, 관련요역동학검사자료가불충분한경우를제외하여선별하였다. 이중, 전립선비대증으로인한 bladder outlet obstruction (BOO) 영향을배제하기위하여, Abrams-Griffiths (AG) number >40, AG number 이면서최소배뇨압이 40cmH2O 이상이거나 LPURR slope 가 2cmH2O/ml/s 이상인경우, 55세이상이면서전립선용적을알수없거나 30ml 이상인경우를제외한 200명을최종적으로분석하였다. 요류검사에서최대요속 (Qmax) 과배뇨후잔뇨 (PVR) 를, 요도내압검사 (UPP) 에서기능적요도길이 (FUL) 와최대요도폐쇄압 (MUCP) 을, 충전방광내압측정술 (filling CMG) 에서방광내압측정술상최대방광용적 (MCC) 과배뇨근유순도를, 압력요류검사 (PFS) 에서 Qmax, PVR, 최대요속시배뇨근압 (PdetQmax), 방광수축력지수 (BCI) 를각각조사하였다. 연령은 63세를기준으로각각의요역동학지표들의차이를비교하였으며, PdetQmax 와 BCI 의나이에따른변화를선형회귀분석을이용하여평가하였다. 결과 : 평균나이는 58.2 ± 13.9 세, 평균전립선용적은 23.9 ± 4.3ml 였으며, 63세미만인군은 105 명, 이상인군은 95명이었다. Qmax 는요류검사와 PFS 에서나이가많은군에서유의하게감소하였으나 ( 각각, 17.8 vs 15.5ml/s, p=0.014; 16.1 vs 13.9ml/s, p=0.013), PVR은나이에따른변화가없었다. UPP 에서 MUCP 는나이가많은군에서감소하였으나 (103.0 vs 79.0cmH2O, p=0.035), FUL 는나이에따른변화가없었다. P-31 배뇨근수축력저하로진단된환자들의임상적치료패턴 Detrusor underactivity: treatment patterns in the real practice 김광모, 국하림, 이한솔, 김기범, 송병도, 김태진, 이인재, 이정근, 조정기, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대병원비뇨기과학교실 배뇨근수축력저하 (detrusor underactivity; DU) 는최근에주목을받고있지만, 아직까지표준화된진단기준이없고, 더욱이, 치료면에서있어서확립된양식이없어실제임상진료에서다양한방법이시도되고있다. 저자들은본기관에서신경학적이상없이 DU로진단된환자들이어떤치료패턴을받는지후향적으로분석하고자하였다. 2003년 5월부터 2014년 3월까지하부요로증상으로요역동학검사를시행받은환자들중, 배뇨기능에영향을줄수있는신경학적, 해부학적이상이있는경우를제외하고, 남성의경우, 방광수축력지수 (bladder contractility index; BCI) 가 100미만, 여성의경우, 압력요류검사에서최대요속이 12ml/s 이하이고최대요속시배뇨근압이 10cmH2O 이하인경우에 DU로진단하였다. 치료패턴은수술, 약물치료, 청결간헐도뇨, 경과관찰로분류하였고약물치료는 alpha-blocker, muscle relaxant, anticholinergic, desmopressin 및 others 로세부분류하여분석하였다. 처음외래내원당시주증상에따라 storage symptom, voiding symptom, stress urinary incontinence symptom 으로분류하였고, 치료평가가가능하였던환자군에서치료전후의 IPSS, 요류검사지표를비교분석하였다. 증상여부와치료방법은교차분석을이용하였고집단간치료전후지표변화는일원배치분석을시행하였다. 기간내에 DU로진단된환자는 327 명으로, 남자 254 명, 여자 73명이었다. 평균나이는 73.3 ± 5.4세였으며 storage symptom 이주증상인경우가 104명 (31.8%), voiding symptom 이주증상인경우가 45명 (13.8%), 둘다호소하는경우가 149 명 (45.6%) 이었다. SUI 가주증상인경우는 27명 (8.3%) 이었다. 치료방법으로, 수술을시행받은경우는 96명 (29.4%), 약물투여를받은경우는 254명 (77.7%), 청결간헐도뇨를시행한경우는 17명 (5.2%) 이었으며, 25명 (7.6%) 에서는경과관찰만하였다. 약물치료와수술적치료를같이받은환 51

74 2015 년도대한비뇨기과학회통합학술대회 자는 48명 (14.7%) 였다. 약물종류는 alpha-blocker 가 119 명 (36.4%), anticholinergic가 105명 (32.1%), muscle relaxant가 3명 (0.9%), desmopressin이 7명 (2.1%), other drug 이 20명 (6.1%) 에서사용되었다. 치료패턴에있어서각증상군별로차이를보였는데, voiding symptom 이나 SUI 증상을가지는군이 storage symptom 군에비해서수술적치료를하는경우가많았고, 반대로 storage 군에서는약물치료를하는경우가더많았다. 치료평가가가능하였던환자군에서각치료후의 IPSS, 요류검사지표는호전되는경향을보였으나, 통계적으로유의하지는않았다. DU의임상적증상은다양하였으며, 여러가지치료방법과약물이사용되고있었다. 대개의치료방법은주증상에따라결정되었으며, 다양한치료방법에도불구하고 IPSS 와요류검사지표상뚜렷한변화를보이지않았다. treatment but the treatment satisfaction rate was lower. Conclusion: The therapeutic effects of alfuzosin were not different with respect to differences in sympathetic activity, but the rate of treatment satisfaction was lower in the HSA group. Keywords: Heart rate, Sympathetic nervous system, Lower urinary tract symptoms Keywords: 요역동학검사, Urodynamic study, Age, bladder underactivity, treatment P-32 Efficacy of alfuzosin according to sympathetic activity 심강희, 박성곤, 김태우, 추설호, 정병하 1, 이성운 2, 박종관 3, 박광성 4, 천준 5, 이경섭 6, 김형지 7, 성도환 8, 오승준 9, 김세웅 10, 이지열 10, 최종보 아주의대비뇨기과학교실, 연세의대비뇨기과학교실 1, 성균관의대비뇨기과학교실 2, 전북의대비뇨기과학교실 3, 전남의대비뇨기과학교실 4, 고려의대비뇨기과학교실 5, 동국의대비뇨기과학교실 6, 단국의대비뇨기과학교실 7, 인하의대비뇨기과학교실 8, 서울의대비뇨기과학교실 9, 카톨릭의대비뇨기과학교실 10 Purpose: To compare outcomes for treatment with an α -blockerbetween two groups of men, one with high sympathetic activity (HSA) and another with low or normal sympathetic activity. Methods: A total of 169 men aged 50 with LUTS resulting from benign prostatic hyperplasia were screened. We assigned patients to groups according to sympathetic activity, which was evaluated by measuring the heart rate variability. A HSA was defined as that with a low frequency/high frequency ratio higher than 1.6. All patients received 10 mg of alfuzosin QD for 12 weeks. The primary end point was the change in total International Prostate Symptom Score (IPSS) at 12 weeks from baseline. Results: Sixty-seven men were assigned to the HSA group and 92 men were assigned to the control group. The baseline characteristics were not significantly different between two groups, and the response to alfuzosin was good in both groups. The mean total IPSS change was not different. Both groups did not present significant differences with respect to changes in maximal flow rate; IPSS voiding or storage symptom subscore; quality of life; and rates of adverse drug events. The HSA group showed similar willingness to continue 52

75 The Korean Urological Congress and Expo: 2015 KUCE P-33 당뇨병환자에서전립선비대증과경동맥내중막두께의연관성 Correlation between prostate volume and intimamedia thickness (IMT) of carotid artery in diabetic benign prostatic hyperplasia 이창민, 허지혜 1, 임정수 1, 강태욱, 양승훈, 채윤병 2, 정현철, 김광진, 송재만, 정재흥연세대학교원주의과대학비뇨기과학교실, 내과학교실 1, 청주성모병원비뇨기과 2 목적 : 전립선비대증은노인에서발생하는가장흔한양성질환으로서노화와남성호르몬이주요원인이고고혈압, 인슐린저항성, 당뇨, 비만, 키, 흡연, 낮은고밀도콜레스테롤 (HDLcholesterol) 와관련이있는것으로보고되어대사증후군과유사한병태생리학적기전을공유하는것으로추정되고있다. 이와더불어최근동맥경화증역시전립선비대증의위험요인으로보고되어본저자들은당뇨병환자에서전립선비대증과경동맥내중막두께의연관성을분석하고자하였다. 대상및방법 : 2010년 1월부터 2014년 8월까지당뇨병으로내분비내과에내원한총 111 명의환자를대상으로하였다. 전립선용적은경직장초음파를이용하여측정하였으며경동맥초음파를이용하여양측의평균내중막두께를측정하여선형회귀분석을시행하였다. 결과 : 전립선비대증이동반된군 44명과동반되지않은대조군 67명으로분류되었으며전립선비대증유무에따라나이, BMI, 허리둘레, HbA1c 가통계학적으로유의한차이가관찰되었다 (Table 1). 전립선용적및이행대용적은경동맥내중막두께와통계학적으로유의한연관관계가관찰되었다 (p=0.027, p=0.008, Figure 1) 결론 : 당뇨병환자에서전립선용적은경동맥내중막두께와연관성을보여당뇨병이있는전립선비대증환자의경우심혈관질환에대한주의깊은추적관찰이필요할것으로생각된다. Keywords: 당뇨병, 전립선비대증, 경동맥내중막 P-34 Limited correlation between presumed circle area ratio (PCAR) and the severity of lower urinary tract symptom (LUTS) in Korean male 이권수, 장재윤, 장준보, 김영욱, 최재영, 고영휘, 송필현, 문기학, 정희창영남의대비뇨기과학교실 Purpose: Though presumed circle area ratio (PCAR) had been highlighted as a mechanism underneath the development of male lower urinary tract symptom (LUTS), there was paucity of data supporting its clinical relevance, particularly in Asian people. We thus investigated the correlation between the degree of PCAR and the severity of LUTS. Material and Methods: From September 2012 to June 2014, 144 consecutive patients without prior medication for LUTS including alpha blocker, 5 alpha reductase inhibitor, anticholinergics, and desmopressin underwent transrectal ultrasonography (TRUS) on the prostate by a single experienced radiologist as a routine evaluation for LUTS, measuring prostatic volume, the ratio between transitional zone volume to total volume (TZTV), prostatic urethral angle (PUA), and PCAR, which was defined as the ratio of the area of the maximum horizontal section to that of a presumed circle with the equal circumference of the section. The severity of LUTS was prospectively assessed using International Prostate Symptom Score (IPSS) and uroflowmetry values. Correlation between TRUS variables and the severity of LUTS was then analyzed. Results: The mean age was 65.6±9.4 years, and the mean prostatic volume, TZTV, and PCAR was 33.2±23.4 ml, 0.48±0.16, 33.5±10.9, and 0.76±0.05, respectively. In simple correlation analysis using IPSS as a continuous variable, no ultrasonographic variable showed a significant link. When dividing total IPSS into obstructive (IPSS Q 1, 3, 5, 6) and irritative component (Q 2, 4, 7), obstructive symptoms showed significant correlation soley with the degree of PCAR (rho=-0.17, p=0.037). However, when dividing total IPSS into three categorical grades based on severity, no association was observed (PCAR in mild vs. 53

76 2015 년도대한비뇨기과학회통합학술대회 moderate vs. severe: n=39, mean=12.8±6.7 vs. 56, 14.3±6.7 vs. 49, 11.7±3.5, p=0.078). In a multiple linear regression model, none of the TRUS measurable variables showed significant association with the degrees of LUTS using both in continuoues and categorical parameters except age, which showed a significant link between irritative symptoms (R squre = 0.027, B=0.073, p=0.049). Conclusions: In this prospective observational series for Korean men, no significant associations were found between the degree of PCAR and the severity of LUTS. of IPSS after TURP. Keywords: acute urinary retention, benign prostate hyperplasia, transurethral resection of prostate Keywords: 전립선비대증, 하부요로증상, 초음파 P-35 Outcomes and complications of transurethral resection of prostate in patients with history of acute urinary retention Yang heon Jo, Ho Seok Jeong, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Purpose: To assess the association between a history of acute urinary retention (AUR) and outcomes and complications after transurethral resection of prostate (TURP) in men. Patients and methods: Clinical data of 104 patients with benign prostate hyperplasia (BPH) undergoing TURP from January 2011 to March 2013 were retrospectively analyzed. The patients were divided into two groups by a history of AUR before the operation: AUR group (n=27) and no AUR group (n=77). Patients who had episodes of AUR and Foley catheterization at least 6 months before TURP were selected for inclusion in AUR group. Patients who had any previous surgery of the lower urinary tract or AUR secondary to a specific cause such as a urethral stricture or neurogenic bladder were excluded. Postoperative complications, e.g. re-catheterization, hematuria, urinary tract infection or urinary incontinence, were compared. Changes in pre- and postoperative International Prostatic Symptom Score (IPSS), maximal flow rate and postvoid residual were compared. Results: Postoperative re-catheterization, urinary tract infection and urinary incontinence were found in both groups. The incidence of those events does not showed significant difference between the two groups (p=o.443, 0.403, 0.468, 0.439, respectively). Improvement of the maximal flow rate and postvoid residual urine were significantly marked in the AUR group after TURP (p=0.004, <0.001, respectively). There was no significant difference between groups in the improvement P-36 Changes in muscarinic and ErbB2 receptor expression in a rat model of partial bladder outlet obstruction. 이충렬, 김영호, 박종목, 신주현, 임재성, 송기학, 나용길, 설종구충남의대비뇨기과학교실 Introduction: Binding of NRG1 Results in tyrosine phophorylation of ErbB receptors which initiates multiple downstream signals including PI3 kinase, MAP kinase, and cyclin-dependent kinase to modulate expression and activity of different functional proteins such as ion channels and neurotransmitter receptors. The aim of this study is to determine the expression of muscarinic and NRG1/ErbB2receptor in rat bladder, and changes in their distribution and expression following detrusor overactivity (DO) induced by bladder outlet obstruction (BOO). Materials and Methods: The study was conducted using 40 male Sprague-Dawley rats (body weight g), subdivided into control (n=20) and BOO groups (n=20). 54

77 The Korean Urological Congress and Expo: 2015 KUCE Partial BOO was induced for 3weeks and DO was confirmed with measuring intravesical pressure and intraabdominal pressure. A portion of the bladder was dissected into bladder urothelium and the smooth muscle layer, and the expression of receptors was detected by RT-PCR and Western blotting. Results: Cystometrography showed a significant decrease in contraction interval and increase in contraction pressure in the BOO group. On RT-PCR and Western blotting, the expression of M2, M3 receptors was increased in the urothelium of the BOO group, and there was increased M3 receptor expression in the muscle layer of the BOO group. The expression of NRG1/ErbB2 receptors was only increased in the urothelium of the BOO group; there was a smaller increase in the muscle layer. Conclusions: There were detectable changes in NRG1, muscarinic and ErbB receptors with DO induced by BOO. The NRG1 may up-regulate M3 receptor via multiple binding profiles such as PI3K/MAPK signal cascades to affect the ErbB2 receptor and thus enhanced DO. Our Results suggest that the changes of NRG1 expression could have a role in mediating the afferent sensory responses in the urinary bladder. Keywords: 방광출구폐색, 무스카리닉수용체 P-37 페이퍼타올을이용한배뇨후점적의이환율및정량적평가연구 김마태, 정경화, 고경태, 이원기, 이성호, 김하영, 김성용, 양대열한림대학교의과대학비뇨기과학교실 Introduction: 정상배뇨가완전히끝난이후에자신도모르게소 변이새는증상인배뇨후점적 (Post-micturition dribbling) 은모든연령의남성에게서발생하는증상이지만, 역학적조사를포함한적절한진단과치료가이루어지지않고있다. 이에저자들은페이퍼타올을이용하여배뇨후점적의이환율및정량적평가를시행하였다. Material and Method: 하부요로증상으로비뇨기과추적관찰중인환자및신환 197명을대상으로하였다. 모든환자는검사전국제전립선증상점수 (IPSS) 와저자들이개발한배뇨후점적에관한설문 (Hallym Post Voided Dribbling questionnaire: HPVDQ) 을시행하였다. 환자는요의가있을때요류측정검사와방광초음파잔뇨검사를시행하였다. 그후, 페이퍼타올을이용하여배뇨후요점적량을정략적으로측정하여 IPSS 및 HPVDQ 와함께분석하였다. Result: 환자의평균나이는 62.0 ± 이었다. IPSS 는평균 12.2 ± 7.7 ( 배뇨증상 7.0 ± 5.4, 저장증상 5.2 ± 7.7) 이었다. 요류측정검사에서평균배뇨양은 ± ml, 최대요속은 11.7 ± 6.5 ml/s 이었다. 잔뇨량은평균 39.9±88.9 ml이었다. 배뇨후점적에관한설문에서, 환자의 47.7% 는배뇨후점적증상을호소하지않았으나 7.1% 에서는항상배뇨후점적증상을호소하였다. 페이퍼타올을이용하여배뇨후점적양을정량적으로평가하였을때, 8.6% 만이음성이었고, 91.4% 의환자에서격자 1칸이상의소변자국이측정되었다. 증상이있는환자에서배뇨후점적의평균양은 0.07ml 이었다. 배뇨후점적증상을불편해하는환자일수록, 배뇨후점적증상을자주호소하는환자일수로통계학적으로유의하게배뇨후요점적양이증가하였다 Conclusion: 배뇨후점적에대한정량분석결과하부요로증상이있는환자의대부분에서배뇨후요점적이관찰되었으며실제양이 0.1ml 이상인경우환자들은불편하게받아들였으며. 배뇨후점적증상의빈도수가높을수록점적양이많았다. 따라서배뇨후요점적은비뇨기과영역의매우흔하고중요한증상으로향후적극적인평가와치료가필요할것으로여겨진다. Keywords: 배뇨후점적, 하부요로증상, 정량화 55

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79 Poster Session 4 E-poster Incontinence, Female Urology and Neurourology

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81 The Korean Urological Congress and Expo: 2015 KUCE P-38 Systematic review and meta-analysis of intravesical hyaluronic acid instillation for interstitial cystitis/ painful bladder syndrome Chang yong Lee, Seung Baek, Dong Hoon Lim, Joon Nho, Chul Sung Kim, Won Jin Cho Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, South Korea Objective: To assess the efficacy of intravesical hyaluronic acid instillation in patients with interstitial cystitis/painful bladder syndrome by systematic review and meta-analysis Methods: A systematic literature search was performed using the Keywords IC`or painful bladder syndrome` and hyaluronic acid`, up to October 31, The primary outcome was visual analogue scale related pain symptom (VAS). Secondary outcomes were total scores of the O Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), frequency, nocturia, bladder volume and voided urine volume. Results: Nine articles involving 377 patients were retrieved and assessed in this analysis. A significant improvement in mean VAS on fixed-effect and random-effect models (mean difference [MD] , 95% confidence interval [CI] to , p<0.001, and MD , 95% CI to , p <0.001, respectively) was found. Significant improvements were found in the ICSI (MD , 95% CI to , p <0.001) and ICPI (MD , 95% CI to , p <0.001). Similarly, the other secondary outcomes were significantly improved. There was no evidence of publication bias except in nocturia. However, the number of missing studies that would bring the p value to greater than alpha was 33 on the fail-safe N test and the number of observed studies was 4 in nocturia. Conclusion: Intravesical hyaluronic acid instillation improved pain symptoms, quality of life and other outcomes and might be an attractive modality considering multiple therapeutic modalities. Keywords: 간질성방광염, 통증성방광증후군, 방광내히알루론산주입요법 P-39 하부요로증상이있는남성에서방광수축력저하의예측인자로서악력검사의의미 함동엽, 김지원, 최우석, 최재경 1, 정성진 2, 백성현, 노용수, 김형곤, 박형근건국대학교병원비뇨기과학교실, 건국대학교병원가정의학과교실 1, 분당서울대병원비뇨기과학교실 2 목적 : 악력검사 (Hand Grip Test) 에서측정된악력 (Hand Grip Strength; HGS) 은전신의모든근력과연관성을보이며, 나아가환자의질병이환, 입원치료, 사망등과관련성을보인다. 하지만, 악력과방광근의수축력과의연관성에대하여는잘알려져있지않다. 본연구에서는악력과방광수축력과의연관성을규명하고자하였다. 대상및방법 : 하부요로증상으로요역동학검사를시행하는환자 59

82 2015 년도대한비뇨기과학회통합학술대회 를대상으로전향적연구를시행하였다. 척수질환을포함한신경학적질환이있는환자는대상에서제외하였다. 악력검사는주로사용하는손에서 maximal isometric tester 를사용하여악력 (HGS) 을측정하였고, 모든악력검사는요역동학검사직전에시행하였다. 방광수축력은방광수축지수 (bladder contractility index; BCI, PdetQmax + 5Qmax) 를이용하였고, BCI 가 100 이하인경우를배뇨근저활동성 (detrusor underactivity; DU) 으로정의하였다. BCI 와악력의연관성에대한상관분석을시행하였고, DU군과 DU가없는 non-du 군에서악력을비교하였다. 또한악력이 DU를예측하는진단적가치를평가하기위하여 ROC 분석을시행하였다. 결과 : 연구에참여한총 64명환자의평균나이는 63.1 ± 15.2 세였다. 전체환자의평균 HGS 는 30.3 ± 6.9 kg, 평균 BCI 는 92.7 ± 34.6 이었다. 상관분석결과 HGS 와 BCI 는유의한양의상관관계를보였다 (R2=0.39, p=0.001). 전체환자중 36명 (56.3%) 에서 DU가확인되었다. DU군은 non-du 군에비하여 HGS 가유의하게낮았다 (non-du vs. DU; 32.7 ± 5.6 vs ± 7.3, p=0.015). ROC 분석에서 HGS 가 DU를예측하는 area under curve (AUC) 는 66.4% (95%CI = %, p=0.026) 였다. HGS 25 kg을기준으로하였을때, DU를예측하는민감도, 특이도, 양성예측율, 음성예측율은 30.6%, 89.3%, 78.6%, 50.0% 였으며, HGS <35 kg을기준으로하였을때의민감도, 특이도, 양성예측율, 음성예측율은 83.3%, 39.3%, 63.8%, 64.7% 였다. 결론 : 본연구는악력 (HGS) 과방광수축력이유의한연관성을있음을규명하였다. 악력이낮은환자에서 DU가있을가능성이높다. 본연구결과, 하부요로증상이있는환자에서단순히악력을측정하는것만으로도방광수축력을예측하는데도움을줄수있으며, 치료의결정에도움을줄수있을것으로기대된다. Keywords: 방광수축력, 배뇨근저활동성, 요역동학검사 P-40 폐쇄공테잎삽입술시행시동시에시행하는골반수술이미치는영향비교 안창, 전태용, 배정범, 조민철, 이해원, 이광수동국의대비뇨기과학교실 목적 : 복압성요실금을보이는여성이항요실금수술을받을때자궁근종, 골반기관탈출또는미용목적으로동시에수술을받는비율이증가하고있다. 하지만골반수술과폐쇄공테잎삽입술 (TOT) 을동시에시행할경우 TOT 수술결과에영향을미칠우려가존재한다. 이에 TOT 수술시골반수술을같이시행하는경우 TOT 수술결과와환자만족도에대하여조사하였다. 대상및방법 : 2008 년 1월부터 2014년 2월까지복압성요실금으로본원에서처음수술받은환자 324명을대상으로후향적으로조사하였다. 환자의병력과수술전요역동학검사결과와술전및술후국제전립선증상설문지 (IPSS), 과민성방광설문지 (OABSS) 와요속도 (UFM) 및잔뇨측정술결과를수집하였다. 또한수술후환자에게주관적증상과만족도에대한조사를하였다. 수술후 1주일후한달후환자증상및배뇨양상을파악하였다. 환자 군을 TOT 수술만한경우 (TOT 군 ) 와골반수술을같이한경우 ( 골반군 ) 로나누어비교하였다. 결과 : TOT 군은 292 명이었고, 골반군은 31명이었다. 환자의나이, 당뇨, 뇌졸중, 폐경, 이전골반수술경력등의과거병력에는차이가없었으며, 수술전복압성요실금의 Stamey 등급의차이가없었으며, 절박성요실금증상과 IPSS, OABSS, UFM 및잔뇨, 요역동학검사에서도두군의차이가없었다. 다만 3등급이상의방광류유무에차이가있었다 (0.3% vs. 23.3%, p <0.001). 술후시행한설문지와 UFM 에서두군은차이를보이지않았으나술후 1주째잔뇨에서통계적차이를보였다 (36.1 vs. 61.2, p=0.021). 또한술후 1달째보인합병증중절박성요실금, 배뇨곤란, 통증등에서차이를보이지않았으나상처회복에통계학적차이를보였다 (0.9% vs. 7.4%, p=0.011). 환자만족도에서는두군간의차이를보이지않았다. 결론 : TOT 수술시같이시행하는골반수술은수술결과및환자만족도에서 TOT 단독으로시행하는경우와비교하였을때큰차이를보이지않고안전하게시행될수있다 Keywords: 요실금, 골반수술 P-41 Effectiveness and Safety of Mirabegron (Adrenergic beta-3 Receptor Agonists) ; Who will benefit from "Mirabegron"? 손희서, 김명주, 김지유, 전유정, 문수영, 허지은, Troya, 김장환연세대학교의과대학비뇨기과학교실 Purpose: Adrenergic beta-3 Receptor Agonists, Mirabegron, is a newly introduced agent for treatment of overactive bladder (OAB). The therapeutic action is believed to be induced by several mechanisms; by inhibition of the afferent nerve, by promoting bladder relaxation, and by indirectly affecting parasympathetic neuron. We aimed to know the efficacy and safety of Mirabegron, in diversely categorized groups of patients. Patients and Methods: From December 2014 to February 2015, a total of 42 patients were enrolled. We prescribed Mirabegron as daily dose of 50mg. Out of 42 patients, 13 were anticholinergic treatment naïve, 14 received Mirabegron in place of anticholinergics because of side effect or poor response, and 15 received Mirabegron in addition to the existing anticholinergics because of insufficient effect. After the mean follow up period of 34 days (17~34 days), we evaluated the efficacy and safety of Mirabegron. Results: The mean age of the patients was 61.4(22~82) years old. Out of the 42 patients, 29 were diagnosed with idiopathic OAB, and 13 had OAB of neuropathic origin. Among them, 51.7%(15/29) with idiopathic OAB and 69.2%(9/13) with neurogenic OAB showed subjective symptom improvement. With regard to therapeutic 60

83 The Korean Urological Congress and Expo: 2015 KUCE regimen, 53.8%(7/13) of anticholinergic naïve patients, 50.0%(7/14) of patients who received Mirabegron instead of previous antichloinergics, and 66.7%(10/15) of patients who received Mirabegron in addition to anticholinergics showed subjective improvement. One out of 13 anticholinergic naïve patients (7.7%) suffered from dry mouth. Improvement of xerostomia was observed in 71.4%(5/7) among patients who showed dry mouth with previous anticholinergics and then switched to Mirabegron. There was statistically significant decrease in IPSS-storage symptom (p=0.033) within the idiopathic OAB. The changes of IPSS were substantial in neurogenic OAB; total IPSS (p=0.006), IPSS-storage symptom (p=0.012) and IPSS-voiding symptom (p=0.009). Out of patients with more than 5 points of OABSS, before Mirabegron medication, the decrease of OABSS was also statistically significant in neurogenic OAB (p=0.034). Conclusion: This study has proved that Mirabegron is effective in OAB of both neurogenic and non-neurogenic origin, with negligible adverse effects. And the combination of Mirabegron with anticholinergic agents was also effective and safe. Keywords: Adrenergic beta-3 Receptor Agonists, Overactive Bladder, Mirabegron P-42 Expression and Membrane Translocation of Aquaporin 2 (AQP2) and Vasopressin v1a (AVP-v1a) Receptor After Pelvic Nerve Stimulation in the Urinary bladder Sun woo kim, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Introduction: Aquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. The purposes of this study were to investigate the localization and functional roles of AQP2 and vasopressin v1a (AVP-v1a) receptor in the urinary bladder. Methods: Female Sprague-Dawley rats ( g, N = 20) were anesthetized. The pelvic nerve was stimulated for 60 seconds (10 V, 16 Hz, 0.8 ms), and the animals were sacrificed immediately after nerve stimulation. The expression and cellular localization AQP2 and AVP-v1a of were determined by Western blot and immunohistochemistry of the urinary bladder. The intracellular membrane and plasma membrane fractions of the proteins in bladder tissues were studied by immunoblot analysis with the differential centrifugation. Results: Immunolabeling showed that AQP2 and AVP-v1a were mainly expressed in the cytoplasm of the urotheliym of the urinary bladder. AQP2 and AVP-v1a were found to be present primarily in the cytosolic fraction of untreated tissues. The translocation of AQP 2 and AVP-v1a from the cytosolic compartment to the membrane compartment was observed after nerve stimulation. Conclusions: These Results showed a distinct localization of AQP2 and AVP-v1a in the rat urinary bladder. Pelvic nerve stimulation modulated immediate translocation of AQP2 and AVP-v1a. These Results imply that AQP2 and AVP-v1a may play an important role in bladder activity by nerve stimulation of the urinary bladder. Keywords: AQP2; AVP; bladder P-43 Increased Expression of Urothelial Aquaporin-1 in Caveolin-1 Knockout Mice Urinary Bladder Ji won Rhu, Sun-Ouck Kim, Kyung-Aa Cho 1, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Purpose: We investigated the effect of the deletion of caveolin-1 (CAV1) using CAV1 knockout (KO) mice on the expression of aquaporin 1 (AQP1) to confirm the relationship between them in the urothelium of urinary bladder. Methods: The expression and cellular localization of AQP1 and CAV1 were determined by Western blot and immunofluorescent study in the wild type and CAV1 KO mice urinary bladder. Results: AQP1 and CAV1 were co-expressed in the capillaries, arterioles and venules of the suburothelial layer. The AQP1 protein expression were significantly increased in the CAV1 KO mice compared with wild type control (p<0.05). Conclusions: There was significant increase in the expression of AQP1 in the CAV1 KO mice urinary bladder. This finding may imply that AQP1 and CAV1 might be closely related to the bladder signal activity and may have a functional role in bladder function. Keywords: aquaporin 1, caveolin 1, mice 61

84 P-44 Methylphenidate and Its Effects on Lower Urinary Tract: Assessing cystometrogram in Rats with Hyperactivity Disorder 정하범, 조성태, 최돈경, 김기경, 이영구, 김계환 1 한림의대비뇨기과학교실, 가천의대비뇨기과학교실 1 Purpose: Methylphenidate (MPH) is a central nervous system (CNS) stimulant widely prescribed for the treatment of Attention deficit hyperactivity disorder (ADHD). However, there is limited research on its effects on lower urinary tract (LUT) function. The aim of this study was to investigate whether intragastric injection of MPH affects cystometric parameters in conscious SHRs, an animal model of ADHD. Materials & methods: Ten 14- to 16-week-old male SHRs, weighing between 280 and 315 g, were used. MPH was dissolved in 0.9% saline solution. To evaluate the effects of two different doses of MPH (3 mg/kg and 6 mg/kg), a ml solution was administered intragastrically using the catheter. The micturition cycles were recorded before administering MPH. One hour after each intragastric injection of MPH, the cycles of cystometrogram were obtained in the awake condition. The cystometric parameters were analyzed using the mean values of the three consecutive micturition cycles. The analyzed parameters were basal pressure (BP), maximal pressure (MP), threshold pressure (TP), residual volume (RV), micturition volume (MV), bladder capacity (BC; RV + MV), and micturition interval (MI). Results: Five SHRs were each administered a low dose of MPH (3 mg/kg), and the other five rats a higher dose of MPH (6 mg/kg). The BP and MP significantly increased after the 3 mg/kg MPH injection (BP, 13.9 ± 6.9 cmh2o before the injection versus 23.2 ± 6.9 cmh2o after the injection, p < 0.01; MP, 47.0 ± 9.8 cmh2o before versus 57.9 ± 8.2 cmh2o after, p < 0.05). However, BP and MP did not show any significant changes after the 6 mg/kg MPH injection. There were no significant changes in TP after either injection. BC, MV, and MI significantly increased after the 6 mg/kg MPH injection (BC, 0.47 ± 0.07 ml before the injection versus 0.60 ± 0.05 ml after the injection, p < 0.01; MV, 0.47 ± 0.07 ml before versus 0.60 ± 0.05 ml after, p < 0.01; MI, 4.68 ± 0.21 min before versus 5.75 ± 0.26 min after, p<0.01). However, there were no significant changes in theses parameters after the 3 mg/kg MPH injection. Conclusions: Intragastric injection of MPH (6 mg/kg) in SHRs showed significant increases in BC, MV, and MI. This suggests that the peripheral nervous system as well as the CNS may have important roles in LUT function when treating ADHD with MPH. keywords: 메칠페니데이트, 요역동학검사, 과잉운동장애

85 Poster Session 5 E-poster Stone & Endourology

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87 The Korean Urological Congress and Expo: 2015 KUCE P-45 Is URS helpful for small ureter stones sized around 5mm? Byung Soo Jin, Seok Hyun Kang, Hyun Jin Jung, Duk Yoon Kim Department of Urology, Catholic University of Daegu, School of Medicine, Daegu, Republic of Korea Purpose: Initial treatment of the patient with ureter stone which is smaller than 5mm is usually done by hydration and expectation therapy. However, spontaneous passage of stone requires undefined waiting and usually takes more than 4 weeks. So, patient must suffer unpredictable severe pain. In this study, we analyzed the small ureter stone patient underwent URS who showed ureter narrowing below stone and URS was beneficially performed. Materials & methods: We retrospectively studied 54 patients who underwent ureteroscopic surgery with ureter stone around 5mm who showed ureter stricture in ureteroscopic findings before stone removal. Mean ages was 54.1 (±12.86) old and male to female ratio was 27: patients were performed pre-operative extracorporeal shock-wave lithotripsy (ESWL) and showed no response. Results: Mean stone size was 4.3(±0.93)mm and stone level were as follows; 40 lower ureter stones, 2 midureter stones, 8 upper ureter stones. Pre-operative ESWL was done 0.8 (±1.46) sessions in average. Waiting time before operation was 38.2 (±75.60) days in average. Strictured ureter segments was dilated with ureteral catheter and ureter dilators. Stone removal was succeeded in most of patients and ureteral stenting with 4.7 Fr double-j catheter was indwelled post-operatively for 2-4 weeks. There was no post-operative stricture or severe pain. Conclusion: In this study, we found many patients who have small stones that are resist to remove spontaneously have narrow ureter below the stone. In light of these, for early resolution of ureter stone, we should consider URS treatment even in small-sized ureter stone when it is not willing to remove spontaneously or ESWL resistant. Keywords: 요로결석, 좁은요관, 요관경하배석술 P-46 상부요로결석에서 tamsulosin 제제를이용한기대요법의효용성 최태수, 김동수, 이영, 신용호, 김영빈, 최승권, 이동기, 민경은, 전승현, 이형래, 유구한 경희의대비뇨기과학교실 목적 : 본원에서상부요로결석을진단받은환자들에게기대요법을시행하였을때, tamsulosin 제제가자연배출에미치는영향에대해분석하였으며, 효과적인치료방법의선택에도움이되고자하였다. 대상및방법 : 2012 년 3월부터 2014 년 2월까지본원에내원하여상부요로결석을진단받고, 체외충격파쇄석술및요관경하요관결석제거술을시행하지않은총 73명의환자를대상으로하였다. 추적관찰이되지않거나, 일반요검사, 단순촬영검사 (KUB), 전산화단층촬영검사등의검사를통해결석의배출여부가확인되지않은환자들은제외하였다. 기대요법을하였을때, 이전결석이위치에관계없이남아있는경우를치료실패군으로정의하였다. 치료성공군과실패군의나이, 성별, 당뇨, 고혈압, 결석의크기, 방향, 수신증의정도, 전산화단층촬영검사상의환상음영여부, tamsulosin 복용여부, 저용량스테로이드제복용여부에대해후향적으로비교분석하였다. 결과 : 총 73명의환자를교차분석하였을때, 남성 11/46 명, 여성 3/27 명에서결석이배출되지않았으며치료성공군과유의한차이를보이지않았다.(p=0.228) 4mm 이상의결석 (7/26명 ) 이그이하의결석 (7/47 명 ) 과비교하였을때기대요법의성공률에서큰차이를보이지않았으며 (p=0.230) 좌우방향 (p= 0.561), 수신증의정도 (p=1.000) 및환상음영여부 (p=1.000) 에따른유의한차이는없었다. 기대요법시 tamsulosin 제제는 53명 (72.6%) 이복용하였으며이경우 9명에서, 복용하지않은경우 5/20 명에서결석이배출되지않았고서로간의유의한차이는없었다.(p=0.509) 저용량스테로이드복용 (p=0.764), 당뇨 (p=0.08), 고혈압 (p=0.613) 에의한자연배출의유의한변화역시관찰되지않았다. 다변량분석을통해서, 성별 (p=0.070), 결석의크기 (p=0.259), 방향 (p=0.200), 수신증정도 (p= 0.743), 환상음영여부 (p=0.959), tamsulosin 복용 (p=0.251), 저용량스테로이드복용 (p= 0.447), 당뇨 (p=0.060), 고혈압 (p=0.532) 이치료성공률에미치는유의한상관관계는없음을확인하였다. 결론 : 요로결석의기대요법시투약하는 tamsulosin 제제는상부요로결석의경우자연배출에대한효과가불분명한것으로확인되었다. 이번결과의일반화를위해서는추가적인다기관전향적연구가필요하겠다. Keywords: 요로결석, 당뇨, 예후인자 P-47 10mm이상의 크기가 큰 상부요관결석에 대한 Laser lithotriptor 를이용한경성요관경하배석술과복강경하요관 절석술의비교 김연주, 김재수, 권준범, 조성룡, 이윤형대구파티마병원비뇨기과 목적 : 10mm 이상의크기가큰상부요관결석의치료에있어서 laser lithotriptor 를이용한경성요관경하배석술 (ureteroscopic lithotripsy; URS) 과복강경하요관절석술을비교하여요관경하배석술의효용을알아보고자하였다. 65

88 2015 년도대한비뇨기과학회통합학술대회 대상및방법 : 2009년1월부터 2014년4월까지본원에서 10mm 이상의일측성상부요관결석으로요관경하배석술을시행받은 51명의환자 (A군 ) 와복강경하요관절석술을시행받은 39명의환자 (B군 ) 를후향적으로분석하였다. A군에서는 9Fr. 경성요관경하에 laser lithotriptor 와 10mm stone cone 를사용하였으며 B군은경복막접근법으로시행하으며술후두군의모든환자에서요관부목을설치하였다. 두군의수술시간, 수술후입원기간, 치료성공률, 수술후합병증발생여부및요관부목설치기간을비교하였다. 결과 : 두군모두에서술중, 술후합병증은없었으며개복술로의전환없이수술을마쳤다. 평균수술시간은 A군에서 48±10.7 분, B군에서 82±8.0분 (p<0.001), 평균입원기간은 A군에서 3.6±1.3일, B군에서 5.6±0.8일 (p<0.001), 치료성공률은 A 군에서 86%(44/51), B군에서 100%(39/39), A군에서신장으로이동한결석은체외충격파쇄석술을통해제거하였다. 요관부목의설치기간은 A군에서 15.6±0.8일, B군에서 16.1±0.8 일로유의한차이가없었다. 모든환자에서 3개월후추적관찰하여수술후합병증이없음을확인하였다. 결론 : 수술장비의발달과술자들의요관경수술에대한경험이바탕이되어 10mm 이상의크기가큰상부요관결석의제거에복강경하요관절석술을대신하여요관경하배석술의시행이충분히고려될수있음을알수있었다. Keywords: 요관결석, 요관경, 복강경 P-48 경주에서요로결석의계절에따른유병률비교박동진, 유정우, 서영진, 이경섭, 권세윤, 김기호동국대학교경주병원비뇨기과목적 : 요로결석은더운시기일수록유병률이올라간다고널리알려져있다. 이에 3년간요로결석으로경주동국대학교병원을방문한환자들을대상으로계절에따른요로결석의유병률의차이를비교해보고자하였다. 대상및방법 : 2011 년 1월부터 2013 년 12월까지요로결석으로본원비뇨기과외래및응급실을방문한 1,764 명을대상으로후향적연구를하였다. 3년간월별로내원및입원한환자수를확인하여, 그당시기상청자료에따른월별평균기온에따라요로결석의유병률의변화를비교하였다. 결과 : 대상집단의평균나이는 48.3±15.2 세였고, 남녀비율은 68.3:31.7 이었다. 월별평균기온과요로결석내원환자수는 Table 1이었다. 평균기온이높은 7, 8월달에평균내원환자수역시많았으며, 계절별로는봄에평균기온 11.8 도, 평균내원환자수 44.9명, 여름에 24.5도, 57.1명, 가을에 14.4도, 49 명, 겨울에 0.0도, 45명으로평균기온이높을수록평균내원환자수역시많음을확인할수있었고이는 Figure 1에정리를하였다 (p=0.006). 결론 : 더운여름에땀분비등의이유로체내수분량이줄어들기때문에요로결석의유병률이증가한다고알려져있으며, 본연구를통해서도그사실을확인하였다. 이로써요로결석예방을위해더운여름에수분섭취를많이하는것이좋을것이라고생각한다. Keywords: 요로결석, 계절, 기온 P-49 요석에대한다파장 Nd:YAG 레이저의파쇄효과배민호, 박창후, 조영삼, 박흥재, 권칠훈, 주관중성균관의대비뇨기과학교실목적 : 홀뮴레이저의조직흡수도와유사한 1444nm 파장의 Nd:YAG 레이저와헤모글로빈에흡수도가높은 1064nm 파장의 Nd:YAG 레이저를선택적으로발진시킬수있는레이저를개발하였다. 방광석개모델에서이레이저의파쇄효과및조직에대한안전성을확인하고자하였다. 대상및방법 : 생후 2년령의비글견암컷 14수를흡입마취후방광을절개하여 struvite 석을삽입하고봉합하였다. 24일의회복기간후무작위로두군으로나누어각각 7두씩배정하였다. 흡입마취를유지하면서방광경으로방광석을확인하였다. 1군은 1444nm 파장의 Nd:YAG 레이저를이용하여방광석을파쇄하였고, 2군은 1064nm 파장의 Nd:YAG 레이저를이용하였다. 수술후방광경및복부방사선촬영으로잔석유무를확인하였다. 실험동물을희생시킨뒤방광을적출하고 Hematoxylin-eosin 염색을하여조직상태를관찰하였다. 각군의 1수씩은수술후 10일간회복기를거쳐서희생한뒤방광을적출하여동일한방법으로조직을관찰하였다. 결과 : 방광에삽입된결석의평균장경은 1군에서 10.3mm, 2군에서 9.9mm 로두군간유의한차이는없었다. 잔석이남지않은경우를제석성공으로정의하였고레이저제석성공률은 1군에서 100%, 2군에서 71.4% (5/7) 이었다 (Fig. 1). 수술직후의방광조직에대한병리검사상방광상피층과점막고유층상부의부분손상및출혈이확인되었으며두군간차이는없었다. 10일회복후방광조직에병리검사에서는손상이나출혈이관찰되지않고모두치유된상태이었다. 결론 : 1444nm 파장의 Nd:YAG 레이저가 1064nm 파장의레이저보다요석의파쇄효과가더우수하였고, 요석주변의조직에대한손상은경미하였다. 요석에대한내시경적파쇄수술에 1444nm 파장의 Nd:YAG 레이저를이용함으로써파쇄효과와안전성을동시에얻을수있을것으로사료된다. Keywords: 요석, 방광석, 레이저 66

89 The Korean Urological Congress and Expo: 2015 KUCE P-50 Comparison of post-operative safety profile in tubeless percutaneous nephrolithotomy according to type of sealant 박준형, 정현우, 서윤석, 김정준, 한덕현성균관의대삼성서울병원비뇨기과학교실 Objectives: Several sealants have been used to reduce complication related to bleeding during tubeless percutaneous nephrolithotomy (PCNL). The aim is to investigate the post-operative safety profile in tubeless PCNL according to type of sealant. Material & methods: We retrospectively analyzed medical records of 229 patients who underwent tubeless PCNL from August 2008 to June We used fibrin sealant (Tisseel, n=206) or gelatin matrix hemostatic sealant (FloSeal, n=23). To compare safety profile, the rate of post-operative hemoglobin reduction, transfusion and fluid collection on routine imaging study on postoperative first day were investigated. Pain scale by visual analogue scale (VAS), the frequency of post-operative emergency room visit, and rates of post-operative ureteral stent insertion and angioembolization were investigated. 1:4 propensity score matching method was applied (Table 1). Results: The 1:4 case matching methods was performed according to the propensity score reflecting age, gender, ureteral stent insertion, body mass index, operative time, stone size and residual stone, that could influence the post-operative complication related hemostasis. The post-operative safety profile showed no difference between two groups (table 2). These result was not only in the 1:4 propensity score matching analysis, but also in total patients. Conclusion: The post-operative safety profile were not different according to type of sealant in tubeless PCNL patients. Further prospective study is necessary to confirm this similarity of post-operative safety profile. Keywords: 경피적신쇄석술, 실런트, 합병증 P-51 Predictive factors and treatment outcomes of steinstrasse following extracorporeal shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis 한장희, 최재혁, 정두용, 강호원 1, 조강수, 함원식, 최영득, 이주용연세의대비뇨기과학교실, 비뇨의과학연구소, 1 충북의대비뇨기과학교실 Purpose: The aim of this study was to investigate the predictive factors and treatment outcomes of steinstrasse after extracorporeal shock wave lithotripsy (ESWL) for solitary ureteral calculi using non-contrast computed 67

90 2015 년도대한비뇨기과학회통합학술대회 tomography (NCCT). Materials and Methods: We reviewed the data from 551 patients who underwent primary ESWL for solitary ureteral calculi. Maximal stone length (MSL), location, Hounsfield units (HU), and skin-to-stone distance (SSD) were determined on pretreatment NCCT. Propensity score-matching minimized selection bias, and predictive factors for steinstrasse formation were evaluated by non-bayesian logistic regression and Bayesian modeling. Results: Steinstrasse incidence after ESWL for ureteral calculi was 2.2% (n=12). The steinstrasse group had a significantly larger mean stone burden, lower HU level, and shorter SSD compare to non-steinstrasse patients (all P<0.05). After propensity-score matching, the steinstrasse group had a significantly shorter SSD versus the non-steinstrasse group (P=0.013). By multivariate logistic regression and Bayesian modeling, MSL, HU, and SSD were independent predictors for steinstrasse development. Of the 12 steinstrasse cases, 6 patients were resolved with expectancy and the remaining 6 patients were successfully managed by repeat ESWL without other serious complications. Conclusions: Steinstrasse development after ESWL for ureteral calculi was relatively rare and could be easily and safely treated by conservative management. MSL, HU, and SSD were significant predictors for developing steinstrasse after ESWL for ureteral calculi. If a patient has a high probability of steinstrasse formation after ESWL for ureteral calculi, patient counseling is indicated. Keywords: 요로결석, 체외충격파쇄석술, 베이지안분석 P-52 The discrimination on the baseline surgical proficiency of virtual simulator manifests in time-consuming exercises: the predictive validity using a urethrovesical anastomosis model 장준보, 장재윤, 이권수, 김영욱, 최재영, 송필현, 문기학, 정희창, 고영휘영남의대비뇨기과학교실 Purpose: The Purposeof this study is to determine how to assess the baseline proficiency and to develop the proper robotic virtual simulator (RVS) curriculum which allows unexperienced trainees to perform complex tasks such as urethrovesical anastomosis. Materials and Methods: This study was conducted in two phases; RVS and hands-on training phase. In RVS, 43 participants repeatedly performed 12 exercises consistent with all primary exercises in the endowrist manipulation category and advanced needle driving category in sequence until the overall score reached beyond 80%. In hands-on phase using a robotic surgical system, 10 randomly selected trainees performed eight sutures at one time simulating urethrovesical anastomosis and console time was recorded. Results: The median of total time and total attempt was minutes and 54 times (91.2 minutes and 34 times for endowrist manipulation category; 76.3 minutes and 18 times for advanced needle driving category). When dividing trainees by median total time and then comparing early and late completion groups, times to accomplish six among 12 exercises were significantly different. These six prolonged exercises, including three exercises in the endowrist manipulation category and all exercises of the advanced needle driving category occupied 88.18% of total time (85% in the early completion group, 89.7% in the late completion group) and 77.61% of total attempts (73% in the early completion group, 80.2% in the late completion group). In 10 participants for hands-on phase who had characteristics similar to those of trainees only for RVS phase, multiple linear regression model showed an association of total RVS time with console time for the urethrovesical anastomosis model (p=0.010). Among time for RVS, time for six prolonged courses was an independent predictor of console time (p=0.018). Conclusion: For the unexperienced trainee, the baseline robotic surgical skills can be determined by the time to accomplish six time-consuming exercises, and this discrimination can be identically applied to hands-on training rehearsing urethrovesical anastomosis, implying the efficacy of training pertaining to difficult exercises rather than relatively simple counterparts. Keywords: 요도방광문합술, 로봇시뮬레이터, 전립선절제술 P-53 Association between the presence of baseline microscopic hematuria and the composition of ureteral urolithiasis 장재윤, 장준보, 이권수, 김영욱, 고영휘, 송필현, 문기학, 정희창, 최재영영남의대비뇨기과학교실 Purpose: Because of the difference in degrees of mucosal damage based on the hardness and structure of urolithiasis, we hypothesized the association between the degrees of microscopic hematuria and stone composition. We investigated these correlations in ureteral calculi, in an ambulatory setting of patients. Materials and Methods: A total of 59 patients who 68

91 The Korean Urological Congress and Expo: 2015 KUCE underwent surgical management without treatment of extracorporeal shockwave lithotripsy from June 2013 to June 2014 were enrolled. The subjects were divided into two groups; with (n=31) and without (n=28) microscopic hematuria at baseline evaluation. The removed ureteral calculi compositions were analyzed using infrared spectrophotometry. The relationships between presence of microscopic hematuria and clinical variables including patient s characteristics (age, sex, past medical history, previous history of ureteral calculi, presence of flank pain), stone size, location (proximal or distal), and laboratory data including stone composition were then analyzed. Results: The mean age was 56.0±16.2 years and the mean size of stone was 9.17±5.15 mm. Location of urolithiasis was proximal in 28 cases and distal in 31 cases. In composition, most common was calcium oxalate stone (n=37), followed by uric acid (n=12), carbonate apatite (n=8), cysteine (n=1), and brushite (n=1). In the hematuria group, nearly half of subjects (55%, 17/31) had a non-calcium oxalate stone. In univariable analysis, non-calcium oxalate composition, presence of flank pain, positive blood in dipstick test, and previous history of ureteral calculi showed significant correlation with presence of microscopic hematuria. Multivariable logistic regression model showed that non-calcium oxalate composition, prior history of ureteral calculi, and presence of flank pain were independent factors associated with microscopic hematuria (p=0.009, p=0.02, p=0.035). Conclusions: Our study demonstrated significant correlation between the composition of urolithiasis and the presence of microscopic hematuria, implying an individualized approach based on outcome of initial urinalysis particularly for subjects without microscopic hematuria, who had a high likelihood of calcium oxalate stone. Keywords: 요로결석, 혈뇨, 분석 P-54 The significance of non-enhanced compute tomography for renal colic has been overestimated in absence of pyuria 장인호, 김진욱, 김태형, 명순철, 문영태, 김경도중앙의대비뇨기과학교실 Objecetive: The study was undertaken to compare clinical utility in patients undergoing non ehanced computed tomogrpahy (NECT) and intravenous urography (IVU) in patient with classic symptoms of renal colic without evidence of urine infection and to determine the clinical importance. Materials and Methods: This was a retrospective observational analysis of all adult patients berween 2005 and All NECT and IVU were reviewed and categorized as the cause of symptoms. Non urolithiasis cause were further categorized as acutely important, follow-up recommended, and other unimportant cause. Full record review blinding to imaging finding was underwent including demographics, daignosis, and management. We compared stone charactersitics on imaging study, and demogrpahic, exact diagnosis, and managment methods between NECT and IVU groups. Results: 2,218 patients were available inclusion criteria and 1525 (68.8%) patients were underwent IVU and 693 patients were NECT. The incidence of NECT was 1.25% at 2005, but 94.9% at NECT group was older (45.5±15.0 vs 42.4±13.7 years old, p<0.01), less hematuria in urine analysis (87.2 vs 90.2%, p<0.05) and more admit (18.6 vs 12.0%, p<0.01) than IVU group. Urinary stones were detected 1413 (63.7%) patients. NECT group showed higher proportion of renal stone, mid ureteral stone and multiple stones (20.9 vs 13.8%, p<0.001, 5.5 vs 2.7%, p<0.01, 14.6 vs 6.5%, p<0.001, respectively), and smaller stone (3.62±3.23 vs 4.15±2.36 mm, p<0.001), and more radiolucent stone (25.7 vs 13.2%, p<0.001) comparing to IVU group. The incidence of urolithiasis more than 4mm were no difference between NECT and IVU groups (20.5 vs 20.0%, p=0.79 on radiologic finding, and 20.2 vs 20.5%, p=0.87 on full chart record). Moreover, the incidence of "acutely important" among non urolithiasis cause was similar between NECT and IVU groups on full record review (1.3 vs 0.9%, p=0.14). The incidence of the active management including surgery and extracoporal shock wave therapy (ESWL) were not difference between NECT and IVU group (35.4 vs 39.9%, p=0.67). Conclusions: NECT is a rapid and accurate diagnosis test for suspecte/d renal colic, and nowaday almost renal colic patients in our hospial underwent NECT in ED. Keywords: Non enhanced computed tomogrphay, intravenous urography, urolithiasis P-55 Daily Mean Temperature affects Urolithiasis Presentation in Seoul: A Time-series Analysis 장인호, 김진욱, 김태형, 명순철, 문영태, 김경도중앙의대비뇨기과학교실 Object: we investigated the overall cumulative exposureresponse and the lag response relationships between daily temperature and urolithiasis presentation in Seoul. Materials and Methods: Using a time-series design and distributing lag nonlinear methods, we estimated the 69

92 2015 년도대한비뇨기과학회통합학술대회 relative risk (RR) of urolithiasis presentation associated mean daily temperature, including the cumulative RR for 20 days period, and RR for individual daily lag through 20 days. Our analysis used data from 4 hospitals emergency department for 14,518 patients who sought medical evaluation or treatment of urolithiasis from in Seoul. RR was estimated according to sex and age. Results: Associations between mean daily temperature and urolithiasis presentation were not monotonic, and there was variation in the exposure-response curve shapes and the strength of association at different temperatures, although in most cases RRs increased for temperatures above the reference value of 13. The RRs for urolothiasis at 29 compared with 13 were 2.54 in all patient [95% confidence interval (CI): ], 2.59 in male (95% CI: ), 2.42 in female (95% CI: ), 3.83 in male less than 40 years old (95% CI: ), and 2.47 in male between 40 and 60 years old (95% CI: ). Consistent trends of increasing RR of urolithiasis presentation were observed within 5 days of high temperatures across all groups. Conclusions: In our study, urolithiasis presentation increased with high temperature with higher daily mean temperratures, with the strongest associations estimated for lags of only a few days, in Seoul, metropolitan city in Korea. Keywords: Urolithiasis, Temperature, Time series analysis 70

93 Poster Session 6 E-poster Infertility & Sexual Dysfunction

94

95 The Korean Urological Congress and Expo: 2015 KUCE P-56 Ameliorative Effects of Urechis Unicintus Against Erectile Dysfunction in a Streptozotocin Induced Diabetic Rat 문형우, 허경재, 김강섭, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 황태곤, 김세웅 Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea Purpose: We investigated the effect of Urechis Unicintus (UU) on erectile dysfunction in streptozotocin induced diabetic rats. Materials and Methods: Sixteen 12-week-old Sprague- Dawley rats were induced Diabetes by a one-time intraperitoneal injection of streptozocin (50 mg/kg). 1 week later, the diabetic rats were randomly divided into 4 groups including a normal control, DM control and two UU treated group (100, and 500 mg/kg/d). The latter 8 rats were fed UU by intragastric administration for 8 weeks. After 8 weeks, penile hemodynamic function was evaluated by measuring the intracavernosal pressure after electrostimulating cavernous nerve. We measured nitric oxide (NO) and cyclic guanosine monophosphate (cgmp) activity. Endothelial nitric oxide synthase (enos) and neuronal NOS (nnos) protein expression was determined by Western blot. Masson s trichrome staining was also assessed. Results: Serum glucose level in DM +UU group was significant lower than in that of the DM control groups. Maximum intracavernosal pressure in DM control rats decreased significantly compared to normal control rats and increased significantly compared to untreated DM rats after UU supplementation. DM + UU500 group had significantly increased NO and cgmp level compared with the DM control group. Decreased activity and expression enos and nnos were found in the DM groups compare with normal control group. Decreased enos and nnos in diabetic rats were improved by UU administration. Decreased the cavernous smooth muscle to collagen ratio was improved in DM + UU groups in the Masson s trichrome staining. Conclusions: UU effectively ameliorated erectile function in a streptozocin induced diabetic rat model of erectile dysfunction. Keywords: erectile dysfunction, urechis unicintus, DM P-57 Long-term survival and current patient satisfaction on the inflatable penile prosthesis as a treatment of medical refractory erectile dysfunction 김영욱, 장재윤, 장준보, 이권수, 최재영, 고영휘, 송필현, 정희창, 문기학영남의대비뇨기과학교실 Purpose: Implantation of penile prosthesis has been the standard treatment for management of medical refractory erectile dysfunction (ED). We investigated the long-term survival and patient satisfaction on AMS 700TMCXM inflatable penile prosthesis as a treatment for ED. Materials and Methods: Between July 1997 and September 2014, a total of 74 patients underwent implantation of an AMS 700TMCXM inflatable penile prosthesis. The current status of prosthesis and patients satisfaction were investigated by direct telephone interview. Mechanical and overall survival rates of the prosthesis were assessed and related clinical factors were analyzed. To calculate the degrees of satisfaction, we designed novel questionnaires consisting of eight items across the current sexual life. Results: The mean (± SD) age and follow-up period were 57.0 ± 12.2 years and ± 64.0 months, respectively. Sixteen patients (21.6%) experienced a mechanical failure and 4 patients (5.4%) experienced a non-mechanical failure. Mechanical and overall survival rate of the inflatable penile prosthesis at 5, 10, and 15 years were 93.3%, 76.5%, and 64.8% and 89.1%, 71.4%, and 60.5%, respectively, without significant correlation with host factors including age, presence of obesity, hypertension, diabetes mellitus, and cause of ED. Overall, 53 patients (71.6%) completed the questionnaires. Overall patient satisfaction rate was 86.8%, and 86.6% of men replied that they have an intention to repeat the same procedure (Table 1). Among 8 item asked, satisfaction with the rigidity was the highest (90.6%). In contrast, 73

96 2015 년도대한비뇨기과학회통합학술대회 only 60.4% of subjects experienced orgasm. Conclusions: Despite diminishing survival with passage of time, satisfaction of the patient with the inflatable prosthesis remains relatively high, at the cost of relatively lower satisfaction in orgasm. Keywords: 발기부전, 음경보형물, 환자만족도 P-58 Expression of Tight Junction Proteins in Rat Vagina Sang Un Yim, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Aim: Tight junction play a role in apical cell-to-cell adhesion and epithelial polarity. In this study, we investigated the expression of tight junction proteins, such as Claudin-1, zonula occludens (ZO)-1, junction adhesion molecule (JAM)-A, and occludin in rat vagina. Methods: Female Sprague-Dawley rats ( g, n=20) were divided into 2 groups: control (n=10) and bilateral ovariectomy (n=10). The expression and cellular localization of claudin-1, ZO-1, JAM-A, and occludin were determined in each group by immunohistochemistry and Western blot. Results: Immunolabeling of ZO-1 was mainly expressed in the capillaries and venules of the vagina. Claudin-1, JAM-A, and occludin were expressed in the epithelium of the vagina. The immunoreactivity and protein expression of claudin-1 was significantly decreased in the ovariectomy group compared with the control group. Conclusions: Our Results suggest that tight junction proteins may have an important role in the vagina. Further studies are needed to clarify the role of each tight junction protein on vaginal lubrication. Keywords: Tight junction, Vagina 74

97 Poster Session 7 E-poster Pediatrics

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99 The Korean Urological Congress and Expo: 2015 KUCE P-59 Cumulative Sum Analysis of Learning Curve for Endoscopic Dextranomer/hyaluronic acid Injection in Vesicoureteral Reflux 김상운, 지병훈, 이용승, 임영재, 한상원 연세대학교 의과대학 비뇨기과학교실 Purpose: To investigate the correlation between surgical volumes and the outcome of endoscopic Deflux injection, surgical outcome was assessed using cumulative sum analysis (CUSUM). Materials and Methods: From January 2008 to December 2013, a total of 417 patients underwent endoscopic injection of Deflux by a single surgeon (SWHAN) in our hospital. On the basis of exclusion criteria, 250 patients P-60 Is it necessary to repeat the uroflowmetry in children? (382 units) were included finally. Postoperative voiding cystourethrogram was done 6 months after surgery and VUR of grade 1 or 0 were defined as a success. Results: Of 382 units of ureter included, grade II VUR were 152 (39.8%) and grade III were 169 (44.2%), which was most prevalent. Overall success rate was 김상운, 지병훈, 이용승, 임영재, 한상원 연세대학교 의과대학 비뇨기과학교실 Purpose: Uroflowmetry (UF), only non-invasive urodynamic means of assessing the function of lower urinary tract, is widely used in children. This study was conducted to compare the parameters of repeated UF in a single child with the Results of single UF performed in a group of children. The goal of the study was to evaluate 73.2% (476 from 650 units). Mean age at Deflux injection was 2.65 years (range 0-15 years). On multivariate regression analysis, grade of VUR, presence of paraureteral diverticulum and surgical volume of Deflux were relevant factors of surgical outcome (Table 1). After rising until the initial 110th case, CUSUM curve tended to the necessity of a repeated UF in children. Materials and Methods: Medical records of the children who first visited the Severance Children s Hospital between August 2013 and May 2014 for lower urinary tract symptoms were obtained retrospectively. During this period, 120 children with age of 6-10 years who underwent UF were included in the study. UF was repeated under the conditions below: abnormal shape, including staccato or irregular, tower, interruption or plateau and too small volume for evaluation. Results: Average values of the voided volume, maximal and average flow rate were lower in in the 58 children who underwent repeated UF than in 62 single UF children while other parameters demonstrated no significant differences.on 2nd UF, voided volume was significantly increased (87.82ml to ml), followed by increased maximal flow rate (14.54ml/s to 18.66ml/s) and average flow rate. After classification according to the amount of increased voided volume on 2nd UF, the group with more increase of voided volume (Group 2) demonstrated less residual volume and voiding time on 1st UF than Group 1, showing little changes on 2nd UF. Children with small voided volume and tower shape uroflow curve were more prevalent in group 1. Children showing small voided volume and tower shape uroflow curve on 1st UF demonstrated significant increase of voided volume on 2nd UF (Figure 1). be flat and declined in overall cases (Figure 1). CUSUM curve of grade I reflux tended to be flat from the initial case, while grade II reflux demonstrated a flat and declined curve after the 109th case. High grade reflux including III,IV and V, showed static curve after approximately 200th case. Conclusions: We demonstrated a learning curve for endoscopic injection of Deflux on CUSUM analysis. CUSUM curve demonstrated gradual improvement in high grade VUR while relatively small cases were required for reaching a plateau in grade II VUR. Keywords: 방광요관역류, 디플럭스, 학습 곡선 77

100 2015 년도대한비뇨기과학회통합학술대회 Conclusions: Repetition of uroflowmetric study seems to increase voided volume, consequently maximal flow rate and this change was demonstrated more clearly in children, showing small voided volume or tower shape of uroflow curve in the 1st test. Keywords: 반복요속검사, 소아, 하부요로증상 78

101 Poster Session 8 E-poster Trauma, Infection and Others

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103 The Korean Urological Congress and Expo: 2015 KUCE P-61 Clinical Evaluation of Renal Trauma Chang yong Lee, Seung Baik, Dong hoon Lim, Chul sung Kim, Won jin Cho, Joon Rho Department of Urology, Chosun University College of Medicine, Gwang-Ju, Korea Purpose: The evaluation of patients with suspected renal trauma relies mainly on clinical assessment, urinalysis and imaging studies. For the evaluation of the effects of various factors in patients with renal trauma, we performed this study. Materials and Methods: We retrospectively reviewed the medical records of 76 patients who presented to our hospital with renal trauma between January 2008 and December Results: A total of 76 patients presented to our hospital with suspected renal trauma. There were 61 male and 15 female between 2 and 83 years old (mean 45.68). Traffic accident was the most common cause of injury, accounting for 39cases (51.32%). The remaining injuries were caused by falls in 26 (34.21%) cases, assault in 8 (10.7%) and sports-related trauma in 3 (4.0%). Renal injuries were classified as established by the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma in There were 13 cases (17.11%) grade I, 9 cases (11.84%) grade II, 34 cases (44.74%) grade III, 18 cases (23.68%) grade IV and 2 cases (2.63%) grade V. 76 patinets Of, 46 Pt had microscopic hematuria and 25 Pt had gross hematuria. 59 Pt (77.63%) had a total of 132 associated injuries. Surgical exploration was required in 18 Pt (23.68%) for renal or associated injuries. Conclusions: We are managed renal injuries with a consistent approach based on accurate injury definition from clinical, radiographic, and sometimes surgical staging. Accurate renal injury staging was essential to successful management of traumatized patients. Keywords: 신손상, 혈뇨, 복부전산화단층촬영술 P-62 Modified laparoscopic intravesical nonrefluxing ureteral reimplantation with psoas hitch using a submucosal tunneling 김창희, 김주호, 노주환, 김계환, 윤상진, 정한가천의대길병원비뇨기과 We aimed to study the safety and efficacy of the cystoscopy-assisted nonrefluxing ureteral reimplantation technique using submucosal tunneling during laparoscopic ureteroneocystostomy (UNC) with a psoas hitch in patients with distal ureter stricture after gynecologic surgery. We reviewed six female patients who underwent gynecological surgeries. All six female patients showed persistent postoperative distal ureter stricture or obstruction. These patients underwent laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy at our institute. They had corrective surgery at an average of 13.3 weeks (1-19) after ureteral injury. The short-term success was confirmed either by voiding cystourethrography (VCU) or by diuretic isotope renal scan (MAG-3) conducted 3 months after the operation. None of the patients showed evidence of postoperative stricture at the reimplanted site and reflux on either MAG-3 renal scan or VCU. None of the patients showed major or minor complications during follow-up. It is safe and feasible to perform the laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy for ureteral stricture. Keywords: 요관방광문합술, 요관손상 81

104 2015 년도대한비뇨기과학회통합학술대회 (n=5), 요도협착군 (n=5), BSM 단독이식군 (n=5) 및 BSM+ 자가요도조직이식군 (n=5) 으로분류하였다. 실험군에서요도를 2cm종절개하여약 5mm너비의점막을절제후재문합하여요도협착모델을만들었다. 4주후 BSM+ 자가요도조직이식군은요도의배부를종으로절개하고협착부위근위부의정상자가요도조직 (3 3 mm2 ) 을일부채취한후여러개의작은조각으로잘라 5 25 mm2크기의 BSM 위에일정간격으로고정한후요도에이식하였고, BSM 단독이식군은 BSM 만을같은방법으로협착된요도에이식하였다. 술후 4, 8, 12주째에요도조영술을시행하였고, 이식부위요도재건상태를평가하기위하여 H&E, Masson s trichrome 및면역조직화학염색으로조직학적분석을시행하였다. 결과 : 모든군에서실험동물이사망하거나, 완전요도협착이나누공등의합병증은발생하지않았다. 술후 12주째시행한요도조영술에서양성대조군, 음성대조군, BSM 단독이식군및 BSM+ 자가요도조직이식군의평균요도너비는 10.3±0.80, 3.8±1.35, 8.8±0.84 및 9.1±1.14 mm였고술후 4주및 8주째시행한요도조영술에서도유사한결과가관찰되었다. 조직학적분석에서 BSM+ 자가요도조직이식군은정상요도내경을보였고, 치밀한근육층과정상상피화, 요도주위의점진적혈관발달이관찰되었다. 이에반해 BSM 단독이식군에서는각질화된상피, 결합조직의교원질및섬유화, 평활근의감소가다수관찰되었다. 결론 : 요도협착동물모델에서 BSM 과자가요도조직결합지지체를이용한요도재건은특별한합병증없이요도협착을유의하게개선시킬수있어향후재발성요도협착이나이식편을필요로하는긴요도협착에서효과적인대안이될수있을것으로생각한다. Keywords: 요도협착, 이식편, 돼지방광의점막하층 P-64 초음파유도경직장전립선생검에서국소리도카인젤의효용성 P-63 탈세포돼지방광점막하층과자가요도조직결합지지체를이용한요도협착동물모델에서요도재건 우명진, 이유진, 김진우, 전소영 1, 이준녕, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 김법완경북대학교의학전문대학원비뇨기과학교실, 1 경북대학교의학전문대학원생명의학연구소 목적 : 다양한종류의지지체를이용한조직공학적요도재건이요도협착의치료에시도되고있으나, 만족스럽지못한결과로인하여아직까지임상에서활발하게적용되지못하고있다. 본연구에서는협착부위요도를부분절개후탈세포돼지방광점막하층 (BSM) 과자가요도조직결합지지체를이식하는요도재건수술법의효용성에대하여알아보고자하였다. 대상및방법 : 돼지방광을탈세포처리후점막하층을분리, 멸균처리하여 BSM 을제작하였다. 수토끼 20마리를양성대조군 김순기, 김유석, 조인창, 민승기경찰병원비뇨기과 Purpose: 초음파유도경직장전립선생검에서국소적인리도카인젤을이용한마취가환자의통증을경감에효용성이있는지조사하였다. Material and Methods: 2014년 1월에서 2014년 10월까지본원에서경직장초음파전립선생검을받은환자 63명을대상으로하였다. 무작위로두군으로나누어한군은경직장초음파생검을시행하기 10분전리도카인젤과베타딘이흡수되어있는거즈를직장에 10분간거치하고다른군은리도카인젤이아닌일반윤활젤과베타딘을흡수한거즈를 10분간거치한뒤조직검사를시행하였다. 조직검사시행후모든환자의통증정도를 VAS score 로설문조사하였고환자의 age, prostate volume, prostate biopsy 결과와비교하여통증의정도를비교하였다. Results: 63명의환자중일반윤활젤을사용한군 ( 대조군 ) 은 36 명 (57%), 리도카인젤을사용한군 ( 실험군 ) 은 27명 (43%) 이었 82

105 The Korean Urological Congress and Expo: 2015 KUCE 으며각군의평균나이는 63.04±10.94세, 66.03±9.93세로통계적으로유의한차이는없었다. 또한각군의 serum PSA level, prostate volume에대해서도통계적으로유의한차이는없었으나 VAS score 는대조군이 5.78±1.58, 실험군이 4.14±1.31로통계적으로유의한차이를보였다.(p<0.001) 전립선생검결과전립선암이발견된환자 (N=20) 와발견되지않은환자 (N=43) 에대해서통증점수는각각 5.25±1.83, 4.65±1.52 로통계적으로유의한차이는없었으나전립선암이발견된환자에서통증점수는대조군 6.75±1.12, 실험군 4.25±1.5(p<0.05), 전립선암이발견되지않은환자에서통증점수는대조군 5.37±1.57, 실험군 4.08±1.25(p<0.05) 으로전립선암과관계없이통증점수는실험군에서유의하게낮았다. Conclusion: 초음파유도경직장전립선생검시조직검사전국소적인리도카인젤의사용은환자의통증을경감시키며, 또한이는전립선암의유무와상관없이통증경감에기여한다. shock group were significantly lower than in the non-s eptic shock group (p=0.021, p=0.007 and p<0.001, respectively). Multivariate logistic regression analysis identified that old age (OR 1.97, p=0.029), decrease in serum albumin level (OR 2.97, p=0.047), high NLR (OR 3.47, p=0.013) and high mgps (OR 2.84, p=0.037) were independent risk factors for developing septic shock. Conclusions: The mgps is an independent prognostic factor for developing septic shock in patients with obstructive APN associated with upper urinary tract calculi. These findings suggest that mgps is effective tool for predicting septic shock in patients with obstructive APN associated with upper urinary tract calculi. Keywords: pyelonephritis, septic shock, calculi Keywords: 전립선생검, 통증, 리도카인 P-65 Modified Glasgow Prognostic Score as a prognostic factor for septic shock in obstructive acute pyelonephritis Dae Ji Kim, Chae Hong Lim, Seok Heun Jang, Jeong Hwan Son, Jae Won Lee, Dae Sung Cho Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea Objectives: The Purposeof this study was to evaluate the value of modified Glasgow Prognostic Score (mgps) as a prognostic factor for developing septic shock in patients with obstructive acute pyelonephritis (APN) associated with upper urinary tract calculi. Methods: Between January 2004 and December 2014, 90 patients with obstructive APN associated with upper urinary tract calculi were admitted and treated at our institution. Medical records of 90 patients (21 men and 69 women, mean age of 58.3 years) were retrospectively reviewed. The prognostic significance of various clinical variables including mgps was analyzed using multivariate logistic regression analysis. Results: Of the 90 patients, 44 patients (48.9%) developed septic shock. Old age and history of hypertension in septic shock group were more common than in non-septic shock group (p<0.001 and p=0.015). The white blood cell count, neutrophil count, platelet to lymphocyte ratio (PLR), neutorophil to lymphocyte ratio (NLR), C-reactive protein (CRP) level and mgps in septic shock group were significantly higher than in the non-septic shock group (p=0.017, p=0.004, p=0.031, p<0.001, p=0.014 and p<0.001, respectively). Lymphocyte count, platelet count and albumin level in septic 83

106 2015 년도대한비뇨기과학회통합학술대회 P-66 The Increased Expression of Transient Receptor Potential Vanilloid-4 (TRPV4) in Cyclophosphamide- Induced Inflammatory Cystitis Tea joo Park, Sun-Ouck Kim, Seung Hee Song, Hosuck Chung, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Purpose: The purposes of this study were to investigate the effect of cyclophosphamide (CYP)-induced inflammatory cystitis on transient receptor potential vanilloid-4 (TRPV4) in rat urinary bladder and to determine the role of TRPV4 in the bladder dysfucntion that occurs in inflammatory change in rat urinary bladder. Methods: Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. Cystitis in experimental group was induced by intraperitoneal injection of CYP (200mg/kg). The control group underwent an intraperitoneal saline injection. After 3 days, urodynamic studies were done to measure the contraction interval and contraction pressure. The expression and cellular localization of TRPV4 was determined by Western blot and immunofluorescent study in rat urinary bladder. Results: In cystometrograms, the contraction interval (min) was significantly lower in the CYP-induced cystitis rats (16.4 ± 2.3) than in the control group (6.5 ± 1.2) (p<0.05). The average contraction pressure (mmhg) was significantly higher in the CYP-induced cystitis rats (14.9 ± 3.8) than in the control group (10.5 ± 2.5)(p<0.05). TRPV4 were mainly expressed in the cytoplasm of the urothelium. The protein expression of TRPV4 was significantly increased in the CYP -induced cystitis rats (p<0.05). Conclusions: Inflammatory change of urinary bladder maybe related with a significant change in the expression of TRPV4. These findings suggest that TRPV4 might have a functional related with cystitis in rat urinary bladder. Keywords: TRPV4, cystitis, rats P-67 Steroid cream (hydrocortisone propionate butyrate 0.1%) for the treatment of phimosis in boys Young ho Seo, Seheon Jung, Hosuck Chung, Sun-Ouck Kim, Insang Hwang, Ho Song Yu, Eu Chang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park 전남의대비뇨기과학교실 Purpose: Phimosis is a common condition in young age male. This condition is usually improved by aging without special treatment, but some cases need treatment, especially topical steroid cream or circumcision. We investigate phimotic conditioned children that treated with 0.1% hydrocortisone cream. Material and Methods: We reviewed 79 patients who treated by topical steroid cream between January 2005 and December Initial phimotic presentation was evaluated by urologist when visit urologic clinic and we educate the parents to apply 0.1% hydrocortisone cream three times a day for 6 weeks. Patients were evaluated the present phimotic condition at 3 months following treatment. The outcome was defined as (1) a success if the prepuce was retractable and was without a ring; (2) a partial response when both the physician and the parents noted that there was a subjective improvement but not a complete disappearance of the ring; and (3) a failure if a constrictive ring persisted. In all cases, the treatment was well tolerated without local or systemic side effects. Results: 70 of 79 patients or parents were investigated. Age range is from 7 months to 15 years. 59 patients (84.3%) said prepuce can be retractable easily and succesful. 9 patients (12.8%) underwent circumcision because topical steroid cream was not so effective. 2 patients (2.8%) are scheduled to receive circumcision. Conclusion: Topical steroid cream for the treatment of phimosis is safe and inexpensive procedure that avoids invasive surgery in most cases. Keywords: phimosis; steroid; prepuce P-68 Urethral injury and autocastration caused by genital self-mutilation in nonpsychotic heterosexual males: A case report 김성대, 박경기, 김영주, 허정식제주대의학전문대학원비뇨기과학교실 Introduction: Genital self-mutilation (GSM) is a rare and severe form of self-inflicted behavior that is usually described in individuals with psychotic disorders including delusions and hallucinations. In most cases, it is associated with young unmarried people aged in their 20s and 30s, and the most common type is penile mutilation. However, such injuries have also been reported in nonpsychotic patients as a result of various behavior such as bizarre autoerotic acts or transsexuals attempts at performing a crude sex-change operation on themselves, 84

107 The Korean Urological Congress and Expo: 2015 KUCE or secondary to complex religious beliefs and delusions based on sexual guilt. In the present case, we report a GSM consisting of autocastration of both scrota, but saving the penis, in an older nonpsychotic married heterosexual male as a result of moderate depression and anxiety because of fear of divorce. To our knowledge, this is the first and unique case in Korea of male GSM by self-castration and urethral injury to be associated with nonpsychotic disorders. Fortunately, the patient was treated with simple repair by anterior urethrostomy. Case Report: A 56-year-old man was brought to the emergency room by his wife presenting with left scrotal bleeding with a history of self-inflicted trauma.this patient was a businessman who was married and had two grown-up sons. History taking revealed that he was sad and felt uneasy because he had been a grass widower for six months. Starting in his youth, he had often betrayed his wife several times with his womanizing. He said that he could not control his sexual drive even if he only imagined a woman who appealed to his taste. Surprisingly, 4 years previously, he had decided to remove his testis 4 years to suppress his sexual drive, which he considered the cause of his infidelity. He was seen and reevaluated by the psychiatrist, who stated that there was no evidence of psychosis, as he had neither hallucinations nor delusions. Moreover, there was no formal thought disorder or personality disorder; only moderate anxiety and depression, with a normal state of consciousness. We received a diagnosis of bulbous urethral injury (transection) and moderate hematoma in the scrotum with a self-orchiectomy state. We managed this patient via simple urethral repair by an anterior urethrostomy. 및 Pseudomonas aeruginosa 등요로감염과주로연관된여섯개균주를배양하여 plate 에나누었다. 항균펩타이드로재조합된 HBD-3 또는 Cathelicidine을 in 0.01% acetic acid-0.1% human serum albumin 에점진적으로희석된농도를 well 에처리한후 24시간노출을유지하여최소억제농도를확인하였다. 이어 24시간노출후감소되는기준을바탕으로멸균시간을가늠하기위한실험을하였다. 균주들에대해항균펩타이드효과는 24시간에서 3 log 이상감소를바탕으로멸균시간을가늠하였다. 결과 : S. epidermidis, K. pneumonia, E. faecalis, P mirabilis 는항균펩타이드에의해실험농도에서억제되지않았다. E. coli와 P. aeruginosa 는 HBD-3 에의해서는공통적으로 40 μ g/ml 의최종농도에서, Cathelicidine 은 20μg/ml 의최종농도에서억제되었다. 이들두균주에대한멸균시간실험에서 HBD-3 에의한멸균시간은두균주모두 5시간, Cathelicidine 에의해서는 E. coli 가 16시간, P. aeruginosa 가 20시간으로예측되었다. 결론 : 항균펩타이드 HBD-3 와 cathelicidine 은 E. coli 와 P. aeruginosa 의증식에대해성공적으로억제하였으며, 이를이용한항균도뇨관제작을위한가능성을보였다. Keywords: 요로감염, 도뇨관, 항균펩타이드 Keywords: 성기자해, 요도손상 P-69 항균펩타이드방출도뇨관에의한최소억제농도에관한연구김진욱, 장인호, 김태형, 명순철, 문영태, 김경도 중앙의대비뇨기과학교실목적 : 도뇨관에의한이차적요로감염은원내감염의주요원인으로지속되고있다. 항생제및은입자를이용한다양한재질로도뇨관의표면처리에의해세균의요도로상행감염을막고자하는시도가있었다. Human Beta Defensin-3 (HBD-3) 과 Cathelicidine 같은항균펩타이드는요로상피에서선천면역의일환으로방출되는물질로, 본연구에서는도뇨관등기구에처리할경우기대할수있는이들의항균효과를보고자하였다. 방법 : Staphylococcus epidermidis, Klebsiella pneumonia, Enterococcus faecalis, Proteus Mirabilis, Escherichia coli 85

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109 2015년도대한비뇨기과학회통합학술대회 2015KUCE 전공의연수강좌

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111 전공의연수강좌 1 강의실 C( ) 4 월 11 일 ( 토 ) 09:50~10:10 좌장 : 이상돈 ( 부산의대 ) 1. 비뇨기과수술후수액요법의원칙하유신 ( 가톨릭의대 ) 2. 비뇨기과수술후상처합병증의관리이승환 ( 연세의대 ) 3. 비뇨기계통증의단계적관리정승일 ( 전남의대 )

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113 The Korean Urological Congress and Expo: 2015 KUCE 비뇨기과수술후수액요법의원칙 하유신 가톨릭의대 서론수분은체액의주요구성성분이며정상성인체중의약 60%( 세포내액 (ICF) 40%, 세포외액 (ECF) 20%) 를차지한다. 하지만이비율은성별, 연령, 비만정도등에따라상당한차이가나는데, 태아의경우성인보다높은수분함량을보이며출생시에는 70 75%, 그리고 3 5세까지점차감소하게된다. ECF의용적 (ECV) 은노인에비해젊은사람에서그리고여성보다남성에서더크며, 간질액 (ISF) 의용적 (ISV) 과혈장 (plasma) 의용적 (PV) 의비는 1:3에서 1:4 정도이다. 모세혈관막의구멍 (pore) 들을통해단백질을제외한대부분의용질들이자유롭게이동할수있으므로간질액과혈장은지속적으로평형상태가이루어지며전해질분포또한비슷한수준을유지하지만, 혈장에높은농도로존재하는단백질에의해 20 mmhg의교질삼투압의차이가발생하여혈관내용적을유지하는데도움이된다. 성인의평균혈액량은약 5 L( 체중의약 7%; 남성은 ml/kg, 여성은 ml/kg) 이며약 40% 의적혈구 (ICF) 와 60% 의혈장 (ECF) 으로구성되는데이비율은성별, 체중혹은다른요인들에의해상당한차이가있을수있다. Figue1. Body fluid compartment 91

114 2015 년도대한비뇨기과학회통합학술대회 일정하고안정적인체액량과체액분포의유지는항상성을유지하는데필수적이다. 이는수분의섭취와배설에의해서결정되는데, 상당한개인적인차이가있을수있지만정상성인에서수분의하루평균섭취량은약 2300 ml이며배설량은아래표1과같다. 불감성 (insensible) 수분손실은정상조건하에서피부와호흡기를통해서반반씩일어나게된다. 광범위한화상을입은환자에서는피부를통한수분손실이 10배까지증가할수있으므로다량의수액공급이필요하게된다. 수액요법의목적은적절한수액공급을통하여혈관내용적과심장의전부하, 산소운반능, 혈액응고기능, 전해질농도, 산염기항상성등을유지하는것이다. Table 1. 하루의수분손실 Source of Loss Normal Activity and Normal Activity High Temperature (ml) Temperature (ml) Prolonged Exercise (ml) Urine Sweat Feces Insensible losses Total 본론체액상태의평가및감시어떠한지표도단독으로는 ECV 혹은혈관내용적상태를정확히반영할수없으므로병력, 신체검진, 검사실소견, 혈역학적지표등을종합하여평가하는것이중요하다. 1) 장폐색, 술전장청소, 만성이뇨제사용, 화상, 패혈증, 외상등은상당한양의체액결핍과관련이있으므로수액관리시이를고려하여야한다. 2) 저혈량증의 physical sign들은피부긴장도 (skin turgor) 감소, 점막건조, 요량의감소, 기립성저혈압, tilt test (+) 등을들수있다. 3) ECV감소혹은저혈량증의검사실소견은 azotemia (BUN/SCr > 20), 요나트륨감소 (UNa < 20 meq), FENa <1%, 요삼투압의증가 (Uosm > 450 mosm/kg), 요비중증가 (SG > 1.015) 대사성알칼리증혹은산증, 대사성산증의악화, 등을들수있다. Hct은탈수에서는증가하고급성출혈에서는수액주입이나간질액의구획이동전까지는변화가없을수있다. 저혈량증에서는나트륨과수분의재흡수를증가시키므로낮은요나트륨농도는수액투여혹은추가적인수액투여의필요성에대한지표가되지만간경화등의부종성질환에서는수액투여의필요성이아닌 effective circulating volume 결핍을의미한다. 또한 ATN과같은신손상에서는요나트륨이체액상태를반영하지못한다. BUN 증가는고단백식이, 위장관출혈, 이화작용증가등과감별해야하고, 혈청크레아티닌은만성적인쇠약혹은영양결핍환자, 여성, 노인등에서감소하고근육질이나급성의근육단백질대사증가환경에서증가할수있으므로이를고려해야한다. 4) 혈역학적감시체내혈량의 15% 미만의출혈에서는심박수나혈압이정상이고, 혈량의 30 40% 가감소할때까지도심박수의증가, 후부하의증가등의보상작용을통해혈압이정상으로유지될수있다. 또한통증등교감신경계가자극되는많은상황들과많은약물들에의해이들수치가변화한다는것을감안하면이들의정적인수치는혈관내용적상 92

115 The Korean Urological Congress and Expo: 2015 KUCE 태에대한진단적가치가떨어진다고할수있다. CVP, PAOP (Pulmonary Artery Occulusion Pressure) 등오래동안사용해오고있는지표들도마찬가지이다. CVP는우심의충만압으로서우심실의전부하를반영할수있지만이는용적이아닌압력이므로심실유순도의다양성을초래하는많은요인들은그정확성을떨어뜨린다. 따라서그절대값보다는변화하는추세나 fluid challenge에대한반응이 ( 예컨대, CVP 증가가크지않다면좀더수액공급이필요하다.) 좀더유용하게쓰이고있다. PAOP는좌심실의전부하를반영한다고알려져있지만폐내압력이증가되는상황, 폐혈관질환, 승모판막질환, 우심방의 myxoma, 대동맥판막질환, 심실유순도를감소시키는질환 ( 심근경색이나심근비후, 심내막염 ) 등많은요인들은 LVEDV(preload)-LVEDP-LAP-PAOP의연결고리를방해하여이의진단적가치를감소시킨다. 역시 CVP처럼변화추세나 fluid challenge에대한반응성이유용하다. 심박출량의측정은용적상태와수액소생술의가이드로서유용하다. 침습적인 PAC, 덜침습적인 pulse contour/wave analysis와경식도도플러등을이용하는데단일수치보다는수액투여 (fluid challenge) 에대한심박출량의반응성 (preload responsiveness) 을보는것이더중요하다. 기계환기를받는환자들에서흡기시흉강내압의증가로인한정맥환류의감소와이어지는일회심박출량의감소는호흡주기에따른혈압의변이로나타나는데, 저혈량증에서는이변이가커지므로혈관내용적상태와수액투여에대한반응성을알수있는유용한지표가된다. 최근에침습적동맥압파형을분석하여이변이를자동적으로정량화시키는기술 (pulse contour/wave analysis) 의발전에따라, pulse pressure variation (PPV) 과 stroke volume variation (SVV) 은수액에대한반응성을평가하고민감하게심실의반응성을예측하는지표로서그가치를인정받고있다. 하지만부정맥이없고진정상태에서기계환기를받고있어야한다는제한점이있다. 경식도초음파를이용하여좌심실확장기말면적 (LVEDA) 이나용적 (LVEDV) 을측정할수있는데특히임상에서는 LVEDA 가널리쓰이고있지만측정자에따라오차가클수있으므로심기능과심근운동장애, 심장충만에대한직접관찰과수액요법에대한실시간가이드로서의역할이더크다고할수있다. 수액의종류 1860년대, 양피지 (parchment) 막을통한자유로운확산능의여부에따라정질액과교질액이처음으로분류된이후많은수액들이개발되어왔으며, 포도당용액 ( 포도당을함유한자유수 ), 전해질용액인정질액, 그리고고분자용액인교질액들이임상에서매일쓰이고있다. D5W의경우 50 g의포도당이 170 kcal/l 의에너지를공급해주기때문에단백질의분해를막는일일칼로리공급원으로써쓰여져왔으나경장혹은장관외영양지원법들의발달과함께그효용성은더이상존재하지않는다. 오히려고나트륨혈증의치료와같은목적이외에는해로운측면이훨씬크다. 아래표2에서보이는포도당 50 g에의한삼투압을감안하면포도당이용의장애가있는중환자들에게등장성정질액에포도당을혼합한용액의투여는고장성에의한세포탈수를조장할수있다. 또한조직관류의장애가있는상황에서투여된포도당은대사에너지의공급원이되지못하고젖산형성을증가시킨다. D5W 정주시, 전체액구획에분포하여투여용적의 2/3는세포내강에분포하고약 8% 만이혈관내에남게되므로혈관내용적증가의목적으로사용할수없으며세포팽창의원인이된다. ICU 중환자들의 90% 이상에서고혈당이발생하고고혈당이중환자들에미치는위험성을감안하면중환자들에게이수액을투여하는것은바람직하지않다. 1) 정질액 (crystalloids) 정질액은수분과전해질을포함한수액으로서혈관을통해간질액과혈장사이를자유롭게이동할수있으므로등장성정질액투여량의약 25% 는혈관내에 75% 정도는간질액에분포하게된다. 이는출혈을보충하기위해그 3 4 배를투여하는이유이다. 2) 생리식염수 (0.9%NaCl) 등장성식염수로흔히불리지만약간은고장성이며혈장보다높은염소이온을함유하므로뇌부종이문제가되 93

116 2015 년도대한비뇨기과학회통합학술대회 는뇌손상환자나 Hypochloremic metabolic alkalosis, 저나트륨혈증등에서약간의저장성인 LR보다선호된다. 칼륨이함유되어있지않으므로고칼륨혈증시에장점을갖는다. 다량투여시 hyperchloremic metabolic acidosis가문제가되며이는 lactic acidosis와감별되어야한다. 3) 균형전해질용액 (Balanced salt solutions) LR, Normosol, Plasma-lyte, Plasmasolution-A 등은 ECF와비슷한전해질조성을갖고있어이렇게불리운다. Buffer 를함유하고있으며혈장과 ph가유사하다. LR를제외하면농축적혈구의희석을위해사용할수있다. 함유된 Buffer 들이간에서 HCO3-로대사되어대사성알칼리증을유발할수있다. 4) 고장성식염용액 (hypertonic salt solutions) 나트륨농도는 meq/l 로서높을수록소생술에필요한양이줄어든다. 단독혹은교질액과함께심한출혈시의 small volume resuscitation 의개념으로쓰인다. 출혈성숔상태의개들중고장성식염수군만생존한실험이후많은무작위배정연구들이이루어졌으며고장성식염수의사용은평균동맥압의상승, 전신혈관저항과폐혈관저항의감소, 그리고추가적인수혈량의감소등과함께합병증의증가없이치사율을감소시키는경향을보여왔다. 주입되는수분의양이줄어들게되면부종이감소하므로화상, 장시간의장수술, 뇌손상에서처럼조직이부종에빠지기쉬운경우유리하다. 하지만혈관내반감기는등장성식염수와비슷하므로장시간의혈관용적증가를기대할수없다. 또한용액의고삼투압으로인해주입시용혈이일어날수있다. 5) 교질액고분자량의물질들로구성된교질액은혈관벽을자유롭게통과하지못하며혈장과비슷하거나 (20 25 mmhg) 더큰교질삼투압 (COP) 을형성하므로혈관내에남아혈관내용적을증가시킨다. 초기분포용적은혈장용적에상당하며, 일반적으로출혈량의 3 4배를투여하는정질액에비해출혈량에해당하는만큼투여하게된다. 정질액의혈관내반감기가 20 30분인데반해대부분의교질액의반감기는 3 6시간이다. 출혈성숔에서처럼혈관내용적의감소가심할때, 심한저알부민혈증혹은화상처럼단백질손실이많을때수액소생술로써흔히사용된다. 또한수혈전정질액의사용이과량필요할때도함께병용하게된다. 혈액유래교질액 (blood-derived colloids) 과 dextran, gelatin, hydroxyethyl starch(hes) 등의합성교질액이있다. 6) 혈액유래교질액 (blood-derived colloids) 알부민 (5%, 25%) 과 plasma protein fraction(plasmanate) 이있으며바이러스와박테리아를제거하기위한열처리과정을거친다. 5% 알부민은혈장반감기가 16시간이며그농도는혈장알부민과같다. 25% 알부민의경우 50, 100 ml 단위로쓰이는데동량의 5% 용액보다 5배가까이혈장증량효과를보이지만이는간질액공간으로부터의구획이동에의한것이므로실혈등에서의혈관내용적증가의목적이아닌심한저알부민혈증시의혈관내용적증가목적으로사용해야한다. 7) Dextran 포도당중합체로서평균분자량 40 kda의 dextran 40과 70 kda의 dextran 70 이있다. dextran 40은혈전방지의목적으로혈관수술에서, dextran 70은용적증가의목적으로쓰인다. 과민반응 (anaphylactic 혹은 anaphylactoid) 이 1/3300 빈도로일어나며혈소판점착력을감소시키고연전형성 (rouleaux formation) 을하여교차수혈반응을방해한다. 드물지만비심장성폐부종은이용액의직접적인독작용에의한것이라고생각되고있다. 8) Gelatins 94

117 The Korean Urological Congress and Expo: 2015 KUCE 소콜라겐의분해와화학적변형에의해만들어졌으며평균분자량은 kda으로서작으므로신장에서 80% 이상빠르게여과되어배설된다. 체내축적이없어용량제한이없으나 prion감염의위험성과교질액중가장알레르기빈도가높다는약점이있다. 9) HES HES는다당류인전분의변형체로서생리식염수나균형전해질용액에용해시킨다. 용액의농도, 평균분자량, 몰치환 (molar substitution), C2/C6 비등이물리화학적특징을결정한다. 대부분의 HES는 6% 이며등장성인데반해 10% pentastarch 처럼농도를증가시키면혈장증량효과가증가한다. 평균분자량에따라고 (>450 kda), 중 ( kda), 저 (<70 kda) 로나뉘는데저분자량의 HES는빠르게신장으로배설되나더큰분자량은혈청아밀라제에의한가수분해가필요하다. 몰치환과몰치환도 (DS, Degree of Substitution) 는 10개의포도당분자에붙는 hydroxyethyl기의숫자 (tetra,penta, hexa, heta) 와그비이다. 예컨데 7개의 hydroxyethyl기가붙으면 Hetastarch이며 DS 는 0.7로나타낼수있다. 평균분자량과몰치환도가클수록혈장증량효과는오래가지만부작용은증가한다. C2/C6 비는포도당분자의 C2 위치와 C6 위치에치환된 hydroxyethyl 기들의비로서, 값이클수록 (C2에치환된 hydroxyethyl 기가많을수록 ) 아밀라제의분해에저항적이며부작용의증가없이혈장증량효과가커진다. Hespen R (6%HES 450/0.7 in N/S), HextendR (6% HES 670/0.7 in a balanced electrolyte solution, PenaspanR (10%HES 260/0.45 in N/S), VoluvenR (6% HES 130/0.4 inn/s), VolulyteR (6% HES 130/0.4 in a balanced electrolyte solution) 등이그동안사용되어왔다. HES는혈장을증량시키고, 희석효과를통해혈액의점도를감소시켜혈관저항을줄이고, 정맥환류를증가시킴으로써심박출량을증가시킨다. 부작용과관련하여폰윌레브란트인자, 응고인자 VIII, 혈소판기능등을저해하여혈액응고장애를유발할수있으며 10% 처럼고장성용액의투여나고분자량과높은 DS를가진용액의반복적인투여는고점도의요를유발하고요유량을감소시키며, 세뇨관내강을막아급성신부전을일으킬수도있다. 조직내축적에의한소양증이 22% 까지일어날수있다. Table 2. 혈장과주요정질액의비교 ( 단위 meq/l, P Osm = Plasma Osmolality (mosm/kg)) Fluid Na + Cl + K + Ca ++ Mg ++ buffers P Osm ph prbc Plasma Bicarbonate Nomosol-R ph Acetate Yes Lactated Ringer s (LR) Lactate No 0.9%NaCl (N/S) Yes 7.5%NaCl No D5W No 10) 정질액 vs. 교질액수액요법시의정질액과교질액의역할에대한비교는오래동안계속되어온해묵은논쟁거리이다. 정질액의경우, 비용과요량증가의측면에서이점이있으나, 더과량을사용해야하고간질액강으로많이분포되기때문에이곳의부족한용적을채울수도있지만말초부종혹은폐부종의가능성은더높아질수있다. 이에반해, 소량이필요하고, 모세혈관막의투과성에문제가없다면주로혈관내에분포하며또한반감기 ( 교질액은대개 3 6시간, 정질액은 20 30분 ) 가길기때문에오래지속되는혈역학적호전시간과낮은말초부종혹은폐부종의발생가능성을보이는교질액이이론적장점이있어보인다. 하지만임상혹은실험연구들에의하면등장성수액도효과적인혈 95

118 2015 년도대한비뇨기과학회통합학술대회 장증량제이며, 그동안의수많은연구들도어느한쪽의우위를밝히는데실패하였다. 모세혈관안팎에서이루어지는체액의이동과관련한 Starling-Landis 식에서혈장단백에대한 reflection coefficient 는정상적으로는 0.9를초과하지만저산소혈증, 염증, 조직손상등의상황에서는이값이상당히감소하여막의투과성이증가할수있다. 따라서외과적외상과같은병태생리적상황은폐모세혈관막이원래가지고있는중등도의투과성을더욱더증가시켜혈관에투여한교질액의간질액강으로의누출과함께간질성폐부종을조장할수있으며, 또한임파계에의한간질액의제거시간은정질액보다교질액에서길어지므로, 화상이나고위험수술을받는환자들에서교질액의사용은특히큰문제가될수있다. 널리알려져있는 Velanovich 등에의한메타분석에서도, 정질액을사용하여외상환자의소생술을해야하고, 교질액은비외상성, 비패혈성, 정규수술환자들에게효과적이라고하였다. 이러한모세혈관의투과성에영향을미치는요소와더불어정질액의사용에서관찰되는과응고상태처럼수액의선택이혈액응고에미치는영향등을모두고려하여소생수액을선택하는것이바람직하다. 최근에대단위로이루어진무작위배정연구, 메타분석, 관찰연구들에의하면특히중환자들에게사용한 HES가정질액에비해장점이없으며오히려치사율을높이고, 신손상등을유발할수있음을보여주었다. 이는앞에서 HES 사용의합병증으로언급된신기능장애와혈액응고장애등이관계하는것으로보인다. Table3. 정질액과교질액의비교 Crystalloid Colloid Intravascular persistance Poor Good Haemodynamic stabilisation Transient Prolonged Required infusion volume Large Moderate Risk of tissue oedema Obvious Insignificant Enhancement of capillary perfusion Poor Good Risk of anaphylaxis Nil Low to moderate Plasma colloid osmotic pressure Reduced Maintained Cost Inexpensive Expensive 수술전, 후의수액관리수술전, 수술중, 그리고수술후에대한 fluid therapy와관련하여이론에많은발전이있었음에도불구하고아직까지 optimal fluid management 에대한정의는정설이없이단지 clinical 한판단에맡겨지고있다. 하지만, 간과해서는안되는중요한수액치료의목표는, 충분한 effective circulating volume 을유지하여, organ perfusion 을좋게하고, oxygen transport 및세포호흡을최적화하여, 이로인해환자들의 recovery quality를개선것이다. 이런목표에부합하기위해 maintenance volume 을기본으로, 수술전부터존재하는 fluid deficit, 그리고 surgery invasion 정도에따라달라지는 third-space losses 에대한개념, 그리고마지막으로수술중발생할수있는 blood loss를고려하여야한다. 수술전부터존재하는 fluid deficit을확인하기위해수술전 NPO time, bowel preparation. 이나 vomiting, diarrhea, 수술전 bleeding 과같은 fluid loss에대한 history, 그리고 fluid deficit 를시사하는이학적소견등을평가하여야한다. 이러한평가의결과로 fluid deficit 확인되면, 수술시작과함께 2~4시간에걸쳐서 fluid replacement가계획되어야한다. 다음으로, 수술중에일어나는 fluid deficit은 third space fluid loss, 수술중발생할수있는 blood loss가있다. Third space fluid loss에대한개념은수술중외적으로발생하는 blood loss나 insensible loss 같은, 실제적인 fluid loss 가아닌 functional 한 loss의개념으로 surgical trauma 의정도에따라결정된다. 1961년 shires 등의연구에서이러한 functional 한 loss 는평균 2시간수술에서 ECF의 0~28% 까지발생할수있다고발표되었다. 그러면, 주술기에얼마의수액을환자에게주어야할지에대한문제에봉착하게되는데 1960대에 Shires등에의 96

119 The Korean Urological Congress and Expo: 2015 KUCE 해서 third space loss에대한개념이인식되면서 operative trauma 에의해서 fluid sequestration 이일어나고, 이로인한부족한 plasma에대하여 compensation의문제가발생하므로 liberal한 fluid management가필요하다는주장이대두되었다. 그러나 1990년대에는기존의 liberal fluid management 에대한반발로, major surgery 에있어서 fluid restriction을시행한군이 morbidity 및 hospital stay 를단축시킬수있다는주장이시작되다. 2000년대에이르러서는이러한두주장의절충안으로, 각각환자의 fluid status를정확히평가하여수액요법을시행하는 individualized goal-directed fluid therapy에대한개념이대두되었고, 이는여러 Randomized control trial 및 meta-analysis에서 High risk group의 surgical outcome 을개선시키는결과를보였다. 일반적필요수액유지량일반적으로시간당수액유지량은표 4과같은 rule을통하여구하는데, 처음 10kg은시간당 kg당 4ml, 다음 10kg은시간당 kg당 2ml, 이후나머지는시간당 kg당 1ml 로계산한다. 그럼대략 60kg 환자의하루 maintenance volume 은 100ml/hr 로 daily 2400ml 가됩니다. 수술자극등에의한카테콜아민, 코티졸, 성장호르몬등의분비는인슐린분비를줄여고혈당을유발하므로유지수액에는포도당이포함되지않는다. Table 4. 시간당수액유지량 Weight Rate of administration 10kg 4 ml/kg/hr, first 10kg 10~20kg 2 ml/kg/hr, second 10kg > 20kg 1 ml/kg/hr, each kg, above 20kg Third-space loss 는표 5와같이각 surgical trauma의 degree에따라 herniorrhapy 같은 minimal surgery 는시간당, kg 당 0~2 ml, nephrectomy와같은 moderate surgery는시간당, kg당 2~4 ml이고 radical cystectomy와같은 bowel resection 이필요한 severe surgery는시간당, kg당 4~8ml volume requirement 가있다. 3rd space loss는등장성정질액으로보충하고심한발한이나위장관을통한대부분의체액손실은저장성손실이므로 ( 췌장과담즙은등장성 ) 각각 D 5 W 1/4 N/S with 5 meq KCl/L과 D 5 W 1/2 N/S with 30 meq KCl/L으로보충한다. Table 5. Third-space loss 보충 Degree of tissue trauma Minimal Moderate Severe Additional requirement 0~2 ml/kg/hr 2~4 ml/kg/hr 4~8 ml/kg/hr 출혈시에는 1 ml의출혈당 3mL의정질액이나 1 ml의교질액혹은혈액으로보충한다. 건강한환자라면일반적으로 Hb 7.5 g/dl 이면잘견딜수있다. 수혈시에는농축적혈구의 Hct이 60-70% 임을감안하여 2 ml 출혈에대해대략 1 ml의정질액 + 1 ml의농축적혈구를투여하게된다. 출혈시손실되는적혈구용적 (RBClost) 을계산하는법은다음과같다. RBC lost = EBV (Hct i Hct f ) 97

120 2015 년도대한비뇨기과학회통합학술대회 EVB = Estimated blood volume ( 남자는 70 ml/kg, 여자는 55 ml/kg), Hct i = 최초 Hct, Hct f = 최종Hct 계산된 RBC lost 를농축적혈구의 Hct 60% 즉 0.6으로나누면농축적혈구필요량이나온다. 농축적혈구 1단위는대략 200 ml ( 전혈320) 혹은 250 ml ( 전혈400) 이므로이를감안하여계산하면된다. 허용실혈량 (ABL) 은 RBC lost 를 Hct i 로나누면되지만출혈이계속되면서수액으로희석되는부분을감안하여 Hct i 과 Hct f 의평균 Hct (Hct m ) 으로나누는방법도제시되어있다. Liberal vs restrictive 최근까지수술전후로수액필요량에기초하여관습적으로충분한양의수액이투여되어왔다. 하지만, 중증질환자나대수술을받는환자들에게마취와연관된저혈량증과특히신기능의장애를염려하여충분한수액을투여해왔으나이는급성신부전의빈도를줄이지못했고, 오히려과도한수액의투여는조직의부종과폐가스교환, 조직산소화, 혈액응고, 산염기균형등의장애를초래하였다. 또한금식에의한체액결핍을반영하는유지수액량과관련하여불감성손실이나요손실은실제적인혈액량의감소를가져오지않는다는보고나 clear liquid에대해서는 2시간의금식시간이권고되고있다는사실, 그리고실제적인 third space의존재에대한의문등은고전적접근방식을재고하게만들고있다. 현재까지이루어진연구결과들은수술종류에따라충분한수액투여군과제한적인수액투여군사이에이환율이나합병증의차이가있음을보여주고있다. liberal 과 restrictive 를나눌수있는표준화된수액량의기준이없기때문에연구결과들에차이가있을지라도, 외래수술과같은소수술에서는충분한수액의공급이, 위장관계나폐등에대한대수술에는제한적인수액의공급이잇점이많다는데에의견이모아져있다. 예컨대, 부인과복강경수술을받은건강한환자들은충분한수액공급을통해오심과구토, 통증등이감소하였고, 복강경담낭절제술시충분한수액투여는술후폐기능의호전과더나은회복지표들을보여주었다. 이에반해복강내의대수술들에서프로토콜에기반한수액제한에의해심폐합병증, 장운동장애등이감소하였고, 창상치유가더잘되었으며, 문합부위의문제발생이줄어들었다. 또한폐절제술후폐부종은투여된수액량과관계되어있음이알려져있고, 간절제술시에는정맥출혈을줄이기위해 CVP를낮게유지하는전략이쓰이고있다. 급성폐손상 (ALI) 환자들에서도수액의제한이산소화의향상, 기계환기및집중치료기간의감소를가져왔다. 요약하면, 수술의종류, 환자의상태등을고려하여수액투여량을조절할필요가있고만약수술이좀더침습적이고, 많은출혈이있다면체액균형의변화가클것이므로이에대한지속적인감시와평가를통해프로토콜에기반한적절한수액관리가이루어져야한다. Shock 환자의수액관리 Shock은조직, 구체적으로는세포로의산소공급 (DO 2 ) 혹은세포에서의산소이용 (VO 2 ) 의장애로인하여발생한다. 따라서조직으로의산소공급을최적화하려는수액관리가 Shock의치료전략으로써시도되어왔다. 중환자들의산소소모량이정상수준이상으로증가한다는데이론적배경을두고초기의충분한수액공급과심근수축제등을통해 DO (supranormal value) 의목표를달성하는 goal-directed therpy를통해고위험의정규수술환자들과응급실에서초기소생술을받는패혈증환자들의치료성적을향상시켰다는보고가있어왔지만외상환자들에서초기의증가된수액공급이복부의 compartment syndrome 의빈도를증가시켰다는보고처럼이와상반되는연구결과들또한존재한다. goal-directed therapy의논란과관련하여, 말단기관부전이오기전인 shock의초기에는결핍혈량을파악해적극적수액공급을하고, 심기능장애에필요한보조를한다면치료성적의향상을기대할수있지만 late shock 시기에는정상혈관내용적을유지하는것이여전히중요할지라도이를초과하는수액급은치명적일수있다고알려져있다. 98

121 The Korean Urological Congress and Expo: 2015 KUCE Septic Shock Septic shock 환자에서수액제는 albumin을포함한 colloid 제제가 crystalois 보다더효과적이라는근거가없으며, 가격등을고려하면일차적으로는 crystallois를추천한다. 단지속적으로수액공급이필요한경우 albumin을고려할수있다. 또한중증패혈증환자에서수액요법으로서의 HES 제제는의투여는신기능손상을유발할수있으며투석기간이더길어지고사망률이높은경향을보이기때문에권고되지않고있다. 수액치료에있어서치료목표는중심정맥압을 8 mmhg 이상으로유지하거나기계호흡을하는환자에서는중심정맥압을 12 mmhg이상으로유지하는것을권고하고있다. 수액처치에대한반응평가에있어중심정맥압이심실전부하의유용한평가방법으로사용될수없다는보고들이많이있다. 하지만중심정맥압이낮은경우는수액치료에반응을할가능성이많으므로아직은추천하고있으며, 새로운방법들의임상연구를더기다려볼필요가있다. 최근에는수액처치에대한반응평가에있어중심정맥압보다더우수한 pulse pressure variation, systolic pressure variation, stroke volume variation, 그리고 passive leg raise 등을적용하고자하는시도들이이루어지고있다. 특히 pulse pressure variation/ stroke volume variation은폐동맥압이상승된환자들에서는유효성이떨어지지만다른지표들보다수액처치에대한반응을잘반영하는것으로보고되고있어중심정맥압과함께수액처치에대한반응을평가하는지표로고려될수있다. 하지만진정제를사용하면서인공환기기를적용하는환자에서만적용가능하다는단점이있다. 또한 Passive leg raise 검사는심혈관계수술환자의수액처치에대한반응을예측하는좋은지표로보고되었으며아직까지패혈증환자에대한대단위임상연구의근거는부족하지만중심정맥압과함께수액처치에대한반응을평가하는지표로고려될수있다. 특히자발호흡환자에서도측정이가능한장점이있다. 혈량저하가의심되는경우혈량저하를극복하기위한수액시도 (fluid challenge) 요법은초기에는최소 crystallois의셩우 30ml/kg이상투여를권고하고있으며, 환자의상태에따라보다빠른속도나많은양을투여할필요가있는경우도있다. 수액시도요법은혈역핮겅인호전 ( 동맥압, 심박수, 소변량등 ) 이있는한지속하여사용할수있다. Figure 2. Goal Directed Therapy in septic shock patients 99

122 2015 년도대한비뇨기과학회통합학술대회 hemorrhagic shock 1950년대이후이루어진동물실험들의결과, 적극적인수액소생술은심한출혈로인한사망률을감소시키는것처럼보였고이후충분한수액공급은출혈성숔의치료에중요한부분으로자리잡아왔다. 하지만출혈이심하지않을때는과도한수액공급이사망률을증가시킨다는보고또한있어왔다. 출혈성숔의병태생리에대한이해와함께최근의연구결과들에의하면, 필수기관으로의관류가유지되는수준의수축기혈압 ( mmhg;permissive hypotension) 을유지할수있을정도로수액을공급하는것이중요하다. 이는 1) 추가적인출혈, 2) 급속한수액주입으로인한저체온증, 3) 혈색소와혈액응고인자들의희석등을최소화할수있는장점이있다. 출혈에대한보상으로투여한과도한수액은오히려출혈을더욱조장시켜일종의악순환의고리를만들수있으므로수액투여를줄이고지혈에초점을맞춘이러한전략을 hemostatic resuscitation이라고부르는데, 출혈이심한외상환자에대하여 1) 우선적으로해부학적출혈을조절하고 (expedited damage control; 해군재난사고시우선적으로배가가라앉지않도록하자는구조의개념 ), 2) 필요한수준의저혈압을유지하며 (deliberate hypotension), 3) 초기부터적극적으로혈장, 혈소판, 혈액응고인자들을투여하여혈액응고를도와주고유지하는것등이치료의핵심이다. Parenteral nutrition 1) 정맥영양의초기공급시일반적주의사항 1 영양공급을효율적으로하기위해서는수분및전해질상태를최적화한후시작하는것이권고된다. 2 PN 제재는삼투압이상대적으로높기때문에투여경로로는중심정맥이선호되나소아환자에서는말초정맥영양을우선적으로고려할수있다. 3 수액공급의제한이필요한환자 ( 예, 신부전, 간부전환자 ) 에서는필요로되는단백질과포도당을허용하는범위내에서추가로농축하여 PN을시행할수있다. 2) 정맥영양영양소의구성및처방 1 영양소의구성 일반적성인에서요구되는영양성분은표 5과같다. 단백질 : 필수아미노산과비필수아미노산이혼합되어있어야한다. 단백질투여는대사성문제에미치는영향이상대적으로적으므로초기단백질공급은 g/l까지가능하다. 탄수화물 : 정맥영양지원에서 1차영양원으로사용되는구성성분으로환자의열량요구량, 산화속도, 지방과포도당의비율을고려하여정맥영양제제에포함되는포도당양을결정한다. 초기포도당공급은최대 g/day 혹은 15%-20% 농도까지가능하다. 당뇨환자나스트레스로인해고혈당을보이는경우에는 g/day 또는 10-15% 농도의용액으로조절이필요하다. 말초혈당이 180 mg/dl 이넘지않는범위내에서추가포도당공급이가능하다. 지방 : 유제의형태로공급가능하며필수지방산공급원과열량원으로사용한다. 혈중중성지방수치가 400 mg/dl 가넘지않는범위내에서추가지방의공급이가능하다. 물 : 단독으로정맥투여되지않으며수분공급량을충족시키거나삼투압조정을위해스페셜 TPN 제제조제시사용된다. 멸균증류수를주로사용한다. 전해질 : 전해질균형을위해 PN제제에혼합한다. 일반적으로요구되는전해질성분은표 6와같이요약할수있다. 미량원소 : 일반적인권장량에준해정맥영양제제에혼합하며, 미량원소의종류로는 chromium, copper, iodine, iron, manganese, molybdenum, selenium, zinc가있다. 비타민 : PN 제제에비타민은일반적으로권장량에준해고정된양을투여한다. 그러나비타민결핍이있거나, 기저질환상고려점이있는경우, 개별화가필요할수있다. 100

123 The Korean Urological Congress and Expo: 2015 KUCE Table 5. 일반적인성인에서요구되는영양성분 Critical patient Stable patient Protein g/kg/d g/kg/d Carbohydrate Not>4 mg/kg/min Not>7 mg/kg/min Lipid 1 g/kg/d 1 g/kg/d Total calories kcal/kg/d kcal/kg/d Fluid Minimum needed to deliver adequate macronutients Table 6. 일반적인성인에서요구되는전해질성분 전해질성분 일일표준권장량 증량이필요한경우 투여형태 Calcium meq High protein intake Ca gluconate Magnesium 8-20 meq GI losses, Drugs, Refeeding Mg sulfate Phosphorus mmol High dextrose loads, Refeeding Na Phosphate, K Phosphate Potassium 1-2 meq/kg Diarrhea, Vomiting, NG K Phosphate, K acetate, K suction chloride Sodium 1-2 meq/kg Nephritis, adrenal Na Phosphate, Na chloride, insufficiency, heart failure Na acetate, Na lactate (SIADH), Ascite 결론최적화된수액요법을시행하기위해서는수분과전해질 ( 특히나트륨 ) 의생리및장애에대한기본적인이해가바탕이되어야한다. 수액요법의시작은혈관내용적상태의평가로부터시작하는데, 한가지의지표보다는병력, 신체검진, 검사실소견, 혈역학적지표등을종합하여판단하는것이중요하다. 또한, 혈압이나심실충만압, 심박출량, SvO2 등지표들의단일 (static) 수치도의미가있지만, 변화하는추세나 fluid trial에대한전부하반응성과같은동적인 (dynamic) 감시가더유용하다. 공식처럼정형화된수액관리가아닌수술이나환자의상태에따른수액관리가중요한데, 외래수술이나내시경을통한비침습적수술처럼소수술에는고전적인수액필요량에따른충분한공급이, 복부나폐등의대수술에는수액제한을하는것이장점이있다는데의견이모아져있다. 또한숔의초기단계에서는충분한수액공급이이로울수있지만진행된 shock 에서는과량의수액공급은치명적일수있음을인지할필요가있다. 심한출혈상황에서는초기부터적극적인지혈전략과함께 permissive hypotension을유지할수있는수액관리가필요할것으로보인다. 참고문헌 1. Kaye AD, Riopelle JM. Intravascular fluid and electrolyte physiology. In: Miller s Anesthesia. 7th ed. Edited by Miller RD:Philadelphia, Churchill Livingstone. 2010, pp Ganter MT, Hofer CK, Pittet JF. Postoperative intravascular fluid therpy In: Miller s Anesthesia. 7th ed. Edited by Miller RD:Philadelphia, Churchill Livingstone. 2010, pp Kaye AD. Fluid management. In: Basics of Anesthesia. 6th ed. Edited by Miller RD, Pardo MC Jr: Philadelphia, Saunders. 2011,pp

124 2015 년도대한비뇨기과학회통합학술대회 4. Prough DS, Funston JS, Svensen CH, Wolf SW. Fluids, electrolytes, and acid-base physiology. In: Clinical Anesthesia. 6 th ed. Edited by Barash PG, Cullen BF, Stoleting RK, Cahalan MK, Stock MC: Philadelphia, Lippincott Williams and Wilkins. 2009,pp Mount DB. Fluid and electrolyte disturbances. In: Harrison stm Principles of Internal Medicine. 18th. Edited by Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J: McGrow-Hill. 2012, pp Marino PL. The ICU book. 3rd ed. Philadelphia, Lippincott Williams and Wilkins. 2007, pp 21-38, , Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, Intensive Care Med 2013; 39: Dutton RP. Haemostatic resuscitation. Br J Anaesth 2012; 109 (Suppl 1): i39-i meier R, Beglinger C, layer P, Et al ESPEN guideline on nutrition in acute pancreatitis. European Society of Parenteral and Enteral Nutrition. Clin Nutr. 2002;21: McMahon M, Manji N, driscoll DF, Bistrian BR. Parenteral nutrition in patients with diabetes mellitus: theoretical and practical consideration. JPEN J Parenter Enteral Nutr. 1989;13: Kalhan SC, Kilic I. Carbohydrate as nutrient in the infant and child: range of acceptable intake. Eur J Clin Nutr. 1999;53 (Suppl1):S

125 The Korean Urological Congress and Expo: 2015 KUCE 비뇨기과수술후상처합병증의관리 이승환 연세의대 서론비뇨생식기계를포함한수술은 clean wound 보다는 clean contaminated 이상의 wound를대개의경우포함하고있기때문에특히비뇨기과수술에서상처합병증의관리는중요하다고할수있다. 이에 1. Wound healing 의형태및과정 3. Wound complication & management 에대해알아보고자한다. 본론상처란 사람의조직이가지는해부학적인연속성이외부의작용에의해그본래의연속성을상실한상태 를의미합니다. 여기서사람의조직이란주로피부를의미하게되는데, 피부는우리몸에서가장큰장기이며일차적인방어의역할을담당합니다. 1. 상처의치유 (Wound healing) 상처의치유란 세포가재생, 분화, 증식되어잃어버렸던연속성을다시유지하는것, 즉상처조직의장력을형성하는교원질의합성에관여하는세포와혈관의작용을총칭하는것 을말합니다. 상처의종류및외부자극의종류와치료방법등에따라상처의치유에는많은차이가있지만, 상처치유의형태는크게다음세가지로분류할수있습니다. 1) 상처치유의형태 (1) 일차유합창상발생후, 깨끗한창상으로즉시봉합하여치유하는것을말하며, 봉합선정도의적은반흔을남깁니다. (2) 이차유합약간의연조직손실 ( 피부의탈락등 ) 이있거나, 오염된채개방된창상에서일정기간동안치료를통해육아조직 ( 살 ) 이차오르고, 상처크기가수축작용에의해줄어들며, 상처의경계에서피부세포의증식 ( 상피화 ) 으로치유되는것을말합니다. 103

126 2015 년도대한비뇨기과학회통합학술대회 (3) 삼차유합많은양의연조직손실이있고, 오염이심하여개방된채로치료하여상처가깨끗해지면봉합하거나수술 ( 피부이식등 ) 을필요로하는치유를말합니다. 2. 상처치유의단계사람의피부조직이어떤원인으로든손상을입게되면, 상처를치유하려고우리몸은반응은곧장시작되는데, 이는상처의치유형태와상관없이모든상처에서일어나는과정입니다 ( 실제세세한과정은다른부분이있음 ). 각반응을단계별로살펴보면다음과같습니다. 1) 염증단계상처가생기면상처주위손상된혈관에있는세포들 ( 혈소판, 백혈구, 대식세포등 ) 이활성화되어세균과이물질, 괴사조직등을제거하고, 또이들세포에서여러가지활성물질들이분비되어상처주위피부세포들을자극합니다. 2) 상피화단계상처면의피부세포 ( 상피세포 ) 가세포분열을통해분화하고이동하며, 창상면전체에걸쳐분열하는상피세포가가득채워지는단계입니다. 3) 증식단계세포질과세포의기질들이증식하는단계로주로교원질합성을하는단계입니다. 4) 성숙단계상피화단계와증식단계를거쳐형성된반흔조직내에교원질생성과분해사이의균형을맞추어가는단계입니다. 수개월에서수년간지속됩니다. 위반응들은하나하나따로일어나는것이아니라명확한구분없이중첩되어일련의단계를거치게됩니다. 3. 상처합병증종류및치료 (Wound complication & management) 1) Seroma Lymph fluid resulting from or associated with operations in which large areas of lymph-bearing tissues are transected Axillary dissection, inguinal dissection Fertile ground for bacterial infection Repeated aspiration or closed suction drain in conjunction with pressure dressing Location: Incision ~ Fascial layer Extensive lymphadenectomy (inguinal) (limit the extent, preserve saphenous vein) 2) Hematoma Incidence 2% cause inadequate hemostasis, Post op anticoagulation, Host factor (bleeding tendency) 104

127 The Korean Urological Congress and Expo: 2015 KUCE Polycythemia vera myeloprolifertive disease decreased clotting factor Eccymosis, Aching pain, swelling, fever Take great care about hemostasis in a patient in shock or in induced hypotension or in wound in which epinephrine has been used 3) 수술부위감염외과적감염이란상처로침입한병원미생물에의하여일어나는염증성질환을뜻하는것으로써외과적감염의일반적특징으로는감염부위가자연치유되는일이드물다는것이다. 대개화농성염증에서괴사, 괴저그리고전신반응으로사망할수도있고, 복합적감염이며발생이신속하다. 수술후상처감염은병원에서수술을받은부위에서고름이나오거나창상부위배양에서병원균이분리되는경우를상처감염으로간주한다. (1) 청결한창상 (clean wound) : 감염증상이전혀없으며, 정상적인상태에서균이존재하지않는부위 ( 중추신경계등 ) 의수술로서호흡기계, 소화기계, 비뇨기계를포함하지않는다. 외상이없고, 드레인이있는경우는폐쇄드레인이어야한다. 창상감염률 1~5% 수준이다. (2) 청결-오염된창상 (clean-coutaminated wound) : 수술전에감염증상이없으나정상적인상태에서미생물이상주하는호흡기계, 소화기계, 비뇨생식기계등의수술창상을말한다. 창상감염률은 2~11% 수준이다. (3) 오염된창상 (contaminated wound) : 개방창상이나오래되지않은사고후창상 ( 보통 4시간이내 ) 수술중에명백한오염이발생하였거나소화기계로부터다량오염된경우, 급성감염이있으면서농이형성되지않은 rudd, 감염이있는비뇨기계나담도계수술이포함된다. 창상감염률은 10~17% 수준이다. (4) 불결혹은감염된창상 (dirty or infected wound) : 괴사된조직이있거나오래된사고후창상 (4시간이상지연된사고창상 ), 수술한기관이수술창상감염을일으킬원인으로수술도중판단되는경우를말한다. 창상감염은 27% 수준이다. Classification Wound Description Example Class I Clean Varicocelectomy Herniorrhaphy Class ID Clean; prosthetic material implanted Penile prosthesis insertion Class II Clean-contaminated Radical Prostatectomy Class III Contaminated Radical cystectomy with stool spillage Class IV Dirty/infected Fournier s gangrene 수술부위감염발생의위험인자로는환자와관련된수술전요인, 수술시인자, 수술후관련인자로나뉜다. 환자관련인자는보정안되는요인과보정가능한요인으로나뉘게된다. 가장뚜렷한보정안되는인자는나이인데 65세이하는나이가증가하면서수술부위감염위험이증가하는것으로되어있고 65세이후부터는나이가증가할수록수술부위감염위험이감소하였다는보고가있다. 보정가능한환자관련인자는당뇨, 비만, 흡연, 면역억제제사용, 수술전재원기간등이었다. 수술과관련된위험인자로창상등급, 105

128 2015 년도대한비뇨기과학회통합학술대회 수술시간, 면도유무, 저산소증, 저체온등이알려져있다. 또한수술시수술실의혼잡, 환기등이관여하며환기는수술창상의외부균의정착을막는역할을해준다. 또한, 수술전후의고혈당이수술직후에중요한위험인자이며수술후창상관리와수혈이위험인자로알려져있다. 창상관리는수술부위봉합에사용된기술에영향을받으며수술후 1-2일간무균드레싱에의해깨끗하게유지되어야한다. 20개연구를분석한메타분석논문에의하면수혈은수술직후 1 unit의혈액을받은환자에서도수술부위감염위험 (odds ratio, 3.5) 을증가시킨다고발표하였다. 4. 상처드레싱드레싱이란상처면을보호하기위하여무엇인가로상처를덮어주는것을말한다. 초기상처에서는적절한드레싱제재를선택하여치료를통해상처치유를촉진하는것이좋으며, 이또한흉터를적게남기는결과를가져오게된다. 초기상처에적용할수있는드레싱에는전통적인거즈드레싱과폐쇄성습윤드레싱등이있다. 1) 거즈드레싱거즈를이용하여상처면을치료하는것으로경제적이고상처의삼출물흡수및보호의기능을가진다. 하지만습윤환경유지, 세균감염에의취약점, 상처에찌꺼기를남기는등의단점이있어상처치유촉진의기능과는상관없는단순보호가필요한창상에주로적용한다. 2) 습윤드레싱 20세기중후반여러실험에의해상처의딱지를형성시키지않고, 습윤상태로폐쇄유지했을때상처치유속도가빠르다는것이밝혀진후, 다양한종류의습윤드레싱제재가출시되고있고, 이를이용한상처의처치방법도다양해지고있다. 이러한습윤드레싱의목적은상처면을밀폐해서습윤상태를유지시켜주기위한것으로, 밀폐할때상처면뿐만아니라주위정상피부까지도밀폐되어습윤상태가주위정상피부에침연을일으킬수있게된다. 따라서상처의종류와상태에따라적절한흡수성및투습성을가진드레싱제재를사용하여야한다. 시중에쉽게접근할수있는습윤드레싱에는하이드로콜로이드, 필름, 폴리우레탄폼, 하이드로겔등의종류가있다. 결론수술부위합병증중에서특히수술부위감염은병원감염중가장예방할수있는것이기때문에발생위험성을감소시키기위한특별한노력이필요하며감염관리프로그램의평가와효율적인감염관리전략을개발하고외과의는여기에대해한층더관심을가져야한다. 장액종과혈종의합병증예방을위해서는수술도중세심한지혈과동시에술전에환자의모든 clotting abnormality와 bleeding 에영향을미칠수있는 factor를교정하는것이중요하며또한 closed suction drain 을유치하는것이도움이될수있을것이다. 106

129 The Korean Urological Congress and Expo: 2015 KUCE 비뇨기계통증의단계적관리 정승일 전남의대 서론치료되지않은또는잘조절되지못한통증은신체적, 정신적및사회경제적위험을초래하나비뇨기과의사들에게는적절한치료에대한지식이전반적으로부족한게사실이다. 본강의에서는비뇨기과에서흔히접할수있는암성통증, 수술관련통증, 요로결석에의한통증, 만성전립선염과관련된통증에대한치료에대해서살펴보고자한다. 통증치료본론에넘어가기전에통증에대한기본적인개념은아래에정리했다. 통증의종류신경생물학적기전에따른분류는다음과같다. 침해수용통증 (Nociceptive pain) - 침해수용체에기계적, 화학적, 열자극등이가해져생기는통증 - 체성통 : 피부, 뼈, 근육과관련. 위치를명확하게알수있으며예리하고칼로찌르는듯한통증 - 내장통 : 내장기관과관련. 통증부위를구체적으로알기어려우며, 특징적으로표현하기어려운통증 신경병증통증 (Neuropathic pain) - 신경의허혈, 절단등에의한신경세포의손상혹은기능이상으로야기된다. - 신경이손상되지않더라도자극에과민해져이질통 (Allodynia) 이발생된다. - 타는듯하거나저린양상, 찌르거나전기가통하는느낌, 따끔거리는통증 포괄적통증평가항목통증조사 (PQRST) : 통증 (position), 특성 (quality), 관련요인 (relieving or aggravating factor), 통증강도 (severity), 통증의시작및시간적양상 (timing) 107

130 2015 년도대한비뇨기과학회통합학술대회 통증강도평가 숫자통증등급 (Numeric rating scale): 1~10 얼굴통증등급 (pain affecting faces scale):0, 2, 4, 6, 8, 10 통증의강도는치료결정 ( 긴급정도, 진통제의종류, 투여방법, 용량조절속도 ) 에매우중요하다. 숫자통증등급을활용하여객관적으로평가한다. 0~10점까지의숫자통증등급의경우통증없음 (0), 경도 (1~3), 중간정도 (4~6), 심함 (7~10) 으로구분하여흐름도에따라통증을조절한다. 치료약제종류치료약제는 3가지그룹으로나누어진다. 비마약성진통제마약성진통제진통보조제 1. 암성통증의관리 1) 일반원칙암성통증을관리함에있어, 통증조절을위한적절한진통제사용과함께통증치료에관여하는다학제적전문가들의평가와중재도요구된다. 암성통증환자의경우, 우울이나불안과같은정신적인부분에대한평가와지지가필요하며, 가족의협조가중요하므로가족의이해를위한교육과상담도병행되어야한다. 108

131 The Korean Urological Congress and Expo: 2015 KUCE 2) 약물요법 A. 사용원칙 (1) 약물을이용한통증조절의가장중요한원칙은환자개개인 (For the individual) 에게적합한진통제의종류, 용량및투여방법을선택하는것이다. (2) 환자의상황이허락하는한먹는진통제 (By mouth) 를우선투여한다. (3) WHO 3단계진통제사다리 (By the ladder) 를참조하여진통제를선택또는추가하되, 환자의상태에따라서마약성진통제는어느단계에서나시작가능하며, 통증의종류에따라통증정도와상관없이진통보조제를병용하여진통효과를증대시키도록한다. ( 그림 ) 예시 Pain intensity 1~3 à Non-opioid Pain intensity 4~10 à Opioid (4) 진통제를일정한시간간격 (By the clock) 으로투여하여혈중농도를항상일정하게유지하면암성통증의재발을예방할수있다. 급작스럽게발생하는돌발통증에대비하여속효성진통제를미리처방하여돌발통증발생시환자가사용할수있도록한다. (5) 진통제투여후통증조절이잘되고있는지자주관찰 (Attention in detail) 하여효과를평가하고, 통증조절이부족하면진통제처방을변경해야한다. (6) 진통제부작용을예방하고최소화하기위해변비완화제와같은약물을사용한다. (7) 환자와가족에게통증교육및복약지도를시행한다. (8) 약물치료이외에도스스로통증을조절할수있는비약물적방법들을고려해볼수있으며, 이러한방법에는마사지, 냉찜질 / 온찜질, 심호흡과이완요법, 상상요법, 기본전환등이있다. 음악을듣거나텔레비전을보는것과같이통증으로부터주의를환기시키는방법도효과가있다. 109

132 2015 년도대한비뇨기과학회통합학술대회 B. 비마약성진통제비마약성진통제는크게 acetaminophen과비스테로이드소염제 ( 이하 NSAIDs) 로구분된다. NSAIDs와비교해서 acetaminophen은소염작용및혈소판억제작용이없다는특징이있다. 비마약성진통제에는많은종류가있으므로환자의상태를고려하여적절한약제를선택하여야한다. (1) 투여경로의결정 1 경구투여를우선적으로고려하나, 구역구토가있거나장관폐쇄등으로경구약흡수가저해되는경우에는좌약및경피적패치를사용한다. 2 주사는빠른진통효과를원하거나긴급히해열을필요로할때일시적으로사용할수있다. (2) 환자상태를고려하여사용할약제를결정한다. 1 우선이전에사용하였던비마약성진통제중효과적이면서부작용이없었던약제가있는지확인하여, 적절한약물이있다면기존의약을사용한다. 2 이전에사용하였던약제가없거나부적절한경우, ibuprofen을 400mg po qid로시작할수있으며, 환자의반응에따라투여량을최대 3,200mg/day까지사용할수있다. 3 필요한경우, ketorolac 15~30mg을매 6시간마다최대 5일까지단기간사용할수있다. 4 혈소판감소증이나출혈경향이있는경우에는 acetaminophen이나 COX-2 선택억제제를고려할수있다. 또한, 위궤양또는위출혈등소화관장애가우려되는경우에는 acetaminophen이나 COX-2 선택억제제를사용하거나, NSAIDs와함께위점막보호를위한 proton pump 저해제나 H2 차단제, misoprostol 등을함께사용할수있다. 염증을동반한통증이나관절통, 피부전이통증이있는경우에는소염작용이없는 acetaminophen 보다는 NSAIDs를고려할수있다. 천식환자에서는 asprin은사용하지않는다 (3) 진통효과를확인해가며, 결정된약제를최대투여량까지증량한다. NSAIDs는최대투여량이상으로증량하는경우에진통작용은증가하지않고부작용만증가하므로 ( 천정효과, ceiling effect), 최대투여량으로도통증이조절되지않는경우에는 WHO 3단계진통제사다리의다음단계로넘어가다른진통의방법을고려하여야한다. (4) 약물사용중에는부작용이발생할수있으므로주의깊게관찰하도록하며, 여러종류의 NSAIDs를병용하는것은진통효과는늘지않고, 부작용만증가하므로피하는것이좋다. 1 부작용관찰혈압, BUN/Cr, CBC, LFT, 대변잠혈반응등을최소한 3개월간격으로관찰한다. 2 부작용의치료신장부작용의경우 BUN이나 Cr이증가하거나혈압이오르기시작하면 NSAIDs를중지하여야한다. 위장관부작용이있으면 NSAIDs를중지하거나 COX-2 선택억제제로전환을고려한다. (5) 소염작용에의해발열등감염의징후가가려질수있으므로감염의가능성이있는경우환자상태의변화를주시해야한다. (6) 약물의상호작용을고려하여야한다. 항응고제 (warfarin), methotrexate, digoxin, lithium, 경구혈당강하제, aminoglycoside 항생제등을복용하는 110

133 The Korean Urological Congress and Expo: 2015 KUCE 환자에게서이러한약물의혈중농도가증가할수있다. 또한 aldactone과병용할경우에는고칼륨혈증을유발할수도있다. C. 마약성진통제마약성진통제를장기간사용하게되면내성 (tolerance) 과신체적의존성 (physical dependence) 이올수있다. 그러나내성이나신체적의존성을약중독 (addiction) 과혼돈해서는안되며, 통증이있는환자에서마약중독은드물다. 모르핀, 옥시코돈, 하이드로몰폰, 펜타닐등의강한마약성진통제는천정효과가없기때문에용량에비례해진통효과를기대할수있으며, 용량의증량이마약중독을의미하지는않는다. 마약성진통제작동제를사용하고있는환자는 pentazocine, nalbuphine과같은혼합형작동-길항제를같이사용해서는안된다. 왜냐하면혼합형작동-길항제가길항제로작용하여금단증상을초래하고통증을악화시키기때문이다. Meperidine (DemerolR) 은반복적으로사용하면대사산물에의한중추신경계부작용을초래할수있으므로, 지속적인사용을권고하지않는다. 경구투여가간편하기때문에가장많이사용된다. 주사제는정맥내혹은피하주입경로를이용한다. 근육주사는환자에게통증을유발하고흡수가불확실하기때문에사용하지않는것이좋다. 마약성진통제에의한부작용은환자개인간에차이가많기때문에항상자세히관찰하여야하며, 피할수없는부작용에대해서는예방적으로치료하여야한다. (1) 투여방법및제제변경에따른투여량의조절 1 동등진통용량표 (equianalgesic dose table) 를사용한다. 예시 # Iv morphine 10mg= oral morphine 30mg =oxycontin 20mg, targin 20mg=jurnista 8mg=durogesic patch 12.5ug/hr 동등진통용량표 111

134 2015 년도대한비뇨기과학회통합학술대회 경피용펜타닐용량표 2 새약제의초회용량은불완전한교차내성 (incomplete crosstolerance) 을고려하여동등진통용량의 50~75% 로한다. 3 전에사용하던진통제로통증조절이불충분하였던경우, 새약제의초회용량은동등진통용량의 75~100% 로한다. 4 돌발통증 (breakthrough pain) 에대비하여새로결정된약제의 1일사용용량의 10~20% 를필요한경우 (prn) 에복용할수있도록처방한다 예시 *Renal cell cancer with multiple metastasis C/C : Generalized pain (esp, flank pain) NRS 8점 Basal pain control ( 외래에서사용함 ): durogesic 25ug/hr IV morphine PRN 5mg에 NRS 0-4로감소 ( 하루 3회사용으로통증조절됨 ) 퇴원예정 basal opioid dose와돌발성통증을예방하기위한 PRN 용량의계산총 morphine사용량 : PRN morphine 양 15mg (5mg x 3회 ) + IV morphine 20mg (durogesic 25ug/hr와동등량 )= 35mg - 사용 iv morphine 15mg의 75%= 11.25mg (= durogesic 12.5ug/hr) - Total durogesic =37.5ug/hr로전환 - PRN용량 : 24hr opioid 요구량의 10% 즉, 37.5ug=iv morphine 30mg 이므로 iv morphine 3mg임 = IR codon 5mg (2) 부작용관리 1 변비약물이장관의연동운동을억제하고항문괄약근의긴장을증가시켜변비를초래한다. 마약성진통제에의한변비는내성이생기지않으므로예방적으로대변완화제를투여한다. ( 자극성완화제 : castor oil, sennoids, bisacodyl, 삼투압성완화제 : lactulose, magnesium sulfate) 2 진정 / 졸림마약성진통제투여시작초기또는증량시에나타난다. 내성이빠른시일내에생긴다. 증세가심한경우에는진통제를바꾸거나각성효과를기대서 methylphenidate (5~10mg, 하루 2~3회, 경구 ), caffeine 등을투여할수있다. 112

135 The Korean Urological Congress and Expo: 2015 KUCE 3 구역 / 구토마약성진통제투여시작초기또는증량시에나타난다. 내성이생기기쉽고, 통상 1~2주정도지나면없어질수있다. 심한경우에는약제를바꾸거나항구토제를사용한다. (metoclopramide, chlorpromazine, haloperidol, scopolamine) 4 호흡억제정맥주사를급속하게하는경우에올수있다. 통증자체가호흡억제를길항하고있기때문에통증이있을경우에는호흡억제가오는경우가드물고, 통증이소실되면서호흡억제가생기면마약성진통제에의한것으로의심할수있다. 호흡억제가발생하면모르핀을중지하고기도를확보한후저산소혈증이의심되면산소를흡입시킨다. 모르핀에대한선택적길항제인 Naloxone 1amp(0.4mg) 를생리식염수 10ml에희석, 1ml(0.04mg) 씩증상이호전될때까지 30~60초마다반복투여한다. 일반적으로 Opioid의반감기가 Naloxone 보다길기때문에이과정을반복할준비를한다 ( 경우에따라서는 0.8mg을 250ml 5%DW에혼합하여지속주입할수있다 ). 의식이회복된후에금단현상이올수있다. 5 배뇨장애모르핀을경막외투여할때잘온다. 전립선비대증환자에서발생할빈도가높다. 다른마약성진통제로바꾸거나알파차단제 (α-adrenergic blocker) 의추가사용이도움이될수있다. 6 기타흔한부작용입마름 : 얼음을갈아서물고있거나자주입을적셔주는방법으로해소가능가려움증 : 항히스타민제의사용을고려 7 기타흔하지는않으나발생가능한부작용발한, 어지러움, 간대성근경련 (myoclonus), 불쾌감 (dysphoria), 도취감 (euphoria), 수면장애 (sleep disturbances), 성기능장애 (sexual dysfunction) 등 (3) 마약성진통제약물소개약품명 투여간격 제형 Short acting Morphine IV, p.o PRN IV 황산모르핀R (5mg/mL, 10mg/1mL, 15mg/1mL) p.o S-morphineR (15mg/T) Hydromorphone 4-6h, PRN p.o JurnistaR (2mg/T) Oxycodone 4-6h, PRN IR codonr (5mg/T) Dihydrocodein 4-6h, PRN Hydrocodone 7.5mgR (Hydrocodone 7.5mg + AAP 500mg/T) Long acting 113

136 2015 년도대한비뇨기과학회통합학술대회 약품명 투여간격 제형 Codein phosphate 8h Tacopen (acetaminophen 250mg + ibuprofen 200 mg + codein phosphate 10mg /T) Oxycodone ER 12h Oxycontin 서방정 (10, 20, 40, 80mg/T) Oxycodine HCl + naloxone 12h Targin (5/2.5mg, 10/5mg, 20/10mg, 40/20mg/T) Fentanyl patch 72h Durogesic patch (12.5, 25, 50, 75, 100ug/h) fentamax patch (12.5, 25, 50, 75, 100ug/h) Jurnista 24h Hydromorphone OROS (8, 16, 32 mg/t) D. 암성통증의진통보조제 마약성진통제의효과를증강시키기위해사용한다. 특정한종류의통증에대한진통제로서사용한다. 통증과연관된증상을완화시키기위해사용한다. 마약성진통제의부작용을치료하기위해사용한다. WHO 3단계진통제사다리의어느단계에서도사용가능하다. (1) 신경병증통증의진통보조제 1 항우울제 (antidepressants) 가적응증및효과 i. 통증의보조제, 진통제로서작용, 취침전에투여 ii. 효과 기분을좋게함 (mood elevation) 마약성진통제의효과를상승시킴 화끈거리는지속성신경병증통증에효과적임 통증과우울증이있는수면장애에도유용나약제 Amitriptyline 시작용량 : 10~25mg /day, 최대용량 : 100mg /day Imipramine 시작용량 : 25~75mg /day, 최대용량 : 300mg /day Nortriptyline 시작용량 : 30~75mg /day, 최대용량 : 150mg /day Paroxetine 시작용량 : 20mg /day, 최대용량 : 50mg /day Venlafaxine 시작용량 : 37.5mg /day, 최대용량 : 225mg /day Duloxetine 시작용량 : 30mg /day, 최대용량 : 60mg /day 다주의사항 항콜린성부작용, 부정맥 2 항경련제 (anticonvulsants) 가적응증및효과 i. 통증의보조제, 진통제로서작용 114

137 The Korean Urological Congress and Expo: 2015 KUCE ii. 말초신경장애에따른급성통증 iii. 효과 : 암에의한신경손상에사용나약제 Gabapentin 시작용량 : 100mg tid, 1~3일간격으로증량최대용량 : 3600mg/day Carbamazepine 상용시작용량 : 100mg bid, 최대용량 : 1200mg /day Pregabaline 시작용량 : 75mg bid, 1~3일간격으로증량, 최대용량 : 600 mg/day 다주의사항 Carbamazepin은장기투여시 CBC, LFT 검사요망 Gabapentin, Pregabaline은신기능장애시감량 3 스테로이드 (corticosteroids) 가적응증및효과 i. 급성및만성암성통증에사용, 일부악성종양의치료제 ii. 효과 종양및신경주위의부종을감소시키므로뇌압상승, 척수신경압박, 전이성뼈통증, 신경침범에의한증상에효과 식욕증진효과, 행복감, 편안함등을제공나약제 Dexamethasone 상용용량 : 4~100mg /day Prednisolone상용용량 : 40~100mg /day 다부작용경구와식도의캔디다증, 근육쇠약, 고혈당증, 체중증가, 위장관장애 *, 급성신경증 * 위장관장애예방을위해제산제나 H2 차단제와병용라주의및금기최소의효과량을투여한다. 중단시서서히감량한다. 4 벤조다이아제핀계 (benzodiazepines) 가적응증및효과 i. 급성불안증, 통증과관련된근육경련에사용 ii. 효과 : 진통효과는없음 나약제 Diazepam상용용량 : 4~40mg /day Lorazepam시작용량 : 1~4mg /day, 최대용량 : 20mg /day Midazolam상용용량 : 5mg (100~150μg/kg/day), 마약성진통제와병용시 2~3mg, 최대용량 : 10mg (500 μg /kg/day) 다부작용 : 호흡억제 115

138 2015 년도대한비뇨기과학회통합학술대회 5 페노사이아진계 (phenothiazines) 가적응증및효과 i. 진정제로서진통효과는없음 ii. 효과 : 마약성진통제의보조제로서사용, 마약성진통제사용에의한구역및구토증상완화나약제 Chlorpromazine 상용용량 : 30~100mg /day, 최대용량 : 1000mg /day Haloperidol 상용시작용량 : 경구제제 1~1.5mg /day 상용용량 : 1.5~3mg /day 최대용량 : 10~20mg /day 다부작용 : 졸음, 기립성저혈압, 추체외로증상 (2) 뼈통증의진통보조제 1 비스포스포네이트계 ( bisphosphonates) 가적응증및효과 i. Pyrophosphate의유사체로골흡수를방해 ii. 효과 뼈전이에의한통증조절및골절예방 뼈전이에따른고칼슘혈증조절나약제 Pamidronate상용용량 : 1회 90mg씩 4주마다정주, 1일 300~600mg경구투여, 최대용량 : 경구 1200mg /day Etidronate 상용시작용량 : 5~10mg /kg/day으로시작, 상용용량 : 10~20mg /kg/day, 최대용량 : 경구 1200mg /day Zoledronic acid : 1회 4mg 씩 3~4주마다정주다부작용 Pamidronate : 권태감, 저마그네슘혈증, 구역, 설사, 뼈통증 Etidronate : 발열, 경련, 뼈통증라주의사항 Pamidronate : 신기능이상이있는환자에서주의, 백혈구수의확인필요 Etidronate : 칼슘이나비타민 D섭취가제한된환자에서주의 2 칼시토닌 (calcitonin) 가적응증및효과 i. 비스포스네이트와유사한작용 ii. 효과 고칼슘혈증조절 뼈전이에의한통증조절및골절예방 만성신경병증통증에도효과나상용용량 : 5~10 IU/kg 다부작용 : 안면홍조, 구역, 구토, 설사라주의사항 : skin test 필요 116

139 The Korean Urological Congress and Expo: 2015 KUCE (3) 기타 1 Hydroxyzine 가적응증및효과 i. 항히스타민제제의효과가필요한경우사용 ii. 효과 : 진통, 항구토, 경한진정및항불안효과, 통증이있으면서불안해하는환자에게유용나상용용량 : 75~150mg /day 다부작용 : 졸음, 두통, 피로, 구강건조증 2 Hyoscine N-Butyl Bromide(Buscopan) 가적응증및효과 장운동항진에의한복통 담도계, 요로, 여성생식기계의경련성통증 기타평활근경련에의한통증 장폐색시위액분비를줄여구토를감소시킴나상용용량 : 10~20mg po tid~qid 다장폐색시용량및투여방법 60~120mg /day의용량을피하또는정맥주사 morphine과섞어서사용해도무방 4시간마다피하주사또는 syringe pump 등을이용한지속주입라부작용및주의사항세균성설사, 울혈성심부전, 부정맥, 궤양성대장염, 갑상선기능항진증, 전립선비대증등은질환에의한증상을악화시킬수있으므로주의가필요 3 Ketamine 가적응증및효과 i. 모르핀으로조절되지않은통증 ii. 암성신경병증통증나상용용량 i. 시작용량 : 0.1~0.2mg /kg IV, 0.5mg /kg SQ ii. 증량 : IV는 15분마다 (SQ는 45분마다 ) 통증이경감될때까지 2배로증량, 반복하다가통증이조절되면총용량을시간당 IV나 SQ 지속용량으로시작 ( 예, 60분동안 12mg의 ketamine이필요했다면, 12mg /hr로정주시작 ) 다부작용 : 이상한꿈, 환각, 섬망, 혈압상승, 맥박증가, 안구진탕, 구역, 구토라주의사항 : 침과다분비로 scopolamine필요하기도함 117

140 2015 년도대한비뇨기과학회통합학술대회 2. Peri- and Postoperative Pain 유럽비뇨기과학회에서제시하는비뇨기계수술후통증관리를위한권고안은다음과같다. Extracorporeal shock wave lithotripsy LE GR Administer NSAIDs or midazolam min before SWL procedure to reduce the need for opioids 2b B Transurethral procedures LE GR Postoperative analgesics with spasmolytic effect or mild opioids are preferable. 3 C Antimuscarinic drugs could be helpful in reducing discomfort resulting from the indwelling catheter. 3 B Antimuscarinic drugs may reduce the need for opioids. 3 B Laparoscopic and robotic procedures LE GR Low intra-abdominal pressure and good desufflation at the end of the procedure reduces postoperative pain. 1b A NSAIDs are often sufficient for postoperative pain control. 2a B NSAIDs decrease the need for opioids. 1b B 술전평가와수술종류에따른준비가더욱효과적인통증관리를가능하게한다. 수술후적절한통증평가는더효과적인통증조절과합병증을감소시킬수있다. NSAIDs 는중등도이하의수술에서효과적이며마약성진통제의필요성을줄여준다. atherosclerotic cardiovascular 질환을가진환자에서는장기간의 COX inhibitors 사용을피해야한다. 마약성진통제의용량을줄여주기때문에수술후통증관리를위해 Paracetamol 이추천되며, Paracetamol 단독투여는부작용없이수술후경한통증을줄여준다. intravenous patient controlled analgesia 는수술후통증관리에효과적이고환자의만족도향상과호흡기합병증을줄여주므로추전된다. Epidural analgesia 는수술후진통효과가크고환자만족도를향상시키므로선호되는방법이다., 3. Renal Colic 통증의완화가가장우선적으로급한치료적단계이다. 경정맥 NSAIDs 가대부분의경우에유용하다. (e.g., a bolus of diclofenac sodium, 75 mg, slow iv injection of ketorolac, 30 mg, four times daily 또는 a slow iv infusion of dipyrone, 1 or 2 g (EAU LE: 1a) Diclofenac 에불응하거나 NSAIDs 금기증인경우경정맥 papaverine hydrochloride (120 mg) 이안전한대체요법이다. 대규모연구에의하면 NSAIDs 와 opioids 모두유용한약제이며 opioids 경우에구토증상이더흔하다 (particularly pethidine). 경정맥 morphine + ketorolac 의병합용법이각각의약제보다효과적이며보조진통제의필요성을줄여준다. 항무스카린제제가종종사용되나 hyoscine butylbromide이마약성진통제의필요성을줄여준다는근거는없다. 118

141 The Korean Urological Congress and Expo: 2015 KUCE 4. Chronic Pelvic Pain Syndrome 골반동통증에단일치료방법은성공적이지못하며, 최근 UPOINT 에따른표현형분류가사용되며이러한표현형에따른치료가치료성공율을향상시킬수있다. 전립선동통증에알파차단제, 항생제, NSAIDs 는 EAU LE 1a 의근거를가지며치료효과를가진다. 마약성진통제에대한효과에대한근거는부족하다. Phytotherapy 역시통증에약간의효과가있는것으로정리되고있다. Perineal extracorporeal shock wave therapy 가 EAU LE 1 b 의근거를가지며어느정도효과가있는것으로정리된다. Pregabalin 은효과가입증되지못한상태이다. 신경비뇨기과적인관점에서만성전립선동통증을이해한다면초기 acute, painful pelvic process (e.g. acute prostatitis) 가만성화경과를거쳐 CPPS 에이르는것을막는게중요하다. 이러한과정에통증에대해서 NSAIDs, paracetamol과같은비마약성진통제가사용이되며통증이조절이되지않는다면마약성진통제의사용도고려가필요하겠다. 만일 CPPS 에이르게되면통증치료에중점을두게된다. 이러한상황에서는전립선에국한된관점에서벗어나전립선외적요소에대해서도관심을가져야하고골반근육의 spasm 을동반한 tenderness, central sensitization 과같은과정을거쳐발생하는신경병증통증등을고려하여통증을치료하여야하겠다. 초기에는비마약성진통제가효과적일수있으나신경병증통증을동반한다면신경병증통증의진통보조제인항우울제 (antidepressants) 인 Amitriptyline 등의약제의사용이필요하며조절이되지않는다면항경련제 (anticonvulsants) Gabapentin, Pregabaline 등의사용을고려할수있다. 결론국내연구에따르면암환자중통증유병율은약 80% 로보고되었으며, 진행암환자의경우 70% 가통증을호소하였고그중 50% 이상은통증관리가적절히이루어지지않고있는것으로보고되었다. 비뇨기과의사들도효과적인암성통증관리를위해서는단계적인치료개념과마약성진통제사용에대한관심을가져야하겠다. 마약성진통제를상당한용량을복용하였지만효과가없는경우신경병증통증을의심해야하고이러한경우에사용되는진통보조제에대한개념이필요하다. 급성통통의잘못된관리는만성화를초래하고결국에는신경병증통증을유발할수있다는사실에주목하고암성통증, 수술관련통증, 요로결석에의한통증, 만성전립선염과관련된통증치료에적극적으로임해야하겠다. 참고문헌 1. 암성통증관리지침권고안 5판 EAU guideline (Guidelines on Pain Management & Palliative Care) 3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Adult Cancer Pain Version Long-Term Opioid Use for Urological Chronic Non-Cancer Pain: Questions and Answers (AUA Update Series Lesson 30 Volume ) 5. Tenti G, Hauri D. Pain and its treatment in urology. Urol Int. 2004;73(2):

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143 전공의연수강좌 2 강의실 C( ) 4 월 11 일 ( 토 ) 10:50~11:50 좌장 : 박관진 ( 서울의대 ) 1. 외상외응급실환자의관리손정환 ( 분당제생병원 ) 2. 비뇨기계선천기형의해법정재민 ( 부산의대 ) 3. 전공의가알아야할 UDS 판독법김명기 ( 전북의대 )

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145 The Korean Urological Congress and Expo: 2015 KUCE 외상외응급실환자관리 손정환 분당제생병원 응급실로내원한환자중비뇨기과의사가최종적으로진료하게되는환자들을증상이나증후로분류해보면비뇨기외상, 급성측복부통증, 발열및비특이적전신증상, 급성음낭통증, 급성요폐, 육안적혈뇨, 음경지속발기증등의범주로나눌수있을것이다. 본강좌에서는비뇨기외상을제외한나머지범주에속하는환자들의처치에대해서얘기해보고자한다. 급성측복부통증 (renal colic) 비뇨기과의사로서응급실에서만나게되는환자들이가장빈번하게호소하는증상중하나가급성측복부통증 (renal colic) 일것이다. 발열및전신증상을동반한신장의감염성원인을배제한다면, renal colic은요관폐색에의한집뇨관의압력증가및요관벽의신장으로인한증상발현이다. 동물실험에서밝혀진 spinothalamic pain pathway C fiber 자극을유발하는요관압력의역치는 32mmHg이며, 이는사람에서의 30mmHg와유사한수치이다 (Ammons, 1992). 평상시의요관의압력은 3.7mmHg 정도이며, 과부하가걸리는경우 mmHg의압력으로분당 2-6회의수축을하게된다.(Kiil, 1957; Ross et al, 1972). 이러한 renal colic의 pathophysiology에영향을미쳐 pain을치료할수있는약물로는 NSAIDs, narcotic analgesics, calcium channel blockers, corticosteriods, alpha1blocker가있다 (Micali et al, 2006). 이중 NSAIDs와 narcotic analgesics가장흔하게사용되며 (Davenport et al, 2005;Holdgate and Oh, 2005; Holdgate and Pollock, 2006), NSAIDs: first line drug, narcotics: second line drug으로인정되고있다. NSAIDs는 renal insufficiency 환자에서는주의하여야한다. NSAIDs는 intrapelvic pressure 뿐만아니라, renal blood flow도낮추는효과가있다 (Perlmutter et al, 1993). 다음으로, renal colic에대한 diagnostic tool로는뭐가좋을까하는의문을가지게된다면이에대한답은명확하다. nonenhanced CT imaging은 contrast를사용하지않으며, 비뇨기외의복부이상을진단하는데유리하다는점그리고, radiolucent stone 및 small stone 의진단에유리하다는점등에서 IVU를제치고 standard diagnostic tool로인정받고있다. 요관폐색에의한 renal colic으로진단되었다면 immediate upper tract drainage(percutaneous nephrostomy or uretral stent) 필요유무에따라서, 치료는두방향으로나누어진다. immediate drainage의 indication으로는 complete ureteral obstruction(unilat. or bilat.), obstruction with infection, obstruction with renal failure, obstruction with solitary kidney, obstruction with renal allograft, obstruction with pregrancy 등이있다. immediate drainage가요구되지않는상황이라면진단된요관폐색의원인에대한 definitive treatment를진행하게된다 (Fig.1). 123

146 2015 년도대한비뇨기과학회통합학술대회 Figure 1. 상부요관폐색환자의치료 algorithm 발열및비특이적전신증상 (fever, nonspecific generalized symptoms) 응급실로내원하는요로감염은하부요로증상만호소하는급성방광염부터발열을동반한오한, 근육통, 오심, 구토등의비특이적전신증상으로내원하여생명을위협하는요로패혈증으로진행될수있는 kidney, prostate infection 까지다양하다. 요로감염은단순요로감염과복합요로감염으로나눌수있으며, 복합요로감염은요로의해부학적, 기능적이상을동반하거나, 중요한내과적, 외과적동반질환을가진경우에해당한다. EAU guideline2011에서는복합요로감염에대한필수적평가요소를 Table1 같이제시하고, 이중 1개이상인자를가진경우로정의하고있다. Table 1. 복합요로감염의요소 이러한복합요로감염의요소를가진경우, 항균제내성율이나재감염의위험도가높고, 치료효과도떨어진다. 더구나, 훨씬다양한임상양상을보여, 요로패혈증으로진행되어생명을위협하게될수있으므로, 치료에세심한주의가필요하다. 요로패혈증은요로계의세균감염이원인인systemic inflammatory reaction을의미하며, 다른원인으로인한패혈증과진단기준및치료가다르지는않다. 124

147 The Korean Urological Congress and Expo: 2015 KUCE Table 2. 패혈증의 진단 기준 Table 3. 패혈증의 치료 125

148 2015 년도대한비뇨기과학회통합학술대회 Fournier s gangrene 비뇨기과의사로서응급실에서흔하지는않지만, 아주심각한외음부및회음부피부의괴사성감염의형태로마주치게되는질환이 Fournier s gangrene이다. Gram positive, gram negative, anaerobic bacteria 혼합감염이빠르게진행되어조직괴사를일으키며혈류내감염이일어나면생명에위협을줄수있는응급질환이다. 알콜리즘, 당뇨, 영양실조, 비만, 간경화, 나쁜위생상태, 면역저하질환 (HIV, 크론병등 ), 악성종양항암치료, 약물과용자등이위험인자로꼽힌다. 이런감염에취약한위험인자를가진환자들에서회음부손상, 요로계처치나수술혹은성접촉감염등이유발요인이되어발생한다. 흔한원인균은 Table4 와같으며, 대부분의경우여러균종의혼합감염이다 (Meleney, 1933; Miller, 1983; Cohen, 1986). Table4. Fournier s gangrene 의원인균 외음부나회음부의한부분의근막을침범한세균은같은층으로연결되어있는 Buck s fascia of the penis, Dartos fascia of the scrotum, Colle s fascia of the perineum,scarpa s fascia of ant abdominal wall을침범하며전방위로진행될수있다. 악취를동반한외음부및회음부피부괴사및종창이확인되는경우 Fournier s gangrene을진단하는것은어렵지않다. 초기에는고열, 국소동통, 부종및홍반등비특이적임상양상으로시작되어이질환의중증정도를잘모를수있으므로, 증상및징후변화에대한세심한관찰이필요하다. 치료로는적극적외과적병변절제술 (aggressive surgical excision) 과함께 multiple organism을치료할수있는항생제병용요법 (double or triple regimens) 이즉시필요하다. 불완전한병변절제로감염이계속진행하는경우에는 2 차적인병변절제술을시행하여야한다. 사망률은평균 20% 정도로 7% 에서 75% 까지보고되고있다. 급성음낭통증 (acute scrotal pain) 급성음낭통증을야기할수있는질환은 table5와같이다양하지만, 이중고환염전 (Torsion of the spermatic cord) 은수술적교정까지의시간이고환을보전하는데가장중요한요소이고, 부고환염, 고환수염전등비슷한증상으로내원한타질환과감별해야불필요한수술을줄일수있기때문에급성음낭통증을호소하며응급실로내원한환자는비뇨기과의사를긴장시킨다. 급성음낭통증을호소하는환자에서감별해야할질환은 Table5 와같다. 126

149 The Korean Urological Congress and Expo: 2015 KUCE Table 5. 급성음낭통증의감별진단 환자의병력청취및이학적검사에서감별진단에도움이되는다음의사항들을고려하여야한다. 고환염전의경우통증의시작시기는급작스런통증으로나타나며운동이나경한음낭충격이동반된경우도있다. 과거에유사한통증경험이있으면간헐적고환염전이있을수있다. 방사통이있는경우는서혜부탈장, 부고환염에서는서혜부의불편감및통증이있을수있으며요관결석에서는측복부동통과연관되기도한다. 오심및구토는고환염전에서동반될수있으며배뇨자극증상 (dysuria, urgency, and frequency) 은부고환염의경우동반될수있으며발열을동반한경우급성부고환염의가능성이높다. 급성음낭통증환자의이학적검사는어렵다. 고환이거상되어있거나, 반대측에비해고환이옆으로누워있고부고환의위치가바뀌어있는경우, spermatic cord가만져지지않고 Cremasteric reflex가소실된경우고환염전을의심할수있다. 부고환염에서는고환을들어올릴때통증이호전되는징후가나타나는데이를 positive Prehn sign이라고한다. Doppler ultrasonography, radionuclide testicular flow scan 등의추가적인진단적검사를고려해볼수있으나, 이런검사는증상발현부터오랜시간이경과한후내원한환자나고환염전의가능성이낮은환자에서확인하는과정으로적용하여야하며, 임상적소견에서고환염전이의심되면, 즉각적인수술적치료를주저하지말아야하고, 추가적인진단적검사를위해서수술적치료가지연되어서는안된다 (Fig.2). Figure 2. Management of acute scrotum 127

150 2015 년도대한비뇨기과학회통합학술대회 고환의비가역적인허혈손상은 4시간이후부터시작이된다. 통증시작부터수술적치료까지의시간경과에따른고환절제술비율은통증시작후 6시간이내 5%, 7-12시간 20%, 13-18시간 40%, 19-24시간 60%, 24시간이상 80%, 48시간이상 90% 로보고되었고, 고환을구제한경우에도통증시작부터수술적치료까지의시간이길수록나중에고환위축이생길가능성이높아진다 (Krarup, 1978; Anderson and Williamson, 1986; Tryfonas et al, 1994; Sessions et al, 2003). 수술전에 manual detorsion 을환자의발쪽에서바라볼때, 오른쪽은반시계방향으로왼쪽은시계방향으로시도해볼수있다. Manual detorsion 으로 pain이사라진경우에도 torsion 이완전히풀렸다고장담할수없고, 다시재발할수있으므로 orchiopexy 해주어야한다 (Sessions et al, 2003, Jefferson and colleagues, 1997). 허혈손상된고환의제거여부는수술현장에서 detorsion 시킨후수분간고환색깔회복상태를살펴본후결정하게되며, 이는술자의판단에달려있다. Orchiopexy를시행하는경우반대쪽도 torsion의위험성을가진해부학적이상이있을가능성을고려하여동시에시행해준다. 급성요폐 (acute urinary retention) 요폐는방광안의소변을스스로배출할수없는상태를말하며, 증상발현의완급에따라급성과만성요폐로나눌수있다. 급성요폐는방광벽의급격한신장으로인해하복부에심한통증을일으키며, 환자는불안감을호소한다. 또식은땀과빈맥등의전신증상이동반된다. 반면에만성요폐는대개통증을유발하지않으나, 하복부불쾌감을호소하며 overflow 양상으로소량의소변을배출한다. 요폐는출구폐색이나배뇨근수축장애의방광자체요인및약물이나신경학적이상등의방광외적인요인으로방광출구저항이배뇨근수축에따른방광내압보다클때발생한다. 임상적으로흔한원인으로남성에서는전립선비대증, 전립선암, 요도협착, 여성에서는골반장기탈출증, 요도협착, 요도게실, 골반종양등을들수있다. Hematuria Clot rentetion, 약물 ( 알러지, 감기, 정신작용 ), sacral n. compression or damage, 골반수술, S2-4 Herpes infection, diabetic cystopathy 등도남녀모두에서흔히접할수있는요폐의원인이다. 요폐를호소하여응급실로내원한환자에게가장우선적으로할처치는 catherer를통해서소변을빼주는것이다. Urethra cathertization을우선시행해보고, 실패하는경우에는즉시 suprapubic cystostomy를시행하여야한다. 이후에원인질환에대한검사및근본적인치료가필요하다 (Fig.3). Figure 3. Management of AUR 128

151 The Korean Urological Congress and Expo: 2015 KUCE 육안적혈뇨 (gross hematuria) 혈뇨는유형에따라 microscopic hematuria / gross hematuria 로, 원인질환에따라 nephrological(medical, glomerular) cause hematuria / urologic(surgical, non glomerular) cause hematuria 로나누어진다. 응급실에서접하게되는혈뇨를주증상으로하는환자는 gross urologic cause hematuria 일것이다. 육안적혈뇨는한번나타나더라도자세한검사가필요한징후로흔한원인은신장, 방광의악성종양이나결석, 감염등이다. 통증이나피덩어리가동반되는지, 방광자극증상이있는지, 배뇨시처음에나타나는지끝에나타나는지처음부터끝까지있는지등을물어본다. 혈뇨가소변을시작할때나타나면요도에병변이있을가능성이높고, 소변끝에나타나면방광경부나전립선요도에, 처음부터끝까지지속되면방광이나요관, 신장에병변이있을가능성이높다. 색소가들어있는음식물을섭취했거나출혈증후군으로인한혈색소뇨증이있으면소변이붉게보일수있다. 육안적혈뇨를호소하는환자의 50% 에서원인이발견되는데, 20% 에서 urologic malignancy가발견될수있고, 12% 에서 bladder tumor 가있을가능성이있다 (Khadra et al, 2000). 따라서, hematuria 에대한검사에는 cystoscopy, urine cytology, upper tract imaging(abdomen and pelvis CT scan), PSA 등이포함되어야한다. Risk factor 를고려한 hematuria에대한검사과정은 Fig.4와같다. Figure 4. Diagnosis and Management of hematuria 감돈포경 (paraphimosis) 감돈포경 (paraphimosis) 은좁고단단한조직의고리 (phimotic ring) 가있는꺼풀 (prepuce) 이귀두뒤로당겨진상태에서정상위치로돌아오지않아생기는병으로비뇨기과적응급질환이다. 꺼풀고리 (phimotic ring) 의압박에따른순환장애로조직의허혈, 림프액이나정맥의울혈그리고귀두의부기와종창이생기며, 심한경우동맥피흐름까지차단되어먼쪽음경의괴사까지생길수있다. 검사나치료목적으로음경이나요도를통한처치후에주로생긴다. 주증상은음경통증이나배뇨장애이다. 129

152 2015 년도대한비뇨기과학회통합학술대회 부기로부푼꺼풀과귀두를 5분정도압박하여조직의부기를줄이고귀두크기를감소시킨후꺼풀을정상위치로돌려주면되는데, 심한경우에는국소마취로등쪽을절개하여되돌려주며근본적인치료로환상절제술을시행하기도한다 (Fig. 5). Figure 5. Management of Paraphimosis 음경지속발기증 (priapism) 음경지속발기증은성행위유무와관계없이성적인욕구가없는데도 4시간이상지속적으로발기가유지되는것을말한다. 혈류의흐름에따라서저혈류형 (venoocclusive, low flow, ischemic) 지속발기증과고혈류형 (arterial, high flow, non ischemic) 지속발기증, 그리고간헐적 (shuttering, intermittent) 지속발기증으로나누어진다. 코카인, 마리화나등약물남용, papaverine, phentolamine과같은약물의과용량주사, sickle cell disease, leukemia, malaria, and Fabry disease 등이음경지속발기증이잘발생할수있는위험인자이다. Sickle cell disease 환자의 42% 에서최소한번이상음경지속발기증이발생하고주로간헐적지속발기증으로나타난다. 그리고소아에서가장흔한원인은 sickle cell disease 이다. 알콜, androgenic steroids, anticoagulants (Coumadin, Warfilone), antihypertensives (Prazosin) 등도위험인자로작용한다. 문진시에는발기지속시간, 통증유무, 재발여부, 발기유발제사용여부, hemoglobinopathy, hypercoagulable state 등의과거력, 골반및회음부손상의과거력등을주의하여파악하여야한다. Table 6. Differential diagnosis between venoocclusive and arterial priapism Venoocclusive Arterial Incidence common Uncommon Cause Idiopathic, Alcohol, drug, 발기유발제 Perineal Trauma Symptom Painful, hard penis Painless, not hard penis BGA acidotic ph < 7.25 PO2 < 30 PCO2 > 60 Mixed >7.3 >50 <40 Prognosis Poor(ischemic) Fair 치료는 low-flow의경우먼저음경해면체천자를 fresh blood가확인될때까지몇차례시행한다. 천자배혈만으로도 40% 정도의환자에서치료가된다. 다음단계로는알파아드레날린촉진제를반복하여해면체내주사하여반응을 130

153 The Korean Urological Congress and Expo: 2015 KUCE 확인하게된다. Selective alpha1 agonist인 phenylephrine 이가장추천되는선택약제이고 (Montague, 2003; Pryor, 2004), phenylephrine의경우정해진허용용량을 5-10분정도간격으로 5-10회로나누어주사하면서한시간정도까지치료성공여부를확인할수있다. 이때전신혈압을측정하여지나친혈압상승여부를확인하여야한다. 이상의치료에반응하지않을경우음경해면체와귀두부사이 shunt 등수술적치료를시행하게된다. High-flow 의경우는동맥조영술을시행하여확인되는병변에대한색전술을시행한다 (Fig. 6). Figure 6. Management of Priapism 참고문헌 1. Kavoussi LR, Novick AC, Partin AW, Peters CA, editors.campbell's Urology. 10th ed. Philadelphia: Saunders; Hohenfellner M, Santucci RA Emergencies in urology. Berlin, Germany: Springer; Grossfeld GD, Litwin MS, Wolf JS, Hricak H, Shuler CL, Agerter DC, Carroll PR. Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy recommendations. Part II: patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation, and follow-up. Urology 2001;57(4): Montague DK, Jarow J, Broderick GA, et al. American Urological Association guideline on the management of priapism. J Urol 2003;170: Keoghane SR, Sullivan ME, Miller MAW. The aetiology, pathogenesis and management of priapism. BJU Int 2002;90: Bastuba MD, Saenz de Tejada I, Dinlec CZ, Sarazn A, Goldstein I. Arterial priapism:diagnosis, treatment and long term follow-up. J Urol 1994;151: Knight PJ, Vassy LE. The diagnosis and treatment of the acute scrotum in children and adolescents. Ann Surg 131

154 2015 년도대한비뇨기과학회통합학술대회 1984;200: Morpurgo E, Galandiuk S. Fournier's gangrene. Surg Clin North Am 2002;82: Gurdal M, Yucebas E, Tekin A, et al. Predisposing factors and treatment outcome in Fournier's gangrene: Analysis of 28 cases. Urol Int 2003;70: Dahm P, Roland FH, Vaslef SN, et al. Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology 2000;56: Eke N. Fournier's gangrene: A review of 1726 cases. Br J Surg 2000;87: unders; 2007;

155 The Korean Urological Congress and Expo: 2015 KUCE 비뇨기계선천기형의해법 정재민 부산의대 1. 서론비뇨기계선천기형 (Congenital anomalies of the kidney and urinary tract (CAKUT)) 은산전에진단되는모든기형의약 20-30% 를차지한다. 대부분임신중정기산전초음파검사로발견된다. 이러한비뇨기계선천기형은증례마다정도가다양하며치료방법도나이나증상등의여러가지많은변수들로인해다양한치료법이요구된다. 따라서한가지획일화된치료를고집하는것은바람직하지않으므로이럴땐이렇게라는정형화된해법을제시하기는어렵다. 비뇨기계선천기형중흔한수신증과방광요관역류의일반적인해법에대해정리하고자한다. 2. 본론 (1) 출생후검사 1) 병력청취및신체검사산전에신장기형으로진단된유아는출산후자세한가족력과임신력및신체검사를시행해야한다. 폐저형성증의위험이있는심한양수과소증을보인태아에서출생후폐에대한검사는필요하다. 복부신체검사로폐색성요로병증이나 multicystic dysplastic kidney (MCDK) 에의해증대된신장을의심해볼수있는종물이존재하는지확인해야한다. 배뇨후에도확장된방광이촉진된다면후부요도판막과같은방광출구폐색을의심해볼수있다. 2) 출생후검사의시기양측성이나단일신장의수신증, 양수과소증의병력이있다면생후 24시간이내초음파를시행해야한다. 특히양측성수신증과방광벽의비후를보이는확장된방광소견이보인다면수술이필요한후부요도판막을의심해볼수있다. 유아들은 prone position으로신장의길이를측정하여신장의성장을확인할수있다. 일측성수신증의경우대부분응급검사는필요없으며신장초음파를생후 48시간후, 1주이내시행하게된다. 48시간이전에는탈수와요량이감소되어수신증이저평가될수있으므로, 신장혈류량과사구체여과율이회복되는 48시간이후에검사하는것이바람직하다. 폐색성요로병증유아가수신증이없으면신성신부전을의 133

156 2015 년도대한비뇨기과학회통합학술대회 심해야한다. 3) 진단검사혈청크레아티닌양측성이나단일신장의수신증환아에서측정해야한다. 혈청크레아티닌으로신장의기능뿐만아니라신장기능부전의존재와정도를확인하고, 신장기능의추적관찰을할수있다. 출생시혈청크레아티닌는산모의수치와비슷하며이후점차감소하므로결과해석에유의해야한다. Voiding cystourethrography (VCUG) 하부요로계를확인하는데유용하며방광벽이두꺼워져있거나수신증혹은요관확장이있다면시행하여야한다. 특히남아의경우후부요도판막을확인하기위해시행한다. 특히 VCUG는방광요관역류를확인하는확진검사로산전수신증환아의 15% 에서방광요관역류가발견된다. 따라서수신증이있는환아들은 VCUG 검사의대상이된다. 수신증의정도에따라 VCUG 검사시행여부를결정하게되고방광요관역류의정도에따라치료를결정하게된다. 유의한방광요관역류유아는예방적항생제치료를시행하여야한다. Dynamic renal scan 신장의배출기능을확인하는데유용한검사로주로사용되는방사성트레이서는 99mTc-mercaptotriglycylglycine (MAG-3 or MAG3) 와 99mTc-diethylenetriamine penta-acetic acid (DTPA) 가있다. 수신증의원인으로요로계폐색여부를확진하는검사로사용된다. Static renal scan 국소신장실질의이상을확인하는데유용한검사로주로사용되는방사성트레이서는 99mTc dimercaptosuccinic acid (DMSA) 이다. 두신장의분리상대신기능및신반흔의유무를확인하기위해시행한다. 미성숙신장기능시기를피하기위해출생후 4-6주뒤에시행하는것이좋다. (2) 수신증의치료치료의목표는신장기능부전, 감염, 결석, 고혈압, 통증및혈뇨등의합병증을예방하는데있다. 수신증은임상적으로유의한폐색은비교적빈도가적고환아마다다양한경과를가진다. 대부분의수신증의초기치료는보존치료이다. 134

157 The Korean Urological Congress and Expo: 2015 KUCE 일반적으로수신증의정도가심하면요로감염의빈도는증가한다. 하지만수신증에서예방적항생제치료에 대해서는아직논란이있다. 고등급의산전수신증유아에서는예방적항생제치료가도움이된다. 아래와같은 경우에는수술적치료가적응증이된다. Reduced differential function < 40% Deterioration of differential function > 5% Sustained or increased hydronephrosis Unilateral gross hydronephrosis > 50 mm Severe hydronephrosis in solitary kidney Severe bilateral hydronephrosis > 30 mm Febrile breakthrough infection or symptoms 수술선택시조기수술과지연수술에대해서는아직논란이있다. 3. 결론비뇨기계선천기형은산전의상태가출생후경과에도영향을준다. 신장방광초음파검사로초기검사를시행하고수신증의유무에따라 VCUG, renal scan 검사를시행하게된다. 대부분의초기치료는보존치료이며수술이필요한경우성공율은높은편이다. 비뇨기계선천기형은출생후의초기진단및치료뿐만아니라지속적인추적관찰이더욱중요하다. 135

158 2015 년도대한비뇨기과학회통합학술대회 전공의가알아야할 UDS 판독법 김명기 전북의대 서론요역동학검사 (urodynamic study, UDS) 는하부요로기능을측정할수있는객관적인검사방법으로임상적으로유용한정보를제공한다. UDS라는동적인검사를통해환자의증상을재현하고환자의증상에대한병태생리적설명이가능하게된다. 1. UDS 종류 Uroflowmetry, PVR (postvoid residual), cystometry, electromyography, urethral pressure profile, pressure-flow study. 2. UDS 전평가 1) 문진 : Storage symptom- UUI, SUI, frequency, nocturia Voiding symptom- Straining, hesitancy, RUS, NUS, postvoid dribbling Sensation abnormality- Urgency, dysuria, no sensation, pain 2) 과거력 : CVA, Dementia, Parkinson s disease, SCI, Multiple sclerosis, Disc disease, pelvic surgery 3) 신체검사 : 환자의증상과그증상을일으킨기저의병인론적인과정을알아내는데필요한신체검사에주력, 신경학적검사동반. 4) 소변검사 : 모든환자에서소변검사를시행. 요로감염 : 배뇨증상악화, 위양성배뇨근과활동, 방광순응도감소등. 혈뇨 : 방광암, 요석. 5) 배뇨일지 : 객관적인배뇨양상평가, 기능성방광용적, 빈뇨, 야간뇨에대한정확한정보제공 6) 패드검사 : 요실금을간단하고비침습적으로측정하는객관적인검사법. 3. UDS 전준비환자가편안함을느끼면서도개인적인영역이침해당하지않도록주의감염방지, 멸균의원칙. 자신이검사하는기구와환자에대한기본지식 : 검사의기술적측면, 신체의해부구조 136

159 The Korean Urological Congress and Expo: 2015 KUCE 4. Uroflowmetry and PVR 1) LUTS 환자에서간단하게방광과요도의기능을간접적으로예측 2) 배뇨근의수축력과방광출구저항간의상호작용을반영 3) UDS 중에서덜침습적이고상대적으로경제적이며가장간단하고유용한검사. 4) Pattern Normal: 지속적이고종모양의부드러운곡선형태, 빠르게증가하는요류. BOO: 해부학적혹은기능적인원인, 거의항상낮은요류속도로평탄한곡선유지. Interrupted flow pattern: 요류가자꾸중단되고요동을보이는경우. Supervoider pattern: Qmax 40mL/sec 이상, 요류곡선의형태는정상. ISD 5) 최대요속 : 요류검사의여러지수중가장중요. 정상남성 : 20~25 ml/sec, 여성 : 25~30 ml/sec. 배뇨량 150mL 이상, 배뇨량과나이관련. 5. Cystometry 방광의수동적방광충전과능동적방광수축동안에발생되는방광내의압력변화를측정. Intravesical Pressure (Pr) = Abdominal Pr + Detrusor Pr 충전매체, 속도, 온도보통누운자세, dual or triple lumen catheter, rectal catheter Intravesical, abdominal Pr 대기압하에서영점. 방광내압측정술의축적기검사중대표적인변수들가 ) 용량 : 최대방광용적나 ) 감각 : first desire, normal desire, strong desire. i. Increase/decrease/absent ii. Nonspecific sensation/urgency/pain 다 ) 순응도 : Decreased compliance 20ml/cmH2O 라 ) 비억제성배뇨근수축의유무정상 : first desire 100~300mL, MCC 400~500mL, intravesical Pr <6~10 cmh2o. 배뇨기최대압력은 60~120 cmh2o 정도까지상승. 6. Leak point pressure DLPP = Detrusor LPP Upper urinary tract damage 가능성을예측 40 cmh2o 이상 ALPP = Abdominal LPP Valsalva LPP, Cough LPP 200~300 ml, MCC 1/2 7. Urethral pressure profile 내요도조임근으로부터외요도조임근이끝나는부분까지요도의내부압력을기록하는검사 MUCP maximum Urethral closing Pressure 요도압과동시에측정한방광내압의차이로요자제를이루는능력을대변 20 cmh2o 미만 : ISD 137

160 2015 년도대한비뇨기과학회통합학술대회 8. Pressure flow study 배뇨하는동안방광내압및요류를동시에측정하는검사법배뇨기능을정확히정량적으로평가할수있는검사법가능한환자가일상적인배뇨를재현할수있도록노력해야함방광출구폐색이의심되는하부요로증상의평가에유용. BOO vs detrusor underactivity SCI: DSD 9. Electromyographic study Sphinter function Surface, needle electrode DSD, Pseudo DSD 10. Video UDS Obstruction 위치, incontinence, VUR 값이비싸고 X-ray 노출, 많은장비때문에환자안정하기어려움. 결론 UDS 에는두가지기본적인목적이있다. 첫째로 UDS 중환자의증상을재현하고둘째로환자의증상과 UDS 결과를연관시키는병태생리학적설명을제공하기위함이다. 138

161 2015년도대한비뇨기과학회통합학술대회 2015 KUCE Index Author Index Keyword Index

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163 The Korean Urological Congress and Expo: 2015 KUCE Author Index ㄱ 강동혁 P-15 강석현 P-29 강석호 P-17, P-18, P-3 강성구 P-17, P-18, P-3 강숭구 P-20 강준구 P-16 강태욱 P-33 강호원 P-11, P-22, P-51 고경태 P-37 고영휘 P-21, P-34, P-52, P-53, P-57 구교철 P-9 구자윤 P-5, P-6 국하림 P-31, P-7 권세윤 P-48 권종규 P-15 권준범 P-47 권칠훈 P-49 권태균 P-16, P-63 김강섭 P-26, P-56 김경도 P-54, P-55, P-69 김계환 P-44, P-62, P-1 김광모 P-31, P-7 김광진 P-33 김기경 P-44 김기범 P-30, P-31, P-7 김기호 P-48 김덕윤 P-29 김동수 P-46 김두상 P-8 김마태 P-37 김명주 P-41 김범수 P-16, P-63 김법완 P-16, P-63 김상운 P-59, P-60 김상원 P-16 김성대 P-68 김성용 P-37 김세웅 P-26, P-32, P-56 김수동 P-4 김숙영 P-20 김순기 P-64 김승빈 P-17, P-18, P-3 김연주 P-47 김영빈 P-2, P-46 김영욱 P-21, P-34, P-52, P-53, P-57 김영주 P-68 김영호 P-36 김예환 P-11, P-22 김용준 P-11, P-22 김원재 P-22, P-11 김원태 P-11, P-22 김유석 P-64 김장환 P-41 김재수 P-47 김재윤 P-17, P-18, P-3 김정준 P-50 김제종 P-17, P-18, P-3 김종원 P-20 김주호 P-62 김준석 P-28 김지원 P-39 김지유 P-41 김진우 P-63 김진욱 P-54, P-55, P-69 김창희 P-1, P-62 김철성 P-10 김태우 P-32 김태진 P-31, P-7 김태형 P-54, P-55, P-69 김태환 P-16, P-63 김하영 P-37 김현태 P-16, P-63 김형곤 P-39 김형근 P-17, P-18, P-3 김형지 P-32 나군호 P-9 나용길 P-36 나준필 P-19 노용수 P-39 노준 P-10 노주환 P-62 노준화 P-28 ㄴㅁ 명순철 P-54, P-55, P-69 문기학 P-21, P-34, P-52, P-53, P-57 문수영 P-41 문영태 P-54, P-55, P-69 문형우 P-26, P-56 민경은 P-2, P-46 민승기 P-64 ㅂ 박경기 P-68 박광성 P-32 박동재 P-16 박동진 P-48 박성곤 P-32 박성운 P-28 박용현 P-26, P-56 박종관 P-32 박종목 P-36 박준형 P-50 박창후 P

164 2015 년도대한비뇨기과학회통합학술대회 박형근 P-39 박흥재 P-49 배민호 P-49 배웅진 P-26, P-56 배정범 P-40 백성현 P-39 백승 P-10 변석수 P-30, P-31, P-7 ㅅ 서성일 P-19 서성필 P-11, P-22 서영진 P-48 서윤석 P-50 설종구 P-36 성경탁 P-4 성도환 P-32 성현환 P-19 손희서 P-41 송기학 P-36 송병도 P-31 송재만 P-33 송필현 P-21, P-34, P-52, P-53, P-57 신용호 P-2, P-46 신주현 P-36 심강희 P-32 ㅇ 안창 P-40 안현규 P-9 양대열 P-37 양승훈 P-33 양희조 P-8 엄춘일 P-11, P-22 오승준 P-32 오종진 P-30, P-31, P-7 우명진 P-63 유구한 P-2, P-46 유동훈 P-28 유은상 P-16, P-63 유재호 P-19 유정우 P-48 윤상진 P-1, P-62 윤석중 P-11, P-22 윤성구 P-3, P-17, P-18 윤영은 P-20 이경 P-5, P-6 이경섭 P-32, P-48 이광석 P-9 이광수 P-40 이권수 P-21, P-34, P-52, P-53, P-57 이동기 P-2, P-46 이상근 P-11, P-22 이상은 P-30, P-31, P-7 이상철 P-11, P-22, P-30, P-31, P-7 이성운 P-32 이성호 P-37 이승규 P-1 이영 P-2, P-46 이영구 P-44 이영익 P-30 이용승 P-59, P-60 이원기 P-37 이유진 P-63 이윤형 P-47 이인재 P-31, P-7 이정구 P-17, P-18, P-3 이정근 P-30, P-31, P-7 이주용 P-51, P-15 이준녕 P-16, P-63 이지열 P-26, P-32, P-56 이창민 P-33 이창용 P-10 이창호 P-8 이충렬 P-36 이학민 P-30 이한솔 P-30, P-31, P-7 이해원 P-40 이현무 P-19 이형래 P-2, P-46 임동훈 P-10 임영재 P-59, P-60 임재성 P-36 임정수 P-33 ㅈ 장인호 P-54, P-55, P-69 장재윤 P-21, P-34, P-52, P-53, P-57 장준보 P-21, P-34, P-52, P-53, P-57 장현경 P-1 전성수 P-19 전소영 P-16, P-63 전승현 P-46 전유정 P-41 전윤수 P-8 전태용 P-40 전황균 P-19 정경진 P-1 정경화 P-37 정두용 P-51 정병창 P-19 정병하 P-32, P-9 정성광 P-16, P-63 정성진 P-30, P-31, P-39, P-7 정재흥 P-33 정필두 P-11, P-22 정하범 P-44 정한 P-62 정현우 P-50 정현진 P-29 정현철 P-33 정희창 P-21, P-34, P-52, P-53, P-57 조강수 P-15, P-51 조민철 P-40 조석 P-17, P-18, P-3 조성룡 P-47 조성태 P-44 조영삼 P-49 조영인 P-20 조원진 P-10 조인창 P-64 조정기 P-31 조혁진 P-26, P

165 The Korean Urological Congress and Expo: 2015 KUCE 주관중 P-49 지병훈 P-59, P-60 진병수 P-29 ㅊ 채윤병 P-33 천준 P-17, P-18, P-3, P-32 최돈경 P-44 최석환 P-16, P-63 최세웅 P-26, P-56 최승권 P-2, P-46 최영득 P-15, P-51 최우석 P-39 최재경 P-39 최재영 P-21, P-34, P-52, P-53, P-57 최재혁 P-51 최종보 P-32 최태수 P-2, P-46 최한용 P-19 추설호 P-32 ㅌ 태종현 P-17, P-18, P-3 ㅍ 편종현 P-17, P-18, P-3 ㅎ 하윤석 P-16, P-63 하홍구 P-5, P-6 한덕현 P-50 한상원 P-59, P-60 한웅규 P-20 한장희 P-51 함동엽 P-39 함원식 P-15, P-51 허경재 P-26, P-56 허정식 P-68 허지은 P-41 허지혜 P-33 홍성규 P-30, P-31, P-7 홍성준 P-9 홍성후 P-26 홍성후 P-56 황태곤 P-26, P

166 2015 년도대한비뇨기과학회통합학술대회 A Ahn Hanjong P-12 B Baek Seung P-23, P-38, P-61 C Chang Young Seop P-27 Cho Dae Sung P-13, P-65 Cho Kyung-Aa P-43 Cho Won Jin P-23, P-38, P-61 Choi Han Yong P-14 Choi Young Hyo P-14 Choo Min Soo P-25 Choo Seol Ho P-13 Chung Hosuck P-42, P-43, P-58, P-66, P-67 H Han Jun Hyun P-25 Hong Bumsik P-12 Hong Jun Hyuk P-12 Hwang Eu Chang P-35, P-42, P-43, P-58, P-66, P-67 Hwang Insang P-35, P-42, P-43, P-58, P-66, P-67 J Jang Seok Heun P-65 Jeon Gin Gab P-12 Jeon Hwang Gyun P-14 Jeon Seong Soo P-14 Jeong Byong Chang P-14 Jeong Ho Seok P-35 Jin Byung Soo P-45 Jo Yang heon P-35 Jung Hyun Jin P-45 Jung Jaeyoon P-12 Jung Seheon P-67 Jung Seung Il P-35, P-42, P-43, P-58, P-66, P-67 K Kang Seok Hyun P-45 Kang Taek Won P-35, P-42, P-43, P-58, P-66, P-67 Kim Choung-Soo P-12 Kim Chul Sung P-23, P-38, P-61 Kim Dae Ji P-65 Kim Duk Yoon P-45 Kim Hong Wook P-27 Kim Hyung Jun P-27 Kim Jin Bum P-27 Kim Jun Seok P-24 Kim Se Joong P-13 Kim Sun Il P-13 Kim Sun woo P-42 Kim Sun-Ouck P-35, P-42, P-43, P-58, P-66, P-67 Kwon Dong Deuk P-35, P-42, P-43, P-58, P-66, P-67 Kwon Taekmin P-12 L Lee Chang Yong P-23, P-38, P-61 Lee Chunwoo P-12 Lee Donghyun P-12 Lee Hyun Moo P-14 Lee Jae Won P-65 Lee Sang Eun P-14 Lee Sang Kon P-25 Lee Seong Ho P-25 Lee Won Ki P-25 Lim Chae Hong P-65 Lim Dong Hoon P-23, P-38, P-61 M Moon Young Jun P-27 N Nho Joon P-23, P-38 Noh Joon Hwa P-24 P Park Kwangsung P-35, P-42, P-43, P-58, P-66, P-67 Park Seong Woon P-24 Park Tea joo P-66 R Rho Joon P-61 Rhu Ji won P-43 S Seo Seong Il P-14 Seo Young ho P-67 Sohn Mooyoung P-12 Son Jeong Hwan P-65 Song Cheryn P-12 Song Seung Hee P-42, P-43, P-58, P-66 Song Wan P-14 Troya P-41 T 144

167 The Korean Urological Congress and Expo: 2015 KUCE Y Yim Sang Un P-58 Yoo Dong Hoon P-24 You Dalsan P-12 Yu Ho Song P-35, P-42, P-43, P-58, P-66, P

168 2015 년도대한비뇨기과학회통합학술대회 Keyword Index ㄱ ㅂ ㅇ 간질성방광염 P-38 경동맥내중막 P-33 경요도전립선적출술 P-23 경피적신쇄석술 P-50 계절 P-48 골반수술 P-40 과잉운동장애 P-44 기온 P-48 ㄴ 나이 P-30 남성 P-30 남성암 P-15 남성호르몬박탈요법 P-9 ㄷ 당뇨 P-46 당뇨병 P-33 대동맥석회화 P-27 대체치료 P-17 도뇨관 P-69 돼지방광의점막하층 P-63 디플럭스 P-59 ㄹ 레이저 P-49 로봇 P-5, P-6 로봇시뮬레이터 P-52 리도카인 P-64 ㅁ 메칠페니데이트 P-44 무스카리닉수용체 P-36 반복요속검사 P-60 발기부전 P-57 방광내히알루론산주입요법 P-38 방광내재발 P-19 방광석 P-49 방광수축력 P-39 방광요관역류 P-59 방광출구폐색 P-36 배뇨증상 P-6 배뇨근저활동성 P-39 배뇨후점적 P-37 베이지안분석 P-51 병기 P-16 복강경 P-47 복부전산화단층촬영술 P-61 부분냉동치료 P-3 부분신절제술 P-20 분석 P-53 비마약성진통제 P-10 비뇨기암 P-15 ㅅ 상부요로상피암 P-21 생존률 P-14 성기자해 P-68 소신종물 P-17 소아 P-60 신손상 P-61 신기능 P-20 신냉동수술 P-17 신세포암 P-16, P-20 신장암 P-12, P-14 신장요관절제술 P-19 실런트합병증 P-50 역행성요로조영술 P-21 예후 P-12 예후인자 P-46 요관결석 P-47 요관경 P-47 요관경하배석술 P-45 요관경하요관조직검사 P-19 요관방광문합술 P-62 요관손상 P-62 요도방광문합술 P-52 요도손상 P-68 요도협착 P-63 요로감염 P-69 요로결석 P-45, P-46, P-48, P-51, P-53 요석 P-49 요실금 P-6, P-40 요역동학검사 P-30, P-31, P-39, P-44 우울증 P-1 음경보형물 P-57 이식편 P-63 ㅈ 재발 P-21 저중위험도 P-3 전립선 P-23 전립선생검 P-2, P-64 전립선신생물 P-5 전립선절제술 P-52 전립선조직검사 P-10 전립선비대증 P-23, P-29, P-33, P-34 전립선암 P-2, P-3, P-9 전립선적출술 P-5 전립선항원수치 P-2 정량화 P

169 The Korean Urological Congress and Expo: 2015 KUCE 좁은요관 P-45 종양크기 P-14, P-16 ㅊ 체외충격파쇄석술 P-51 초음파 P-34 ㅌ 테스토스테론 P-1 통증 P-64 통증조절 P-10 통증성방광증후군 P-38 트렌드분석 P-15 ㅎ 하부요로증상 P-27, P-34, P-37, P-60 학습곡선 P-59 항균펩타이드 P-69 항암화학요법 P-9 혈뇨 P-53, P-61 홀뮴레이저 P-29 환자만족도 P-57 황체형성호르몬방출호르몬 P-1 기타 ABO 혈액형 P

170 2015 년도대한비뇨기과학회통합학술대회 A active surveillance P-7 acute urinary retention P-35 Adrenergic beta-3 Receptor Agonists P-41 Age P-31 AQP2 P-42 aquaporin 1 P-43 AVP P-42 H Heart rate P-32 HoLEP P-28 HPS laser P-26 intravenous urography P-54 I prostate P-8 Prostate cancer P-7, P-11 Prostatic hyperplasia P-24 PSA P-8 pyelonephritis P-65 R rats P-66 Renal cell carcinoma P-13 B L S barbed suture urethrovesical anastomosis P-4 benign prostate hyperplasia P-35 benign prostatic hyperplasia P-25 bladder P-42 bladder cancer P-18, P-22 bladder underactivity P-31 Body mass index P-13 BPH P-26 C calculi P-65 caveolin 1 P-43 cell-free nucleic acid P-11 cystitis P-66 DHIC P-28 DM P-56 D E erectile dysfunction P-56 Expression P-22 Laser therapy P-24 lower urinary tract symptoms P-25 Lower urinary tract symptoms P-32 M median lobe P-26 metabolic syndrome P-25 mice P-43 Mirabegron P-41 Mutation P-22 N NBI P-18 Nephrectomy P-13 Non enhanced computed tomogrphay P-54 O Overactive Bladder P-41 P septic shock P-65 steroid P-67 stone P-8 Sympathetic nervous system P-32 T Temperature P-55 Tight junction P-58 Time series analysis P-55 transurethral resection of prostate P-35 treatment P-31 TRPV4 P-66 TURBT P-18 U upgrading P-7 urechis unicintus P-56 Urinary retention P-24 urine P-11 Urodynamic study P-31 urolithiasis P-54, P-55 FGFR3 P-22 F phimosis P-67 prepuce P-67 Prognosis P-22 Vagina P-58 V 148

171 2015 년도대한비뇨기과학회통합학술대회 2015 KUCE 인쇄 : 2015 년 4 월 7 일빌행 : 2015 년 4 월 11 일 발행인 : 주명수 발행처 : 대한비뇨기과학회서울시용산구서빙고로 동 1102호 ( 용산동 5가용산파크타워오피스텔 ) Tel: , Fax: urology@urology.or.kr Homepage: 편집제작 : 가온컨벤션경기도김포시중봉1로 ( 감정동은빛프라자 ) Tel, Fax : gaonpco@naver.com