Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. CONTENTS 임원명단... 2 Programs 전체일정표 세부일정표... 8 ㆍEducation... 8 ㆍSpecial Lecture... 8 ㆍP

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. CONTENTS 임원명단... 2 Programs... 4 - 전체일정표... 5 - 세부일정표... 8 ㆍEducation... 8 ㆍSpecial Lecture... 8 ㆍPlenary Session I... 9 ㆍPlenary Session II... 9 ㆍPlenary Session III... 0 ㆍPlenary Session IV... 0 ㆍNurses Forum... ㆍSponsored Symposium... 2 ㆍKUA-AUA Urology Resident Review Course... 3 Abstracts... 4 Index - Author Index... 2 - Keyword Index... 2

임원명단 회장 천 준 명예회장 송재만 직전회장 주명수 부회장 이영구 부회장 성경탁 부회장 어홍선 보험정책사업단장 이영구 국제교류사업단장 성경탁 미래전략사업단장 김태형 총무이사 김준철 보험이사 민승기 기획이사 김대경 연구이사 변석수 학술이사 곽철 수련이사 이상돈 고시이사 최종보 국제교류이사 홍준혁 법제이사 전성수 재무이사 박홍석 홍보이사 조문기 정보이사 윤석중 간행이사 권동득 대외협력이사 송기학 정책특별이사 권태균 표준진료개발이사 김형지 개원발전이사 이동수 Editor in Chief, ICUrology 박광성 교과서발간위원장 백재승 윤리특별위원장 이정구 신의료기술평가위원장 최영득 부총무 정병창 부총무 홍성후 부총무 강성구 재단총괄기획본부장이형래 재단사무국장 백성현 재단사무부국장 배재현 감사 정재용 감사 김형진 207년평의원회 ( 성명가나다순총 9명 ) 강성구 ( 고려의대안암병원 ) 강주호 ( 안동성소병원 ) 고우진 ( 국민건강보험공단일산병원 ) 곽철 ( 서울대학교병원 ) 권경일 ( 권비뇨기과 ) 권동득 ( 화순전남대학교병원 ) 권태균 ( 경북대학교병원 ) 금학조 ( 금학조비뇨기과 ) 김건석 ( 울산의대서울아산병원 ) 김계환 ( 가천의대길병원 ) 김대경 ( 을지대학교병원 ) 김명기 ( 전북대학교병원 ) 김선일 ( 아주대학교병원 ) 김수웅 ( 서울대학교병원 ) 김영식 ( 국민건강보험공단일산병원 ) 김용태 ( 한양대학교병원 ) 김장환 ( 연세의대신촌세브란스병원 ) 김정현 ( 강원대학교병원 ) 김종현 ( 미즈메디병원 ) 김준철 ( 가톨릭의대부천성모병원 ) 김태형 ( 중앙대학교병원 ) 김현우 ( 가톨릭의대성바오로병원 ) 김형곤 ( 건국대학교병원 ) 김형지 ( 단국대학교병원 ) 나군호 ( 연세의대신촌세브란스병원 ) 나용길 ( 충남대학교병원 ) 노준 ( 조선대학교병원 ) 류동수 ( 성균관의대삼성창원병원 ) 명순철 ( 중앙대학교병원 ) 문경현 ( 울산대학교병원 ) 문기학 ( 영남대학교병원 ) 문두건 ( 고려의대구로병원 ) 민승기 ( 국립경찰병원 ) 박광성 ( 전남대학교병원 ) 박상현 ( 인제의대해운대백병원 ) 박종관 ( 전북대학교병원 ) 박홍석 ( 고려의대구로병원 ) 백성현 ( 건국대학교병원 ) 변석수 ( 분당서울대학교병원 ) 서영진 ( 동국대학교병원 ) 서일영 ( 원광대학교병원 ) 성경탁 ( 동아대학교병원 ) 손환철 ( 서울특별시보라매병원 ) 송기학 ( 충남대학교병원 ) 송병주 (PSI한솔비뇨기과 ) 송윤섭 ( 순천향대학교병원 ) 송재만 ( 연세의대원주세브란스기독병원 ) 신동길 ( 부산대학교병원 ) 신명식 ( 명비뇨기과 ) 양대열 ( 한림의대강동성심병원 ) 양상국 ( 건국의대충주병원 ) 어홍선 ( 어비뇨기과 ) 오승준 ( 서울대학교병원 ) 유은상 ( 경북대학교병원 ) 유정우 ( 타워비뇨기과 ) 윤상진 ( 가천의대길병원 ) 윤석중 ( 충북대학교병원 ) 이건철 ( 인제의대일산백병원 ) 이동수 ( 고려에이스비뇨기과 ) 이동현 ( 이화의대목동병원 ) 이동환 ( 가톨릭의대인천성모병원 ) 이상돈 ( 양산부산대학교병원 ) 이영구 ( 한림의대강남성심병원 ) 이정구 ( 고려의대안암병원 ) 이정훈 ( 새봄비뇨기과 ) 이종복 ( 국립중앙의료원 ) 이지열 ( 가톨릭의대서울성모병원 ) 이택 ( 인하대학교병원 ) 이형래 ( 강동경희대학교병원 ) 장석흔 ( 분당제생병원 ) 장영섭 ( 건양대학교병원 ) 전성수 ( 성균관의대삼성서울병원 ) 전승현 ( 경희대학교병원 ) 정병창 ( 성균관의대삼성서울병원 ) 정재용 ( 인제의대상계백병원 ) 정진수 ( 국립암센터 ) 정희창 ( 영남대학교병원 ) 조규선 ( 서울탑비뇨기과 ) 조문기 ( 원자력병원 ) 조진선 ( 한림의대성심병원 ) 주관중 ( 성균관의대강북삼성병원 ) 주명수 ( 울산의대서울아산병원 ) 천준 ( 고려의대안암병원 ) 최영득 ( 연세의대신촌세브란스병원 ) 최종보 ( 아주대학교병원 ) 허정식 ( 제주대학교병원 ) 홍범식 ( 울산의대서울아산병원 ) 홍성후 ( 가톨릭의대서울성모병원 ) 홍재엽 ( 차의대분당차병원 ) 홍준혁 ( 울산의대서울아산병원 ) 화정석 ( 경상대학교병원 ) 2

임원명단 세부전공학회및연구회 지회 대한남성과학회장 양대열 강원지회장 송재만 대한비뇨기종양학회장 조진선 대구경북지회장 문기학 대한소아비뇨기과학회장 한창희 대전세종충청지회장 권경일 대한배뇨장애요실금학회장 오승준 부산경남지회장 금학조 대한 ENDOUROLOGY 학회장 나군호 서울지회장 정재용 대한요로생식기감염학회장 나용길 인천경기지회장 홍재엽 대한비뇨기초음파학회장 김태형 제주지회장 허정식 대한전립선학회장 이지열 호남지회장 박종관 대한비뇨기과의사회장 어홍선 비뇨기계기초의학연구회장 김준철 요로생식기손상재건연구회장 박홍석 노인비뇨기요양연구회장 김형지 학술위원회 학술이사 곽철 ( 서울대학교병원 ) 학술간사 정창욱 ( 서울대학교병원 ) 학술위원 김계환 ( 가천의대길병원 ) 김형준 ( 건양대학교병원 ) 나웅 ( 국립중앙의료원 ) 박현준 ( 부산대학교병원 ) 백민기 ( 성균관의대삼성서울병원 ) 임영재 ( 서울대학교병원 ) 정승일 ( 전남대학교병원 ) 정인갑 ( 울산의대서울아산병원 ) 조성용 ( 서울특별시보라매병원 ) 최석환 ( 경북대학교병원 ) 하홍구 ( 부산대학교병원 ) 한병규 ( 퍼펙트비뇨기과 ) 3

www.urology.or.kr 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Programs

207년제69차대한비뇨기과학회추계학술대회 Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. PROGRAM Wednesday 27 September 시간 Grand Ballroom (2F) Crystal A (3F) Crystal B (3F) Geomungo Hall (THE-K HOTEL 3F) 07:30- 등록 ( 층등록데스크 ) 09:00-0:00 0:00-:00 :00-2:00 지도전문의교육. ( 수련위원회 ) 2:00-3:00 Lunch (Four Seasons, F) 3:00-4:00 Oral Session. Cancer - Kidney (I). (O00-O00). 권동득 ( 전남의대 ). 한웅규 ( 연세의대 ) Oral Session 2. Infertility & Sexual Dysfunction (I). (O0-O020). 문두건 ( 고려의대 ). 손환철 ( 서울의대 ) Oral Session 3. LUTS/BPH (I). (O02-O030). 김대경 ( 을지의대 ). 조영삼 ( 성균관의대 ) 4:00-5:00 Oral Session 4. Cancer - Prostate (I). (O03-O040). 이강현 ( 국립암센터 ). 홍성규 ( 서울의대 ) Oral Session 5. Endourology &. Stone Disease (I). (O04-O050). 안현수 ( 아주의대 ). 김범수 ( 경북의대 ) Oral Session 6. Trauma & Others. (O05-O060). 문홍상 ( 한양의대 ). 박재영 ( 고려의대 ) 5:00-6:00 Oral Session 7. Basic Research - Cancer (I). (O06-O070). 김원재 ( 충북의대 ). 장인호 ( 중앙의대 ) Video Session. (V00-V005). 이상철 ( 충북의대 ). 오철규 ( 인제의대 ) Oral Session 8. Incontinence/Female Urology/Neurourology. (O07-O080). 이정주 ( 부산의대 ). 배재현 ( 고려의대 ) 평의원회. (4:30-8:00) 6:00-7:00 Oral Session 9. Cancer - Prostate (II). (O08-O090). 정재일 ( 인제의대 ). 이동현 ( 이화의대 ) Video Session 2. (V006-V00). 한준현 ( 한림의대 ). 박성열 ( 한양의대 ) Oral Session 0. Pediatrics. (O09-O00). 조원열 ( 동아의대 ). 박관진 ( 서울의대 ) 7:00-8:00 8:30-20:30 Presidential Reception 5

207년제69차대한비뇨기과학회추계학술대회 Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. PROGRAM Thursday 28 September 시간 Grand Ballroom (2F) Crystal A (3F) Crystal B (3F) 07:50-08:00 Booth 개장식 08:00-09:00 Oral Session. Cancer - Bladder,. Pelvis, Ureter & Others (I). (O0-O0). 김형진 ( 전북의대 ). 강석호 ( 고려의대 ) 09:00-09:20 개회식 09:20-0:20 0:20-:20 :20-:50 Plenary Session I Oral Session 2. Basic Research -. Cancer (II). (O-O20). 김세중 ( 아주의대 ). 변석수 ( 서울의대 ) Oral Session 4. Basic Research - Neurourology &. LUTS/BPH & Others. (O3-O40). 이택 ( 인하의대 ). 김계환 ( 가천의대 ) Sponsored Symposium Oral Session 3. LUTS/BPH (II). (O2-O30). 최종보 ( 아주의대 ). 유은상 ( 경북의대 ) Oral Session 5. Infections & Pediatrics. (O4-O50). 이상돈 ( 부산의대 ). 정승일 ( 전남의대 ) Geumkang Hall (Avenue 2F) ICUrology Workshop. ( 편집위원회 ) Satellite Symposium I Satellite Symposium II Satellite Symposium III Satellite Symposium IV 2:00-3:00 Lunch (Four Seasons, F) 3:00-4:00 4:00-5:00 5:00-6:00 Plenary Session II Oral Session 6. Cancer - Prostate (III). (O5-O60). 이경섭 ( 동국의대 ). 홍준혁 ( 울산의대 ) Oral Session 8. Cancer - Kidney (II). (O7-O80). 김현회 ( 서울의대 ). 박승철 ( 원광의대 ) Oral Session 20. Endourology &. Stone Disease (II). (O9-O200). 성경탁 ( 동아의대 ). 조성용 ( 서울의대 ) 6:00-7:00 Plenary Session III. 7:00-8:00 ( 특강 ) 8:0-20:00 Welcome Dinner Oral Session 7. Cancer-Bladder, Pelvis, Ureter & Others (II). (O6-O70). 이형래 ( 경희의대 ). 서호경 ( 국립암센터 ) Oral Session 9. Infertility & Sexual Dysfunction (II). (O8-O90). 양대열 ( 한림의대 ). 김수웅 ( 서울의대 ) Oral Session 2. LUTS/BPH (III). (O20-O20). 주명수 ( 울산의대 ). 김형곤 ( 건국의대 ) International Session (I00-I00) 김수동 ( 동아의대 ) Kexin Xu (Peking University People s Hospital) 6

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. PROGRAM Friday 29 September 시간 Grand Ballroom (2F) Crystal A (3F) Crystal B (3F) 08:00-09:00 Plenary Session IV (08:00-:00) Oral Session 22. Cancer - Prostate (IV). (O2-O220). 박동수 ( 차의대 ). 전성수 ( 성균관의대 ) Oral Session 23. Cancer - Kidney (III). (O22-O230). 권태균 ( 경북의대 ). 홍성후 ( 가톨릭의대 ) 09:00-09:30 Satellite Symposium Ⅴ Satellite Symposium Ⅵ Geumkang Hall (Avenue 2F) Video Session 3. (V0-V05). 나군호 ( 연세의대 ). 전승현 ( 경희의대 ) 09:30-0:20 Break 0:20-:20 :20-:50 Satellite Symposium VII Nurses Forum. (0:20-:50) KUA-AUA. Urology Resident. Review Course. (0:00-2:00) 2:00-3:00 Lunch (Four Seasons, F) 3:00-4:00 69차정기총회 4:00-4:45 보험정책강좌 4:45-5:00 Special Lecture 5:00-6:00 Oral Session 24. Cancer - Prostate (V). (O23-O240). 김청수 ( 울산의대 ). 조진선 ( 한림의대 ) Nurses Forum. (3:00-6:05) KUA-AUA. Urology Resident. Review Course. (3:00-6:30) 6:00-7:00 Oral Session 25. Cancer - Bladder, Pelvis,. Ureter & Others (III). (O24-O250). 김홍섭 ( 건국의대 ). 정병창 ( 성균관의대 ) 7

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Education - 지도전문의교육 일시 : Wednesday 27 September 09:00-2:00 장소 : Crystal Ballroom B 시간주제강사 09:00-09:40 연차별수련목표및수련내용손정환 ( 분당제생병원 ) 09:40-0:20 비뇨기과전문의공통역량및전문역량개발하유신 ( 가톨릭의대 ) 0:20-0:40 Break 0:40-:20 수련교육프로그램의효과적인평가방법오경진 ( 전남의대 ) :20-2:00 비뇨기과전문의자격취득요건및자격시험정재민 ( 부산의대 ) 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Education - 보험정책강좌 일시 : Friday 29 September 4:00-4:45 장소 : Grand Ballroom, 2F 시간주제강사 4:00-4:45 보험정책강좌좌장 : 이영구 ( 대한비뇨기과학회부회장 ) 국가보건의료정책방향김용익 ( 前국회의원 ) 8

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. ICUrology Workshop 일시 : Thursday 28 September 09:20-:20 장소 : Geumkang Hall (Avenue 2F) 시간주제강사 09:20-09:50 How to get your journal indexed in SCI(E) 정현진 ( 엘스비어 Journal Consultant) 09:50-0:0 편집위원회회의 0:0-0:20 Coffee break 0:20-0:40 ICUrology current report 0:40-:0 의학저널의최신동향, 의학저널의미래그리고, ICUrology 가나아갈길홍성태 (JKMS 편집위원장 ) :0-:20 시상식 Reviewer of the Year Award 207, Most Cited Article Award 207 :20 기념촬영및폐회 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Special Lecture 일시 : Friday 29 September 4:45-5:00 장소 : Grand Ballroom, 2F 시간주제강사 4:45-5:00 김세철학술인상수상자기념강연 좌장 : 천준 ( 대한비뇨기과학회회장 ) 홍성규 ( 서울의대 ) 9

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Plenary Session I 일시 : Thursday 28 September 09:20-:20 장소 : Grand Ballroom, 2F 시간주제강사 09:20-09:35 How to manage high risk prostate cancer patient after surgery 안한종 ( 울산의대 ) 09:35-09:50 Renal biopsy: To whom, how and when? 서성일 ( 성균관의대 ) 09:50-0:05 The development of PSA guidelines - The Australian experience Peter Heathcote (USANZ President, Princess Alexandra Hospital, Brisbane, Australia) 0:05-0:20 종양면역학과비뇨기종양최경호 ( 서울의대생화학과 ) 0:20-0:35 What to do with BCG refractory NMIBC when cystectomy is not an option 구자현 ( 서울의대 ) 0:35-0:50 New drugs in metastatic bladder cancer 서호경 ( 국립암센터 ) 0:50-:05 Diet and prostate cancer outcome J. Kellogg Parsons. (University of California, San Diego, USA) :05-:20 Fascial sling for female SUI: Should we go forward to the past? Alex Tong-Long Lin (TUA President,. Taipei Veterans General Hospital, Taiwan) 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Plenary Session II 일시 : Thursday 28 September 3:00-6:00 장소 : Grand Ballroom, 2F 시간주제강사 3:00-3:5 New concepts in the pathogenesis of nephrolithiasis Marshall L. Stoller (University of California, San Francisco, USA) 3:5-3:30 It is my honor! The clinical experience of (Sun) tip-flexible semi-rigid ureterorenoscope Guosheng Yang (Guangdong No.2. Provincial People s Hospital, China) 3:30-3:45 Methods of tract dilation in PCNL Lei Shi (Qingdao University, China) 3:45-4:00 ISD: Definition, UDS based diagnosis, additional methods to diagnostic accuracy 신동길 ( 부산의대 ) 4:00-4:5 ISD influences therapeutic option and outcome 김장환 ( 연세의대 ) 4:5-4:30 How to manage delayed ejaculation? 류지간 ( 인하의대 ) 4:30-4:45 High grade of renal injury: Current trend of management in the era of trauma center 이종복 ( 국립중앙의료원 ) 4:45-4:55 The evolution of USANZ Michael Nugara (USANZ CEO, Australia) 4:55-5:05 Patient-derived xenografts as in vivo models for research in urological malignancies Osamu Ogawa. (Kyoto University, Japan) 5:05-5:5 The future prospect of robotic partial nephrectomy in Japan Masato Fujisawa (JUA President, Kobe University, Japan) 5:5-5:30 Post-chemotherapy RPLND for testicular cancer 정창욱 ( 서울의대 ) 5:30-5:45 New biomarkers in prostate cancer 윤석중 ( 충북의대 ) 5:45-6:00 Role of surgery in metastatic prostate cancer or even in CRPC Axel Heidenreich. (University of Cologne, Germany) 0

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Plenary Session III ( 특강 ) 일시 : Thursday 28 September 6:00-8:00 장소 : Grand Ballroom, 2F 시간주제강사 New Paradigms in Medicine 6:00-6:25 딥러닝의의료영역활용사례이예하 ( 뷰노코리아 ) 6:25-6:50 의료에서의 IoT 이연희 ( 한국보건사회연구원정보통계연구실팀장 ) 6:50-7:0 의료에서의증강 / 가상현실 Alaric Hamacher ( 광운대정보콘텐츠대학원 ) 7:0-7:30 인공지능, 융합의학그리고비뇨기과의미래김남국 ( 울산의대융합의학과 ) Pain Management in Urology 7:30-7:45 비뇨기과외래처치시진정요법. (Pain management of urological procedures) 7:45-8:00 진행성비뇨기종양환자의통증조절. (Pain management for metastatic urologic cancer) 최근주 ( 중앙의대마취통증의학과 ) 이국진 ( 가톨릭의대혈액종양내과 ) 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Plenary Session IV 일시 : Friday 29 September 08:00-:00 장소 : Grand Ballroom, 2F 시간주제강사 08:00-08:5 The role of invasive urodynamics prior to surgery for LUTS/BPH 이상욱 ( 강원의대 ) 08:5-08:30 Contemporary management of vesicoureteral reflux in children: Low grade VUR 조원열 ( 동아의대 ) 08:30-08:45 Contemporary management of vesicoureteral reflux in children: High grade VUR 한창희 ( 가톨릭의대 ) 08:45-09:00 Clinical outcomes of varicocele repair in infertile men 서주태 ( 단국의대 ) 09:00-09:5 What I've learnt from terrain trial and future perspective on the treatment of metastatic prostate cancer 09:5-09:30 Medical evaluation and treatment for urinary stone former: Tips for everyday practice 09:30-09:45 Complications of robotic urological surgery: Prevention, recognition and management Axel Heidenreich. (University of Cologne, Germany) 박형근 ( 울산의대 ) 서일영 ( 원광의대 ) 09:45-0:00 Orgasmic dysfunction after radical prostatectomy Run Wang (The University of Texas Medical School at Houston, USA) 0:00-0:5 Surgical management of post-prostatectomy incontinence 이규성 ( 성균관의대 ) 0:5-0:30 Standardization of sacral neuromodulation: Care pathway for urinary, bowel and sexual function in women Courtenay K. Moore (The Cleveland Clinic Center for Continuing Education, USA) 0:30-0:45 Antibiotics prophylaxis for transrectal prostate biopsy 이지열 ( 가톨릭의대 ) 0:45-:00 Treatment of multi-resistant gram negative bacteria in UTI 강철인 ( 성균관의대내과학교실 )

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Nurses Forum 일시 : Friday 29 September 0:20-6:05 장소 : Crystal Ballroom, 3F 사회 : 하홍구 ( 부산의대 ) / 최석환 ( 경북의대 ) 시간주제강사 Nurses Forum I (0:20-:50) 0:20-0:30 축사천준 ( 대한비뇨기과학회장 ) 0:30-:0 비뇨기해부학의이해좌장 : 정승일 ( 전남의대 ) 0:30-0:50 수술중접하는비뇨기해부학강성구 ( 고려의대 ) 0:50-:0 영상에서보이는비뇨기해부학천혜진 ( 경북의대영상의학과 ) :0-:50 비뇨기종양환자의항암치료좌장 : 박홍석 ( 고려의대 ) :0-:30 신장암의표적치료황의창 ( 전남의대 ) :30-:50 방광암및전립선암의항암치료김수동 ( 동아의대 ) 2:00-3:00 Lunch Nurses Forum II (3:00-6:05) 3:00-3:40 요역동학검사의실제좌장 : 김계환 ( 가천의대 ) 3:00-3:20 남성환자에서요역동학검사의팁김귀식 ( 서울대병원 ) 3:20-3:40 여성환자에서요역동학검사의팁허경옥 ( 서울아산병원 ) 3:40-4:20 수술후합병증관리좌장 : 전승현 ( 경희의대 ) 3:40-4:00 근치적전립선적출술후발생한요실금과발기부전의치료이주용 ( 연세의대 ) 4:00-4:20 경요도수술후합병증관리조혁진 ( 가톨릭의대 ) 4:20-4:45 Coffee Break 4:45-5:25 결석환자의식이와치료좌장 : 이승배 (Sheikh Khalifa Specialty Hospital) 4:45-5:05 결석환자의식단홍미경 ( 삼성서울병원 ) 5:05-5:25 내시경결석치료의실제조성용 ( 서울의대 ) 5:25-6:05 남성발기부전의이해좌장 : 박현준 ( 부산의대 ) 5:25-5:45 발기부전의원인과기전박민구 ( 인제의대 ) 5:45-6:05 발기부전의약물약제한병규 ( 퍼펙트비뇨기과 ) 6:05 Adjourn 2

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Sponsored Symposium 일시 : Thursday 28 September 장소 : Grand Ballroom, 2F 시간 Satellite Symposium I (Sponsor : Astellas) 좌장 : 김청수 ( 울산의대 ) :20-:50 Updates on Enzalutamide in Korean patients with chemo-naïve mcrpc 권동득 ( 전남의대 ) 일시 : Thursday 28 September 장소 : Crystal Ballroom A, 3F 시간 Satellite Symposium II (Sponsor : MSD) 좌장 : 조진선 ( 한림의대 ) :20-:50 PROSCAR; Journey for the BPH treatment and current data update 추설호 ( 아주의대 ) 일시 : Thursday 28 September 장소 : Crystal Ballroom B, 3F 시간 Satellite Symposium III (Sponsor : Olympus) 좌장 : 강석호 ( 고려의대 ) :20-:50 Flexible Cystoscopy - less pain and good image - Junichi Inokuchi (Kyushu University, Japan) 일시 : Thursday 28 September 장소 : Geumkang Hall (Avenue 2F) 시간 Satellite Symposium IV (Sponsor : 종근당 ) 좌장 : 오승준 ( 서울의대 ) :20-:50 Update on interstitial cystitis/bladder pain syndrome 김계환 ( 가천의대 ) 일시 : Friday 29 September 장소 : Crystal Ballroom A, 3F 시간 Satellite Symposium V (Sponsor : Coloplast) 좌장 : 이규성 ( 성균관의대 ) 09:00-09:5 Choice of intermittent catheters 이영숙 ( 성균관의대 ) 09:5-09:20 자가도뇨카테터요양급여제도현황조영삼 ( 성균관의대 ) 일시 : Friday 29 September 장소 : Crystal Ballroom B, 3F 시간 Satellite Symposium VI (Sponsor : Boston Scientific) 좌장 : 박성열 ( 한양의대 ) 09:00-09:30 Past, present and future of RIRS 조성용 ( 서울의대 ) 일시 : Friday 29 September 장소 : Grand Ballroom, 2F 시간 Satellite Symposium VII (Sponsor : GSK) 좌장 : 김준철 ( 가톨릭의대 ) :20-:50 The evolution of medical management for BPH James Van Hasselt (GSK Urologist, South Africa) 3

Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. KUA-AUA Urology Resident Review Course 일시 : Friday 29 September 0:00-7:00 장소 : Geumkang Hall (Avenue 2F) 시간주제강사 0:00-0:05 Opening and Welcome Remark (KUA, AUA) Jun Cheon (KUA President) 0:05-:00 Urolithiasis Update Marshall L. Stoller (University of California, San Francisco, USA) Medical and surgical management of stone disease Medical expulsive therapy, SWL URS PCNL :00-2:00 Kidney Cancer Update J. Kellogg Parsons (University of California, San Diego, USA) Diagnostics 2:00-3:00 Lunch Nephrometry score systems, role of percutaneous biopsy localized disease management Small renal masses, surgical treatments, ablative therapies advanced disease Cytoreductive therapy, targeted therapies, metastasectomy 3:00-4:00 Bladder Cancer Update J. Kellogg Parsons (University of California, San Diego, USA) Management of non-invasive disease Diagnostics Intravesical therapies, surgical therapies, management of invasive and metastatic disease, neoadjuvant and adjuvant chemotherapy, surgical therapy and lymph node dissection 4:00-5:00 Erectile Dysfunction / Andrology Update Run Wang (The University of Texas Medical School at Houston, USA) Physiology of erection Pathophysiology of erectile dysfunction, evaluation and management of erectile dysfunction, Peyronie s disease, penile reconstruction, prosthetic surgery, hypogonadism Testosterone Controversies Male Infertility 5:00-5:20 Afternoon Break 5:20-6:20 Female Urology, Neurourology and Voding Dysfuction Update Courtenay K. Moore (The Cleveland Clinic Center. for Continuing Education, USA) Overactive bladder, medical management, surgical management Stress incontinence, pelvic organ prolapse, neurogenic bladder dysfunction 6:20-6:30 Closing Remarks / Adjourn 4

www.urology.or.kr 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. Abstracts

Contents Wednesday 27 September Grand Ballroom 3:00-4:00 Oral Session : Cancer - Kidney (I) (O00-O00) 좌장 : 권동득 ( 전남의대 ), 한웅규 ( 연세의대 ) O-00 직업성노출과신장암의관련성에대한환자대조군연구... 53 김태헌, 전황균, 정병창, 서성일, 이현무, 최한용, 김환철 2, 임종한 2, 전성수 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 인하대학교의과대학직업환경의학과학교실 O-002 신세포암에서성별과콜레스테롤수치에따른 BMI 의예측인자로서의가치 - 다기관연구... 54 Fahad Bashraheel, 정현철, 변석수 2, 곽철 3, 김용준 4, 황의창 5, 김태환 6, 강석호 7, 정진수 8, 홍성후 가톨릭대학교서울성모병원, 2 분당서울대학교병원, 3 서울대학교병원, 4 충북대학교병원, 5 전남대학교병원, 6 경북대학교병원, 7 고려대학교안암병원, 8 국립암센터 O-003 R.E.N.A.L. nephrometry 점수에따른신장종괴에대한경피하생검에대한결과분석... 55 김진우, 박지수, 안현규, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 O-004 Yonsei nomogram: a predictive model of new onset chronic kidney disease following partial nephrectomy in patients with T renal tumors... 56 Ahmed Elghiaty, Ali Abdel Raheem, Tae Young Chin, Ki Don Chang, Mohamed Alenzi, Young Eun Yoon, Won Sik Ham, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine O-005 Impact of surgical margin status after partial nephrectomy for renal cell carcinoma... 57 이종수, 장원식, 김종찬, 함원식, 한웅규, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실 O-006 부분신적출술후환측신장의장기간추적관찰... 58 김종근 2, 박사현, 김명, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 김청수, 안한종 울산대학교서울아산병원, 2 한림대학교동탄성심병원 O-007 Indicators of CKD upstaging: multicenter long term matched comparison of robotic,. laparoscopic and open partial nephrectomy 308 cases... 59 장기돈, 알리압델라힘, 한웅규, 최영득, 나군호 연세대학교의과대학비뇨기과학교실 O-008 부분신절제술후기능변화예측에있어 CSA, RENAL, PADUA 및 C-index 의포괄적비교 :. 컴퓨터단층촬영기반신장용적측정법을사용한접근법... 60 이찬호, 구자윤, 백승룡, 이경, 김경환, 박지훈, 강병진, 하홍구 부산대학교병원 O-009 복강경하부분신절제술의혈관결찰과신절제마진확보방법에따른단기 6 개월신기능비교연구... 6 강수환, 강필문, 류현열, 김택상 고신대학교의과대학비뇨기과학교실 O-00 Outcome of off-clamp robot-assisted partial nephrectomy:. propensity matched comparison to on-clamp... 62 Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Woong Kyu Han,. Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea 6

Contents Crystal A 3:00-4:00 Oral Session 2: Infertility & Sexual Dysfunction (I) (O0-O020) 좌장 : 문두건 ( 고려의대 ), 손환철 ( 서울의대 ) O-0 효소생물연료전지를이용한나노스케일전기자극의정자운동성에대한영향... 63 김대근, 신태은 2, 박진우 2, 이은지 2, 이재호 3 CHA 의과학대학교서울역센터 비뇨기과학교실, 2 남성의학연구실, 3 CHA 의과학대학교의생명과학과 O-02 발기부전유발당뇨동물모델에서새로운세대저에너지충격파치료의효능... 64 정현철, 전승환, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교서울성모병원 O-03 인간전압의존성양성자통로의단백질키나아제 C 매개활성화를통한양파껍질추출물 (OPE) 의. 인간정자운동성조절... 65 채미리, 강수정, 방석환, 성현환, 이성원 성균관대학교의과대학삼성서울병원비뇨기과학교실 O-04 Genetic screening for Y chromosome microdeletions in,226 infertile men from Korea... 66 이효석, 김신영 2, 최진호, 이중식, 서주태 단국대학교제일병원 비뇨기과, 2 유전학연구실 O-05 Relationship between sperm parameters and human sperm dna fragmentation (SDF). as assessed with the sperm chromatin dispersion test... 67 이효석, 박용석 2, 최진호, 이중식, 서주태 단국대학교의과대학제일병원 비뇨기과, 2 생식의학연구실 O-06 비폐쇄성무정자증환자에서수술현미경이 microsurgical TESE 정자추출률에미치는영향... 68 김기영, 변현근, 이영진 2, 김종현 미즈메디병원비뇨기과, 2 아이드림센터 O-07 당뇨성발기부전마우스에서항 -prongf 항체의혈관신생및신경재생을통한발기력개선효과... 69 응웬낫민, 송강문, 최민지, 칼얀가탁, 권미혜, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 O-08 웹설문을이용한한국의발기부전에대한 0 년추적연구... 70 송원훈, 박주현 2, 조성용 2, 조민철 2, 정현 2, 손환철 2 서울대학교병원비뇨기과, 2 서울특별시립보라매병원비뇨기과 O-09 페이로니병환자의섬유화경결에서분리된섬유모세포에서 activin receptor-like kinase 5. 저해제의항섬유화효과... 7 최민지, 송강문, 칼얀가탁, 응웬낫민, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 O-020 통증을주소로시행한고환정계정맥류제거술후장기추적관찰시수술성적및술후통증개선의영향인자분석... 72 송원훈, 김정권, 조민철 2, 손환철 2, 김수웅, 백재승 서울대학교병원비뇨기과, 2 보라매병원비뇨기과 Crystal B 3:00-4:00 Oral Session 3: LUTS/BPH (I) (O02-O030) 좌장 : 김대경 ( 을지의대 ), 조영삼 ( 성균관의대 ) O-02 배뇨근저활동성이동반된전립선비대증환자의요로상피에서 adenosine triphosphate와 nitric oxide의변화... 73 조강준, 최진봉, 고준성, 김준철가톨릭대학교부천성모병원 7

Contents O-022 전립선건강검진데이터에서연령에따른배뇨및저장증상의변화... 74 이신우, 윤솔, 도정모, 서덕하, 이천우, 제성욱, 최세민, 감성철, 화정석, 정기현, 현재석 경상대학교의과대학비뇨기과학교실, 경상대학교병원 O-023 The efficacy and validity of the penile cuff test as an alternative diagnostic tool for bladder outlet obstruction.... 75 태종현, 윤성구, 김승빈, 김재윤, 심지성, 강성구, 강석호, 천준, 김제종, 이정구 고려대학교의과대학비뇨기과학교실 O-024 Can penile cuff test predict the outcomes of Holmium laser enucleation of the prostate for benign prostatic obstruction?... 76 고광진, 이규성,2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 삼성융합의과학원의료기기산업학과 O-025 전립선비대증환자에서알파차단제사용의결과예측을위한탄성초음파영상의유용성... 77 손수민, 오정훈, 박태주, 신상수, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 권동득, 박광성, 강택원 전남대학교의과대학 비뇨기과학교실, 2 영상의학과학교실 O-026 Impacts of serum vitamin D level on lower urinary tracts symptoms in men... 78 유상준, 박주현, 조성용, 손환철, 정현, 조민철 서울특별시립보라매병원 O-027 배뇨근과활동성및저하된수축성을동시에가지는여성환자의장기간추적관찰결과보고... 79 김아람, 박영진, 최우석, 박형근, 백성현, 김형곤 Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine O-028 Efficacy and safety of combination of tolterodine and pilocarpine in overactive bladder patients:. a randomized double-blind multicenter phase 3 study... 80 고광진, 김계환 2, 김세웅 3, 김선옥 4, 서주태 5, 주명수 6, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 가천대학교의과대학길병원비뇨기과학교실, 3 가톨릭대학교서울성모병원비뇨기과학교실, 4 전남대학교병원비뇨기과학교실, 5 관동대학교의과대학제일병원비뇨기과학교실, 6 울산대학교서울아산병원비뇨기과학교실 O-029 A 2-week open-label extension study to assess the efficacy and safety of combination. of tolterodine and pilocarpine in the treatment of patients with overactive bladder after 2-week randomized study... 8 고광진, 이정주 2, 오승준 3, 김형곤 4, 민권식 5, 홍재엽 6, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 부산대학교병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 건국대학교병원비뇨기과학교실, 5 인제대학교부산백병원비뇨기과학교실, 6 CHA 의과학대학교분당차병원비뇨기과학교실 O-030 과민성방광환자군에서항무스카린제처방변경사례와그이유에관한연구... 82 강병진, 박지훈, 백승룡, 김경환, 이경, 김현우, 신동길, 이정주 부산대학교의과대학비뇨기과학교실 Grand Ballroom 4:00-5:00 Oral Session 4: Cancer - Prostate (I) (O03-O040) 좌장 : 이강현 ( 국립암센터 ), 홍성규 ( 서울의대 ) O-03 전립선암발생에대한대사건강상태의영향 : 전국코호트연구... 83 김종욱, 정형국, 박태용, 안순태, 오미미, 문두건, 박홍석 고려대학교의과대학비뇨기과학교실 O-032 Is serum testosterone level is NOT related to adenocarcinoma diagnosis of. the prostate even among definitely hypogonadal patients?... 84 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 8

Contents O-033 메트포민 (metformin) 이전립선특이항원에미치는영향 :. 미국국가보건영양실태조사 (NHANES) 2007-2008 데이터... 85 박지수, 이광석 2, 함원식, 정병하 2, 구교철 2 연세대학교의과대학 신촌세브란스병원, 2 강남세브란스병원 O-034 Age-specific prostate-specific antigen in Korean men with biopsy-confirmed benign prostate... 86 전병조, 태범식, 박재영,2, 최훈,2, 배재현,2, 홍성규 3, 이상은 3, 변석수 3 고려대학교안산병원비뇨기과학교실, 2 고려대학교의과대학비뇨기과학교실, 3 서울대학교의과대학비뇨기과학교실 O-035 전립선조직검사에서항생제용법이갖는임상적중요성 : 단일기관 만례보고... 87 서영은, 유영동, 황진호, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은 분당서울대학교의과대학비뇨기과학교실 O-036 전립선암으로근치적전립선절제술을시행받은환자의병리학적결과을예측하는데있어수술전. prostate health index 의유용성 : 강원도지역비뇨기종양다기관연구... 88 박홍주, 송기현, 서인범, 강태욱 2, 정현철 2, 김성진 3, 박창후 3, 박종연 3, 김정현 강원대학교병원비뇨기과학교실, 2 연세대학교원주기독병원, 3 울산대학교강릉아산병원 O-037 PI-RADS 의진단적정확도 : 전층절편조직검사와 2 구획별평가비교... 89 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 O-038 전립선암수술후전립선피막침범에대한 MRI PI-RADS version2 score 의예측력... 90 한재현, 최세영, 경윤수, 류제만, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교서울아산병원비뇨기과학교실 O-039 근치적전립선절제술을받은한국인에서의새로운 5 단계 grading system 에대한외부검증및평가... 9 조민현, 정창욱, 구자현, 곽철, 김현회, 박주현 2, 조민철 2, 정현 2 서울대학교병원, 2 서울특별시립보라매병원 O-040 Verification for staging groups of prostate cancer suggested by eighth edition of TNM. staging manual of the American joint committee on cancer: emphasis on the gleason score... 92 이학민, 이인재, 오종진, 이상철, 변석수, 이상은, 홍성규 분당서울대학교병원비뇨기과학교실 Crystal A 4:00-5:00 Oral Session 5: Endourology & Stone Disease (I) (O04-O050) 좌장 : 안현수 ( 아주의대 ), 김범수 ( 경북의대 ) O-04 결석질환의치료경향과비용... 93 윤영은, 정재훈, 조정기, 문홍상, 김용태, 최홍용, 박해영, 박성열 한양대학교의과대학비뇨기과학교실 O-042 요로결석성분과대사성요인들과의연관성에관한연구... 94 김재윤, 김승빈, 태종현, 윤성구, 심지성, 강성구, 강석호, 천준, 이정구, 김제종 고려대학교의과대학비뇨기과학교실 O-043 요로결석의약물배출촉진요법으로 tamsulosin, alfuzosin, silodosin 및 placebo 의결석배출율의비교 :. 체계적문헌고찰및네트워크메타분석... 95 강동혁, 권종규 2, 김종찬 2, 조강수 2, 함원식 2, 최영득 2, 이주용 2 인하대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소 O-044 비조영전산단층촬영 hounsfield units 를이용한결석이질성지수, 평균결석밀도및최대직경을이용한. 요관결석의체외충격파쇄석술 차성공률예측노모그램... 96 오경택, 김종찬, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실 9

Contents O-045 0 mm 이상크기의신장결석에대해연성요관내시경수술법을선택할수있는. 결석의크기와관련인자들에대한고찰... 97 박주현, 선인영, 류호영, 유상준, 조민철, 손환철, 정현, 조성용 서울특별시립보라매병원비뇨기과 O-046 신장결석에대한치료로 retrograde intrarenal surgery, percutaneous nephrolithotomy,. mini-percutaneous nephrolithotmy 결과비교 : 체계적문헌고찰및네트워크메타분석... 98 강동혁, 김종찬 2, 권종규 2, 조강수 2, 함원식 2, 최영득 2, 이주용 2 인하대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소 O-047 신장결석수술방법에따른급성신손상바이오마커의차이... 99 육형동, 윤민영, 정창욱 서울대학교병원비뇨기과 O-048 증상을가진요관결석환자와비교한무증상결석의특성및치료후신기능회복에대한분석... 00 편종현, 김재윤 2, 강석호 2, 천준 2, 이정구 2, 김제종 2, 강성구 2 성균관대학교의과대학강북삼성병원비뇨기과학교실, 2 고려대학교안암병원비뇨기과학교실 O-049 역행성신내수술후치료실패위험인자에대한연구... 0 김영빈, 신용호, 최태수, 유구한, 이동기, 민경은, 전승현, 이형래, 이선주, 이충현, 장성구, 이상협 경희대학교의과대학비뇨기과학교실 O-050 역행성신내수술후발생하는열성요로감염의위험인자에대한연구... 02 최정혁, 신용호, 최태수, 유구한, 이동기, 민경은, 전승현, 이형래, 이선주, 이충현, 장성구, 이상협 경희대학교의과대학비뇨기과학교실 Crystal B 4:00-5:00 Oral Session 6: Trauma & Others (O05-O060) 좌장 : 문홍상 ( 한양의대 ), 박재영 ( 고려의대 ) O-05 요도협착환자에서내시경적요도절개술및일시적요도스텐트삽입술의유효성... 03 조대성, 장석흔, 손정환, 이재원 대진의료재단분당제생병원비뇨기과 O-052 요도협착환자에서요도성형술시행후결과에영향을줄수있는요인... 04 이충언, 성현환 성균관대학교의과대학비뇨기과학교실 O-053 The impact of single kidney dysfunction on the psychopathology in young men:. population-based analysis of military manpower administration database in Korea... 05 김정준, 성현환 2, 한덕현 2, 최한용 2 분당서울대학교병원비뇨기과, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실 O-054 Development of silicone surgical guide for partial nephrectomy with 3D printing and. injection molding... 06 경윤수 2, 류제만, 최세영, 김국배 3, 송현경 3, 김남국 3, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강증진센터, 3 융합의학교실 O-055 부분신절제술 3D 프린팅모형의오차에대한분석... 07 경윤수 2, 최세영, 류제만, 김국배 3, 송현경 3, 유달산, 정인갑, 홍준혁, 김남국 3, 김청수 울산대학교서울아산병원 비뇨기과, 2 건강증진센터, 3 융합의학과 O-056 장기간편측요관카테터유치로인한신실질폭의변화... 08 김희연, 이준호, 유제모, 이승주, 이동섭 가톨릭대학교성빈센트병원비뇨기과학교실 Withdrawal 20

Contents O-057 생체신공여자의신적출술후만성신장질환위험예측모델... 09 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 O-058 The implication of the dominant side split renal function by. diethylenetriamine penta-acetic acid (DTPA) in live kidney donor... 0 이형호 3, 윤영은 4, 나준채, 허규하 2, 김명수 2, 김순일 2, 김유선 2, 한웅규 연세대학교의과대학신촌세브란스병원비뇨기과학교실, 2 연세대학교의과대학신촌세브란스병원이식외과학교실, 3 국민건강보험공단일산병원 비뇨기과, 4 한양대학교병원비뇨기과학교실 O-059 비뇨기과병동에서입원전담전문의도입에따른의료진의만족도와진료의질향상인식에대한연구... 이동환, 정연수, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 변석수, 이상은, 김은선 2, 김낙현 2, 온정헌 2, 장학철 2 분당서울대학교병원 비뇨기과, 2 종합내과 & 입원전담진료센터 O-060 스마트폰을이용한휴대용정액검사시스템의유용성... 2 박지훈, 임미영, 류장현, 박현준, 이경민, 박민정, 박남철 부산대학교병원비뇨기과학교실, 한국공공정자은행연구원 Grand Ballroom 5:00-6:00 Oral Session 7: Basic Research - Cancer (I) (O06-O070) 좌장 : 김원재 ( 충북의대 ), 장인호 ( 중앙의대 ) O-06 거세저항성전립선암의맞춤형치료전략수립을위한환자유래세포및마우스모델개발... 3 김윤림, 김봉민, 최세영 2, 류제만 2, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 O-062 RNA 시퀀싱기법을활용한엔잘루타마이드저항성전립선암세포주의유전자발현특성분석및표적유전자탐색... 4 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원 O-063 mtor 경로및남성호르몬수용체억제를통한새로운바이구아니드유도체 (IM76) 의전립선암억제효과... 5 류제만, 유상준 2, 김윤림 3, 최세영, 김청수 울산대학교서울아산병원비뇨기과학교실, 2 서울대학교보라매병원비뇨기과학교실, 3 서울아산병원의생명연구소 O-064 골수조혈줄기세포유래수지상세포를이용한동종이소전립선암면역세포치료제유효성평가... 6 김봉민, 김윤림, 최세영 2, 류제만 2, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 O-065 전립선암환자의혈액에존재하는혈액순환암세포를바이오마커로이용하여전립선암의. 예후예측및치료전략발굴... 7 김윤림, 김봉민, 최세영 2, 류제만 2, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 O-066 전립선암에서의자성나노와이어기반순환종양세포의검출 : 선행연구... 8 김정권, 조영남 2, 김성한, 정재영, 서호경, 정진수, 이강현 국립암센터전립선암센터비뇨기과, 2 국립암센터암의생명과학과 O-067 전립선암세포에서 CWP 29 의 ER stress 경로를통한세포고사유발에관한연구... 9 김명, 김윤림, 박사현, 임고산, 안한종 울산대학교서울아산병원비뇨기과학교실 O-068 Expression of HMGB in prostate cancer: clinical and biological correlations... 20 박용현, 정애량, 김가은, 김미영, 이지영, 이규원, 이지열 가톨릭대학교서울성모병원 2

Contents O-069 근치적전립선절제술후요실금및발기장애와음부신경감각유발전위와의연관성... 2 권세윤, 박진모 2, 김기호, 서영진, 이경섭 동국대학교경주병원, 동국대학교의과대학 비뇨기과학교실, 2 신경과학교실 O-070 Trends of medical trevel from non-seoul residents to Seoul to seek treatment modalities for. prostate cancer: Korean national health insurance system data study from 2005 to 204... 22 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 Crystal A 5:00-6:00 Video Session (V00-V005) 좌장 : 이상철 ( 충북의대 ), 오철규 ( 인제의대 ) V-00 손보조복강경하신우절석술에대한증례보고... 23 최대헌, 홍범식 울산대학교서울아산병원비뇨기과학교실 V-002 단일세션양측비디오스콥역행성신장내결석수술... 24 김종찬, 정재용, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실 V-003 Flexible ureteroscopic management of parapelvic renal cysts... 25 윤영은, 정재훈, 조정기, 이형호 2, 나준채 3, 박성열, 김용태, 박해영, 한웅규 3 한양대학교병원, 2 일산병원, 3 연세대학교비뇨기과학교실 V-004 복강경폴리타노레드베터방광요관재문합술 : 요관이동을위한근위부방광절개창을. 방광내시경도움없이만드는술식... 26 백민기, 김태헌, 한덕현 성균관대학교의과대학삼성서울병원비뇨기과학교실 V-005 후부요도협착과관련된골반골절요도손상에서요도성형술... 27 박휘준, 고광진, 성현환 성균관대학교의과대학삼성서울병원비뇨기과학교실 Crystal B 5:00-6:00 Oral Session 8: Incontinence/Female Urology/Neurourology (O07-O080) 좌장 : 이정주 ( 부산의대 ), 배재현 ( 고려의대 ) O-07 과민성방광의치료에있어서보톡스주입술의위치에따른효과와안정성에대한메타분석... 28 조정기, 정재훈, 김규식, 윤영은, 이승욱, 문홍상, 최홍용, 박성열, 박해영, 김용태 한양대학교의과대학비뇨기과학교실 O-072 Safety and efficacy of BOTOX in patients with NDO or OAB: a Korean post-marketing surveillance.. 29 고광진, 정성진 2, 윤하나 3, 모교익 4, 신동길 5, 오승준 6, 주명수 7, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 분당서울대학교병원비뇨기과학교실, 3 이화여자대학교부속목동병원비뇨기과학교실, 4 근로복지공단인천병원비뇨기과, 5 부산대학교병원비뇨기과학교실, 6 서울대학교병원비뇨기과학교실, 7 울산대학교서울아산병원비뇨기과학교실 O-073 The prevalence of bladder pain syndrome in Korea... 30 전병조, 태범식, 최훈, 박재영, 배재현 고려대학교의과대학안산병원비뇨기과학교실 22

Contents O-074 Female urinary incontinence and obesity assessed by anthropometry and. dual-energy X-ray absorptiometry: analysis from the 2008-2009 Korean national health and. nutrition examination survey... 3 이준호, 박연원, 최기복 국립경찰병원 O-075 Nutrient intake and urinary incontinence in Korean women: a propensity score-matched analysis. from the Korean national health and nutrition examination survey data... 32 이준호, 박연원, 최기복 국립경찰병원 O-076 최대요도폐쇄길이와전립선절제술후요실금회복과의연관성... 33 박경기, 김성대, 김영주, 허정식 제주대학교병원비뇨기과학교실 O-077 전립선수술후발생한남성요실금의치료로 Re-adjustable male sling 수술의결과... 34 문경태, 최재덕 2, 조희주, 조정만, 강정윤, 김정훈 2, 안승현 2, 유탁근 을지병원, 2 한전병원 O-078 전립선적출술후요실금의수술적치료의실패에영향을미치는인자들 : 단일기관의경험을통한. 개별환자에적절한수술방법선택에관한연구... 35 김명, 최대헌, 김아람, 홍준혁, 김청수, 안한종, 주명수 울산대학교서울아산병원비뇨기과학교실 O-079 Fate of overactive bladder after artificial urinary sphincter implantation... 36 손희서, 강숭구, 김장환 연세대학교의과대학비뇨기과학교실 O-080 The effect of low bladder compliance on upper urinary tract. after artificial urinary sphincter implantation... 37 손희서, 강숭구, 김명주, 김장환 연세대학교의과대학비뇨기과학교실 Grand Ballroom 6:00-7:00 Oral Session 9: Cancer - Prostate (II) (O08-O090) 좌장 : 정재일 ( 인제의대 ), 이동현 ( 이화의대 ) O-08 전립선특이항원범위에따른전립선조직검사방법 (TRUS versus MRI guided) 간의. 암진단율차이에대한비교분석연구... 38 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 이현무, 최한용, 박병관 2, 김찬교 2 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 O-082 첫번째경직장초음파전립선조직검사에서 ASAP 또는 HGPIN 이진단된환자에서. 두번째조직검사를시행할때생검방법 (TRUS vs MRI guided) 에따른전립선암진단율비교... 39 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 이현무, 박병관 2, 김찬교 2 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 O-083 Serial comparison of cancer detection rate between TRUS and MRI guided initial and. repeat prostate biopsy: a single center experienced... 40 방석환, 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 김찬교 2, 박병관 2, 이현무 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 O-084 이전음성전립선조직검사에대한자기공명영상융합전립선조직검사의영향 :. 경직장초음파유도전립선생검과비교... 4 변경현, 김진우, 박경민, 이유진, 정재욱, 하윤석, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 구자윤 2, 하홍구 2, 최석환 경북대학교의과대학비뇨기과학교실, 2 부산대학교의과대학비뇨기과학교실 23

Contents O-085 이전음성환자의전립선조직재생검에서자기공명 - 경직장초음파융합생검법의가치... 42 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 변석수, 이상은, 홍성규 분당서울대학교병원비뇨기과학교실 O-086 MR-U/S fusion prostate biopsy 의유용성 : 단일기관연구... 43 박경기, 김영주, 김성대, 허정식 제주대학교병원비뇨기과학교실 O-087 Initial experience with magnetic resonance imaging/transrectal ultrasound-fusion biopsy. for prostate cancer detection performed by urologists... 44 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 O-088 능동적감시대상의전립선암환자에서수술전 MRI 의 PI-RADS score 와. 수술후병리결과상의암의위치와의상관관계... 45 김휘우, 이원철, 한재현, 박사현, 임고산, 김명, 안한종 울산대학교서울아산병원 O-089 자기공명영상이적극적감시기준에합당한전립선암환자들에서병리학적결과를예측하는데도움이되는가?... 46 박사현, 임고산, 김명, 유달산, 정인갑, 송채린, 홍준혁, 김청수, 안한종 울산대학교서울아산병원 O-090 초저위험군과저위험군전립선암환자에서적극적추적관찰의 8 년간의결과... 47 최창일, 강민용, 전황균, 성현환, 정병창, 전성수, 이현무, 최한용, 서성일 성균관대학교의과대학삼성서울병원 Crystal A 6:00-7:00 Video Session 2 (V006-V00) 좌장 : 한준현 ( 한림의대 ), 박성열 ( 한양의대 ) V-006 크기가큰낭성신문부종양에대한로봇보조부분신절제술... 48 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 V-007 거대복합낭종성신장종양에대해로봇을이용한부분신절제술을시행한보고... 49 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원 비뇨기과, 4 한양대학교의과대학비뇨기과학교실 V-008 4 cm 보다큰신장종양에대한 Xi 다빈치수술시스템을이용한로봇단일공복강경 (LESS). 신장부분절제술의최초보고... 50 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원 비뇨기과, 4 한양대학교의과대학비뇨기과학교실 V-009 신세포암에서 double loop tourniquet 을이용한복강경하하대정맥혈전제거술... 5 정현철, 성재우, 양종협, 조신제, 강성민, 문형우, 이규원, 배웅진, 박용현, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교서울성모병원비뇨기과학교실 V-00 단일신환자에서로봇보조복강경하부분신절제술의증례보고... 52 서영은, 유영동, 황진호, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 분당서울대학교의과대학비뇨기과학교실 24

Contents Crystal B 6:00-7:00 Oral Session 0: Pediatrics (O09-O00) 좌장 : 조원열 ( 동아의대 ), 박관진 ( 서울의대 ) O-09 소아수신증평가에서 3 차원자동화초음파부피계산프로그램 (SonoAVC) 과. 2 차원초음파영상계산방법의예비비교연구... 53 송상훈, 김휘우, 이종필, 이상민, 안동현, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실 O-092 신우요관성형술후초기수술적평가및관리에신실질대수신증면적비. (renal parenchyma to hydronephrosis area ratio) 의역할... 54 한재현, 이상민, 이종필, 안동현, 김휘우, 김건석, 송상훈 울산대학교서울아산병원비뇨기과학교실 O-093 세미만신우성형술에서술전역행성조영술의가치... 55 백민기 성균관대학교의과대학삼성서울병원 O-094 신우요관이행부협착소아환자에서신우성형술중역행성신우충만을통해확인한교차성혈관의특징분석... 56 강숭구, 김성훈 2, 이초녕 2, Gilbert Khoyo Marabi, 김상운, 한상원, 이용승 연세대학교의과대학비뇨기과학교실, 2 세브란스어린이병원소아비뇨기과 O-095 양측신우성형술시행후장기추적결과... 57 임영재, 박관진 서울대학교의과대학비뇨기과학교실 O-096 Impacts of asymptomatic pyuria and vesicoureteral reflux (VUR) grade on the developing of. post-voiding dystourethrogram (VCUG) urinary tract infection (UTI)... 58 Jeong Hoon Oh, Sumin Son, Ji Won Ryu, Seong Jong Eun, Jong Bum Kim, Yang Hyun Cho, Myung Soo Kim, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Sun-Ouck Kim 전남대학교의과대학비뇨기과학교실 O-097 방광요관역류로수술받은환아들에서신반흔과돌파요로감염의위험인자들... 59 변혜진, 신택준, 하지용, 정원호, 김병훈, 박철희, 김천일 계명대학교의과대학비뇨기과학교실 O-098 Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in. pediatric patients with ureteroceles... 60 송상훈, 이동현, 김휘우, 이종필, 이상민, 안동현, 박성찬 2, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 2 울산대학교병원, 울산대학교의과대학비뇨기과학교실 O-099 정계정맥류수술중시행한정맥조영술에서 bahren system 을이용한수술실패의주요원인분석... 6 오경택, 김성훈 2, 이초녕 2, Gilbert Khoyo Marabi, 김상운, 한상원, 이용승 연세대학교의과대학비뇨기과학교실, 2 세브란스어린이병원소아비뇨기과 O-00 Pathologic analysis of the testis in patients with postpubertal cryptorchidism... 62 정재민, 이승수, 이동훈, 한지연, 남종길, 박성우, 정문기, 이상돈 부산대학교의과대학비뇨기과학교실 Withdrawal 25

Contents Thursday 28 September Grand Ballroom 08:00-09:00 Oral Session : Cancer - Bladder, Pelvis, Ureter & Others (I) (O0-O0) 좌장 : 김형진 ( 전북의대 ), 강석호 ( 고려의대 ) O-0 한국에서침습적방광암을가진여자환자에서근치적방광전절제술의추세... 63 김승빈, 심지성, 홍범식 2, 구자현 3, 정병창 4, 서호경 5, 강석호 ; UCART (urothelial cancer-advanced research and treatment group in Korea) group 고려대학교안암병원비뇨기과학교실, 2 울산대학교서울아산병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 성균관대학교의과대학 삼성서울병원비뇨기과학교실, 5 국립암센터비뇨기과학교실 O-02 근치적방광절제술을받은방광암환자에서시행한조기회복프로그램 : 단일기관경험... 64 최창일, 강민용, 전황균, 성현환, 서성일, 전성수, 이현무, 최한용, 정병창 성균관대학교의과대학삼성서울병원 O-03 방광세척과카테터설치를간소화한신방광조형술의가능성및안전성... 65 윤현석, 김광현, 송완, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 O-04 근치적방광절제술후비스테로이드소염진통제기반통증자가조절적용에의한위장관기능회복효과... 66 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대학교병원비뇨기과학교실 O-05 근치적방광절제술및인공방광형성술후장폐색을예방할수있는효과적인방법 :. bowel suspension technique... 67 송완, 윤현석, 김광현, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 O-06 근치적방광절제술및인공방광형성술후방광요관역류를줄일수있는개선된방법 :. reposition of orthotopic ileal neobladder... 68 송완, 윤현석, 김광현, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 O-07 The incidence of robot-assisted radical cystectomy complications according to body mass index: multicenter study from Korea... 69 성재우, 양종협, 조신제, 이규원, 정현철, 최진봉, 박용현, 권태균 2, 나군호 3, 이영구 4, 정병창 5, 강석호 6, 이지열 가톨릭대학교서울성모병원비뇨기과학교실, 2 경북대학교병원, 3 연세대학교의과대학신촌세브란스병원, 4 한림대학교강남성심병원, 5 성균관대학교 의과대학삼성서울병원, 6 고려대학교안암병원 O-08 Differential complications following radical cystectomy between the irradiated and. nonirradiated pelvis... 70 남종길, 이동훈, 김태남, 박성우, 정문기 양산부산대학교병원 O-09 근치적방광적출술후장기적신기능에영향을미치는인자들 : 최소 3 년이상추적환자대상연구... 7 신정현, 이동현 2, 김명, 송채린, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 국군수도병원 O-0 Factors that predict neutropenia in Korean patients with advanced urothelial cancer. after cisplatin-based systemic chemotherapy... 72 권휘안, 오태훈, 이재환, 서일영, 박승철 원광대학교의과대학비뇨기과학교실 Withdrawal Withdrawal 26

Contents Crystal A 08:00-09:00 Oral Session 2: Basic Research - Cancer (II) (O-O20) 좌장 : 김세중 ( 아주의대 ), 변석수 ( 서울의대 ) O- 신세포암세포주의 clear cytoplasm 증가유도후 PGC 활성을통한약물감수성변화및. mitochondria 활성변화... 73 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 O-2 신장암에서메트포르민과에버로리무스의효과... 74 윤영은, 정아라, 조정기, 이형호 2, 나준채 3, 한웅규 3, 김용태, 박해영, 박성열 한양대학교병원비뇨기과학교실, 2 일산병원비뇨기과학교실, 3 연세대학교비뇨기과학교실 O-3 TRPM7 유전자 downregulation 은신장암세포주의 migration 과 invation 을 Src 와. Akt 신호전달체계의불활성을통해억제한다... 75 하윤석, 김연용, 전소영, 이유진, 정재욱, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균 경북대학교병원 O-4 TFE3 양성신세포암의포괄적유전학적특성분석... 76 정창욱, 이모제 2, 조재소 2, 최무림 2, 송채린 3, 구자현, 곽철, 김현회 서울대학교의과대학 비뇨기과학교실, 2 의과학과, 3 울산대학교서울아산병원비뇨기과학교실 O-5 SIC 을발현시킨재조합 BCG 의방광암세포내내재화효과연구... 77 김명주, 황영미, 지병훈, 문영태, 김경도, 명순철, 김태형, 김진욱, 장인호 중앙대학교병원비뇨기과학교실 O-6 Urinary Cell-free microrna ratio with mir-624/mir-45 can discriminate bladder cancer. from benign hematuria... 78 변영준, 박현미, 김예환, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 O-7 방광암에서소변의세포유리 DNA 와소포체 DNA 를이용한유전분석 : 액상생검 pilot 연구... 79 김광현, 송완, 윤현석, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 O-8 LKB 발현여부에따른방광암세포에대한 BCG 의항암효과에관한연구... 80 황영미, 김명주, 지병훈, 문영태, 김경도, 명순철, 김태형, 김진욱, 장인호 중앙대학교병원비뇨기과학교실 O-9 거세저항성전립선암에서 docetaxel 과 HDAC 저해제병용처리에의한안드로젠수용체과그변이체신호억제... 8 박상은, 김윤림, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 O-20 The expression of androgen receptor and its variants in human prostate cancer tissue. according to disease status... 82 Jeong Woo Lee, Jung Hee Kim, Seung Soo Lee, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital Crystal B 08:00-09:00 Oral Session 3: LUTS/BPH (II) (O2-O30) 좌장 : 최종보 ( 아주의대 ), 유은상 ( 경북의대 ) O-2 고혈압을동반한전립선비대증환자에서 naftopidil의임상적유효성과와안정성 : 전향적, 공개표지연구... 83 정문수, 윤병일, 이승환 2 가톨릭관동대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실 27

Contents O-22 전립선비대증환자에서 naftopidil 및 tamsulosin 의방광저장관련증상개선효과에대한비교 :. 전향적, 다기관연구... 84 권세윤, 이경섭, 유탁근 2, 정재일 3, 이지열 4, 홍준혁 5, 서성일 6, 정태영 7, 곽철 8, 강택원 9, 윤석중 0 동국대학교경주병원, 동국대학교의과대학비뇨기과학교실, 2 을지대학교병원, 을지대학교의과대학비뇨기과학교실, 3 부산대학교병원, 부산대학교의과대학비뇨기과학교실, 4 가톨릭대학교서울성모병원, 가톨릭대학교의과대학비뇨기과학교실, 5 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 6 성균관대학교의과대학삼성서울병원, 성균관대학교의과대학비뇨기과학교실, 7 중앙보훈병원비뇨기과, 8 서울대학교병원, 서울대학교의과대학비뇨기과학교실, 9 전남대학교병원, 전남대학교의과대학비뇨기과학교실, 0 충북대학교병원, 충북대학교의과대학비뇨기과학교실 O-23 전립선비대증환자에서실로도신의효과 : 코크란체계적문헌고찰및메타분석... 85 정재흥,2,3,4, Roderick MacDonald 5, 김지예 2,6, 김명하 2,7, Philipp Dahm 3,4 연세대학교원주의과대학 비뇨기과학교실, 2 근거중심의학연구단, 3 Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, 4 Department of Urology, University of Minnesota, Minneapolis, Minnesota, 5 General Internal Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA, 연세대학교원주의과대학 6 성형외과학교실, 7 의학도서관 O-24 신체활동정도및착석시간과하부요로증상발생과의연관성... 86 정재용, 편종현, 박창후 2, 장유수 3, 유승호 3, 박흥재 성균관대학교의과대학강북삼성병원비뇨기과, 2 울산대학교의과대학강릉아산병원비뇨기과, 3 성균관대학교의과대학강북삼성병원 직업환경의학과 O-25 야간뇨를동반한전립선비대증환자를대상으로 silodosin 의유효성및안전성을평가하기위한. 2 주, 단일군, 공개, 전향적, 다기관, 제 4 상연구... 87 조강준, 이정주 2, 송윤섭 3, 최종보 4, 김대경 5, 김용태 6, 김준철 가톨릭대학교부천성모병원, 2 부산대학교병원, 3 순천향대학교병원, 4 아주대학교병원, 5 을지대학병원, 6 한양대학교병원 O-26 야간뇨를호소하는 55 세이상의만성불면증환자에서서방형멜라토닌의치료효과... 88 안순태, 정형국, 박태용, 김종욱, 오미미, 박홍석, 문두건 고려대학교의과대학비뇨기과학교실 O-27 전립선비대증환자에서 5-ARI 의간헐적사용시전립선크기변화에대한고찰... 89 최귀복, 조인창, 민승기 국립경찰병원비뇨기과 O-28 PSA 2.5 이하남성형탈모환자에서저용량피나스테라이드와두테스테라이드장기복용이. 혈청 PSA 에미치는영향... 90 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 O-29 전립선비대증환자에서 5α-Reductase inhibitor 치료중단시전립선크기회복에대한영향인자... 9 최귀복, 조인창, 민승기 국립경찰병원비뇨기과 O-30 연령에따른 Tadalafil 에의한전립선이행대혈행변화... 92 김진욱, 지병훈, 장인호, 명순철, 문영태, 김경도, 김태형 중앙대학교병원비뇨기과학교실 Crystal A 0:20-:20 Oral Session 4: Basic Research - Neurourology & LUTS/BPH & Others (O3-O40) 좌장 : 이택 ( 인하의대 ), 김계환 ( 가천의대 ) O-3 발기부전치료에서저에너지충격파치료와중배엽줄기세포통합치료로. autophagy 와 angiogenesis 의효과적인촉진작용... 93 Guanqun Zhu, 정현철, 전승환, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교서울성모병원 28

Contents O-32 Effects of controlling oxygen release from hollow microparticles for prolonged stem cell survival. and improved erectile function... 94 박용현, 정애량, 김가은, 김미영, 이지영, 이규원, 이지열 가톨릭대학교서울성모병원 O-33 TGF-β/Rho-kinase/LIMK 경로가일측성요관폐색랫드모델에서신장사구체와. 세뇨관사이질의섬유화에미치는영향 : preliminary study... 95 송상훈, 한재현, 류채민 2, 김휘우, 이종필, 이상민, 안동현, 주명수, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 2 서울아산병원의생명연구소 O-34 간질성방광염 / 방광통증증후군 (IC/BPS) 환자에서유전자발현프로파일의. 특성규명및섬유형성의주요조절자로서의 WNT2B 의연구... 96 한주영, 류채민, 유환열, 최대헌, 김아람 2, 신동명, 주명수 울산대학교서울아산병원, 2 건국대학교병원 O-35 마우스에서면역조직화학염색을통한방광신경 - 혈관구조의 3 차원영상이미지구축... 97 응웬낫민, 최민지, 송강문, 칼얀가탁, 권미혜, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 O-36 인간의신장교감신경섬유의해부학적분포분석및 3D 생체모델링 : 신장적출조직을이용한연구... 98 송원훈, 최원석 2, 예은비 3, 박성민 3, 최의근 2, 정창욱 서울대학교병원비뇨기과, 2 서울대학교병원내과, 3 포항공과대학교창의 IT 융합공학과 O-37 저활동성방광을재현하기위한죽상동맥경화증유발골만만성허혈쥐모델의개발에관한연구... 99 김명, 유환열 2, 최대헌, 김아람, 유채민 2, 한주영 2, 신동명 2, 주명수 울산대학교서울아산병원 비뇨기과학교실, 2 의생명과학교실 O-38 간질성방광염백서모델에서내장과민성에대한인간배아줄기세포유도체의효과... 200 최대헌, 유환열,2, 류채민,2, 한주영,2, 김아람 3, 신동명 2, 주명수 울산대학교서울아산병원 비뇨기과학교실, 2 의생명과학교실, 3 건국대학교병원비뇨기과학교실 O-39 신경인성방광백서모델에서 immortalized 중간엽줄기세포의치료효과... 20 전승환, GuanQun Zhu, 정현철, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교의과대학비뇨기과학교실 O-40 The comparison of therapeutic efficacy of CHA MSC and ADMSC and evaluate the therapeutic mechanism in a chronic interstitial cystitis rat model... 202 이영은, 홍재엽, 최경화 CHA 의과학대학교분당차병원비뇨기과학교실 Crystal B 0:20-:20 Oral Session 5: Infections & Pediatrics (O4-O50) 좌장 : 이상돈 ( 부산의대 ), 정승일 ( 전남의대 ) O-4 종사지방종환아들의수술전, 후요역동학검사분석... 203 신상희, 김수연, 김상운 2, 이용승 2, 한상원 2 세브란스어린이병원, 소아비뇨기과, 방광요도재활실, 2 연세대학교의과대학비뇨기과학교실 O-42 신경인성방광에서초음파탄성영상을이용한방광유순도측정의초기경험... 204 임영재, 김기원 2, 최영훈 3, 이지연 4, 박관진 서울대학교의과대학 비뇨기과학교실, 2 재활의학교실, 3 영상의학교실, 4 신경외과학교실 O-43 약물불응성야뇨증에대한경요도방광내보툴리늄독소주입술의초기치료경험... 205 박관진, 송원훈, 임영재서울대학교병원비뇨기과 29

Contents O-44 요도하열교정술후배뇨기능의평가 : 요속검사와환아의배뇨를촬영한동영상간의상관관계... 206 류제만, 송상훈, 김건석 울산대학교서울아산병원비뇨기과학교실 O-45 일측성서혜부탈장 / 음낭수종남아에서반대측개방성칼집돌기와관련된수술전초음파검사에서의. 반대측서혜부내륜형태의예측가치... 207 박현식, 신현빈, 조현욱, 유대선, 박진성, 김대경, 우승효 을지대학교의과대학비뇨기과학교실 O-46 고령에서발생한급성신우신염의연령에따른임상적특징과항생제감수성 : 다기관연구... 208 김웅빈, 조규형 2, 김기홍 3, 이상욱, 양희조 3, 두승환 4, 김재헌 4, 윤종현 2, 김두상 3, 양원재 4, 이광우, 김준모, 이창호 3, 김영호, 송윤섭 4, 전윤수 3, 김민의 순천향대학교 부천병원, 2 구미병원, 3 천안병원, 4 서울병원 O-47 요관경하결석제거술후발생하는전신염증반응증후군의발생율및위험인자... 209 김웅빈, 이상욱, 이광우, 김준모, 김영호, 김민의 순천향대학교의과대학비뇨기과학교실 O-48 요로결석을동반한발열성요로감염환자에서미생물학적특징과경험적항생제내성균발생의예측인자... 20 조석, 김형석 2, 박민구 3, 이건철, 조성용, 이정우 2 인제대학교일산백병원, 2 동국대학교일산병원, 3 인제대학교서울백병원 O-49 Prevalence of fluoroquinolone resistant rectal flora in patients undergoing transrectal. ultrasound guided prostate needle biopsy: a prospective multicenter study... 2 Seong Jong Eun, Ji Won Ryu, Taeju Park, Jong Bum Kim, Yang Hyun Cho, Myung Soo Kim, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Sun-Ouck Kim, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Seung Il Jung 전남대학교의과대학비뇨기과학교실 O-50 술전포비돈요오드좌약투여의경직장전립선조직검사시행후합병증예방효과연구 :. 전향적무작위대조군연구... 22 이인재, 이상철, 권오성 2, 강민용 3, 이상은 분당서울대학교병원비뇨기과학교실, 2 성균관대학교삼성서울병원비뇨기과학교실, 3 한림대학교강남성심병원비뇨기과학교실 Crystal A 3:00-4:00 Oral Session 6: Cancer - Prostate (III) (O5-O60) 좌장 : 이경섭 ( 동국의대 ), 홍준혁 ( 울산의대 ) O-5 한국인전립선암환자의 0 년간 (2005-04) 치료패턴과의료비용변화연구 :. 건강보험데이터베이스를이용한전수조사... 23 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 O-52 로봇보조전립선적출술후 MRI 로확인한 neurovascular bundle 보존여부와성기능의상관관계... 24 최원석, 유달산, 정인갑, 송채린, 홍범식, 김청수, 안한종, 홍준혁 울산대학교서울아산병원 O-53 근치적전립선절제술후양성절제연을예측하는 P.R.O.S.T.A.T.E scoring system 과. D amico 및 NCCN 분류와의비교연구... 25 백승룡, 강병진, 김경환, 박지훈, 이경, 이찬호, 구자윤, 이정주, 하홍구 부산대학교의과대학비뇨기과학교실 30

Contents O-54 로봇보조근치적전립선적출술을시행한환자에서전립선피막절개의의미... 26 김대희, 유달산, 정인갑, 송채린, 홍범식, 김청수, 안한종, 홍준혁 울산대학교의과대학비뇨기과학교실 O-55 전립선첨단부형태에따른근치적전립선절제술후첨단부절제변연양성율의변화... 27 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실 O-56 전립선암환자에서근치적전립선절제술시수술중동결절편검사가종양학적결과에미치는영향... 28 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 O-57 다중전립선생검의영향 : 근치적전립선절제술후수술전후합병증및생화학적재발위험성... 29 강준구, 하헌, 정재욱, 신택준 2, 권세윤 3, 장현찬 4, 하윤석, 최석환, 이준녕, 김병훈 2, 김범수, 김현태, 김재수 4, 유은상, 권태균, 이경섭 3, 김천일 2, 김태환 경북대학교의과대학비뇨기과학교실, 2 계명대학교의과대학비뇨기과학교실, 3 동국대학교의과대학비뇨기과학교실, 4 대구파티마병원 비뇨기과학교실 O-58 Conditional probability of biochemical recurrence free survival following radical prostatectomy... 220 Jung Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital O-59 Significance of surgeon experience as a predictor of biochemical failure and. continence after robot-assisted laparoscopic prostatectomy... 22 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 O-60 국소전립선압의초점또는부분 brachytherapy 의단기추적관찰결과... 222 김종녕, 노주현, 김문성, 임건우, 이태호, 정재호, 최경화, 박동수 차의과학대학교의과대학비뇨기과학교실 Crystal B 3:00-4:00 Oral Session 7: Cancer-Bladder, Pelvis, Ureter & Others (II) (O6-O70) 좌장 : 이형래 ( 경희의대 ), 서호경 ( 국립암센터 ) O-6 Does uneven geographic distribution of urologists affect bladder and prostate cancers mortality?. - national health insurance data in Korea from 2007 to 20... 223 김재헌, 선화연, 김현정 2, 박재영 3 순천향대학교의과대학비뇨기과학교실, 2 고려대학교의과대학예방의학교실, 3 고려대학교의과대학안산병원비뇨기과학교실 O-62 2 차경요도방광종양절제술후 T0 에서의방광내 BCG 치료의효과... 224 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현 서울대학교병원비뇨기과 O-63 재경요도방광종양절제술의시행양상및환자군의임상병리학적특징및무재발생존양상분석... 225 서윤석, 김성한, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과 O-64 한국여성환자에서의근치적방광절제술종양학적인성적... 226 윤성구, 심지성, 홍범식 2, 구자현 3, 정병창 4, 서호경 5, 강석호 고려대학교안암병원, 2 울산대학교서울아산병원, 3 서울대학교병원, 4 성균관대학교의과대학삼성서울병원, 5 국립암센터 O-65 근치적방광절제술을받은 T2 이하의환자에서신보조화학요법이예후에미치는영향... 227 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현 서울대학교병원비뇨기과 3

Contents O-66 방광암으로근치적방광절제술과골반임파절절제술을시행받은환자에서신보조화학요법이수술에미치는영향 : propensity score matching 연구... 228 김정권, 김성한, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과 O-67 림프혈관및신경주위침윤이근침윤성방광암에서근치적방광절제술후종양학적예후에미치는영향... 229 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실 O-68 방광암으로방광절제술을시행받은환자에서상피분화와선분화가생존율에미치는영향... 230 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 이상철, 정성진, 홍성규, 변석수, 이상은, 오종진 분당서울대학교병원비뇨기과학교실 O-69 전방광절제술후조직학적변이가종양학적으로미치는영향에대한연구... 23 한재현, 유상준, 최세영, 류제만, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 O-70 침습성요로상피암의방광보존치료 : 항암치료후부분방광절제술... 232 한재현, 이종필, 최대헌, 안한종, 홍범식 울산대학교서울아산병원비뇨기과학교실 Crystal A 4:00-5:00 Oral Session 8: Cancer - Kidney (II) (O7-O80) 좌장 : 김현회 ( 서울의대 ), 박승철 ( 원광의대 ) O-7 신세포암의바이오마커로혈청 PHD3 와 ESM- 의임상적의미... 233 김광현, 나준채 2, 이형호 3, 윤영은 4, 김숙영 2, 윤민지 2, 김경섭 5, 홍성준 2, 한웅규 2 이화여자대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 3 국민건강보험일산병원비뇨기과, 4 한양대학교의과대학 비뇨기과학교실, 5 연세대학교의과대학생화학분자생물학교실 O-72 Personalized 3D anatomic kidney model produced by rapid prototyping method and. its usefulness in clinical applications... 234 Hakmin Lee, Sung Il Hwang 2, Hak Jong Lee 2, Jong Jin Oh, Sangchul Lee, Sung Kyu Hong, Sang Eun Lee, Seok-Soo Byun Departments of Urology, 2 Radiology, Seoul National University Bundang Hospital, Seongnam, Korea O-73 최소침습부분신절제술 (minimally invasive surgery (MIS) partial nephrectomy) 와. 개복부분신절제술 (open partial nephrectomy) 의초기임상결과와삶의질전향적코호트비교... 235 윤민영, 정창욱 서울대학교병원비뇨기과학교실 O-74 ct2a 이하의내인성신세포암의수술방법에따른임상결과비교 : 부분신적출술대근치적신적출술... 236 육형동, 윤민영, 정창욱, 구자현, 김현회, 곽철 서울대학교병원비뇨기과 O-75 병리학적 T 과 T2 신장암에서수술전혈소판증가증이예후에미치는영향 : 다기관종합연구... 237 박경민, 하윤석, 정재욱, 전소영, 최석환, 이준녕, 김범수, 김현태, 김태환, 변석수 2, 황은창 3, 강석호 4, 홍성후 5, 정진수 6, 곽철 7, 김용준 8, 권태균 경북대학교의과대학비뇨기과학교실, 2 서울대학교의과대학분당서울대병원비뇨기과학교실, 3 전남대학교의과대학비뇨기과학교실, 4 고려대학교의과대학비뇨기과학교실, 5 가톨릭대학교의과대학비뇨기과학교실, 6 국립암센터비뇨기과학교실, 7 서울대학교의과대학비뇨기과학교실, 8 충북대학교의과대학비뇨기과학교실 O-76 차표적치료제를시행받은전이성신장암환자에서치료전아스파르트산아미노전이효소 / 알라닌. 아미노전이효소비율의예후적가치... 238 유지웅, 강민용, 성현환, 전황균, 정병창, 박세훈 2, 전성수, 이현무, 최한용, 서성일 성균관대학교의과대학삼성서울병원 비뇨기과학교실, 2 내과학교실혈액종양내과 32

Contents O-77 조직형이투명세포형으로분류되지않은전이신장암환자에대한표적치료의효과 :. 대한비뇨기종양학회신암연구회 database 를이용한분석... 239 김정권, 서윤석, 김성한, 송미경 2, 주정남 2, 서성일 3, 곽철 4, 정창욱 4, 송채린 5, 황의창 6, 서일영 7, 이학민 8, 홍성후 9, 정진수 ; 대한비뇨기종양학회신암연구회 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방교실바이오메트릭스교실, 3 성균관대학교의과대학비뇨기과학교실, 4 서울대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 전남대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 서울대학교의과대학비뇨기과학교실, 분당서울대학교병원, 9 가톨릭대학교의과대학비뇨기과학교실 O-78 비투명세포형환자군에서 MSKCC 와 Heng risk criteria 의질병무진행생존률및종양특이생존률에대한. 중간위험군과고위험군에서의예후감별력연구 : 신암연구회 database 를이용한후향적다기관연구... 240 김정권, 서윤석, 김성한, 송미경 2, 주정남 2, 서성일 3, 곽철 4, 정창욱 4, 송채린 5, 황의창 6, 서일영 7, 이학민 8, 홍성후 9, 정진수 ; 대한비뇨기종양학회신암연구회 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방교실바이오메트릭스교실, 3 성균관대학교의과대학비뇨기과학교실, 4 서울대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 전남대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 서울대학교의과대학비뇨기과학교실, 분당서울대학교병원, 9 가톨릭대학교의과대학비뇨기과학교실 O-79 Preoperative cholesterol level as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma... 24 Hakmin Lee, Wun-Jae Kim 2, Eu Chang Hwang 3, Seok Ho Kang 4, Sung-Hoo Hong 5, Jinsoo Chung 6,. Tae Gyun Kwon 7, Cheol Kwak 8, Hyeon Hoe Kim 8, Jong Jin Oh, Sangchul Lee, Sung Kyu Hong,. Sang Eun Lee, Seok-Soo Byun, Korean Renal Cell Carcinoma (KORCC) Group Department of Urology, Seoul National University Bundang Hospital, Seongnam, 2 Department of Urology, Chungbuk National University College of Medicine, Cheongju, 3 Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, 4 Department of Urology, Korea University School of Medicine, Seoul, 5 Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, 6 Department of Urology, National Cancer Center, Goyang, 7 Department of Urology, Kyungpook National University College of Medicine, Daegu, 8 Department of Urology, Seoul National University Hospital, Seoul, Korea O-80 전이신장암환자에서세포감퇴신적출술의예후적가치에대한분석 : 단일기관의경험... 242 최창일, 강민용, 전황균, 성현환, 정병창, 전성수, 이현무, 최한용, 서성일 성균관대학교의과대학삼성서울병원 Crystal B 4:00-5:00 Oral Session 9: Infertility & Sexual Dysfunction (II) (O8-O90) 좌장 : 양대열 ( 한림의대 ), 김수웅 ( 서울의대 ) O-8 대사이상질환과혈중테스토스테론의상관관계에관한연구... 243 김명, 안태영 울산대학교서울아산병원비뇨기과학교실 O-82 Association between handgrip strength and erectile dysfunction in older men:. a cross-sectional study... 244 류지원, 손수민, 김태희, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 강택원, 건동득, 박광성 전남대학교의과대학비뇨기과학교실 O-83 남성갱년기환자에서천연추출물구기자가증상개선에미치는영향 :. 무작위배정, 위약대조, 양측눈가림, 평행투약... 245 배상락, 전승환 2, 권은비 4, 오현아 4, 정현철 2, 최세웅 2, 배웅진 2,3, 김수진 2, 조혁진 2, 하유신 2, 홍성후 2, 이지열 2, 황성연 4, 김세웅 2,3 가톨릭대학교 의정부성모병원, 2 서울성모병원, 3 가톨릭양한방융합연구소, 4 한국전통의학연구소 O-84 남성갱년기증후군환자에서두타스테리드병용투여가남성호르몬보충요법의치료효과에미치는영향... 246 박현준, 이경민, 박민정, 박남철 부산대학교병원 O-85 남성갱년기환자에서테스토스테론치료중단후치료효과지속에영향을미치는인자... 247 박민구, 여정균 인제대학교의과대학비뇨기과학교실 33

Contents O-86 남성에서갑상선기능저하증이하부요로증상, 남성호르몬및성기능에미치는영향... 248 제성욱, 윤솔, 도정모, 서덕하 2, 이신우, 이천우 2, 최세민, 감성철 2, 정기현 2, 화정석, 현재석 경상대학교의과대학 비뇨기과학교실, 2 창원병원비뇨기과학교실 O-87 페이로니씨병에서백색막절개후복재정맥이식이음경혈류에미치는영향... 249 이준호, 유제모, 김희연, 이승주, 이동섭가톨릭대학교성빈센트병원비뇨기과학교실 O-88 당뇨에의한역행성사정환자에서 imipramine, pseudoephedrine 약물병합치료의임상적의의... 250 김대근, 김동석 2, 양승철 2, 송승훈 2 CHA의과학대학교 서울역센터비뇨기과학교실, 2 강남차병원비뇨기과학교실 O-89 남성형탈모에있어서김치추출유산균음료의효과에대한 pilot study... 25 이효석, 최진호, 이중식, 서주태단국대학교제일병원비뇨기과 O-90 가임기남성에서탈모치료를위한 5-AR 저해제의사용이가임력에미치는영향... 252 송승훈, 김동석, 김대근 2, 양승철, 권성원 차의과학대학교강남차병원비뇨기과, 2 서울역센터비뇨기과 Crystal A 5:00-6:00 Oral Session 20: Endourology & Stone Disease (II) (O9-O200) 좌장 : 성경탁 ( 동아의대 ), 조성용 ( 서울의대 ) O-9 Expereice of Korean surgical robot REVO-I: first clinical trial... 253 장기돈, 알리압델라힘, 함원식, 최영득, 나군호 연세대학교의과대학비뇨기과학교실 O-92 Xi 다빈치수술시스템을이용한단일술자의로봇단일공복강경 (LESS) 신장부분절제술의초기경험... 254 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원 비뇨기과, 4 한양대학교의과대학비뇨기과학교실 O-93 Long-term results of the plugging method with regard to the prevention of. a postoperative inguinal hernia after robot-assisted laparoscopic prostatectomy... 255 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 O-94 Report of pneumoscopic vesicovaginal fistula repair... 256 전병조, 태범식, 최훈, 박재영, 배재현 고려대학교의과대학안산병원비뇨기과학교실 O-95 신장및요관질환의진단, 치료를위한양방향구동이가능한외경 2.85 mm 이하. 연성요관신우경의생체내, 임상실험... 257 김대희, 최세영, 유달산, 김청수, 박형근 울산대학교의과대학비뇨기과학교실 O-96 A multicenter, prospective, observational study to investigate feasibility of the disposable. flexible ureterorenoscope (Lithovue ) in patients with renal stones... 258 조성용, 이주용 2, 신동길 3, 서일영 4, 유상준, 박형근 5 서울특별시립보라매병원, 2 연세대학교의과대학신촌세브란스병원, 3 부산대학교병원, 4 원광대학교부속병원, 5 울산대학교서울아산병원 O-97 후행적신장내결석제거술전선택적알파차단제를사용함으로써, 요관진입집의. 요관진입압력을줄이고이차적요관손상을예방할수있는가?: 무작위대조군연구... 259 구교철, 윤준호 2, 박노철 2, 안현규, 이광석, 김도경, 하윤수, 정병하, 홍창희 연세대학교의과대학비뇨기과학교실, 2 연세대학교공과대학기계공학부 34

Contents O-98 연성내시경하신장결석수술에서수술전요관부목삽입의효과... 260 육형동, 윤민영, 정창욱서울대학교병원비뇨기과 O-99 7.5 Fr. nephroscope를이용한 ultra-mini perculaneous nephrolithotomy의초기경험및합병증... 26 고경태, 임송원, 김성용, 최낙규, 양대열한림대학교강동성심병원 O-200 변형된앙와위자세에서경피적신결석제거술시행시유도철사견인을이용한신루확장술의효용성... 262 하헌, 이유진, 정재욱, 하윤석, 김태환, 최석환, 이준녕, 김현태, 유은상, 정성광, 권태균, 김범수경북대학교의과대학비뇨기과학교실 Crystal B 5:00-6:00 Oral Session 2: LUTS/BPH (III) (O20-O20) 좌장 : 주명수 ( 울산의대 ), 김형곤 ( 건국의대 ) O-20 고농도히알루산과콘드로친산의요관부목삽입에따른요로증상에서의효과에관한. 다기관한쪽가림임의배정연구... 263 조정기, 정재훈, 김규식, 김용태, 박성열, 최홍용, 문홍상, 이승욱, 김재헌 2 한양대학교의과대학비뇨기과학교실, 2 순천향대학교의과대학비뇨기과학교실 O-202 Therapeutic effects of endoscopic ablation of hunner lesions in. interstitial cystitis/bladder pain syndrome patients... 264 고광진, 이규성,2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 삼성융합의과학원의료기기산업학과 O-203 Effects of apolipoprotein A- and alpha-fetoprotein on the development of benign prostatic. hyperplasia and lower urinary tract symptoms: results from a large retrospective study... 265 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 O-204 Urolift: 전립선비대증치료를위한최소침습 intra-prostatic implant - 국내파일럿연구... 266 정현철, 성재우, 양종협, 조신제, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교서울성모병원 O-205 홀뮴레이저전립선절제술 (HoLEP) 시행의적절한타이밍을예측할수있는가?... 267 김승빈, 태종현, 윤성구, 김재윤, 심지성, 강성구, 강석호, 천준, 김제종, 이정구 고려대학교안암병원비뇨기과학교실 O-206 What is different according to prostate size following holmium laser enucleation of. the prostate in men with benign prostatic hyperplasia?... 268 이정우, 이승수, 이동훈, 한지연, 남종길, 정문기, 박성우 양산부산대학교병원비뇨기과학교실 O-207 전립선절제술후배뇨증상변화를통한배뇨근저활동성진단지표의효용성비교... 269 김상원, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광 경북대학교의과대학비뇨기과학교실 O-208 LUTS/BPH 환자의 HoLEP 수술후골반통의호전 : 전향적연구... 270 윤민영, 김병수, 오승준 서울대학교병원비뇨기과학교실 O-209 요역동학검사방광출구폐색모호군으로진단된환자에서홀뮴레이저를이용한. 전립선절제술이후증상호전에관한예측인자분석... 27 한지연, 이정우, 이승수, 이동훈, 남종길, 정재민, 박성우, 이상돈, 정문기 부산대학교의과대학양산부산대학교병원비뇨기과학교실 35

Contents O-20 술전급성요폐가홀뮴레이저전립선절제술에미치는영향... 272 정준세, 박지운, 배상락, 박봉희, 이용석, 강성학, 한창희 가톨릭대학교의정부성모병원비뇨기과학교실 Geumkang Hall (Avenue 2F) 5:00-6:00 International Session (I00-I00) 좌장 : 김수동 ( 동아의대 ), Kexin Xu (Peking University People s Hospital) I-00 A novel training model for laparoscopic ureteroureterostomy using urechis unicinctus... 273 Yinan Zhang, Xunbo Jin Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China I-002 Comparative analysis of early outcomes and QoL in the radical nephrectomy vs. partial nephrectomy: a prospective cohort study... 274 윤민영, 정창욱 서울대학교병원비뇨기과학교실 I-003 Long-term functional and oncological outcomes of robot-assisted versus open. partial nephrectomy for treatment of totally endophytic renal tumors... 275 Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Woong Kyu Han,. Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine I-004 Does lymph node dissection during robot-assisted radical prostatectomy. affect urinary incontinence?... 276 Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Won Sik Ham,. Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine I-005 National practice patterns and direct medical costs for prostate cancer in Korea across a 0 year. period: a nationwide population-based study using a national health insurance database... 277 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 I-006 Percutaneous nephrolithotomy versus ureteroscopic lithotripsy for the management of impacted, proximal ureteral stones: multi-center prospective randomized controlled trials... 278 Yan Song ShengJing Hospital of China Medical University I-007 Low hertz holmium laser enucleation of the prostate... 279 한병규, 문기혁, 정해원, 한준현 2, 장현석 대한비뇨기과의사회장비연구회, 2 한림대학교의과대학비뇨기과학교실 I-008 Could MOTILIPERM improve on acute use of finasteride induced infertility?... 280 Keshab Kumar Karna, Kiran Kumar Soni, Bo Ram Choi, Hye Kyung Kim 2, Yu Seob Shin, Jong Kwan Park 전북대학교병원, 2 경성대학교약학대학 I-009 Analysis of gene expression characteristics of enzalutamide resistant castration-resistant. prostate cancer cells by using RNA sequencing technology... 28 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원 I-00 A novel nomogram for predicting high grade prostate cancer after initial negative results... 282 Gang Song Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center of China, Beijing, China 36

Contents Friday 29 September Crystal A 08:00-09:00 Oral Session 22: Cancer - Prostate (IV) (O2-O220) 좌장 : 박동수 ( 차의대 ), 전성수 ( 성균관의대 ) O-2 전립선암환자에서의림프절전이 : 골반림프절절제술결과와비교한술전자기공명영상을이용한탐지... 283 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은 분당서울대학교병원비뇨기과학교실 O-22 전립선암의근치적전립선절제술후전립선특이항원 nadir 수치와전립선암생화학적재발의연관성... 284 정재용, 전황균 2, 정병창 2, 서성일 2, 이현무 2, 최한용 2, 전성수 2 성균관대학교의과대학 강북삼성병원비뇨기과학교실, 2 삼성서울병원비뇨기과학교실 O-23 전립선수술을시행한 positive surgical margin 환자들에서생화학적재발인자로서의 cribriform pattern... 285 구자윤 부산대학교의과대학비뇨기과학교실 O-24 Adverse features and biochemical recurrence free survival in men with high-risk prostate cancer... 286 Jung Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital O-25 전립선암환자에서전립선절제술후늦게발생한생화학적재발의임상적의미... 287 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 O-26 전립선적출술후보조방사선요법, 조기구제방사선요법, 지연구제방사선요법의종양학적성적비교 :. 다기관연구... 288 김명, 박사현, 임고산, 전황균 2, 전성수 2, 송완 2, 김태헌 2, 곽철 3, 정창욱 3, 변석수 4, 이상철 4, 김종욱 5, 박홍석 5, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 분당서울대학교병원비뇨기과학교실, 5 고려대학교구로병원비뇨기과학교실 O-27 전립선암희귀변이에대한연구... 289 오종진, Manu Shivakumar 2, Jason Miller 2, Shefali Verma 2, 이학민, 홍성규, 이상은, 김도균 2,3, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실, 2 Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USAB, 3 The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA O-28 근치적전립선적출술을시행받는환자의불안과우울에대한분석 : 다기관, 전향적연구... 290 조희주, 김상진 2, 문경태, 조정만, 류재현 2, 김윤범 2, 정태영 2, 고우진 3, 유탁근, 김덕윤 4 을지병원, 2 중앙보훈병원, 3 국립암센터, 4 대구가톨릭대학교병원 O-29 Health-related quality of life (HRQoL), perceived social support, and depression in. disease-free survivors of surgically treated prostate, kidney and bladder cancer... 29 신현빈, 박현식, 신동욱 2, 이상협 3, 전승현 3, 조석 4, 강석호 4, 박승철 5, 박종혁 6, 박진성 을지대학병원, 2 성균관대학교의과대학삼성서울병원, 3 경희의료원, 4 고려대학교안암병원, 5 원광대학교부속병원, 6 충북대학교병원 O-220 Changes of health-related quality of life (HRQOL) in prostate cancer patients after. radical prostatectomy: a longitudinal cohort study in Korea... 292 박현식, 신현빈, 신동욱 2, 이상협 3, 전승현 3, 윤석중 4, 박승철 5, 남종길 6, 김태환 7, 정승일 8, 박진성 을지대학병원, 2 성균관대학교의과대학삼성서울병원, 3 경희의료원, 4 충북대학교병원, 5 원광대학교부속병원, 6 양산부산대학교병원, 7 경북대학교병원, 8 전남대학교병원 37

Contents Crystal B 08:00-09:00 Oral Session 23: Cancer - Kidney (III) (O22-O230) 좌장 : 권태균 ( 경북의대 ), 홍성후 ( 가톨릭의대 ) O-22 신장암병기결정을위해수술전흉부전산화단층촬영 (CT) 을어느경우시행하여야하는가?... 293 강준구, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김태환, 유은상, 권태균, 정성광, 김현태 경북대학교의과대학비뇨기과학교실 O-222 신장피질봉합을생략한로봇부분신절제술의실행가능성 : 예비연구... 294 강성민, 성재우, 양종협, 조신제, Fahad Bashraheel, 정현철, 박용현, 배웅진, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교의과대학비뇨기과학교실 O-223 Ta 신세포암에서복강경하고주파열치료의종양학적및신기능적장기추적관찰결과보고... 295 이재근, 박종목, 나용길, 송기학, 임재성 충남대학교병원의과대학비뇨기과학교실 O-224 근치적신장절제술을시행한신세포암환자에서수술전후예후영양지표변화양상의예후적가치... 296 장춘태, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 이현무 성균관대학교의과대학삼성서울병원비뇨기과학교실 O-225 단일 3 차대형병원에 년동안내원한신세포암환자 3076 례의보고 -. (2) 병기및치료에따른예후및생존률... 297 나준채, 윤민지, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원 비뇨기과, 4 한양대학교의과대학비뇨기과학교실 O-226 Effect of diverse histologic differentiation on the oncological outcomes of patients with upper. urinary tract carcinoma after radical nephroureterectomy: the korean multi-institutional results... 298 오주용, 오정훈, 손수민, 류지원, 박태주, 김태희, 은성종, 김명수, 정호석, 황의창, 정승일, 권동득, 김종범, 조양현, 오경진, 김선옥, 강택원, 박광성, 최석환 2, 권태균 2, 김준석 3, 노준화 3, 유재형 4, 김명기 4, 조원진 5, 강성구 6, 강석호 6, 전준 6, 오태훈 7, 서일영 7, 정홍 8, 김홍섭 8, 이찬호 9, 구자윤 9, 하홍구 9, 김병훈 0, 정창욱, 구자현, 곽철, 김현회 전남대학교의과대학비뇨기과학교실, 2 경북대학교의과대학비뇨기과학교실, 3 광주기독병원비뇨기과, 4 충북대학교의과대학비뇨기과학교실, 5 조선대학교의과대학비뇨기과학교실, 6 고려대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 건국대학교의과대학비뇨기과학교실, 9 부산대학교의과대학비뇨기과학교실, 0 계명대학교의과대학비뇨기과학교실, 서울대학교의과대학비뇨기과학교실 O-227 Development of the clinical calculator for mortality of patients with metastatic renal cell. carcinoma: an analysis of patients from Korean renal cancer study group database... 299 박재영, 정창욱 2, 송채린 3, 서성일 4, 정진수 5, 홍성후 6, 황의창 7, 곽철 2, 서일영 8, 박수연 9 ; 한국신장암연구회 고려대학교안산병원, 2 서울대학교병원, 3 울산대학교서울아산병원, 4 성균관대학교의과대학삼성서울병원, 5 국립암센터, 6 가톨릭대학교 서울성모병원, 7 화순전남대학교병원, 8 원광대학교부속병원, 9 순천향대학교의학통계학과 O-228 혈액투석중인환자와신이식을받은환자에서발생한신세포암의병리학적특징및종양학적결과비교... 300 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 O-229 Efficacy of first line targeted therapy in real world Korean metastatic renal cell carcinoma patients: focused on sunitinib and pazopanib... 30 Ju Yong Oh, Jeong Hoon Oh, Taeju Park, Myung Soo Kim, Ho Seok Chung, Seung Il Jung,. Dong Deuk Kwon, Jong Bum Kim, Yang Hyun Cho, Kyung Jin Oh, Sun-Ouck Kim, Taek Won Kang, Kwangsung Park, Jun Eul Hwang 2, Woo Kyun Bae 2, Jae Young Park 3, Chang Wook Jeong 4, Cheol Kwak 4, Cheryn Song 5, Hwang Gyun Jeon 6, Seong Il Seo 6, Seok-Soo Byun 7, Sung-Hoo Hong 8, Jin Soo Chung 9,. Eu Chang Hwang 화순전남대학교병원 비뇨기과학교실, 2 혈액종양학교실, 3 안산고려대학교병원비뇨기과학교실, 4 서울대학교병원비뇨기과학교실, 5 서울아산병원비뇨기과학교실, 6 성균관대학교삼성병원비뇨기과학교실, 7 분당서울대학교병원비뇨기과학교실, 8 강남성모병원비뇨기과학교실, 9 국립암센터비뇨기과학교실 38

Contents O-230 차표적치료제를시행받은전이신장암환자에서조건부생존및관련예측인자에대한분석 : 국내다기관연구... 302 나준필, 강민용, 성현환, 전황균, 정병창, 박세훈, 전성수, 이현무, 최한용, 정진수 2, 정창욱 3,. 곽철 3, 송채린 4, 홍성후 5, 박재영 6, 황의창 7, 서성일 성균관대학교의과대학삼성서울병원, 2 국립암센터, 3 서울대학교병원, 4 울산대학교서울아산병원, 5 가톨릭대학교서울성모병원, 6 고려대학교 안산병원, 7 화순전남대학교병원 Geumkang Hall (Avenue 2F) 08:00-09:00 Video Session 3 (V0-V05) 좌장 : 나군호 ( 연세의대 ), 전승현 ( 경희의대 ) V-0 임상적 T2 및 T3 전립선암환자에서근치적전립선적출술후요실금회복을위한술중중요 5 단계술식 :. 로봇보조전립선적출술과순수복강경하전립선적출술의차이는존재하는가?... 303 김태남, 이경, 남종길, 이정주, 정문기 부산대학교의과대학비뇨기과학교실 V-02 로봇보조복강경전립선절제술에서성기능및요자제의최대보존을위한술식... 304 최세영, 류제만, 이재훈, 이원철, 채한규, 김휘우, 유달산, 정인갑, 김청수 울산대학교의과대학비뇨기과학교실 V-03 로봇근치적전립선절제술시토글링을이용한역행성초기노출과표지동맥의확인... 305 김승빈, 태종현, 윤성구, 김재윤, 심지성, 강석호, 이정구, 김제종, 천준, 강성구 고려대학교안암병원비뇨기과학교실 V-04 방광요도문합술을함께시행한변형된복강경하단순전립선절제술... 306 정현철, 성재우, 양종협, 조신제, 강성민, 문형우, 이규원, 배웅진, 박용현, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교서울성모병원비뇨기과학교실 V-05 로봇하부요관절제술... 307 윤영은, 정재훈, 조정기, 이형호 2, 나준채 3, 박성열, 김용태, 박해영, 한웅규 3 한양대학교비뇨기과학교실, 2 일산병원비뇨기과학교실, 3 연세대학교의과대학비뇨기과학교실 Grand Ballroom 5:00-6:00 Oral Session 24: Cancer - Prostate (V) (O23-O240) 좌장 : 김청수 ( 울산의대 ), 조진선 ( 한림의대 ) O-23 소수전이가있는전립선암환자에서의로봇보조근치적전립선적출술... 308 박재원, 장원식, 김명수, 정원식, 장기돈, 조강수, 함원식, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실 O-232 전립선암환자에서호르몬치료중단이후남성호르몬수치의회복에영향을미치는인자... 309 남욱, 최세영, 류재만, 한재현, 최원석, 신정현, 이재훈, 이원철, 채한규, 김휘우, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과교실 O-233 복합운동이호르몬박탈치료를받는전립선암환자의신체활동량, 체력, 그리고삶의질에미치는영향... 30 김규식, 임정준 2, 김연수 2, 최홍용, 문홍상 한양대학교의과대학비뇨기과학교실, 2 서울대학교대학원체육교육학교실 O-234 전립선암환자에서남성호르몬박탈요법이심뇌혈관의발병에미치는위험요인에대한연구 :. 국민건강보험표본코호트를이용한연구... 3 문형우, 조신제, 양종협, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 김세웅, 성종미 2, 하유신 가톨릭대학교서울성모병원비뇨기과, 2 이화여자대학교약학대학 O-235 진단당시전이성전립선암으로진단받은환자들에게안드로겐차단요법을시행하였을때,. 전이부담정도가거세저항성전립선암으로진행하는시간에미치는영향... 32 이상민, 김성진, 박창후, 김한권, 박종연 울산대학교강릉아산병원 39

Contents O-236 호르몬박탈요법을받은한국인환자에서거세저항성전립선암의위험도평가 : KCS-prostate scoring model... 33 최세영, 류제만, 경윤수, 남욱, 유달산, 정인갑, 홍준혁, 안한종, 김청수울산대학교의과대학비뇨기과학교실 O-237 전이성전립선암에서도세탁셀항암요법방법에따른효과와독성의비교... 34 육형동, 윤민영, 구자현, 곽철, 김현회, 정창욱서울대학교병원비뇨기과 O-238 도세탁셀로치료한전이성거세저항성전립선암환자의치료반응에대한예측인자... 35 김정권, 김성한, 정재영, 서호경, 정진수, 이강현국립암센터전립선암센터비뇨기과 O-239 전립선암과거력과 25(OH)D2 수치와의상관관계 : 미국국가보건영양실태조사 (NHANES) 2007-2008 데이터... 36 박지수, 김종찬, 이형호 2, 허지은, 최영득, 나군호, 이주용, 함원식 연세대학교의과대학신촌세브란스병원비뇨기과학교실, 비뇨기과의과학연구소, 2 국민건강보험공단일산병원 O-240 엔잘루타마이드를사용한항암치료받지않은거세저항전립선암환자에서생존예측인자... 37 최세영, 류제만, 경윤수, 채한규, 유달산, 정인갑, 홍준혁, 안한종, 김청수울산대학교의과대학비뇨기과학교실 Grand Ballroom 6:00-7:00 Oral Session 25: Cancer - Bladder, Pelvis, Ureter & Others (III) (O24-O250) 좌장 : 김홍섭 ( 건국의대 ), 정병창 ( 성균관의대 ) O-24 신이식환자에서발생하는요로상피암... 38 유지웅, 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원비뇨기과학교실 O-242 신체질량지수 (BMI) 에따른방광암발생위험예측... 39 성재우 4, 양종협 4, 조신제 4, 문형우 4, 최진봉, 이은주 2, 한경도 3, 홍성후 4,5, 하유신 4,5 가톨릭대학교부천성모병원비뇨기과학교실, 2 국민건강보험공단 Department of Big Data Steering, 가톨릭대학교서울성모병원 3 생물통계학교실, 4 비뇨기과학교실, 5 The Cancer Research Institute O-243 Identification of red/green/blue values from white-light imaging and narrow-band imaging. for the discrimination of bladder cancer features... 320 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 O-244 BCG 치료를받은비근육침윤성방광암환자의예후예측을위한 NLR 의효용성과. CUETO scoring model 과의관계... 32 김진우, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 유은상, 권태균, 정성광, 김태환 경북대학교의과대학비뇨기과학교실 O-245 비근침습방광암에서 BCG 유지요법시행후 BCG failure 에대한예측인자... 322 백승룡, 강병진, 박지훈, 김경환, 이경, 이찬호, 구자윤, 이정주, 하홍구 부산대학교의과대학비뇨기과학교실 O-246 상부요로상피암에서진단적요관경검사의정확성... 323 정재동, 나준필, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원비뇨기과학교실 O-247 상부요로상피종양에대한근치적신요관절제술이후신기능감소의예측인자 :. 술전 99mTc-DTPA 결과와의연관성... 324 류제만, 남욱, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 40

Contents O-248 근치적전립선절제술을시행받은환자에서수술전배뇨근과활동이수술후저장증세에미치는영향... 325 양종협, 성재우, 조신제, 이규원, 정현철, 최진봉, 최세웅, 박용현, 배웅진, 조혁진, 하유신, 홍성후, 김세웅, 이지열 가톨릭대학교서울성모병원 O-249 한국인전립선암환자에서의근치적전립선절제술후건강관련삶의질변화 :. 어떤요인이수술후만족도에영향을주는가?... 326 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 O-250 2 주간체계적인골반저근운동이근치적전립선절제술후요실금회복에미치는영향... 327 박주현, 유상준, 조성용, 조민철, 손환철, 한가영 2, 송욱 2, 정현 서울특별시보라매병원, 서울대학교의과대학비뇨기과학교실, 2 서울대학교의과대학체육교육과 4

Contents Non Discussion Poster NP-00 신세포암세포주 (Caki-) 에서 clear cell induction 및 metformin 에의한 mitochondria 활성이. mtor inhibitor 에의한세포고사효과를증대시킨다... 328 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 NP-002 hsv2-mir-h9 and hsv-mir-h8 in formalin-fixed paraffin-embedded (FFPE). are valuable diagnostic biomarkers for prostate cancer... 329 변영준, 박현미, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 NP-003 새로운비침습적방광암진단마커로서소변 cell-free nucleic acid IQGAP3 의진단적가치... 330 변영준, 김예환, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 NP-004 방광암에서 UroVysion TM FISH 를이용한혈중순환종양세포의염색체이상검출... 33 하유신, 성재우, 조신제, 양종협, 문형우, 홍성후, 김태정 2 가톨릭대학교의과대학 서울성모병원비뇨기과학교실, 2 여의도성모병원병리학교실 NP-005 인간방광암세포주에서 MutT homolog (MTH) inhibitors 의항암효과... 332 이정우, 호진녕 2, 이상철 2, 변석수 2, 이은식 3 동국대학교의과대학비뇨기과학교실, 2 서울대학교의과대학비뇨기과학교실분당서울대학교병원, 3 서울대학교병원 NP-006 Association of FOXP3 expression and related signaling pathway with prognosis in. human prostate cancer... 333 최승권, 최태수 2, 이상협 2, 유구한 2, 이동기 2, 민경은 2, 전승현 2, 이선주 2, 이형래 2, 장성구 2 서울의료원비뇨기과, 2 경희대학교의과대학비뇨기과학교실 NP-007 전기임피던스스펙트로스코피니들을이용한정상신조직및악성신종양조직의구분... 334 김현우, 윤조호 2, 김경환, 강병진, 이경, 백승룡, 박지훈, 신동길, 이종현 2, 이정주 부산대학교의학전문대학원비뇨기과학교실, 2 광주과학기술원의생명공학과 NP-008 투명신세포암환자에서 AKT 발현과의상관관계및임상적유효성... 335 최태수, 유구한, 신용호, 김영빈, 최정혁, 이상협 2, 이동기, 민경은, 전승현 2, 이형래, 이선주 2, 이충현 2, 장성구 2 강동경희대학교병원, 2 경희의료원 NP-009 음경해면체평활근에서 Kv7 채널의특성및기능적역할... 336 정재동, 채미리, 강수정, 이종훈, 성현환, 이성원 성균관대학교의과대학삼성서울병원비뇨기과학교실 NP-00 당뇨성발기부전마우스에서배아줄기세포및혈관주위세포유래엑소좀의발기능개선효과... 337 송강문, 권미혜, 칼얀가탁, 응웬낫민, 최민지, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 NP-0 정상신세포의새로운 3 차원세포배양법제시... 338 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 NP-02 백서요도에서요자제기전에관한베타 3 수용체의역할... 339 권준범,2, 스즈키타카히사 2, 타카오카에이이치로 2, 시미즈노부타카 2, 타카이 2, 요시무라나오키 2 대구파티마병원비뇨기과, 2 피츠버그대학교의과대학비뇨기과학교실 NP-03 홀뮴레이저를이용한전립선절제술후회수한일반전립선비대증조직과비치볼사이의전기임피던스차이... 340 김현우, 윤조호 2, 김경환, 강병진, 이경, 백승룡, 박지훈, 신동길, 이종현 2, 이정주 부산대학교의학전문대학원비뇨기과학교실, 2 광주과학기술원의생명공학과 42

Contents NP-04 Overexpression of transient receptor potential vanilloid-4 (TRPV4) in urothelium of. rat urinary bladder following bladder outlet obstruction... 34 오주용, 오정훈, 손수민, 류지원, 박태주, 김태희, 은성종, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 강택원, 권동득, 박광성 전남대학교의과대학비뇨기과학교실 NP-05 로봇이용근치적방광절제술 : 로봇 naïve 술자의학습곡선분석... 342 윤성구, 태종현, 김승빈, 김재윤, 심지성, 강성구, 천준, 이정구, 김제종, 강석호 고려대학교의과대학비뇨기과학교실 NP-06 골반계측치가근치적방광절제술및신방광조형술후요역동학패턴에미치는영향... 343 김광현, 윤현석, 송완, 추희정 2, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실, 2 이화여자대학교부속목동병원비뇨기과 NP-07 초기방광암및진행성방광암환자의전치적방광절제술후생존률의비교분석... 344 김태진, 이인재, 이상철, 홍성규, 변석수, 오종진 분당서울대학교병원비뇨기과학교실 NP-08 방광암으로근치적방광절제술을받은여성환자에서생식기관침범의예측인자... 345 최세영, 류제만, 경윤수, 한재현, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 NP-09 원위부요관의요로상피암에대한개복및최소침습신우요관절제술의종양학적결과비교... 346 류제만, 남욱, 홍준혁, 김청수, 안한종, 홍범식 울산대학교서울아산병원비뇨기과학교실 NP-020 로봇보조근치적방광전절제술의학습곡선 : 단일술자의초기경험... 347 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 이상철, 정성진, 홍성규, 변석수, 이상은, 오종진 분당서울대학교병원비뇨기과학교실 NP-02 수술받은상부요로암환자에서방광내무재발생존률, 질병무진행생존률,. 암특이생존률에대한유의한예후인자분석... 348 김정권, 김성한, 송미경 2, 주정남 2, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방연구과바이오메트릭스연구과 NP-022 기생식세포종환자에서혈중종양표지자의임상영역에서의실용적평가... 349 채한규, 최세영, 유달산, 정인갑, 홍범식, 홍준혁, 김건석, 안한종, 김청수 울산대학교의과대학서울아산병원비뇨기과 NP-023 근치적방광절제술환자에서림프관침윤의예후적가치... 350 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현 서울대학교병원비뇨기과 NP-024 요관에위치한 pt3b 상부요관종양에서의수술후보조적치료... 35 김종근 2, 박사현, 김명, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 김청수, 안한종 울산대학교서울아산병원, 2 한림대학교동탄성심병원 NP-025 Identifying carcinoma in situ lesions in the bladder using red/green/blue. numerical values from white-light imaging... 352 이광석, 구교철, 김장환 2, 홍성준 2, 정병하 연세대학교의과대학 강남세브란스병원, 2 신촌세브란스병원 NP-026 OPD based biopsy and fulguration during follow-up period in NMIBC... 353 김문성, 노주현, 김종녕, 임건우, 정재호, 이태호, 최경화, 이승렬, 홍영권, 박동수 CHA 의과학대학교분당차병원 43

Contents NP-027 The impact of waist circumference on the risk of bladder cancer development according. to body mass index: complete enumeration results of the Koreans... 354 양종협, 강성민, 문형우 2, 이규원, 정현철, 최진봉 3, 김정호 2, 홍성후, 하유신 가톨릭대학교서울성모병원, 2 동남권원자력의학원, 3 가톨릭대학교부천성모병원 NP-028 신경보존근치방광절제술 : 발기능및장기종양학적결과... 355 권세윤, 하윤석 2, 최석환 2, 김현태 3, 김태환 3, 권태균 3 동국대학교경주병원, 동국대학교의과대학비뇨기과학교실, 2 경북대학교병원, 경북대학교의과대학비뇨기과학교실, 3 칠곡경북대학교병원, 경북대학교의과대학비뇨기과학교실 NP-029 Tb 신세포암에서수술전 CKD 2 등급인환자가수술후 CKD 3 등급이하로진행할위험이부분신절제술과근치적신절제술사이에유의한차이가없다... 356 나준채, 윤민지, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원 비뇨기과, 4 한양대학교의과대학비뇨기과학교실 NP-030 Clinical considerations for achieving the trifecta of laparoscopic partial nephrectomy... 357 이경, 김태남, 남종길 2, 이완 3, 이정주, 정문기 2 부산대학교의과대학비뇨기과학교실, 2 양산부산대학교의과대학비뇨기과학교실, 3 동남권원자력의학원 NP-03 25 개의면역염색조직인자를이용한 multilocular cystic RCC 와 multilocular cystic clear cell RCC. with low malignant potential 의신장조직의발현비교연구... 358 김성한, 박원서 2, 정진수 국립암센터전립선암센터 비뇨기과, 2 병리과 NP-032 신장암환자의부분신절제술후만성신장질환위험예측모델... 359 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 NP-033 Is intraoperative sonography really useful in patients with open partial nephrectomy?... 360 노주현, 김종녕, 최경화, 이승렬, 홍영권, 박동수 CHA 의과학대학교분당차병원비뇨기과학교실 NP-034 4 cm 이상의단일신장종양에대한개복신부분절제술과로봇신부분절제술의비교 : 후향적연구... 36 정연수, 이동환, 이상철, 홍성규, 변석수, 이상은 분당서울대학교병원 NP-035 Epithelioid Angiomyolipoma 는 Classical Angiomyolipoma 와비교하여더불량한예후를가지는가... 362 이원철, 최세영, 이찬우, 유상준, 유달산, 정인갑, 송채린, 김건석, 홍범식, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 NP-036 병리학적 T3a 신세포암환자에서신주위지방침범과신동지방침범의종양학적결과비교... 363 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 NP-037 Prognostic factors for recurrence in patients with pathologic stage T3a renal cell carcinoma... 364 신택준, 변혜진, 정원호, 하지용, 김병훈, 박철희, 하윤석 2, 권태균 2, 권세윤 3, 이경섭 3, 김천일 계명대학교의과대학비뇨기과학교실, 2 경북대학교의과대학비뇨기과학교실, 3 동국대학교경주병원비뇨기과학교실 NP-038 NP-039 Retrospective comparative study between robot-assisted partial nephrectomy and open partial nephrectomy for the treatment of cystic tumors... 365 김정준, 국하림, 김광모, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 Retrospective comparative study between robot-assisted partial nephrectomy and open partial nephrectomy for the treatment of highly complex renal tumors with RENAL nephrometry score 8... 366 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 44

Contents NP-040 복강경하부분신절제술시행 년후신기능손상발생의위험인자... 367 김상원, 하헌, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 김태환, 유은상, 정성광, 권태균 경북대학교의과대학비뇨기과학교실 NP-04 T 병기투명신세포암환자에서부분신절제후절제변연양성이암재발에미치는영향... 368 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 NP-042 제 형및제 2 형유두상신장암, 그리고투명세포신장암의비교 :. T 병기에있어조직학적타입과종양학적예후간의상관관계... 369 이재훈, 채한규, 이원철, 최세영, 류제만, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 NP-043 신장에서발견된 2 cm 이하의고형종물의병리결과를예측하는데 MRI 가 CT 보다정확한가?... 370 이동훈, 이정우, 남종길, 박성우, 정문기 부산대학교의과대학양산부산대학교병원비뇨기과학교실 NP-044 불량한예부를보이는전이투명세포신장암에서 차치료효과... 37 김정호, 정진수 2, 곽철 3, 정창욱 3, 서성일 4, 송채린 5, 서일영 6, 강성구 7, 박재영 7, 황의창 8, 홍성후 9 동남권원자력의학원암센터, 2 국립암센터전립선암센터, 3 서울대학교의과대학비뇨기과학교실, 4 성균관대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 원광대학교의과대학비뇨기과학교실, 7 고려대학교의과대학비뇨기과학교실, 8 전남대학교의과대학 비뇨기과학교실, 9 가톨릭대학교의과대학비뇨기과학교실 NP-045 로봇전전립선절제술시행후전립선특이항원수치가최저점까지도달한. 고위험군전립선암환자에서질병진행까지의시간이전이와사망을예측할수있는가?... 372 김도경, 구교철, 이광석, 하윤수, 나군호, 홍성준, 양승철, 정병하 연세대학교의과대학비뇨기과학교실 NP-046 진행된전립선암환자에서고식적경요도전립선절제술이종양학적결과에미치는영향 : 성향점수분석... 373 최세영, 류제만, 경윤수, 신정현, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 NP-047 근치적방광절제술로우연히발견된전립선암의임상양상및예후... 374 신정현, 류제만, 최세영, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원비뇨기과학교실 NP-048 비전이성전립선암에대한안드로겐차단요법및근치적전립선절제술간의생존율비교... 375 하유신,, 최진봉 2, 최인영 3, 곽철 4, 김청수 5, 변석수 6, 서성일 7, 이승주 8, 이승환 9, 강민주 0, 강신희 0, 박주연 0, 심정임 0, 양장미 0, 최인순 0, 박은정 0, 이지열, 가톨릭대학교서울성모병원비뇨기과학교실, 2 가톨릭대학교부천성모병원비뇨기과학교실, 3 가톨릭대학교서울성모병원 Department of Medical Informatics, 4 서울대학교병원비뇨기과학교실, 5 울산대학교서울아산병원비뇨기과학교실, 6 분당서울대학교병원비뇨기과학교실, 7 성균관대학교의과대학삼성서울병원비뇨기과학교실, 8 가톨릭대학교성빈센트병원비뇨기과학교실, 9 연세대학교의과대학 Department of Urology, Urological Science Institute, 0 National Evidence-based Healthcare Collaborating Agency, Seoul, 가톨릭대학교서울성모병원 The Cancer Research Institute NP-049 전립선암의배부정맥침범은로봇보조복강경전립선적출술후생화학적재발의예측인자이다... 376 최세영, 류제만, 경윤수, 신정현, 이재훈, 이원철, 유달산, 정인갑, 김청수 울산대학교의과대학비뇨기과학교실 NP-050 SNUPCRC 전립선암위험도계산기의임상적유용성... 377 육형동, 윤민영, 구자현, 김현회, 곽철, 정창욱 서울대학교병원비뇨기과 NP-05 전립선적출술후요자제능회복에영향을미치는해부학적, 기능적, 수술적인자에대한고찰... 378 김명, 박명찬 2, 박사현, 임고산, 최승권, 심명선, 송채린, 정인갑, 유달산, 홍준혁, 김청수, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 인제대학교해운대백병원비뇨기과학교실 45

Contents NP-052 Predictors of biochemical recurrence in margin positive prostate cancer after radical prostatectomy without adjuvant radiotherapy... 379 고동훈, 장원식, 박재원, 조강수, 함원식, 나군호, 홍성준, 최영득 연세대학교의과대학신촌세브란스병원 NP-053 혈중지질농도와전립선암의관련성에관한연구... 380 정재윤, 김명, 김종근, 이찬우, 유달산, 정인갑, 송채린, 홍준혁, 김청수, 안한종 울산대학교의과대학서울아산병원비뇨기과학교실 NP-054 근치적전립선절제술후발생한탈장의위험인자와발병률... 38 구자윤, 이찬호, 이경, 김경환, 백승룡, 박지훈, 하홍구 부산대학교의과대학비뇨기과학교실 NP-055 원격전이를동반하지않은림프절전이전립선암환자에서첫치료에따른종양학적결과의차이 :. 근치적전립선절제술 vs. 남성호르몬박탈요법... 382 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 NP-056 도세탁셀항암화학요법치료를받는거세저항성전립선암환자에서남성호르몬박탈요법의기간이. 종양학적결과에미치는영향... 383 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 NP-057 The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy in a contemporary grading system for prostate cancer... 384 장원식, 함원식, 김명수, 정원식, 조강수, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실 NP-058 A propensity score matched analysis comparing retzius-sparing versus anterior. robot-assisted radical prostatectomy... 385 Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Ahmed Al-ghiaty, Trung Van, Won Sik Ham,. Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine NP-059 전립선암발견에있어 multiparametric MRI 의정확성 : whole-mount radical prostatectomy. 병리시료와의직접비교... 386 이찬호, 구자윤, 강병진, 이경, 김경환, 백승룡, 박지훈, 박원영, 이남경, 하홍구 부산대학교병원비뇨기과 NP-060 전립선암고위험군환자에서 ISUP grade group IV 에대한. 저용량방사선동위원소영구삽입술단독치료의성적... 387 임건우, 김종녕, 노주현, 이승렬, 최경화, 이태호, 정재호, 김문성, 박동수 CHA 의과학대학교분당차병원비뇨기과 NP-06 TRUS biopsy 후발생하는직장출혈에대한위험요인... 388 노주현, 김문성, 김종녕, 임건우, 이태호, 정재호, 최경화, 이승렬, 홍영권, 박동수 CHA 의과학대학교분당차병원 NP-062 조직검사 Gleason 7 전립선암에서 upgrading 이근치적전립선암적출술후생화학재발에미치는영향... 389 안치현, 유상준, 박주현, 조성용, 조민철, 손환철, 정현 서울특별시립보라매병원비뇨기과 NP-063 국소전립선암의근치적전립선절제술후원격전이가발생한환자군에서호르몬요법개시시점이. 생존율에미치는영향... 390 안현규, 구교철, 이광석, 김도경, 나군호, 홍성준, 정병하 연세대학교의과대학비뇨기과학교실 46

Contents NP-064 로봇보조전립선적출술와근치적전립선적출술의초기임상결과의전향적코호트비교... 39 윤민영, 정창욱 서울대학교병원비뇨기과학교실 NP-065 근치적전립선절제술후기능적회복평가시인터뷰와설문지방법의비교 :. 차이를발생시키는요인은무엇인가?... 392 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 NP-066 Predicting tumor volume using a novel biopsy-related parameter derived from location and. relationship of positive cores on standard 2-core trans-rectal ultrasound-guided prostate biopsy... 393 유상준, 안치현, 박주현, 조성용, 조민철, 손환철, 정현 서울특별시립보라매병원 NP-067 수술절제면양성 pt3an0/nx 전립선암환자에서글리슨점수가생화학적재발에미치는영상 :. 전립선암연구회내다기관연구... 394 송완, 전황균 2, 정병창 2, 서성일 2, 이현무 2, 최한용 2, 김종욱 3, 이상철 4, 변석수 4, 정창욱 5, 곽철 5, 조진선 6, 안한종 7, 전성수 2 이화여자대학교의과대학비뇨기과학교실, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 3 고려대학교의과대학구로병원비뇨기과학교실, 4 서울대학교의과대학분당서울대병원비뇨기과학교실, 5 서울대학교의과대학서울대병원비뇨기과학교실, 6 한림대학교의과대학비뇨기과학교실, 7 울산대학교의과대학서울아산병원비뇨기과학교실 NP-068 아스피린을복용에따른로봇보조근치적전립선절제술의수술직후결과비교... 395 변경현, 박경민, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김태환, 유은상, 권태균, 정성광, 김현태 경북대학교의과대학비뇨기과학교실 NP-069 로봇보조근치적전립선적출술중골반자율신경모니터링의안전성과효용성 :. MMEN (monitoring and mapping of erectile nerve during RALP) study 초기분석... 396 정창욱, 윤민영, 태범식 2, 박주현 3, 김기원 4, 서정화 5, 구자현, 곽철, 김현회 서울대학교병원비뇨기과, 2 고려대학교안산병원비뇨기과, 3 서울특별시립보라매병원비뇨기과, 4 서울대학교병원재활의학과, 5 서울대학교병원 마취통증의학과 NP-070 술전초고위험전립선암에대해근치적전립선절제술시행시예후인자로써. charlson comorbidity index 의적용가능성... 397 박재원, 장원식, 함원식, 이주용, 김명수 2, 정원식 3, 조강수, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실, 2 전남대학교의과대학비뇨기과학교실, 3 광주기독병원비뇨기과 NP-07 The oncological outcomes following radical prostatectomy in men with. Gleason grade 3+5, 4+5, and 5+5 on prostate biopsy... 398 Jeong Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital NP-072 경직장초음파유도전립선생검후출혈에대한옥시셀룰로오스국소지혈제의효과... 399 박지운, 정준세, 배상락, 박봉희, 이용석, 강성학, 한창희 가톨릭대학교의과대학비뇨기과학교실 NP-073 호르몬박탈요법은고위험또는초고위험국소전립선암환자에서단독으로사용돼서는안된다... 400 최세영, 류제만, 경윤수, 김휘우, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 NP-074 요산결석의예측인자분석 : mean stone density, stone heterogeneity index, and. variation coefficient of stone density on single-energy NCCT, and urine ph... 40 김종찬, 정해도, 이종수, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실 NP-075 로봇을이용한산과적수술과복강경을이용한산과적수술이후발생한요관 - 질누공에대한. 보존적치료로서요관경하요관부목시술... 402 김경환, 강병진, 박지훈, 백승룡, 이경, 김현우, 이정주, 신동길 부산대학교의과대학비뇨기과학교실 47

Contents NP-076 경피적신절석술후출혈에영향을끼치는위험인자들... 403 장재윤, 장준보, 고영휘, 송필현, 문기학, 정희창, 최재영 영남대학교의과대학비뇨기과학교실 NP-077 2-3 cm 크기의신결석환자에서역행성신장내결석수술의시행시 ureteral access sheath 의직경이. 수술결과에영향을미치는가?... 404 장재윤, 장준보, 고영휘, 송필현, 문기학, 정희창, 최재영 영남대학교의과대학비뇨기과학교실 NP-078 하대정맥후요관 (retrocaval ureter) 의치료를위한복강경하신우성형술의유용성 : 단일술자경험및문헌고찰... 405 오태훈, 이재환, 박승철, 정희종, 서일영 원광대학교의과대학비뇨기과학교실 NP-079 누적합법을이용한영상보조최소절개술 (video-assisted minilaparotomy surgery) 을이용한. 부분신장절제술의학습곡선 (learning curve) 분석... 406 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 NP-080 역행성요관경하접근법을이용한매복요관결석 (impacted ureteral stone) 의수술적치료에대한고찰... 407 민경찬, 김상원, 권순오, 김범수 경북대학교의과대학비뇨기과학교실 NP-08 방사선투과성신장및요관결석의 potassium citrate/sodium bicarbonate 를이용한. 용해요법의성공에미치는인자... 408 이승수, 이정우, 이동훈, 남종길, 박성우, 한지연, 정문기, 정재민, 이상돈 부산대학교의과대학양산부산대학교병원비뇨기과학교실 NP-082 The efficacy of OPD based-pudendal nerve block in the treatment of chronic pelvic pain... 409 김문성, 노주현, 김종녕, 임건우, 홍재엽, 최경화 CHA 의과학대학교분당차병원비뇨기과학교실 NP-083 여성요실금치료에서새로운회음질압측정기 (KegelQ) 를이용한바이오피드백의임상적유용성에대한연구 :. 다기관전향적무작위배정대조연구... 40 이영주, 이정근, 이순미, 천성희 2, 이유경 3, 김성화 3, 조성용 2, 오승준 3, 정성진 분당서울대학교병원비뇨기과, 2 서울특별시립보라매병원비뇨기과, 3 서울대학교병원비뇨기과 NP-084 단일기관에서시행한방광질루교정술의장기추적결과... 4 정현우, 고광진, 이규성 성균관대학교의과대학비뇨기과학교실 NP-085 복압성요실금정도평가척도들의비교분석 : 전향적연구... 42 윤민영, 김병수, 조성용 2, 오승준 서울대학교병원비뇨기과학교실, 2 서울특별시립보라매병원비뇨기과 NP-086 뇌졸중환자에서과민성방광증상이삶의질및기능수행척도에미치는영향... 43 홍정희, 표혜나 2, 김은주 2 단국대학교의과대학비뇨기과학교실, 2 국립재활병원재활의학과 NP-087 The effect of observing the degree and pattern of urine leakage during the provocative test before applying and adjustment of the mesh during trans-obturator tape (TOT) procedure in mixed incontinence... 44 김종원, 이형호, 박상언, 이석영, 고우진, 김영식 국민건강보험공단일산병원비뇨기과 NP-088 영유아에서포피의 HPV 유병률 : 문헌고찰및메타분석... 45 이현영, 김재헌, 두승환, 양원재, 송윤섭 순천향대학교서울병원비뇨기과학교실 48

Contents NP-089 단일일차의료기관을방문한여성급성단순방광염환자의원인균및항생제감수성검사결과... 46 두진경, 어홍선 PSI 어비뇨기과의원 NP-090 ESBL 생성균에의한요로감염으로 ertapenem 치료후재발한 ESBL 양성환자의임상양상과재치료패턴 :. 다기관연구, 예비조사... 47 강정윤, 김정훈 2, 최재덕 2, 안승현 2, 문경태, 조희주, 조정만, 유탁근 을지대학교의과대학비뇨기과학교실, 2 한일병원비뇨기과 NP-09 Advanced paternal age does not affect to sperm DNA fragmentation... 48 이효석, 박용석 2, 최진호, 이중식, 서주태 단국대학교제일병원 비뇨기과학교실, 2 생식의학연구실 NP-092 정관복원술후정액검사결과와임신성공과의연관성... 49 정영환, 장춘태, 정승찬, 류동수 성균관대학교의과대학삼성창원병원비뇨기과학교실 NP-093 하부요로증상을가진한국남성을대상으로한타다라필 5 mg 매일복용법의시판후조사 : 다기관연구... 420 Ji-Eon Won, Ji Yeon Chu, Hyunah Caroline Choi, Yun Chen 2, Hyun-Jun Park 3, Héctor José Dueñas 4 Lilly Korea, Seoul, Korea, 2 Lilly Suzhou Pharmaceutical Company, Shanghai, China, 3 Department of Urology, Pusan National University School of Medicine, Busan, Korea, 4 Eli Lilly de Mexico, Mexico City, Mexico NP-094 잠복정자증, 감소정자증환자에대한시험관아기시술전정자냉동의임상적의의... 42 김대근, 강기예 2, 김동석 3, 송승훈 3 CHA 의과학대학교서울역센터비뇨기과학교실, 2 차병원여성의학연구소서울역센터배아생식연구실, 3 CHA 의과학대학교강남차병원 비뇨기과학교실 NP-095 남성호르몬보충요법의치료유지영향인자비교... 422 김진욱, 지병훈, 장인호, 명순철, 문영태, 김경도, 김태형 중앙대학교병원비뇨기과학교실 NP-096 고환통증동반유무에따른정계정맥류환자의특성차이... 423 백승룡, 박현준, 이경민, 박민정, 박남철 부산대학교병원 NP-097 무증상남성갱년기증후군환자 : 남성호르몬보충요법이필요한가?... 424 박현준, 이경민, 박민정, 박남철 부산대학교병원 NP-098 무자녀상태에서시행된정관복원술 20 례의임상적특성... 425 박지훈, 김경환, 이경, 백승룡, 임미영, 류장현, 박민정, 박현준, 박남철 부산대학교병원비뇨기과학교실, 한국공공정자은행연구원 NP-099 당뇨를동반한전립선비대증환자에게있어서경요도전립선절제술의임상적의의... 426 강태욱, 이창민, 정현철, 김광진, 정재흥, 송재만 연세대학교원주의과대학비뇨기과학교실 NP-00 HoLEP 시전립선암우연종의발견률및술전위험인자에대한고찰... 427 김명, 안태영 울산대학교서울아산병원비뇨기과학교실 NP-0 전립선침생검시만성염증양성코어수의임상적의의... 428 강수환, 서원태, 강필문, 최성, 류현열, 김택상 고신대학교의과대학비뇨기과학교실 NP-02 홀뮴레이저전립선적출술후전립선이행대에서우연히발견된전립선암의특성... 429 김상훈, 이규원 2, 조수연, 김현우 가톨릭대학교 성바오로병원, 2 서울성모병원 49

Contents NP-03 홀뮴레이저전립선적출술 (HoLEP) 후초기에나타나는발기능변화... 430 김상훈, 이규원 2, 조수연, 김현우 가톨릭대학교 성바오로병원, 2 서울성모병원 NP-04 하부요로증상 / 전립선비대증환자에서 urethral pressure profile 의유용성에대한재조명... 43 박송철, 김병수 2, 윤민영 2, 오승준 2 Department of Urology, YanBian University Hospital, China, 2 서울대학교병원 NP-05 A novel vaporization-enucleation technique for benign prostate hyperplasia by. using 20-W HPS GreenLight TM laser: seoul technique II... 432 유상준, 강순호, 박주현, 조성용, 조민철, 정현, 손환철 서울특별시립보라매병원 NP-06 증상평가만으로저활동성방광과방광출구폐색남성환자의구별진단이가능한지에대한연구... 433 김아람, 박영진, 최우석, 박형근, 백성현, 김형곤 건국대학교병원비뇨기과, 건국대학교의학전문대학원 NP-07 The predictive factor for favorable outcome after surgical treatment of benign prostate hyperplasia performed by beginner urologist - is surgical modality important in young urologists?... 434 김기홍, 양희조, 김두상, 전윤수 순천향대학교천안병원비뇨기과학교실 NP-08 갑상선호르몬과하부요로증상 / 전립선비대증과의상관관계... 435 이준호, 최기복, 박연원 국립경찰병원비뇨기과 NP-09 로봇보조복강경하단순전립선절제술의초기경험... 436 문경태, 조희주, 조정만, 강정윤, 유탁근 을지병원 NP-0 홀뮴레이저를이용한전립선광적출술을받은전립선비대증환자에서환자 - 중심목표를이용한. 성공적인수술적결과의평가... 437 김경환, 강병진, 박지훈, 백승룡, 이경, 김현우, 신동길, 이정주 부산대학교의과대학비뇨기과학교실 NP- Holmium laser enucleation of the prostate (HoLEP) can be one of the modality for. treatment of benign prostatic hyperplasia (BPH) in young urologists... 438 김기홍, 양희조, 김두상, 전윤수 순천향대학교천안병원비뇨기과학교실 NP-3 택시운전자에서야간운전이남성하부요로증상에미치는영향... 439 박지운, 정준세, 배상락, 박봉희, 이용석, 강성학, 한창희 가톨릭대학교의과대학의정부성모병원비뇨기과학교실 NP-4 척수이형성증으로인한신경인성방광에서요로감염의발생과유발요인... 440 박관진, 송원훈, 임영재 서울대학교병원비뇨기과 NP-5 Tubularized incised plate 수술시사용한카테터크기에따른장기추적요속의비교... 44 허지은, 이초녕 2, 김상운, 이용승, 한상원 연세대학교의과대학비뇨기과학교실, 2 연세대학교세브란스병원소아비뇨기과 NP-6 방광요관역류가동반된신우요관협착 : 치료순서결정인자와치료경과분석... 442 한재현, 이상민, 이종필, 안동현, 김휘우, 송상훈, 김건석 울산대학교서울아산병원비뇨기과학교실 NP-7 중복신장에서의동시요관재이식 : 단일기관경험... 443 신정현, 안동현, 이상민, 이종필, 김휘우, 송상훈, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실 50

Contents NP-8 방광요관역류환아에서로봇보조방광근외봉수술법의초기경험... 444 송상훈, 김휘우, 이종필, 이상민, 안동현, 김건석 울산대학교의과대학비뇨기과학교실 NP-9 Pathologic analysis of the testicular remnant associated with the nonpalpable testes in children... 445 정재민, 이승수, 이동훈, 한지연, 남종길, 박성우, 정문기, 이상돈 부산대학교의과대학비뇨기과학교실 NP-20 Association between lipid profiles and CKD in Kidney donors... 446 조신제, 성재우, 양종협, 문형우, 강성민, 이규원, 정현철, 최세웅, 배웅진, 조혁진 가톨릭대학교서울성모병원 NP-2 증상의발현으로진단된성인의신우요관이행부협착에서신우성형술후이뇨성신주사의필요성... 447 강준구, 하헌, 이유진, 정재욱, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 이준녕 경북대학교의과대학비뇨기과학교실 NP-22 경직장초음파유도하전립선생검후발생한대량직장출혈의치료사례... 448 서원익, 황진원 2, 김완석, 윤장호, 민권식, 정재일 인제대학교부산백병원 비뇨기과학교실, 2 소화기내과학교실 NP-23 Factors influencing rate of testicular salvage in acute testicular torsion... 449 오주용, 오정훈, 손수민, 류지원, 박태주, 김태희, 은성종, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 강택원, 권동득, 박광성 전남대학교의괴대학비뇨기과학교실 5

www.urology.or.kr 207 Annual Meeting of The Korean Urological Association Changing Urology, Leading Future 변화하는비뇨기과, 미래를이끌다. 일반연제

O-00 직업성노출과신장암의관련성에대한환자대조군연구 김태헌, 전황균, 정병창, 서성일, 이현무, 최한용, 김환철 2, 임종한 2, 전성수 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 인하대학교의과대학직업환경의학과학교실 Introduction & Objectives: The aim of this study was to identify occupational exposures associated with renal cell carcinoma (RCC). Materials & Methods: This is a multicenter case-control study conducted in Korea. Cases were subjects diagnosed with histologically confirmed RCC in four hospitals in 205. Population-based controls were matched to cases : by sex, age (±5 year), and town or neighborhood. All subjects were interviewed to gather relevant information on socio-demographic factors, lifetime smoking history, and lifetime occupational history using a structured questionnaire. Lifetime occupational history consisted of every occupation in which the case or control ever had been employed for at least 2 months. Conditional logistic regression models were used to estimate smoking adjusted odds ratios (ORs) and 95% confidence intervals (CIs) relating occupation and industry to RCC risk. Results: A total of 347 cases and 347 controls were included in the analysis. Of all subjects, 472 (68.0%) were male. The mean age was 55.7±.0 years for cases and 56.7±9.8 years for controls. No statistically significant differences existed between cases and controls with regard to gender and age. Controls were more likely than cases to have a lower educational level (P=0.00) and be current smokers (P<0.00). After adjusting for cigarette smoking, an increased risk of RCC was observed for workers in the cleaning services industry (OR 5.90; 95% CI.96 to 7.76). Employment in food processing was also associated with elevated risk of RCC (OR 3.74; 95% CI.45 to 9.37). Exposure to non-arsenic pesticides was inversely associated with RCC risk, with an OR of 0.38 (95% CI 0.20 to 0.72). Conclusion: Our data indicate that ever having worked in the cleaning services or food processing is independently associated with an increased risk of RCC, whereas exposure to non-arsenic pesticides is associated with a decreased risk of RCC in Korean subjects. Keywords: Kidney cancer, Epidemiology, Race 53

O-002 신세포암에서성별과콜레스테롤수치에따른 BMI 의예측인자로서의가치 - 다기관연구 Fahad Bashraheel, 정현철, 변석수 2, 곽철 3, 김용준 4, 황의창 5, 김태환 6, 강석호 7, 정진수 8, 홍성후 가톨릭대학교서울성모병원, 2 분당서울대학교병원, 3 서울대학교병원, 4 충북대학교병원, 5 전남대학교병원, 6 경북대학교병원, 7 고려대학교안암병원, 8 국립암센터 Purpose: Recently, the effect of preoperative body mass index (BMI) and total cholesterol on prognosis has been reported in patients with RCC but is still controversial and poorly understood. We analyzed the effects of BMI and total cholesterol on the prognosis of RCC. Materials and Methods: From 988 to 205, we retrospectively collected data from 727 patients surgically treated for non-metastatic RCC from 8 centers. ROC curve was analyzed to calculate the cut-off value of cholestrol as a predictive factor of RCC. The highest Youden index was shown in 63.5. According to WHO criteria, low BMI and high BMI groups are divided by 25. Kaplan Meyer analysis, Multivariate Cox regression model were performed to identify overall survival (OS), Recurrence free survival (RFS). Results: Low BMI and low cholesterol group was associated with short OS and RFS (p<0.00) than any other groups in total cohort. As a subgroup analysis we divided groups by gender. In the male group, the result showed that low BMI and low cholesterol was associated with short OS and RFS similar to total cohort results (p<0.00). But in the female group, the effect of cholesterol on the prognosis was same as male (p<0.00) but BMI didn t associated with OS and RFS (p=0.650, 0.799 respectively). And on multivariate Cox regression analysis, cholesterol was an independent predictor for OS in both gender groups (HR=.502 p<0.00, HR=.758 p=0.037 respectively). However, BMI was a significant prognostic factor in the male group only (HR=.925 p<0.00). Conclusion: Preoperative BMI and total cholesterol in RCC patients showed statistical significance as OS and RFS predictive factor. But in the subgroup analysis divided by gender, cholesterol was an independent predictor for OS in both groups but BMI had statistical significant only in the male group. Keywords: Renal cell carcinoma, Body mass index, Total cholesterol 54

O-003 R.E.N.A.L. nephrometry 점수에따른신장종괴에대한경피하생검에대한결과분석 김진우, 박지수, 안현규, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 본연구진은 203년부터 207년까지 small renal mass (SRM) 에대해경피하생검을진행하였고. R.E.N.A.L Nephrometry score를통해종괴의특징을구분하였고그점수와종괴생검의결과와의관련성을알아보고자하였다. 방법 : 본원에서 203년부터 207년까지영상학적으로진단된 4 cm 이하의신장종괴중진행된 49건의경피적신생검을대상으로하였다. 모두 R.E.N.A.L Nephrometry score에따라구분하였다, 합병증은출혈, 혈종, 혈뇨를대상으로하였고생검정확성은조직병리가진단되지않은건수를이용하여계산하였다. 결과 : 총 49건의신장종괴생검을진행하였고합병증은총 8건발생하여 2% 이었으며진단에실패한경우는 4건으로 9.4% 에해당했다. 고혈압, 당뇨및체질량지수와신장종괴경피적생검의합병증및진단정확성에서는유의미한경향성이보이지않았다. R.E.N.A.L Nephrometry score로신장종괴들을분류했을때낮음 (4-6점) 이 5건으로 34.2%, 중간 (7-9점) 이 75건 50.2%, 높음 (0-2점) 이 23건, 5.4% 를차지하였다. 각각의점수에대해합병증은 5건중 3건 (5.80%), 75 건중 0건 (3.30%) 23건중 5건 (2.7%) 로 Nephrometry score가높을수록합병증이높아지는경향성을발견할수있었다. 추가적으로종괴들을 cm 이하, -2 cm, 2-4 cm으로세분화였을때에도각각의경우에서 R.E.N.A.L Nephrometry score가낮음에서높음으로갈수록합병증의빈도가증가함을알수있었다. 진단의정확성은종괴의크기와경향성을보였는데 cm 이하의종괴에서는 3건중 건 (33.3%) 진단된반면, -2 cm 종괴는 54건중 47건 (87%), 2-4 cm 종괴에서는 94.5% 로증가하였다. 결론 : R.E.N.A.L Nephrometry score를이용하여종괴를구분하였을때그점수가높을수록생검시합병증이높아짐을알수있었고크기가클수록진단의정확성이높아짐을알수있었다. 따라서 4 cm 이하의신장종괴의생검실시전 R.E.N.A.L Nephrometry score를이용하면, 생검후합병증을예측할수있어그점수가높은경우보다더주의를요할필요가있으며종괴의크기가작을수록진단이실패할확률이있음을인지하여야하겠다. Keywords: Renal cell carcinoma, Renal biopsy, Nephrometry score 55

O-004 Yonsei nomogram: a predictive model of new onset chronic kidney disease following partial nephrectomy in patients with T renal tumors Ahmed Elghiaty, Ali Abdel Raheem, Tae Young Chin, Ki Don Chang, Mohamed Alenzi, Young Eun Yoon, Won Sik Ham, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine Purpose: To develop a predictive nomogram for chronic kidney disease (CKD)-free survival probability on the long-term after PN. Methods: A retrospective analysis of 698 patients with T renal tumors undergoing PN at tertiary academic institute was done. A multivariable Cox regression analysis was conducted based on parameters proven to have an impact on postoperative renal function. Patients with incomplete data, less than 2 months follow-up, and preoperative CKD stage III were excluded. The study end points were to identify independent risk factors for new onset CKD development, as well as, to construct a predictive model for CKD-free survival probability after PN. Results: Median age was 52 years and median tumor size was 2.5 cm. Ninety-one patients (3.%) developed new onset CKD at a median follow-up of 60 months. The CKD-free survival rates at -yr, 3-yr, 5-yr, and 0-yr were 97.%, 94.4%, 85.3%, and 70.6%, respectively. On multivariable cox regression analysis, age (hazard ratio [HR]:.04, p=0.00), male (HR:.653, p<0.00), diabetes mellitus (HR:.92, p=0.046), tumor size (HR:.33, p<0.00), and preoperative egfr (HR: 0.937, p<0.00) were independent predictors for new onset CKD. The c-index (95%CI) for CKD-free survival was 0.853 (0.85-0.895). Conclusion: We developed a novel nomogram for predicting the 0-yr CKD-free survival probability following PN. This model may have an important role in PN decision making and follow-up plan after surgery. External validation of our nomogram in a larger cohort of patients should be considered. Keywords: Partial nephrectomy, Nomogram, CKD 56

O-005 Impact of surgical margin status after partial nephrectomy for renal cell carcinoma 이종수, 장원식, 김종찬, 함원식, 한웅규, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실 Purpose: The clinical significance of surgical margin status after partial nephrectomy has a lack of literature. Thus, we analyzed the association between positive surgical margin and risk of cancer recurrence in patients with clinically localized renal cell cancer who underwent partial nephrectomy. Moreover, we evaluated whether a minimal surgical margin less than mm is really safe for cancer control after partial nephrectomy. Materials and Methods: We retrospectively reviewed medical records of 855 patients with clinical T renal mass who underwent partial nephrectomy at our institution between 2005 and 204. After exclusion of patients who benign pathology was reported and those with incomplete pathological or follow-up data, 748 patients were included in the final analysis. We analyzed data using Kaplan-Meier method with log-rank tests and multivariate Cox regression models. Results: Of the 748 patients enrolled in this study, 704 (94.2%) had negative surgical margin and 44 (5.8%) had positive surgical margin. Recurrence-free survival for patients with positive surgical margin was significantly lower compared to those with negative surgical margin (p<0.00). When cases of negative surgical margin were divided into two groups ( mm vs.< mm), there was no significant difference in recurrence-free survival (p=0.604). Both univariate and multivariate Cox regression analyses showed positive surgical margin was a significant predictor of recurrence (hazard ratio 8.03, 95% confidence interval 2.74-23.56, p<0.00), while the safety margin of< mm was not (p=0.680). Conclusions: Our study shows that positive surgical margin resulting from partial nephrectomy increases the risk of recurrence in patients with renal cell cancer. Moreover, we demonstrated that even a safety margin less than mm may be adequate to prevent recurrence. To confirm our findings, not only large-scale but also long-term studies are required. Keywords: Partial nephrectomy, Surgical margin, Local recurrence 57

O-006 부분신적출술후환측신장의장기간추적관찰 김종근 2, 박사현, 김명, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 김청수, 안한종 울산대학교서울아산병원, 2 한림대학교동탄성심병원 Introduction: There has been a debate whether the long-term ipsilateral renal function after partial nephrectomy (PN) is affected by preserved kidney parenchyma volume or ischemic insult during the surgery. Materials and Methods: We analyzed the data from 530 patients who received PN. Separated renal functions were measured preoperatively and followed at postoperative 3 months and annually thereafter using DTPA GFR scan. Perioperative variables affecting the long-term ipsilateral GFR were assessed by the linear mixed model. Results: The mean preop. ipsilateral kidney volume and mean volume at 3 mo. were 70.9 ml/min and 4.6 ml/ min, respectively. The ipsilateral renal volume decreased by 7.2% at postop. 3 mo. The mean preoperative ipsilateral GFR and mean GFR at 3 mo. were 42.9 ml/min and 3.2 ml/min. The ipsilateral GFR decreased by 26.7%. The ipsilateral GFR hit bottom at postoperative 3 mo, recovered thereafter postoperative 4 years (decreased by postoperative, 2, 3, and 4 years GFR; 26.7%, 2.8%, 7.7% and.5%), and no further increment was observed at postoperative 5 years (2.4%; p=0.549). On linear mixed model, age (β=-0.070), prolonged ischemic time (per min; β=-0.60), high preoperative GFR (per ml/min; β=-0.406), and high RENAL score (per point; β=-0.683) were negatively associated with the change of GFR during postoperative 5 years. On the other hands, BMI (β=0.254), male gender (β=2.38) and preserved ipsilateral kidney volume (β=0.305) were positively related to the recovery of GFR. Especially, in the group with lower preop. ipsilateral GFR (<30 ml/min, per %; β=0.239) and more advanced CKD stage ( III, β=0.89), preserved renal volume is only one factor in the recovering of GFR. Conclusion: Long-term GFR was affected by preserved kidney parenchyma volume and ischemic time. Irreversible renal damage can be minimized by the preservation of nephron mass and the reduction of ischemic time. Keywords: Kidney neoplasms, Glomerular filtration rate, Ischemia time 58

O-007 Indicators of CKD upstaging: multicenter long term matched comparison of robotic, laparoscopic and open partial nephrectomy 308 cases 장기돈, 알리압델라힘, 한웅규, 최영득, 나군호 연세대학교의과대학비뇨기과학교실 Introduction: In this study, we aim to compare outcomes between robotic, laparoscopic assisted and open partial nephrectomy (RPN, LPN, and OPN) with a 5-year median follow up. Patients and Methods: A retrospective analyses of 308 patients (RPN n=380, LPN n=206 OPN n=722) who underwent PN between 2003 and 202 in 6 academic centers was carried out. We performed :: propensity score (PS) matching adjustment based on the confounding variables between groups (age, CCI, median tumor size, and preoperative e-gfr). Results: In the perioperative outcomes, there were significant differences in the mean operative time, mean estimated blood loss (EBL) and mean period of hospital stay between there groups (82.53±68.60, 24.98±90.04, and 72.58±64.00, P<0.00, 39.84±467.59, 422.6±46.53 and 30.9±347.9 P=0.049, 5.38±46, 6.97±4.37, and 6.2±3.24, P<0.0087), (RPN, LPN, and OPN, respectively). In the oncological outcomes, there were no differences between three groups regarding local recurrence, metastasis, and cancer death (p>0.05). In the postoperative renal functional outcomes,there were diffierences of CKD upstaging between three groups [25 (20.5%), 39 (32.0%), 4 (33.6%) (RPN, LPN, OPN)] (P=0.048). On the logistic regression analysis, RPN, higher preoperative egfr, and lower age were predictors for prevent of CKD upstaging. Conclusions: Among long-term renal functional outcome, RPN, higher preoperative egfr, and lower age were predictors for prevent of CKD upstaging. Long-term oncological outcome between these approaches was comparable at median follow-up of 5-years. Keywords: Chronic kidney disease, Partial nephrectomy, Robotic 59

O-008 부분신절제술후기능변화예측에있어 CSA, RENAL, PADUA 및 C-index 의포괄적비교 : 컴퓨터단층촬영기반신장용적측정법을사용한접근법 이찬호, 구자윤, 백승룡, 이경, 김경환, 박지훈, 강병진, 하홍구 부산대학교병원 Objective: To evaluate the renal cortical volume (RCV) change after nephron sparing surgery and the predictive value of nephrometry score in RCV preservation after partial nephrectomy. Materials and Methods: Overall, 62 patients with renal tumors treated with open partial nephrectomy were retrospectively analyzed. The renal cortical volume (RCV) of tumor-bearing kidney was measured preoperatively and postoperatively using dedicated software. CSA, RENAL, PADUA, and C-index were obtained from preoperative CT scan. The correlation between nephrometry scores and perioperative parameters were evaluated, and the 4 nephrometry scores were compared in predicting reduction in RCV. Results: The median percent reduction in RCV of operated kidney was 7% and the median percent reduction in global egfr was 5.6%. All scores showed a significant association with reduction in RCV (p<0.00), percent reduction in RCV (p<0.00), and estimated blood loss (CSA and C-index, p<0.00; RENAL, p=0.07; PADUA, p=0.004). CSA and PADUA scores showed a significant association with percent reduction in egfr (p=0.038 and p=0.026). On multivariate analysis CSA, PADUA, C-index independently affected percent reduction in RCV (p=0.003, p=0.025, and p=0.03, respectively). No correlation was found for the RENAL score (p=0.234). On ROC curve analysis CSA was a better independent predictor of greater than 0% and 20% percent reduction in RCV (AUC 0.89 and 0.723, respectively). Conclusions: CT based RCV measurement successfully differentiated the RCV change after partial nephrectomy. Compared to other nephrometry scores, CSA was a superior predictor for RCV change of operated kidney. Keywords: Nephrometry score, Partial nephrectomy, Renal cortical volume 60

O-009 복강경하부분신절제술의혈관결찰과신절제마진확보방법에따른단기 6 개월신기능비교연구 강수환, 강필문, 류현열, 김택상 고신대학교의과대학비뇨기과학교실 Objective: To analyze the effect of renal hilar-clamp and depth of safety margin on short-term change of renal function after laparoscopic partial nephrectomy (LPN). Materials and Methods: We retrospectively reviewed 0 cases of LPN performed between March 2008 and January 207 in our hospital. Of these, 98 patients were enrolled in this study who were able to measure the width of the peripheral and central parenchymal safety margin on resected specimen and were able to observe for 6 months after operation. By the renal hilar-clamp/off-clamp and tumor resection/enucleoresection, we divided the patients into 3 groups, resection with hilar-clamp (group ), and enucleoresection with off-clamp (group 2), enucleoresection with renal hilar-clamp (group 3). Results: The patient number of group, 2, and 3 were 23, 40, and 35, respectively. Age (mean 58.8, 56.2, 59.5 years old), mass size (mean 3.0, 2.9, 3.3 cm), operation (anesthesia) time (mean 80.6, 67.3, 78.5 min), estimated blood loss (mean 39.5, 324.6, 305. ml), hemoglobin decline (mean.62,.74,.32 g/dl), preoperative egfr (mean 92.0, 90.3, 94.2 ml/min/.73 m 2 ) were not different between groups. RENAL nephrometry score, tumor size, pathologic outcome, pt stage and complication rate were also not different between groups. Mean postoperative egfr at 6 months was 84.3, 92.9, 93.9 ml/mim/.73 m 2, peripheral parenchymal safety margin of the renal tumors was 3.35,.34,.53 mm, and the central parenchymal safety margin was.22, 0.0, 0.0 mm in the, 2, 3 group, respectively. Postoperative egfr at 6 months showed higher trend in group 2,3 than group (one-way ANOVA, p=0.056). However, there was no significant difference between group 2 and 3 (post-hoc analysis, group 2 vs 3, p=0.67). Mean warm ischemia time were 25.6, 0, and 22.9 minutes in group,2,3 respectively. Conclusion: With enucleoresection, there was no difference in short-term renal function change between hilar-clamp and off-clamp (group 2 vs 3). When renal hilar-clamp was performed, however, there were significant differences in renal function change between the resection group and the enucleoresection group (group vs 3). The minimal safety margin (preserved renal parenchymal voluime) is a significant factor for minimal renal function loss after LPN. Further follow-up of long-term renal function is necessary. Keywords: Laparoscopin partial nephrectomy, Renal function, Depth of safety margin 6

O-00 Outcome of off-clamp robot-assisted partial nephrectomy: propensity matched comparison to on-clamp Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Purpose: Several studies have shown better renal functional outcomes of off-clamp robot-assisted partial nephrectomy (RAPN). The aim of this study is to compare the risks of developing chronic kidney disease (CKD) in patients undergoing either off-clamp or on-clamp RAPN. Methods: Patients who underwent trans-peritoneal RAPN for renal tumor at our institution between 2006 and 207 were retrospectively analyzed. Patients were divided into 2 groups according to the clamping type. Group A if on-clamp (n=96) and group B if off-clamp (n-62). A : propensity score-matched (PSM) analysis was performedto minimize the selection bias for the following variables: tumor size, clinical stage, preoperative CKD, PADUA score and complexity. Kaplan-Meier analysis curve was performed to assess and compare the CKD free survival between both groups. Results: Before matching patients in group Ahad larger tumors (p<0.00), higher clinical stage (p=0.032), more complex PADUA score (p<0.00), and higherprevalence of advanced CKD (p=0.025) and complex tumors (p<0.00). After matching, the two cohorts of 62on-clamp and 62off-clampRAPN cases did not differ for all clinical and pathologic covariates (p>0.05). Regarding renal function at the last follow-up, there were no significant difference in latestegfr (p=0.86), overall CKD upgrading (p=0.46), as well as CKD upstaging 3 (p=). The 4-yr CKD free survival was 85% vs 87.% in the off-clamp and on-clamp RAPN, respectively (log-rank, p=0.643). Conclusions: The present study shows that off-clamp RAPN had no long-term functional benefits with similar CKF free-survival rate compared to on-clamp RAPN. Further larger prospective studies are warranted to evaluate the exact functional benefit of off-clamp RAPN technique. Keywords: Robotic, Partial nephrectomy, Off-clamp 62

O-0 효소생물연료전지를이용한나노스케일전기자극의정자운동성에대한영향 김대근, 신태은 2, 박진우 2, 이은지 2, 이재호 3 CHA의과학대학교서울역센터 비뇨기과학교실, 2 남성의학연구실, 3 CHA의과학대학교의생명과학과 Objectives: To investigate the impact of nanoscale electrical stimulation of enzymatic biofuel cell in human sperm motility. Methods: The enzymatic biofuel cell (EBFC) is set up by two different enzymes: one being the glucose oxidase (GOX) for the generation of the anodic current only to be followed by the oxidation of glucose; the other being Bilirubin oxidase (BOD) for the generation of cathodic currents only to be followed by oxygen reduction. At the anode electrode site, glucose is oxidized by GOX in the anode electrode. Then the electron is made in to the anode electrode. Anode electrodes have many electrons. So the anode electrode can give the electron to the cell through media solution. This condition is rich of electrons. At the cathode electrode site, oxygen reacting with the hydrogen in the media solution can be changed to water by BOD. Electrons would then be consumed by BOD from the media solution, as this condition is poor of electrons. Then the electron grade condition of the enzymatic biofuel cells create electrical currents between anodic (electron rich) and cathodic (electron poor) sites in the culture dish. The electrical amps are then regulated and increased by the enzyme concentration from 0 na to ma. Ejaculated semen followed a regular procedure for motile sperm preparation for proper analysis. Then each samples performed a motility analysis by computer-assisted semen analysis (CASA) and looked into the viability of the sperm, and went through an acrosomal reaction test using fluorescein isothiocyanate-conjugated Pisum sativum lectin. The optimal electrical stimulation condition of the EBFC which enhances sperm motility was compared to the control group. Results: We found enhancement of sperm motility from 0 na to 500 na of electrical stimulation by EBFC. Electrical stimulation enhanced the mitochondria functional activity through the biogenesis of tyrosine phosphorylation signaling on spermatozoa. ma didn t show an enhanced effect to the sperm motility. However, electrically stimulated sperm had no significant effects in acrosome reaction and sperm viability compared to the control group. Conclusion: EBFC can be applied for male infertility therapy such as an enhancer for asthenozoospermia patient. Keywords: Nanoscale electrical stimulation, Enzymatic biofuel cell, Sperm motility 63

O-02 발기부전유발당뇨동물모델에서새로운세대저에너지충격파치료의효능 정현철, 전승환, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅가톨릭대학교서울성모병원 Purpose: The treatment of refractory erectile dysfunction is still under investigation for gene and stem cells and low-energy shockwave therapy, but the evidence is insufficient. We investigated the effect of a new generation electro-magnetic cylinder type ESWT device on erectile dysfunction animal model. Materials and Methods: DM induced rats were divided into 3 groups. for control, 2 for DM, and 3 for DM + ESWT. ESWT treatment was three times a week for 2 weeks. After the treatment course, intracavernous pressure was measured. And corpus cavernosum and cavernous nerve were evaluated. Results: In DM group, parameters that we expected to significantly lower in erectile dysfunction model were all statistically significant decreased (p<0.0). As a measurement of erectile function, we evaluated intracavernous pressure and DM + ESWT group restored erectile function significantly compared to the DM group (p<0.05). And we found ESWT treatment restored smooth muscle contents through Masson s trichrome staining (p<0.05). ESWT increased nnos significantly compared to DM group (p<0.05) in the immunohistochemstry of nnos test of dorsal nerve tissue. And finally, using immunohistochemistry, western blot and ELISA, we evaluated corporal tissue. After ESWT treatment, VEGF, enos, PECAM-, cgmp expression were recovered compared to DM group (p<0.05). Conclusions: We confirmed the electromagnetic cylinder type ESWT's efficacy using a DM-associated ED model. It seemed that safe and effective application in future clinical studies is possible. Keywords: Erectile dysfunction, Animal, ESWT 64

O-03 인간전압의존성양성자통로의단백질키나아제 C 매개활성화를통한양파껍질추출물 (OPE) 의인간정자운동성조절 채미리, 강수정, 방석환, 성현환, 이성원 성균관대학교의과대학삼성서울병원비뇨기과학교실 Objectives: Onion (Allium cepa L.) and quercetin protect against oxidative damage and have positive effects on multiple functional parameters of sperm, including viability and motility. However, the associated underlying mechanisms of action have not yet been identified. The aim of this study was to investigate the effect of onion peel extract (OPE) on voltage-gated proton (Hv) channels, which play a critical role in rapid proton extrusion. This process underlies a wide range of physiological processes, particularly male fertility. Materials & Methods: HEK 293 cells were transiently transfected with pqbi25-fc3 of human Hv (HVCN), using commercially available transfection reagent. At 20-24 h after transfection, the cells were used for electrophysiological experiments. For the electrophysiological studies, the whole-cell patch clamp recording technique was used to record the changes in Hv currents. The effects of OPE on human sperm motility were also analyzed. Results: OPE significantly activated the outward-rectifying proton currents in a concentration-dependent manner, with an EC50 value of 30 μg/ml. This effect was largely reversible upon washout. Moreover, OPE induced an increase in the proton current amplitude and decreased the time constant of activation at 0 mv from 4.9±.7 s to 0.6±0. s (n=6). In the presence of OPE, the half-inactivation voltage (V/2) shifted in the negative direction, from 20.±5.8 mv to 5.2±8.7 mv (n=6), but the slope was not significantly altered. The OPE-induced current was profoundly inhibited by 0 μm Zn2+, the most potent Hv channel inhibitor, and was also inhibited by treatment with GF09203X, a specific protein kinase C (PKC) inhibitor. Furthermore, sperm motility was significantly increased in the OPE-treated groups. Conclusions: OPE exhibits protective effects on sperm motility, at least partially via regulation of the proton channel. Moreover, similar effects were exerted by quercetin, the major flavonoid in OPE. These results suggest OPE, which is rich in the potent Hv channel activator quercetin, as a possible new candidate treatment for human infertility. Keywords: Hv channel, Onion (Allium cepa L.) peel extract, Sperm motility, Quercetin 65

O-04 Genetic screening for Y chromosome microdeletions in,226 infertile men from Korea 이효석, 김신영 2, 최진호, 이중식, 서주태 단국대학교제일병원 비뇨기과, 2 유전학연구실 Objective: To investigate the frequencies and types of Y chromosome microdeletions and analyze their association with defective spermatogenesis in infertile men from Korea. Methods: A total of,226 infertile men were screened for Y chromosome microdeletions using multiplex polymerase chain reaction (PCR) assay. Semen samples were analyzed according to the World Health Organization guidelines and karyotype analysis was performed on peripheral blood lymphocytes with standard G-banding. Serum reproductive hormone (FSH, LH, T, PRL and E2) levels were also measured in all infertile men. Results: Out of,226 infertile patients, 34 (0.93%) presented Y chromosome microdeletion. Of these, 07 of 765 (3.99%) were from the non-obstructive azoospermic and 27 of 33 (20.30%) from the severe oligozoospermic patients. Deletion of AZFc was the most common in both non-obstructive azoospermic (43/765, 5.62%) and severe oligozoospermic patients (26/33, 9.55%) and showed significant difference between the two groups (P<0.00). Only non-obstructive azoospermic patients presented AZFa, AZFb, AZFabc(Yq), or Yp(SRY)+Yq microdeletions. Among the 34 infertile men with Y-microdeletions, the most frequent microdeletions were detected in the AZFc region, followed by AZFbc, AZFb, AZFa, AZFabc (Yq), Yp (SRY)+Yq, and partial AZFc regions. Karyotype analysis was available for 30 (97.02%) of the 34 infertile patients with Y deletion. Of them, 36 (27.69%) patients (all with non-obstructive azoospermia) had sex chromosomal abnormalities. The levels of FSH and LH in patients with AZFc microdeletion were significantly lower, while those in patients with Yp (SRY)+Yq were significantly higher than in patients without Y microdeletions. And T levels in both infertile patients with AZFabc (Yq) and Yp (SRY)+Yq were significantly lower. However, there was no significant difference in the levels of reproductive hormones between total patients with and without Y microdeletions. Conclusion: These results highlighted the need for Y chromosome microdeletion screening to provide a correct diagnosis of male infertility. It is also useful to obtain reliable genetic information for assisted reproductive techniques, thus avoiding unnecessary treatment and vertical transmission of genetic defects to offspring. Keywords: Male infertility, Y chromosome microdeletion, Azoospermia factor (AZF), Non-obstructive azoospermia, Severe oligozoospermia 66

O-05 Relationship between sperm parameters and human sperm dna fragmentation (SDF) as assessed with the sperm chromatin dispersion test 이효석, 박용석 2, 최진호, 이중식, 서주태 단국대학교의과대학제일병원 비뇨기과, 2 생식의학연구실 Objective: This study was performed to evaluate and compare threshold values of sperm parameters and the sperm DNA fragmentation index (DFI), and further analyzed whether normal and abnormal sperm DFI could be predicted from sperm parameters. Materials and Methods: A retrospective study was performed in 256 cases of semen analysis. Sperm parameters were assessed by the World Health Organization (WHO) guideline. Sperm parameters (count, motility, viability, morphology) were assessed and normal values are as follow; count 5 0 6 /ml, motility 40%, viability 58%, and morphology 40%. SDF test was assessed using the Halosperm kit. The fragmentation rate was calculated by the SDF (%)=(fragmented spermatozoa/total 500 spermatozoa counted) 00. Threshold value exceeds as 30% of SDF considered as abnormal. Sperm parameters and sperm DFI results were compared. Results: The overall sperm parameter results and sperm DFI were within normal range; however, morphology values were at the lower limit of those values. The sperm count of the low ( 30%) and high (>30%) sperm DFI groups was similar; however, high sperm DFI was associated with significantly lower motility, viability, and morphology (p<0.05 for all). Sperm motility and morphology were significantly higher in the higher sperm count group compared to the lower sperm count group (p<0.05), while sperm DFI was higher in the lower sperm count group (p<0.05). Sperm parameters and sperm DFI were significantly affected by the quality of sperm motility. In contrast, sperm morphology did not affect viability and sperm DFI in normal value. Sperm viability was not associated with sperm count or motility in normal value. Conclusions: In this study, the negative impact of SDF on sperm parameters was confirmed. Sperm parameters such as count, motility, and viability may be contributing factors. In this study, lower sperm parameters were indicative of increasing SDF. Keywords: Semen parameter, Sperm DNA fragmentation 67

O-06 비폐쇄성무정자증환자에서수술현미경이 microsurgical TESE 정자추출률에미치는영향 김기영, 변현근, 이영진 2, 김종현 미즈메디병원비뇨기과, 2 아이드림센터 목적 : 비폐쇄성무정자증환자의해결방법으로사용되고있는 Microsurgical TESE의정자추출률은수술자의경험, 수술시간뿐아니라수술기구에따라영향을받을수있다. 이에수술현미경이 Microsurgical TESE 정자추출률에미치는영향을알아보고자하였다. 대상및방법 : 2008년 월부터 207년 5월까지남성불임을주소로내원하여정액검사, 혈액검사, 고환조직검사후비폐쇄성무정자증으로진단되고 microsurgical TESE를시행받은 24명의환자를대상으로하였다. 203년 5월까지는 oms- 75 microcope을사용하였고 6월부터는고배율고해상도가가능한 ZEISS사에서제작한 OPMIVARIOS88 microscope으로 microsurgical TESE를하였다. 고환의조직병리학적진단에따라정자형성저하증 (hypospermatogenesis), 성숙정지 (Maturation arrest), 생식세포무형성증 (germ cell aplasia, Sertoli cell only syndrome) 으로구분하여 Microsurgical TESE 시정자추출률을비교하였으며, 수술현미경에따른정자추출률의차이도비교분석하였다. 결과 : 환자들의평균연령은 34.4세였고, 조직학적으로정자형성저하증 4명, 성숙정지 3명, 생식세포무형성증 74명이었다. 전체환자 24명중 56명 (45.2%) 에서정자추출에성공하였는데, 정자형성저하증 35명 (85.4%), 성숙정지 명 (7.7%), 생식세포무형성증 20명 (27%) 에서정자를추출하였다. 수술현미경에따른정자추출률은 203년 5월까지 OMS-75 microscope을사용한경우 85명중 36명 (42.4%) 에서정자를추출하였는데, 정자형성저하증 28명중 24명 (85.7%), 성숙정지 7명중 명 (4.3%), 생식세포무형성증 50명중 명 (22%) 에서정자추출이가능하였다. 203년 6월부터새로도입된 PMIVARIOS88 microscope을사용한경우에는 39명중 20명 (5.3%) 에서정자가추출되었고, 정자형성저하증 3명중 명 (85.7%), 성숙정지 6명중 0명 (0%), 생식세포무형성증 20명중 9명 (45%) 이었다. 수술현미경에따른분석에서는정자형성저하증과성숙정지환자에서는정자추출률에있어유의한차이를보이지않았지만, 생식세포무형성증환자에서는고배율고해상도가가능한새로운수술현미경을사용한경우통계학적으로유의하게향상된정자추출률을보였다. 결론 : 수술현미경을이용한 Microsurgical TESE를통하여절반가까운비폐쇄성무정자증환자에서고환내정자를얻을수있었다. 특히생식세포무형성증환자에서는고배율, 고해상도가가능한새로운수술현미경을사용한경우정자형성조직을좀더세밀하게구분하는것이가능하여유의하게향상된정자추출률을보였다. Keywords: Non-obstructive azoospermia, Sperm retrieval, Operative microscope 68

O-07 당뇨성발기부전마우스에서항 -prongf 항체의혈관신생및신경재생을통한발기력개선효과 응웬낫민, 송강문, 최민지, 칼얀가탁, 권미혜, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 Purpose: Patients with diabetic erectile dysfunction (ED) usually respond poorly to oral PDE5 inhibitors due to a lack of bioavailable nitric oxide from severe endothelial and neural dysfunction. ProNGF and its receptor p75ntr are known to be up-regulated in diabetic condition and to induce endothelial cell apoptosis and neuronal degeneration. The aim of this study was to investigate effectiveness of anti-prongf neutralizing antibody (prongf-ab) in restoring erectile function in streptozotocin-induced diabetic mouse. Methods: Diabetes was induced by intraperitoneal injection of streptozotocin (50 mg/kg) into 8-week-old C57BL/6 male mice for 5 consecutive days. At 8 weeks after the induction of diabetes, the animals were divided into 3 groups: controls, streptozotocin-induced diabetic mice receiving repeated intracavernous injections of PBS (days -3 and 0; 20 μl) or prongf-ab (days -3 and 0; 20 µg in 20 μl of saline). We measured erectile function by electrical stimulation of the cavernous nerve at 2 weeks after treatment. The penis was then harvested for histologic examination. Results: Local delivery of prongf-ab into the corpus cavernosum of diabetic mice induced significant restoration of erectile function in diabetic mice (90-00% of control values). ProNGF-Ab significantly increased cavernous endothelial cell content and endothelial cell-cell junction proteins (VE-cadherin and claudin-5); decreased endothelial cell apoptosis; and restored neuronal cell content in the cavernous tissue of diabetic mice. Conclusion: Our findings suggest that inhibition of prongf pathway is a promising therapeutic strategy for diabetic ED. Keywords: Erectile dysfunction, Diabetes, prongf pathway 69

O-08 웹설문을이용한한국의발기부전에대한 0 년추적연구 송원훈, 박주현 2, 조성용 2, 조민철 2, 정현 2, 손환철 2 서울대학교병원비뇨기과, 2 서울특별시립보라매병원비뇨기과 Background: Previous surveys for erectile dysfunction (ED) are mostly cross-sectional in nature and serial follow-up studies are rare. Objectives: Conduction of a 0-year follow-up study on the prevalence and risk factors of ED in Korea using a web-based survey. Design, Setting, and Participants: We sent e-mails to the panels registered in the Internet survey agency,and requested to participate in the survey of the same design as that in the 2006 study. The participants were requested to complete questionnaires on socioeconomic status, health conditions, sexual behavior,and attitude. ED and voiding symptoms were evaluated by the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS). Outcome Measurements and Statistical Analysis: ED risk factors analyzed using multivariate logistic regression analysis. Results and Limitation: In total, 900 participants were recruited. The overall prevalence, after adjusting for age, of self-reported ED (self-ed) and IIEF-5 score 2 (IIEF-5-ED) in the 206 study was 6.0% and 50.6%, decreased compared with a prevalence of 8.% and 5.4% in 2006. The mean total IPSS score of the self-ed group was 9.±0.9, which was higher than the score of 7.0±0.2 in the no-self-ed group. As IIEF-5-ED severity increased, the mean total IPSS score of those with IIEF-5-ED also increased from 6.9±0.3 to 2.0±4.. Age, marital status, current smoking, alcohol consumption, diabetes mellitus,chronic kidney disease, depression, prostatic disease, constipation, experience of rape or sexual harassment, and self-reported premature ejaculation were significant risk factors in multivariate models of self-ed and IIEF-5-ED. The limitation was that it was not a cohort study. Conclusions: Compared with that in the 2006 study, the prevalence of self-ed and IIEF-5-ED wasslightly decreased; however, risk factors such as age and smoking remained significant. Keywords: Erectile dysfunction, International index of erectile dysfunction, Web-based survey 70

O-09 페이로니병환자의섬유화경결에서분리된섬유모세포에서 activin receptorlike kinase 5 저해제의항섬유화효과 최민지, 송강문, 칼얀가탁, 응웬낫민, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 목적 : Transforming growth factor-β (TGF-β) 신호전달경로는페이로니병을포함한여러섬유화질환의병인에중요한역할을한다. 특히 activin receptor-like kinase 5 (ALK5) 는 TGF-β 제형수용체로서 TGF-β-매개섬유화병변의진행에있어서핵심적인역할을한다. 본연구에서는페이로니병환자의섬유화경결에서분리된섬유모세포에서최근에개발된 ALK5 저해제의항섬유화효과를평가하였다. 대상및방법 : 페이로니병환자의섬유화경결조직으로부터섬유모세포에대한일차배양을시행하였고, 섬유모세포-특이마커항체를이용하여섬유모세포를분리하였다. 실험은대조군, TGF-β 처리군 (0 ng/ml), TGF-β (0 ng/ml) + ALK5 저해제처리군 (400 ng/ml) 으로나누어진행하였다. TGF-β을 시간처리후 ALK5 저해제에의한 Smad2/3 의인산화및핵내전위 (nuclear translocation) 를 western blot과면역형광염색으로평가하였다. TGF-β을 24시간처리후 ALK5 저해제에의한세포외기질 (extracellular matrix) 의발현양상을 plasminogen activator inhibitor- (PAI-), fibronectin, collagen I, IV에대한 western blot과면역형광염색으로평가하였고, hydroxyproline assay도시행하였다. 또한fibroblast에서 myofibroblast로의 differentiation을확인하기위해서 phalloidin/α-sma에대한면역형광염색을수행하였다. 결과 : 페이로니병환자의섬유화경결에서분리된섬유모세포에서 TGF-β 투여후 Smad2/3 인산화및핵내전위가촉진되었고, PAI-, fibronectin, collagen I, IV에대한단백발현및 collagen 합성이현저하게증가되었다. ALK5 저해제는 Smad2/3의인산화및핵내전위를효과적으로차단함으로써세포외기질의합성및 myofibroblastic differentiation을정상수준으로회복하였다. 결론 : ALK5 저해제는 TGF-β 경로를성공적으로억제함으로써항섬유화효과를나타냈다. 향후페이로니병동물모델을이용한추가연구가필요하다. Keywords: Peyronie s disease, Fibroblast, Activin receptor-like kinase 5 7

O-020 통증을주소로시행한고환정계정맥류제거술후장기추적관찰시수술성적및술후통증개선의영향인자분석 송원훈, 김정권, 조민철 2, 손환철 2, 김수웅, 백재승 서울대학교병원비뇨기과, 2 보라매병원비뇨기과 연구배경 : 고환정계정맥류제거술은보존적치료에도지속되는통증이주소인환자에대한선택적치료법이다. 하지만, 지금까지의연구들은적은환자수와짧은추적기간동안의결과들이대부분이었고, 수술성공률과통증호전의영향인자에대해서도다양하게보고되었다. 본연구에서는음낭통증을주소로내원한 300명이상의정계정맥류환자에서정계정맥류제거술시행후장기추적관찰시통증에대한수술성적과통증호전의영향인자에대해분석해보고자하였다. 연구방법 : 2004년부터 207년까지통증을주소로정계정맥류제거술을시행받고 2년이상추적관찰이이루어진 32명의환자를대상으로후향적분석을시행하였다. 술전나이, 일측성혹은양측성, 정계정맥류의심한정도, 문진을통한통증의성상및통증유병기간등을분석하였다. 술후외래추적관찰시신체검진을통해정계정맥률소실유무를, 통증개선정도는문진을통해통증의소실 / 호전 / 지속또는악화로구분하였다. 수술의성공은정계정맥류와통증둘다소실된경우로정의하였고, 그렇지않은경우는실패로정의하였다. 술전정액검사시행을원칙으로하였고, 술전과비교하여술후 20% 이상의상승이관찰되었을때이를정액검사지표의호전으로정의하였다. 결과 : 2004년부터 207년까지통증을주소로내원하여정계정맥류제거술을시행받은환자는총 32명이었고, 평균나이 24.4세, 통증유병기간은평균 7.2±3.0개월그리고술후평균추적기간은평균 28.9±3.3개월이었다. 정계정맥류환자들의 96.5% 에서일측성이었고, 증증도에따라 grade I이 2.6%, grade II가 22.% 그리고 grade III가 75% 였다. 20% 이상의양측고환크기의차이가나는경우가 35.3% 였다. 통증의성상은둔통이 88.5%, 견인통이 4.2%, 욱씬거리는통증이.3% 그리고찌르는듯한날카로운통증이.6% 였다. 정계정맥류에대한소실, 음낭통증에대한소실및정액검사의호전을나타낸환자는각각 96.8%, 78.8% 그리고 45.8% 였다. 이에따라, 수술성공률은 77.7% 였다. 나이, 정계정맥류의중증도, 통증유병기간, 정액검사에서정자모양의엄격기준형태이상을보이는환자비율이수술성공군과그렇지않은군에서차이가있었다 (P<0.05). 다변량로지스틱회귀분석에따라, 나이 (P=0.05) 와통증유병기간 (P=0.00) 이통증호전의유의한예측인자였다. 결론 : 본연구를통하여, 고환정계정맥류제거술은통증이주소인정계정맥류환자에대한효과적인치료법임을알수있었다. 또한나이가어릴수록, 통증유병기간이짧을수록정계정맥류에의한음낭통증이소실될가능성이높았다. Keywords: Varicocelectomy, Testicular pain, Surgical outcome 72

O-02 배뇨근저활동성이동반된전립선비대증환자의요로상피에서 adenosine triphosphate 와 nitric oxide 의변화 조강준, 최진봉, 고준성, 김준철 가톨릭대학교부천성모병원 Purpose: The cause of detrusor underactivity (DU) is multifactorial, but its pathophysiology is still so unclear that its diagnosis and management remain difficult. Urothelium can release several neurotransmitters. We investigated changes in the expression of adenosine triphosphate (ATP) and nitric oxide (NO) in the urothelium of DU with benign prostatic hyperplasia (BPH). Materials and Methods: We prospectively enrolled 30 men who planned to undergo surgical treatment for BPH. Patients whose bladder contractility index (BCI) was less than 00 were assigned to the DU group (n=5), while patients whose BCI was more than 00 were assigned to the no DU group (n=5). Bladder mucosal specimens were collected during surgical prostate resection, and ATP and endothelial nitric oxide synthase (enos) were analyzed from these specimens. The expression levels of ATP and enos were compared between the two groups. The correlation of urodynamic parameters with ATP and enos in all patients were assessed. Results: There were no relevant differences between the DU and no DU groups except in IPSS quality of life score, which in the no DU group was significantly lower than of the DU group. In urodynamic results, patients in the DU group had lower uroflow rates, larger postvoid residuals, lower detrusor contractility and lower BOO grades than those in the no DU group. The expression levels of enos were not significantly different between the DU and no DU groups (3.393±0.969 vs..94±0.377 IU/ml, P=0.247). However, the expression level of ATP in the DU group was significantly lower than that in the no DU group (.289±0.320 vs. 9.262±3.285 pmol, P=0.0). In addition, ATP was positively correlated with BCI (r=0.478, P=0.08) and detrusor pressure on maximal flow (r=0.4, P=0.046) in all patients. Conclusions: ATP in urothelium was significantly decreased in DU with BPH and may reflect a change in detrusor function. ATP may play an important role in the pathophysiology of DU and it should be considered a potential diagnostic biomarker and treatment target for DU. Keywords: Adenosine triphosphate, Nitric oxide, Detrusor underactivity 73

O-022 전립선건강검진데이터에서연령에따른배뇨및저장증상의변화 이신우, 윤솔, 도정모, 서덕하, 이천우, 제성욱, 최세민, 감성철, 화정석, 정기현, 현재석경상대학교의과대학비뇨기과학교실, 경상대학교병원 Purpose: To evaluate the age related changes in IPSS (International Prostate Symptom Score) storage and voiding subscore in prostate health screening data. Materials and Methods: From 2009 to 206 years, the prostate health screening data for general public were analyzed. Patients with prostate cancer or prostate specific antigen (PSA) elevation (>3) which needed further evaluation were excluded. All patients had IPSS questionnaire and the sum of 8 voiding subscore or 6 storage subscore were considered as significant symptoms. Results: Total 4097 men were included. The mean age was 73.7 years and mean prostate volume and PSA were 28.8 cc and.±0.7 ng/ml. About % (n=4452) patients had benign prostatic hypertrophy (BPH) medication history. Of total cohort, 34.2% men were asymptomatic and men with storage symptom only or voiding symptom only or both symptom were 2.7%, 3.2% and 39.8% respectively. Increasing with age, the rate of asymptomatic group (58.6 to 25.0%) and voiding symptom only group (5.6 to 0.6%) were decreased and that of storage only group (6.7 to 4.6%) and both symptom group (9.2 to 49.8%) were increased. The rate of BPH medication was also increased with age from 4.4% to 3.0%. Both the sum of voiding subscore and storage subscore showed significant elevation with age and storage subscore (4. to 7.2, 75.6%) showed higher rate of increase compared with voiding subscore (6.3 to 9.4, 49.2%). Conclusions: Through large-scale cohort study, we could find the rates of storage only and both symptoms groups were significantly increased with age. As a clinician, it is necessary to pay more attention to aged patients with storage symptoms. Keywords: Prostate, Age, Overactive bladder 74

O-023 The efficacy and validity of the penile cuff test as an alternative diagnostic tool for bladder outlet obstruction. 태종현, 윤성구, 김승빈, 김재윤, 심지성, 강성구, 강석호, 천준, 김제종, 이정구 고려대학교의과대학비뇨기과학교실 Introduction: The current standard for the diagnosis of bladder outlet obstruction (BOO) in men is determined by results from the urodynamic study (UDS) or to be more specific, the pressure-flow study (PFS). The aim of our study is to evaluate the validity of the penile cuff test (PCT) for diagnosis of BOO. Methods: We enrolled male patients with moderate to severe lower urinary tract symptoms candidates for HOLEP. A total of 84 patients underwent both PFS and PCT from June st, 206 to June st, 207 at a single institute were reviewed retrospectively. The validity of the PCT was evaluated by comparing results from the PFS and estimating the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Results: Overall, at PCT 36 patients were diagnosed as obstructed and 48 patients as unobstructed. At the subsequent PFS, 3 out of 36 patients diagnosed as obstructed at PCT were confirmed to be obstructed. 30 out of the 48 unobtructed at PCT were confirmed to be unobstructed at PFS. By defining PFS results as the standard diagnosis for BOO, PCT showed a SE of 63.3% and a SP of 85.7%. The "obstructed positive predictive value" of the PCT was 86.% and the "non-obstructed-equivocal negative predictive value" was 62.5%. Conclusion: PCT can be an efficient tool in evaluating candidates for HOLEP. In particular, it showed good reliability in ruling out BPO because of its high NPV, with a high rate of correctly classified patients overall. Further studies on a huger number of patients are needed, including post-operative follow-up as well. Keywords: Penile cuff test, Pressure flow study, BPH 75

O-024 Can penile cuff test predict the outcomes of Holmium laser enucleation of the prostate for benign prostatic obstruction? 고광진, 이규성,2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 삼성융합의과학원의료기기산업학과 Purpose: To determine whether the PCT can predict the surgical outcomes prior to Holmium laser enucleation of the prostate (HoLEP) for benign prostatic obstruction Materials and Methods: Men scheduled to undergo HoLEP were enrolled and all patients underwent PCT prior and 3 months after surgery. Patients were categorized as obstructed (upper left quadrant), non-obstructed (lower right quadrant) or uncertain (upper right or lower left quadrant) by nomogram. Surgical outcomes were assessed by change in international prostate symptom score (IPSS), quality of life (QoL) index, and maximum flow rate (Qmax) pre-operatively and 3 months post-operatively. The proportion of patients with good outcome was compared among PCT nomogram-classified groups, and postoperative changes in position on the PCT nomogram were assessed. Results: A total of 25 patients were analyzed. After HoLEP, overall efficacy and symptom efficacy were not different between obstructed and non-obstructed patients. However, functional efficacy was significantly higher in obstructed patients (75.7% [95% CI; 65.7-85.8]) than in non-obstructed patients (53.6% [95% CI; 33.7-75.4]) (Table ). The percentage of good responders in the QoL category was significantly higher in the obstructed group than in the non-obstructed group (p=0.02). After HoLEP, 75.7% of patients with BOO and 63.6% of patients categorized as uncertain were moved to the non-obstructed category, while 77.3% of non-obstructed patients remained in the non-obstructed category (Figure ). Conclusions: A PCT nomogram can be used in patients with BOO to predict good functional outcome and QoL. The majority of patients were classified as non-obstructed after HoLEP. Keywords: Bladder, Urodynamics, Bladder-neck obstruction 76

O-025 전립선비대증환자에서알파차단제사용의결과예측을위한탄성초음파영상의유용성 손수민, 오정훈, 박태주, 신상수, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 권동득, 박광성, 강택원 전남대학교의과대학 비뇨기과학교실, 2 영상의학과학교실 Purpose: 전립선비대증에연관된하부요로증상중폐색증상은전립선의크기와관련이있을것으로생각할수있으나주관적증상정도는이에비례하지않고, 약물의선택과그효과예측을위한인자가거의없다. 탄성초음파를이용하여전립선조직의탄성을측정함으로써증상과의관계, 약물치료의효과를예측할수있는지연구하였다. Materials and Methods: 하부요로증상을호소하는남성 57명을대상으로하였다. 탄성초음파를이용하여전립선의요도주변이행대 / 변연부비율 (central/peripheral ratio; C/P ratio) 을측정하였다. 군은저 c/p ratio (n=28), 2군은고 c/p ratio (n=29) 으로나누었다. 두군에서기본특성, 국제전립선점수 (IPSS), 전립선무게, 최고요속, 잔뇨와알파차단제사용 3주후효과를보인군과그렇지않은군으로구분하여증상점수의변화를폐색증상 (IPSS-O) 과저장증상 (IPSS-S), 총점으로구분하여비교하였다. Results: 두군간에나이와동반질환, 투여약물등의차이는없었다. IPSS는 2군에서의미있게높았으나 (p=0.0) IPSS-O 와 IPSS-S로나누어비교해보면의미있는차이를나타내지않았다. 전립선크기는 2군에서더큰경향을보였다 (p=0.06). 잔뇨나최고요속은두군간에차이가없었다. 알파차단제를사용한후두군모두증상의호전을보였으며효과를보인군과그렇지않은군으로나누었을때전립선크기는차이가없었으나 c/p ratio는효과를보인군에서더큰경향을보였으며 (p=0.06) IPSS-O의변화는효과를보인군에서확실히 c/p ratio가더높게나타났다 (p=0.04). Conclusions: 폐색증상은전립선의크기보다이행대의탄성도가더중요한인자였다. 증상의정도는전립선변연부에비해이행대의탄성도가떨어지는고 c/p ratio 군에서더심하였으며이군에서폐색증상에대한알파차단제의효과가더크게나타났다. 이결과로하부요로증상을유발하는전립선의특징을이해할수있고치료방침을설정하는데도움이될것이다. Keywords: 전립선비대증, 탄성초음파, 알파차단제 77

O-026 Impacts of serum vitamin D level on lower urinary tracts symptoms in men 유상준, 박주현, 조성용, 손환철, 정현, 조민철 서울특별시립보라매병원 Introduction: We evaluated the impacts of serum vitamin D level on lower urinary tracts symptoms (LUTS) in men. Materials and Methods: From March 204 to April 207, 434 male patients with LUTS. Evaluations for all patients included medical history, digital rectal examination, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), urinalysis, serum 25(OH) vitamin D level, prostate-specific antigen (PSA), testosterone, and transrectal ultrasound (TRUS). The impacts of 25(OH) vitamin D level on LUTS were evaluated using multivariate linear regression analysis. To exclude the effect of seasons, we also analyzed the impacts in each season. Results: 25(OH) vitamin D level was significantly lower in winter, compared to the other seasons (7.6 in spring vs. 25.4 in summer vs. 20.2 in fall vs. 6.5 ng/ml in winter, p<0.00). Total IPSS (p=0.03), quality of life (QOL) index (p=0.033), and total OABSS (p=0.033) was significantly higher in winter compared to the others. There was no significant difference in the evaluation parameters, including total IPSS, QOL index, peak flow rate (Qmax) and post-void residual urine (PVR), according to the season. On the other hand, total OABSS was higher in winter, compared the other seasons. In both univariate and multivariate analysis to adjust for age, body mass index, PSA, testosterone, prostate volume on TRUS, decrement in serum 25(OH) vitamin D level (p<0.05) was significantly associated with increased OABSS, particularly in winter. In winter, serum 25(OH) vitamin D level in patients with OAB was significantly lower than those without OAB. Also, men with moderate-to-severe OAB (total OABSS of 6) showed significantly lower serum 25(OH) vitamin D level compared to those with mild OAB (5>total OABSS 3). On contrary, the univariate or multivariate analysis to adjust for the above-mentioned confounding variables showed that serum 25(OH) vitamin D level was not generally associated with total IPSS, QOL index, Qmax, PVR or total prostate volume, irrespective of the season. Conclusions: Our data indicate that decrement in serum vitamin D level in men with LUTS may be involved in aggravated OAB symptoms, especially in winter. However, it does not appear to be associated with benign prostatic hyperplasia. Further studies with larger cohorts are needed to validate our findings. Keywords: Urinary bladder, Overactive, Prostatic hyperplasia, Vitamin D 78

O-027 배뇨근과활동성및저하된수축성을동시에가지는여성환자의장기간추적관찰결과보고 김아람, 박영진, 최우석, 박형근, 백성현, 김형곤 Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine Purpose: To investigate long-term clinical outcome of patients with voiding dysfunction who have detrusor overactivity and impaired contractility (DOIC) diagnosed with urodynamic study (UDS). Material and Methods: The results of UDS from 2008-202 were reviewed and 37 female patients with DOIC were selected. DO was defined as the presence of involuntary contraction during the filling phase. Women with underactive detrusor function (IC) should fullfil the criteria including PdetQmax<20 cmh 2 O and Qmax<5 cm/ sec. Three subgroups were categorized according to the main symptom. Improvement was defined as a patient s satisfaction at last visiting. Results: Median follow-up was 54.6 months. Of 37 women, 5 patients (3.5%) presented with storage symptom involved with DO, 7 (43.2%) presented with voiding symptom involved with IC, and 7 (43.2%) showed combined symptoms. Among the total patients, 35.%, 48.6% and 6.2% showed better, same and worse symptom at last visit than at diagnosis, respectively. Among the patients with symptomatic DO, improvement was reported by 40%. Among the patients with symptomatic IC, improvement was reported by 2.5%. Among the patients with combined symptoms, improvement was reported by 56.2%. Conclusions: Thirty five percentage of patients with DOIC showed improvement in long-term outcome. Conventional pharmacotherapy is reasonable, however accurate diagnosis and characterization of symptom in the elderly patients with complex cluster of symptoms is critical. Keywords: Detrusor overactivity, Impaired contractility 79

O-028 Efficacy and safety of combination of tolterodine and pilocarpine in overactive bladder patients: a randomized double-blind multicenter phase 3 study 고광진, 김계환 2, 김세웅 3, 김선옥 4, 서주태 5, 주명수 6, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 가천대학교의과대학길병원비뇨기과학교실, 3 가톨릭대학교서울성모병원비뇨기과학교실, 4 전남대학교병원비뇨기과학교실, 5 관동대학교의과대학제일병원비뇨기과학교실, 6 울산대학교서울아산병원비뇨기과학교실 Purpose: We aimed to determine the efficacy and safety of combination of tolterodine immediate-release (IR) 2 mg and delayed-release pilocarpine 9 mg (tolterodine/pilocarpine (2/9 mg)) compared with tolterodine IR 2 mg monotherapy for OAB. Materials and Methods: This study was a 2-week, multicenter, randomized, double-blind, parallel, active control study. Those with 8 micturitions and 2 urgency episodes per 24 hours and a total OABSS of 6 or more points were randomized : to tolterodine/pilocarpine (2/9 mg) (n=93) or 2 mg tolterodine (n=9) twice-daily for 2 weeks. Co-primary endpoints were the change from baseline in the mean number of daily micturitions and cumulative incidence of dry mouth at the end of the 2-week. Secondary endpoints included other OAB symptoms, xerostomia inventory total score and visual analogue scale (VAS) for dry mouth overall at the end of treatment period. Results: Baseline characteristics were similar across the treatment groups. In the per protocol set, tolterodine/pilocarpine (2/9 mg) combination treatment was noninferior to tolterodine 2 mg monotherapy. Change from baseline in the mean number of daily micturitions was -.49±2.20 of tolterodine/pilocarpine (2/9 mg) combination group and -.74±.99 of tolterodine 2 mg group, for a difference of -0.26±2.09 between two groups. The 95% confidence limits on the difference (-0.79 to 0.27) was above the prespecified noninferiority threshold of -.0 (Figure ). In the safety analysis set, incidence of dry mouth was lower in tolterodine/pilocarpine (2/9 mg) combination group than tolterodine monotherapy group, significantly (57 of 90 or 30.0% for combination group vs 82 of 9 or 42.93% for monotherapy group, p=0.009). All secondary and other efficacy outcomes related to OAB symptoms were improved in both groups while no statistically differences between two groups at the end of the 2-week. The change from baseline in the xerostomia inventory total score and VAS for dry mouth was significantly lower in tolterodine/ pilocarpine (2/9 mg) combination group than tolterodine 2 mg group. The incidence of adverse events was similar between two groups. Conclusions: A combination of tolterodine and pilocarpine effectively reduced incidence of dry mouth compared with tolterodine alone while preserving treatment efficacy in OAB and it was well tolerated. Keywords: Anticholinergics, Efficacy, Safety 80

O-029 A 2-week open-label extension study to assess the efficacy and safety of combination of tolterodine and pilocarpine in the treatment of patients with overactive bladder after 2-week randomized study 고광진, 이정주 2, 오승준 3, 김형곤 4, 민권식 5, 홍재엽 6, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 부산대학교병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 건국대학교병원비뇨기과학교실, 5 인제대학교부산백병원비뇨기과학교실, 6 CHA의과학대학교분당차병원비뇨기과학교실 Purpose: The aim of this study was to evaluate the safety and efficacy of 2 weeks of open-label extension study with combination of tolterodine/pilocarpine (2/9 mg) following the completion of a blinded randomized controlled trial of acute treatment for overactive bladder (OAB). Materials and Methods: Patients completing 2 weeks of randomized, double-blind treatment with either tolterodine/pilocarpine (2/9 mg) or 2 mg tolterodine twice daily were continued in the 2 weeks, open-label, uncontrolled extension study. Double-blind study medication was discontinued, and patients were started, open-label, on tolterodine/pilocarpine (2/9 mg) twice daily. Efficacy analysis consisted of a comparison of the change from baseline in the mean number of daily micturitions, incontinence episodes, and urgency episodes at the end of the 24-week. Results: Of completers of randomized control study, 256 patients continued the extension study; 24 from tolterodine/pilocarpine (2/9 mg) combination treatment (extended group) and 32 from the 2 mg tolterodine monotherapy group (changed group). In the full analysis set, change from baseline in the mean number of daily micturitions was -.78±2.39 (p<0.000) of extended group and -.6±2.32 (p<0.000) of changed group. Other efficacy outcomes including the change from mean number of daily incontinence episodes and urgency episodes were improved in both groups while no statistically differences between two groups at the end of the 24-week. During the 2 weeks of randomized study period, incidence of dry mouth was lower in tolterodine/pilocarpine (2/9 mg) combination group than tolterodine monotherapy group, significantly (33.06% vs 45.45%, p=0.0427). By the end of the 2-week period of the extension study, the incidence rate of dry mouths was 4.03% (95% confidence interval;.32-9.6) of extended group and 0.00% (confidence interval; 0.00-2.76) of changed group. The other adverse events were not significantly different between two groups. Conclusion: A combination of tolterodine and pilocarpine demonstrated a favourable safety and tolerability profile. The efficacy and safety remained excellent even though 2 mg tolterodine monotherapy was changed to tolterodine/ pilocarpine (2/9 mg) combination treatment. Patients demonstrated sustained improvement in OAB symptoms for up to 24 weeks of combination treatment. Keywords: Overactive bladder, Antimuscarinics 8

O-030 과민성방광환자군에서항무스카린제처방변경사례와그이유에관한연구 강병진, 박지훈, 백승룡, 김경환, 이경, 김현우, 신동길, 이정주부산대학교의과대학비뇨기과학교실 Aims of Study: To investigate the reasons for the prescription change of antimuscarinic agents in patients with OAB. Materials and Methods: The ratio and interval of prescription change assessed 067 patients who were eligible for the study and took of 4 different antimuscarinics (fesoterodine, solifenacin, propiverine or trospium). The reasons for prescription change and evaluation of efficacy analyzed 267 patients whose medical records were complete. Results: Prescription change to another antimuscarinic agent occurred in 30.7% (328/067) patients and the mean duration of taking their first antimuscarinic agent was 6.8±4.2 weeks. Lack of efficacy (57.2%) was the main reason for changing antimuscarinic agent followed by adverse events (28.6%), relatively high cost compared with other antimuscarinics (7.3%), the inconvenience of taking drugs (5.2%) and co-morbidity (.7%). The mean duration of treatment according to each reason increased adverse events (3.3±2.2 weeks), relatively high cost compared with other antimuscarinics (4.7±2.5 weeks), co-morbidity (6.5±2.8 weeks), inconvenience of taking drugs (6.8±2.9 weeks), and lack of efficacy (0.8±6.8 weeks). The proportion of prescription change (6.3%) and prescription change because of adverse events (0.4%) in the fesoterodine group were low compared with other drugs (P<0.05 and P<0.006, respectively). Major reasons for the prescription change in patients taking antimuscarinic agents were a lack of efficacy and adverse events. In the fesoterodine group, the proportion of prescription change was significantly low compared to that in other three groups. Conclusions: The evaluation of the impact of prescription change on the health of patients, adherence to treatment, and disease progression is warranted in the future study. Keywords: OAB, Antimuscarinic agent 82

O-03 전립선암발생에대한대사건강상태의영향 : 전국코호트연구 김종욱, 정형국, 박태용, 안순태, 오미미, 문두건, 박홍석고려대학교의과대학비뇨기과학교실 Objective: We assessed the association between metabolic health status and incidence of prostate cancer with the analysis using a nationwide cohort study in Korea. Materials and Methods: A cohort of,77,252 male was extracted from the National Health Insurance Service, and subjects had received national health examinations at least once between 2009 and 202. Obesity was defined based on a BMI of 25 kg/m 2 and the metabolically obese was defined as the presence of 3 components of metabolic syndrome. Subjects were stratified into 4 groups based on the metabolic health status: metabolically healthy, normal-weight (MHNW), metabolically obese, normal-weight (MONW), metabolically healthy, obese (MHO), metabolically obese, obese (MOO). Multivariate adjusted Cox regression analysis was conducted to examine the hazard ratio (HR) and 95% confidence interval (CI) for the association between metabolic health status and incidence of prostate cancer. Results: Of the study participants, 6,65,05,,226,359, 2,32,838, and 2,067,004 subjects were classified into MHNW, MONW, MHO, MOO group. Mean BMI was 22.2 in the NHNW group and 27.8 in MOO group. Prostate cancer was newly diagnosed in 56,552 individuals during the study period. Age-adjusted hazard ratio (HR) for prostate cancer in the MHNW, MONW, MHO, MOO groups were.0 (ref),.43 (95% CI.8-.69),.09 (95% CI.08-.38),.257 (95% CI.23-.284). HR for prostate cancer showed significant correlation for the number of components of metabolic syndrome. Conclusion: This population-based study shows the evidence of association between metabolic health status and the incidence of prostate cancer, and the risk increases vary according to the number of components of metabolic syndrome. Keywords: Prostate cancer, Metabolic syndrome, Metabolically obese normal weight 83

O-032 Is serum testosterone level is NOT related to adenocarcinoma diagnosis of the prostate even among definitely hypogonadal patients? 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 Background: As far, the testosterone (T) level has been demonstrated no correlation with a prostate cancer detection rate of the general eugonadal populations. The aim was to analyze the relationship between serum T levels and prostate cancer detection among definitely hypogondal patients from large prostate biopsy cohort. Material and Methods: We analyzed a cohort of 2532 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsies with pre-biopsy serum T level in a single institution from 2003 to 207. Indication for prostate biopsy was suspicious digital rectal exam or PSA elevation. Patients on 5-alpha reductase inhibitor or testosterone replacement therapy were excluded from analysis. Patients were classified as definitely hypogonadal (T<230 ng/dl, n=296), marginally hypogonadal (T 230 ng/dl and T<350 ng/dl, n=498) and eugonadal (T 350 ng/dl, n=738) group. Age, body mass index, the number of previous biopsies, PSA, prostate volume (PV), hypoechoic lesion of TRUS and biopsy pathology report were prospectively collected. The prostate cancer detection rate was evaluated and compared between groups by : propensity score matching method. The predictive performance of serum T was analyzed by the multivariate logistic regression model. Results: The total prostate cancer diagnosis rate was 32.5% (822/2532). The prostate cancer detection rate was not different between marginally hypogonadal (3.3%, 56/498) and eugonadal (3.%, 540/738) group. However, the prostate cancer detection rate was higher among definitely hypogonadal (42.5%, 26/296) than both of propensity-matched eugonadal (90/298, 30.2%, p=0.004) and marginally hypogonadal group (30.9%, 92/297, p=0.002). Among eugonadal or marginally hypogonadal group, serum T could not predict prostate cancer detection at the multi-variate logistic model. However, among definitely hypogonadal group, pre-biopsy serum T was an independent predictor for the diagnosis of prostate cancer with covariate of Age, PSA, PV and BMI (p<0.0). Conclusions: For definitely hypogonadal patients, cancer detection was related with testosterone level and the cancer detection rate itself was higher than others. However, testosterone levels are not related to prostate cancer diagnosis among marginally hypogonadal or eugonadal patients. Keywords: Hypogonadism, Prostate cancer, Detection rate 84

O-033 메트포민 (metformin) 이전립선특이항원에미치는영향 : 미국국가보건영양실태조사 (NHANES) 2007-2008 데이터 박지수, 이광석 2, 함원식, 정병하 2, 구교철 2 연세대학교의과대학 신촌세브란스병원, 2 강남세브란스병원 A possible association between metformin use and the development of prostate cancer (PCa) has been reported. The aim of this study was to investigate the association between exposure to metformin and serum prostate-specific antigen (PSA) levels among diabetic patients not previously diagnosed with PCa. The analytic sample consisted of,363 U.S. men aged above 40 in the National Health and Nutrition Examination Survey 2007-2008 cycle. Men who had previous diagnoses of PCa or prostatitis and men who were exposed to manipulations that might have affected serum PSA levels were excluded from analysis. Multivariate logistic regression analyses were used to evaluate the independent association between serum PSA levels and metformin use by adjusting for potential confounding factors. The mean PSA level of the overall population was.8 (SD=3.) ng/ml. There were no differences in PSA levels according to the presence of diabetes (p=0.57). Among patients with diabetes, metformin users exhibited significantly lower PSA levels compared to non-metformin users after adjusting for potential confounders (OR=0.790; 95% CI 0.666-0.938; p=0.007). There was no significant difference in PSA levels in men on metformin for greater than year compared to non-metformin users. A negative association between serum PSA levels and metformin use was observed in patients with diabetes. Metformin use for more than year did not influence PSA levels. Further studies are warranted to elucidate whether the reduction in PSA level with metformin truly reflects reduced risk of disease development. Keywords: Diabetes mellitus, Metformin, Prostate cancer, Prostate-specific antigen 85

O-034 Age-specific prostate-specific antigen in Korean men with biopsyconfirmed benign prostate 전병조, 태범식, 박재영,2, 최훈,2, 배재현,2, 홍성규 3, 이상은 3, 변석수 3 고려대학교안산병원비뇨기과학교실, 2 고려대학교의과대학비뇨기과학교실, 3 서울대학교의과대학비뇨기과학교실 Background: This study is to determine age-specific PSA distributions in Koreans without prostate cancer (PCa) and to recommend reference ranges for this population. Methods: Between 2004 and 204, 3,703 men underwent prostate biopsy to confirm PCa. Clinical information and blood samples were collected prior to biopsy for each patient. 497 patients were diagnosed with core of Gleason score 6 PCa, and 2,553 men were confirmed benign prostate via biopsy. The men with biopsy-confirmed benign prostate and PCa were divided into six age groups. Simple descriptive statistical analyses were carried out and their means were compared. The same analysis was performed among the men with biopsy-confirmed benign prostate and the patients with Gleason score 6 PCa versus the patients with Gleason score 7 or more PCa. Results: Mean age was 64.4±9.4 years old and median serum PSA levels was 5. ng/ml [inter-quartile range, 3.5-9.4] in total group. The median value of PSA of less than forties, forties, fifties, sixties, seventies, and eighties and more with biopsy-confirmed benign prostate were 6.73, 3.99, 3.98, 4.00, 5.43, and 6.52 ng/ml, respectively. Among sixties, PSA value of PCa patients was significantly different from that of men with biopsy-confirmed benign prostate, while others are not. When the same analysis was performed among the men with biopsy-confirmed benign prostate and the patients with Gleason score 6 PCa versus the patients with Gleason score 7 or more PCa, the median values of PSA of each group was almost same as the previous analysis (6.73, 3.99, 4.00, 4.00, 5.5, and 6.6 ng/ml, respectively), while statistical differences were shown from sixties to eighties and more. Conclusion: The cut off value of PSA of less than forties should be set higher than that of older group. From forties to fifties, PSA testing cannot distinguish the man with benign and malignant status nor insignificant and significant lesion. The cutoff value of 4, 5.5, and 6.6 ng/ml in sixties, seventies, and eighties and more, respectively, can tell patients with clinically significant lesion from benign or insignificant lesion. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (207RA2B4005876). Keywords: Prostate-specific antigen, Biopsy, Prostate cancer 86

O-035 전립선조직검사에서항생제용법이갖는임상적중요성 : 단일기관 만례보고 서영은, 유영동, 황진호, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은분당서울대학교의과대학비뇨기과학교실 Objective: This study aims to evaluate the effectiveness of the antibiotic regimen for prostate biopsy by analyzing patients who were hospitalized due to complications after transrectal ultrasound-guided prostate biopsy (TRUS- PBx). Materials and Methods: During May 2003 and April 207, the medical records of 0339 patients who underwent TRUS-PBx at our institution were reviewed. We exclude the patients with low quality data for the final analysis. All patients received IV antibiotics 30-60 minutes before the biopsy after the procedure. Clinicopathologic factors including patient age, antibiotics regimen, the number of biopsy cores, constipation, obesity, prostate specific antigen (PSA), prostate volume and infection-related complications that require hospitalization were analyzed. Results: 9487 patients among the entire patients were included for the final analysis. 33 patients (0.35%) were hospitalized due to infection-related complications. Infection-related hospitalization rate was significantly lower in patients who took cephalosporin (0.2%) compared to patients who received quinolone (.64%). At out institution, cephalosporin has been predominantly used to prevent post-biopsy infections since January 203. Only 5 patients (0.2%) developed post-operative complications among 3863 patient who underwent TRUS-PBx since 203. Multivariate analysis showed the use of 2nd or 3rd cephalosporin was the only independent predictor for the infection-related complications. Conclusion: The antibiotics regimen, especially the use of 2nd or 3rd generation prophylactic cephalosporin, in TRUS-PBx could play an important role in reducing infection-related complications. Keywords: Prostate biopsy, Infectious complication, Antibiotics 87

O-036 전립선암으로근치적전립선절제술을시행받은환자의병리학적결과을예측하는데있어수술전 prostate health index 의유용성 : 강원도지역비뇨기종양다기관연구 박홍주, 송기현, 서인범, 강태욱 2, 정현철 2, 김성진 3, 박창후 3, 박종연 3, 김정현 강원대학교병원비뇨기과학교실, 2 연세대학교원주기독병원, 3 울산대학교강릉아산병원 Purpose: We investigated the hypothesis that prostate-specific antigen (PSA) isoform p2psa and its derivates, percentage of p2psa to free PSA (%p2psa) and the Prostate Health Index (PHI), predict PCa characteristics at final pathology after RP. Materials and Methods: The study was an observational prospective evaluation of a clinical cohort of men undergoing radical prostatectomy from the Gangwon Urology Oncology Group (GUOG). We determined the predictive accuracy of serum total PSA (tpsa), free PSA (fpsa), fpsa-to-tpsa ratio (%fpsa), p2psa, %p2psa, and PHI. The primary end point was to determine the accuracy of these biomarkers in predicting the presence of pt3 disease, pathologic Gleason score (GS) 7, GS upgrading. Multivariable logistic regression models and receiver operating characteristic (ROC) curve analysis were complemented by predictive accuracy analysis. Results: Average age of enrolled 70 patients was 68.0 (46-79) years old. Forty patients (57.%) and 49 (70.0%) were diagnosed with biopsy and pathologic GS 7, respectively. Thirty three patients (47.%) were diagnosed with pt3. GS upgrading was found in 5 (2.4%) patients. The %p2psa and PHI levels were significantly higher in patients with pt3 disease, pathologic GS 7, and GS upgrading. In univariate analysis, both %p2psa and PHI were accurate predictors of pt3 disease, pathologic GS 7, and GS upgrading. In multivariate analyses, the inclusion of PHI significantly increased the predictive accuracy of a base multivariate model that included patient age, tpsa, fpsa, %fpsa, clinical stage. Conclusions: We found that p2psa and its derivatives are predictors of PCa characteristics at final pathology after RP and are more accurate than currently available markers. Keywords: Prostate-specific antigen, Prostatectomy, PHI 88

O-037 PI-RADS 의진단적정확도 : 전층절편조직검사와 2 구획별평가비교 박사현, 임고산, 김명, 송채린, 안한종울산대학교서울아산병원 Purpose: We aimed to analyze diagnostic accuracy of multiparametric MRI based on site-specific Prostate Imaging Reporting and Data System (PI-RADS) using whole mount section slide analysis of radical prostatectomy specimens. Materials and Methods: From January 204 to December 205, a total of 4 consecutive patients with prostate cancer who had undergone multiparametric MRI and radical prostatectomy were evaluated. MRI was performed at 3.0 T, including T-, T2-weighted imaging, diffusion-weighted imaging, apparent diffusion coefficient mapping, and dynamic contrast-enhanced imaging in our institution. Experienced genitourinary radiologists performed PI-RADS scoring divided into 2 zones (right/left, anterior/posterior, and base/mid/apex). Radical prostatectomy specimens were examined by whole mount section slides. Positive findings of PI-RADS were defined when a score of site was 4 or greater. Results: A total of 4932 sites were evaluated. Overall sensitivity/specificity of MRI for tumor presence was 7.%/79.4%. The sensitivity/specificity for extracapsular extension (ECE) and seminal vesicle (SVI) invasion were 20.4%/95.9% and 23.4%/96.9%. By site-specific analysis, the sensitivity for tumor presence was lower in anterior site than posterior site (66.8% vs 74.%, p<0.00). Also, the sensitivity of tumor presence was lower in apex than base (66.7% vs 8.2%, p<0.00). By pathologic Gleason scores, the sensitivity of tumor presence was lower in GS 6 (60.4%), GS 3+4 (66.2%) than in GS 4+3 (74.0%), GS 8(82.7%), and GS 9-0 (77.4%) cancers. The sensitivity was 75.4% in high risk, 69.0% in intermediate risk, and 68.4% in low risk group patients. Conclusions: Multiparametric MRI based on PI-RADS showed good diagnostic accuracy for tumor presence in prostate. However, multiparametric MRI was not useful to detect ECE or SVI. By site-specific analysis, PI-RADS scoring system showed poor sensitivity in anterior tumors, apex tumors, and low-risk tumors. Lowering cutoff scores of PI-RADS would be helpful to detect hidden lesions in these tumors. Keywords: Prostatic neoplasms, Magnetic resonance imaging, Diagnostic imaging 89

O-038 전립선암수술후전립선피막침범에대한 MRI PI-RADS version2 score 의예측력 한재현, 최세영, 경윤수, 류제만, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교서울아산병원비뇨기과학교실 Objectives: We investigated the role of MP MRI PI-RADS version2 interpretation in predicting extracapsular extension during radical prostatectomy Materials and Methods: We analyzed patients who underwent radical prostatectomy for prostate cancer with MRI preoperatively. We investigated the association between MRI PI-RADS version 2 interpretation of extracapsular extension and pathologic result using multivariate Cox regression and 2 2 table for predictive value calculation. In this study, pathologic extracapsular extension is the gold standard for MRI prediction. Results: Data from 02 patients who received prostatectomy with preoperative MRI with PI RADS version 2 interpretation in 207 January to Jun were evaluated retrospectively. Among them, 32 (3.3%) patients had pathologic ECE (extracapsular extension) and 6 patients (8.7%) had seminal vesicle invasion. We performed bilateral neurovascular bundle sparing in 94 patients (92%) and unilateral in patient (%). There were no statistical differences in prostate volume, Gleason score, and preoperative PSA between the two groups. The pathologic ECE group had a higher number of patients with a high Gleason score of 7 (4+3) or higher, and the tumor volume was relatively larger than the non-ece group (4.6 cm 3 vs 2.5 cm 3 p<0.00). Prostate lesions were divided into 2 sections according to PI-RADS version 2 and the predictive power was analyzed for each region. Overall, the sensitivity to predict the extracapsular extension is 47.8% and the specificity is 97.%. Positive predictive value was 43.7% and negative predictive value was 96.9%. The logistic regression analysis showed that biopsy Gleason score of 8 or more and MRI clinical stage were significant when ECE predictors were analyzed. Conclusion: Prediction of extracapsular extension with MRI PI-RADS version 2 shows low sensitivity and high specificity. MRI PI-RADS version 2 analysis has a high negative predictive value for extracapsular extension. Keywords: Prostate cancer, Extracapsular extension, MRI PI-RADS version 2 90

O-039 근치적전립선절제술을받은한국인에서의새로운 5 단계 grading system 에대한외부검증및평가 조민현, 정창욱, 구자현, 곽철, 김현회, 박주현 2, 조민철 2, 정현 2 서울대학교병원, 2 서울특별시립보라매병원 Objective: To report the external validation and evaluation of the new five-tiered prostate cancer grading system for the radical prostatectomy (RP) population in Korea Materials and Methods: Between 996 and 206, 2883 consecutive patients who had biopsy proven prostate cancer and underwent radical prostatectomy were retrospectively reviewed from two prospectively collected prostate cancer databases. To report external validation and evaluation of the new five-tiered prostate cancer grading system, biochemical recurrence-free survival (brfs) rates were assessed using Kaplan-Meier tests, Cox-regression modelling, and discriminatory comparison analyses. Separate analyses were performed based on biopsy and RP grade. Results: The 5-year actuarial brfs for biopsy grade groups -5 were 87.0%, 73.8%, 7.3%, 58.4%, and 44.4%, respectively. Similarly, the 5-year actuarial brfs based on RP grade groups was 89.0%, 78.6%, 63.0%, 54.8%, and 47.8% for grade groups -5, respectively. The adjusted hazard ratios for brfs relative to biopsy grade group were.97, 2.47, 3.39, and 4.0 for groups 2, 3, 4, and 5, respectively, and for RP grade groups were.82, 3.8, 3.70, and 3.63. Conclusion: In Korean radical prostatectomy population, we have validated the new five-tiered prostate cancer grading system for brfs, and shown that Group -5 is respectively 92.2%, 84.6%, 75.4%, 69.2%, 7.0%, There was a significant difference between groups, 2, 3 and 5, but between groups 3, 4 and 5, significant differences were not found. Keywords: Prostate cancer, New grading system 9

O-040 Verification for staging groups of prostate cancer suggested by eighth edition of TNM staging manual of the American joint committee on cancer: emphasis on the gleason score 이학민, 이인재, 오종진, 이상철, 변석수, 이상은, 홍성규 분당서울대학교병원비뇨기과학교실 Introduction: The American Joint Committee on Cancer (AJCC) TNM staging manual has been recently updated and provided more specified stage group for prediction of prognosis for prostate cancer. We evaluated the accuracy of AJCC stage group on the biochemical recurrence (BCR) after surgery. Materials and Methods: We analyzed the data of 2,684 patients treated by radical prostatectomy who qualified the definitions for AJCC stage groups from IIB to IIIB. We stratified patients into several subgroups according to the Gleason score (GS) and the BCR-free survivals were compared using Kaplan-Meier analyses. Results: There were,0 patients in group IIB, 535 in IIC, 29 in IIIA, and 795 in IIIB, respectively. We observed no significant differences of BCR-free survival between IIC and IIIA (p=0.875). When we sub-divided IIIA group according to the GS, we could observe significant differences of BCR-free survival (all p<0.00) between subgroups. Moreover, the GS 4+4 subgroup of IIC showed significantly worse BCR-free survival than GS 3+3, 3+4 subgroups of IIIA (p=0.0) and no significant difference with GS 4+3 subgroup (p=0.78) of IIIA. From our results, we suggest new system which showed better ability to discriminate the prognosis of each group. Conclusions: The current AJCC prognostic groups showed some contradictory results particularly in IIC and IIIA groups. We carefully suggest that the stage groups of IIC and IIIA should be revised according to the GS not only by prostatic antigen level. Keywords: Prostate, Cancer, Staging, Survival 92

O-04 결석질환의치료경향과비용 윤영은, 정재훈, 조정기, 문홍상, 김용태, 최홍용, 박해영, 박성열한양대학교의과대학비뇨기과학교실 Introduction: There are only a few longitudinal studies regarding treatment and costs for patients with urinary tract stone disease. We conducted this study to provide a recent update on the changes in prevalence and treatment of urinary tract stone disease in Korea. Materials and Methods: Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 200 to 206, urinary tract stone patients were identified. The prevalence, trends of treatment and costs were analyzed. Result: In 206, 283,964 patients were diagnosed as urinary stone, increased by 5.6% from 202. As the patient increases, the urinary stone-related procedure is also increasing; the percentage of patients treated surgically each year rose from 38.0% to 40.% (an increase of 5.5%) between 202 and 206. In 206, total cost of urinary tract stone treatment was 209.3 million USD, an increase of about 33.8% compared to 56.4 million USD in 202. In particular, the proportion of treatment costs for patients over 60 increased steadily. While ESWL is still the norm (~90%), endoscopic surgeries were increased. The rigid URS increased by 93.4% and the flexible URS increased by 550% during the period. Considering repeated procedures in one patient, claimed cost of each patient for ESWL was the highest (3 USD). Conclusion: Urinary stone disease and surgeries for them is increasing in Korea, but the percentage of ESWL is still high compared to other countries. Despite the need of skillful surgeon and expensive instruments, it seems that charges for endoscopic surgeries are relatively low in Korea, so rearrangement of cost for stone treatment should be discussed. Keywords: Stone, Medical cost, Lithiasis 93

O-042 요로결석성분과대사성요인들과의연관성에관한연구 김재윤, 김승빈, 태종현, 윤성구, 심지성, 강성구, 강석호, 천준, 이정구, 김제종고려대학교의과대학비뇨기과학교실목적 : 본연구는요로결석의성분과여러대사성요인들의연관성을규명하여요로결석의치료및재발의예방에활용하기위해시행되었다. 대상및방법 : 204년부터 207년까지요로결석제거술을시행받은환자중 stone analysis를시행한총 209명의환자들을대상으로연구가진행되었으며요로결석의성분에따라총 2군 ( 요산결석군, 비요산결석군 ) 으로분류하였다. 양군간에환자의나이, 성별및체중, 신장, 체질량지수등의일반적인지표들이비교되었다. 양군간에당뇨, 고지혈증, 고혈압, 만성신부전, 심혈관질환등의기저질환에차이가나는지비교하였으며, 이외에도결석군에따른혈액검사및요검사, 영상의학검사결과를비교분석하였다. 결과 : 총 209명의환자중요산결석군은 36명이었으며, 비요산결석군은 73명이었다. 요산결석군은비요산결석군에비하여당뇨, 고혈압, 만성신부전, 심혈관질환의이환율에있어통계적으로유의하게높은결과를나타냈으며, 혈액검사상 HbAc 및 uric acid, creatinine 수치에서도높은결과를보였다. 결론 : 요산결석을가진환자들은당뇨, 심혈관질환, 고혈압등의대사성질환에서높은빈도를나타내었으나비만도나이상지질혈증과의연관성은유의하게관찰되지않았다. HbAc와요산결석의발생률은유의한상관관계를보여당뇨환자에서철저한혈당관리를통한요산결석의예방효과가있을것으로기대된다. 향후이와관련한더많은환자수를대상으로한추가적인연구가필요하다. Keywords: Metabolic disease, Stone analysis, Metabolic stone 94

O-043 요로결석의약물배출촉진요법으로 tamsulosin, alfuzosin, silodosin 및 placebo 의결석배출율의비교 : 체계적문헌고찰및네트워크메타분석 강동혁, 권종규 2, 김종찬 2, 조강수 2, 함원식 2, 최영득 2, 이주용 2 인하대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소 목적 : 요로결석의약물배출촉진요법은요관결석과충격파쇄석술로파쇄된잔석의배출을가속화시키고, 통증을경감시킨다. EAU 요로결석진료지침에서는 tamsulosin, terazosin, doxazosin, alfuzosin 및 silodosin이결석배출을증가시킨다는권고사항을제시하고있다. 그러나, 현재까지각약물들의명확한비교분석결과는소규모연구에서만비교분석하였다. 이에저자들은지금까지출판된연구들을바탕으로가장흔히사용하는알파차단제인 tamsulosin, alfuzosin 및 silodosin 과위약에대한결석배출율을체계적문헌고찰및네트워크메타분석을시행하였다. 대상및방법 : 206년 7월까지의자료를국외 PubMed, EMBASE 를이용하여검색하였고전자검색된자료의참고문헌을수기검색하였다. 두명의연구자가자료추출양식을사용하여연구설계, 대상자수와특성및요로결석에대한약물배출촉진요법 (tamsulosin 0.4 mg, alfuzosin 0 mg, silodosin 8 mg과위약연구 ) 의결석배출율을비교한자료를추출하였다. 연구의질을평가하기위하여관찰연구질평가도구인 Downs and Black checklist를사용하였고, PRISMA statement 를적용하여분석하였다. 결과 : 전체 39개의연구가요로결석에대하여 tamsulosin 0.4 mg, alfuzosin 0 mg 및 silodosin과위약과의비교를시행하였다. 비교대상은 tamsulosin과위약이 2개, alfuzosin과위약이 4개, silodosin과위약이 4개, tamsulosin 0.4 mg 및 alfuzosin 0 mg 비교연구가 5개, tamsulosin과 silodosin 비교연구가 6개이었다. 네트워크메타분석에서 tamsulosin (OR 3.6; 95% CI 2.2.6-5.3), alfuzosin (OR 2.2; 95% CI.2-4.5), silodosin (OR 4.7; 95% CI 2.6-8.9) 은위약에비하여높은배출율을보였다. Tamsulosin (OR 0.47; 95% CI 0.2-.2) 과 alfuzosin (OR 0.4; 95% CI 0.4-.4) 은 silodosin과차이를보이지않았다. Absolute risk는 silodosin이가장높았다 (AR 0.80; 95% CI 0.75-0.86). 순위분석에서는 silodosin 이 순위를차지하였으며, tamsulosin이 2순위를차지하였다 (Fig ). 결론 : 요로결석의약물배출촉진요법으로사용되는알파차단제중, tamsulosin과 alfuzosin, silodosin은배출율에있어서차이를보이지않았고, 위약에비하여높은배출율을보였다. 그러나, 순위확률에서는 silodosin이가장높은배출확률을보였다. Keywords: Medical explusive therapy, Ureter stone, Network meta-analysis 95

O-044 비조영전산단층촬영 hounsfield units 를이용한결석이질성지수, 평균결석밀도및최대직경을이용한요관결석의체외충격파쇄석술 차성공률예측노모그램 오경택, 김종찬, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실 목적 : 이미보고된체외충격파쇄석술시행전성공률을예측할수있는인자는결석의크기와비조영전산단층촬영 (NCCT) 에서결석의 Hounsfield units (HU) 의평균값인평균결석밀도 (MSD), 결석이질성지수 (SHI) 및결석최대직경 (MSL) 등이보고된바가있다. 저자들은 MSL과 MSD, SHI를이용하여요관결석환자에서체외충격파쇄석술의 차성공율을예측하는노모그램을만들어성공률을예측할수있는지를확인하고자하였다. 대상및방법 : 2005년 월에서 206년 2월까지단일기관에서체외충격파쇄석술을시행받은신환자 824명을대상으로의무기록을분석하였으며, 그중 204년 2월까지시술받은 NCCT가있는요관결석환자 700명을이용하여노모그램을작성하였다. 205년 월부터 206년 2월까지 3명을대상으로내적타당도분석을시행하였다. 로지스틱회귀분석을바탕으로의미있는인자를추출하여, 다변량분석을통해최종인자들을선택하였고, 선택된인자들의 regression coefficient 를기반으로노모그램을작성하였다. 결과 : 700명의환자의환자의평균나이는 52.55±3.88세이었으며, 요관결석의위치는 573명 (8.9%) 이상부요관, 48명 (6.9%) 이중부요관, 79명 (.2%) 이하부요관이었다. 결석의평균 MSL은 9.2±3.89 mm이었으며, 평균 MSD 및 SHI는 707.04±272.0 HU 및 244.90±0.6 HU이었다. 다변량분석에서 MSL, MSD, SHI가의미있는예측인자이었으며, 이를통하여노모그램을작성하였다 (Fig ). 내적타당도분석에서예측모형의 AUC는 0.796이었으며, Calibration plot은 mean absolute error는 2.3%, 내적타당도분석에서 calibration plot의 mean absolute error는 2.% 이었다. 결론 : 본연구를통하여체외충격파쇄석술 차성공률을예측하는노모그램을개발하였으며, internal 및 external validation에서도높은예측도를갖는노모그램을개발하였다. 본연구는요관결석환자의치료방침선택에있어서기본적인모형이될수있을것으로생각한다. Keywords: Ureter stone, Shock wave lithotripsy, Nomogram 96

O-045 0 mm 이상크기의신장결석에대해연성요관내시경수술법을선택할수있는결석의크기와관련인자들에대한고찰 박주현, 선인영, 류호영, 유상준, 조민철, 손환철, 정현, 조성용 서울특별시립보라매병원비뇨기과 Objective: We investigated the surgical efficiency and cut-off criteria to determine whether retrograde intrarenal surgery (RIRS) or supine miniaturized percutaneous nephrolithotomy (MPCNL) is appropriate for managing renal stones >0 mm Methods: Patients underwent a single session of RIRS or supine MPCNL when they have a main stone >0 mm. Change point analysis with a cumulative sum of ordered value of fragmentation efficiency and stone size was used to detect the point at which the statistical properties of a sequence of observation changes. Results: No differences in mean age, gender, body mass index, comorbidities, or stone composition were observed between the two groups. Stone burden, fragmentation efficiency, area of stone distribution, and the presence of staghorn stones were higher in the MPCNL group than those in the RIRS group. Stone-free rates and complication rates were not different between the two groups. The fragmentation efficiency increased to 40.4 ml/min, at which the stone size in the RIRS was 9. mm. The level of the fragmentation efficiency at the renal stone of 0 mm and 30 mm was similar to each other. The fragmentation efficiency in the MPCNL group continuously increased until the size of 35. mm. Conclusions: RIRS shows the highest efficiency at the maximal diameter of 9. mm and the volume of 5,000 mm 3. The acceptable level of stone size and volume for RIRS would be 30.0 mm and 27,000 mm 3 Keywords: MPCNL, RIRS, Urinary stone 97

O-046 신장결석에대한치료로 retrograde intrarenal surgery, percutaneous nephrolithotomy, mini-percutaneous nephrolithotmy 결과비교 : 체계적문헌고찰및네트워크메타분석 강동혁, 김종찬 2, 권종규 2, 조강수 2, 함원식 2, 최영득 2, 이주용 2 인하대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소 목적 : 신장결석의수술적치료로 retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) 이시행되고있다. PCNL은 2 cm 이상의신장결석에있어효과적이나, RIRS에비하여침습적치료이다. Mini-PCNL은 -20 Fr의 miniature endoscope을이용하여시행하는수술로 PCNL의대안적치료로시행되어왔다. 이에저자들은지금까지출판된연구들을바탕으로 RIRS, PCNL 그리고 mini-pcnl의 3가지치료법에대한체계적문헌고찰및 success 또는 stone-free rate의네트워크메타분석을시행하였다. 대상및방법 : 206년 월까지의자료를국외 PubMed, EMBASE 를이용하여검색하였고전자검색된자료의참고문헌을수기검색하였다. 두명의연구자가자료추출양식을사용하여연구설계, 대상자수와특성및신장결석에대한치료 (RIRS, PCNL 및 m-pcnl) 에 stone-free 또는 success rate를비교분석한자료를추출하였다. 연구의질을평가하기위하여관찰연구질평가도구인 Downs and Black checklist를사용하였고, PRISMA statement를적용하여분석하였다. 결과 : 전체 25개의연구가신장결석에대하여 RIRS, PCNL 및 mini-pcnl의 stone-free 또는 success rate를비교하였다. PCNL과 mini-pcnl의비교연구 6개, mini-pcnl과 RIRS 비교연구 7개, RIRS와 PCNL 비교연구 2개가선정되었다. 네트워크메타분석에서 mini-pcnl과비교하였을때, RIRS와비교하였을때, PCNL (OR 2.4; 95% CI.2-4.7) 과 mini- PCNL (OR 2.4; 95% CI.2-4.7) 은의미있게높은 success 또는 stone-free rate를보였다. 그러나, PCNL과비교하였을때, mini-pcnl은통계적차이를보이지않았다 (OR.0; 95% CI 0.53-2.0). 순위분석에서 Rankogram은 mini-pcnl, PCNL, RIRS의순위를보였으며 (Fig ), P-score는 mini-pcnl이 0.798, PCNL이 0.7069 및 RIRS 0.003의순위를기록하였다. 결론 : 신장결석의수술적치료에서 PCNL 과 mini-pcnl 은 RIRS 에비하여높은 success 또는 stone-free rate 를보였다. Keywords: Renal stone treatment, Network meta-analysis 98

O-047 신장결석수술방법에따른급성신손상바이오마커의차이 육형동, 윤민영, 정창욱서울대학교병원비뇨기과 Introduction: To compare the acute renal injury according to the difference of renal stone surgery using urine biomarkers. Methods: We retrospectively analyzed 68 patients who underwent renal stone surgery between 204 and 207. The patients were divided into retrograde intrarenal surgery (RIRS) and percutaneous lithotripsy (PNL) groups according to the surgical procedure. Urine biomarkers were used with microalbumin, N-Acetylglucosamine (NAG) and beta2 microglobulin. Urine biomarkers were measured 3 time points (preoperative, postoperative month and 3 months) Results: In the comparison of mean values, microalbumin and microalbumin/cr were significantly different between POD and POD3 (p=0.002 and 0.062), and NAG/Cr was significantly different between preop-pod and POD-POD3 (p=0.006 and 0.047). Microalbumin, microalbumin/cr and NAG/Cr were significant different in the comparison of the mean difference between the section (P=0.000, P=0.005 and P=0.053). In the comparison of the mean difference between the two groups, the PNL group has a more mean difference than RIRS group between preoperative and postoperative month microalbumin/cr. There was no difference in operation time, stone free rate, complication after 3 months, additional treatment, postoperative hospital stay and DJ stent maintenance period between two groups. Conclusion: Microalbumin, microalbumin/cr, and NAG/Cr may reflect well the degree of acute renal injury during and after renal stone surgery. PNL shows more mean difference of acute renal injury biomarkers after surgery compared to RIRS. Keywords: Renal stone, RIRS, PNL 99

O-048 증상을가진요관결석환자와비교한무증상결석의특성및치료후신기능회복에대한분석 편종현, 김재윤 2, 강석호 2, 천준 2, 이정구 2, 김제종 2, 강성구 2 성균관대학교의과대학강북삼성병원비뇨기과학교실, 2 고려대학교안암병원비뇨기과학교실 Objective: Recently, asymptomatic ureteral stones have been detected more frequently on regular health examination. However, most reports on silent stones have involved small numbers of patients, and few have compared findings with symptomatic ureteral stones. In this study, we investigated the route of diagnosis and characteristics of silent stones, as well as the impact of renal function recovery, compared to symptomatic ureteral stones. Materials and Methods: We retrospectively reviewed data for 398 patients who had undergone ureterolithotripsy or ureterolithotomy for ureteral stones between 20 and 206. A silent ureteral stone was considered to be in the absence of any specific or subjective symptoms related to the ureteral stone. We compared patient and stone characteristics, urinary analysis, images with CT findings, and recovery of renal function after surgery based on serum creatinine level and GFR between the two groups. Results: Among 398 patients, 8 had asymptomatic ureteral stones greater than 6 mm, and the remaining 37 had symptomatic ureteral stones. Most silent stones were diagnosed via ultrasonography (49.4%) or microscopic hematuria (24.7%) during regular health screenings. There were significant differences in the distributions of the locations and lateralizations of stones (all p<0.05). In the silent stone group, the proportion of males was higher (80.2% vs. 60.6%), mean stone size was greater (.4 mm vs. 9.6 mm), and the rate of severe-grade hydronephrosis was higher (25.9% vs. 3.5%) than in the symptomatic stone group (all p<0.05). Regarding the risk factors of asymptomatic ureteral stones, age, sex, grade IV hydronephrosis, hypertension, and hyperlipidemia were all significant on multivariable logistic regression analysis. Mean GFR value at 7 days and 3 months postoperatively showed significant improvements (7.2 and 8.9) in the symptomatic stone group, while improvements of mean GFR value were not significant in the asymptomatic group. Conclusion: This study demonstrated that asymptomatic ureteral stones were more associated with large size and severity of hydronephrosis than symptomatic ureteral stones. Thus, prolonged ureteral obstruction caused by asymptomatic ureteral stones may be related to impaired kidney function. Keywords: Ureterolithiasis, Asymptomatic diseases, Ureteral obstruction 00

O-049 역행성신내수술후치료실패위험인자에대한연구 김영빈, 신용호, 최태수, 유구한, 이동기, 민경은, 전승현, 이형래, 이선주, 이충현, 장성구, 이상협경희대학교의과대학비뇨기과학교실 Introduction: Retrograde intra-renal surgery (RIRS) has become one of the preferred treatment options for renal stones. Technique of RIRS may be challenging, which needs adequate training to achieve optimal results. The aim of this study is to figure out the risk factors of RIRS failure. Materials and Methods: From January 204 to May 207, 279 patients received RIRS at Kyung Hee University Medical Center. All cases were performed by single surgeon. We included patients who had a stone with maximal diameter between 0 and 30 mm. All patients checked non-enhanced CT at one month after surgery. Patients, stone and surgical factors were reviewed retrospectively. Success of treatment was defined as complete stone free or the presence of residual stone size less than 3 mm. In addition, we considered learning curve was overcome if more than 50 cases of RIRS were performed. The risk factors for treatment failure after RIRS were assessed using univariate and multivariate logistic regression analysis. Results: According to the univariate analysis, surgical proficiency and multiple renal stones were significantly associated with treatment failure after RIRS. There was no association between treatment failure with gender, body mass index, stone size, or operative time. In addition, according to the multivariate analysis, beginner and stone multiplicity were the independent risk factors for RIRS failure. Conclusions: Patients with multiple renal stones had higher possibility of treatment failure after RIRS. Before performing RIRS, it is necessary to give patients sufficient explanation about this possibility. Keywords: Urolithiasis, Kidney, Surgery 0

O-050 역행성신내수술후발생하는열성요로감염의위험인자에대한연구 최정혁, 신용호, 최태수, 유구한, 이동기, 민경은, 전승현, 이형래, 이선주, 이충현, 장성구, 이상협경희대학교의과대학비뇨기과학교실 Purpose: We aimed to evaluate the risk factors of febrile urinary tract infection (UTI) following retrograde intrarenal surgery (RIRS) for treating renal stone. Materials and Methods: We retrospectively reviewed the data of patients with 0-30 mm sized kidney stones who underwent RIRS from January 204 to June 207, including age, gender, body mass index, comorbidity, preoperative urinalysis, urine culture results, prescription of antibiotics before surgery, stone size, location, operative time, and residual stones. All surgeries were performed by single surgeon. The risk factors for febrile UTI after RIRS were assessed using univariate and multivariate logistic regression analysis. Results: Total 40 patients were included in the present study. Seventeen patients (2.%) had febrile UTI after RIRS. According to the univariate analysis, preoperative pyuria and the usage of preoperative were associated with postoperative febrile UTI. Moreover, multivariate logistic regression analysis showed that preoperative pyuria was the only independent risk factor for infectious complications after RIRS (OR, 8.3; 95% CI,.759 to 39.275; p=0.008). Age, gender, BMI, comorbidity, preoperative bacteriuria, presence of hydronephrosis, stone factors, and operative time were not associated with febrile UTI after RIRS. Conclusions: Preoperative pyuria was the only risk factors for infectious complications following RIRS. Therefore, careful management after RIRS is necessary especially when preoperative urinalysis showed pyuria. Keywords: Urolithiasis, Urinary tract infections, Postoperative complications 02

O-05 요도협착환자에서내시경적요도절개술및일시적요도스텐트삽입술의유효성 조대성, 장석흔, 손정환, 이재원 대진의료재단분당제생병원비뇨기과 Purpose: To report our early experience with self-expandable metallic urethral stent placement for the management of urethral stricture and to evaluate the efficacy of the stent. Materials and Methods: This prospective study included 9 patients with urethral stricture who underwent endoscopic urethrotomy and temporary urethral stent insertion. All patients performed endoscopic urethrotomy and temporary self-expandable urethral stent (UventaTM) insertion during operation. After removal of stent, patients were followed by uroflowmetry at, 3, 6, 2 months and uerthroscopy at 2 months. Results: The mean age was 63.2 (54-79) years and the mean stricture length was 3.7 (.5-7.0) cm. Among these patients, 7 (77.7%) patients showed stricture-free status at a mean follow-up of 4. (4-22) months and uroflowmetry showed that mean Qmax was maintained at 2 months after stent removal. However 2 (22.2%) patient underwent repeat endoscopic urethrotomy for stricture recurrence. There was no significant procedure-related complication and urinary incontinence (66.7%) and mild pain (55.6%) were common mild complication after surgery. Conclusions: Self-expandable metallic urethral stent combined with endoscopic urethrotomy is effective and safe surgical procedure for urethral stricture. This procedure may be an useful treatment option for patients with urethral stricture. Keywords: Urethral stricture, Urethral stent, Endoscopic urethrotomy 03

O-052 요도협착환자에서요도성형술시행후결과에영향을줄수있는요인 이충언, 성현환성균관대학교의과대학비뇨기과학교실목적 : 요도협착에대하여가장효과적인치료방법은요도성형술로알려져있다. 하지만국내에서요도성형술의보고는많지않으며, 수술에영향을줄수있는요인에대한보고도많지않다. 본연구에서는요도협착환자에서요도성형술시행후결과에영향을줄수있는요인에대하여알아보고자한다. 대상및방법 : 203년 4월부터 207년 4월까지요도협착환자 69명에서시행한 76건의요도성형술을후향적으로분석하였다. 요도협착의원인, 위치, 길이, 개수, 이전시술횟수, 재발, U-score 등의결과에대하여알아보았다. 협착위치에대하여후부요도및전요도에해당하는요인에 3점을추가한새로운 U-score를적용하여분석하였다. 각요인별평균을전후로두그룹으로나눈뒤각그룹별 U-score를비교하였다. 각요인에대하여재발의위험도를다변량분석을통하여알아보았다. 수술후재발은요도협착으로추가적인시술및수술을시행한경우로정의하였다. 결과 : 환자들의평균나이는 57.±7.6세였으며, 원인은외상 29명 (38.2%), 특발성 명 (4.5%), 의인성 29명 (38.2%), 감염 4명 (5.2%) 였다. 평균협착길이는 32.6±32.2 mm이었으며, 협착개수는 개이하가 56명 (73.7%), 2개이상이 20명 (26.3%) 이었다. 협착의부위는음경요도 20명 (26.3%), 구부요도 35명 (46.%), 후부요도 5명 (9.7%), 전요도 6명 (7.9%) 이었다. 이전에시술을 회이하받은환자는 50명 (65.8%), 2회이상시술받은환자는 26명 (34.2%) 이었다. 평균수술시간은 37.8±50.0분이었으며, 평균실혈량은 77.3±84.8 ml였다. 평균추적관찰은.6±9.7개월이었다. 각요인별평균을전후로두그룹으로나눈뒤각그룹별 U-score를비교한결과는 Table 과같다. 나이, 이전시술횟수, 협착개수, 원인, 길이, 위치에대하여재발의위험정도를다변량분석을하였을때, 나이및협착의위치가유의한예측인자였다. U-score 의평균을전후로생존곡선을통한분석을시행하였을때 U-score 6점미만인군이 6점이상인군에비하여재발이적은것을알수있었다 (p=0.03). 결론 : 본연구에서 U-score는전부요도협착에서뿐만아니라, 모든요도협착에서복잡성과예후를예측할수있음을알수있었으며, 요도협착환자에서치료의방향과결정을하는데도움을줄수있을것으로생각된다. Keywords: Urethral stricture, Urethroplasty, Urethral score 04

O-053 The impact of single kidney dysfunction on the psychopathology in young men: population-based analysis of military manpower administration database in Korea 김정준, 성현환 2, 한덕현 2, 최한용 2 분당서울대학교병원비뇨기과, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실 Purpose: To evaluate the psychopathological status of young men who have single kidney dysfunction (SKD) which was defined as at least 50% volume loss or 50% functional loss of one kidney on CT scan or on DMSA scan, respectively. Material and Methods: We used the Korean Military Manpower Administration(MMA) database of the 0-year duration (from Jan. 2003 to Dec. 202). In Korea, all of the male population of age 9 should take the detailed physical examination at MMA to qualify suitability for military service. The medical tests including a screening of renal dysfunction and Military Multiphasic Personality Inventory (MMPI, consist of 9 domains, 365 questionnaires) are indispensable parts of this qualification. A total of four million cases were retrospectively analyzed. Among them, SKD was identified in,925 men, and chronic azotemia (CA, persistently elevated creatinine >2.0 mg/dl) was in 202 men. Dialysis patients were excluded in this cross-sectional study. The psychopathological status of examinees with SKD was evaluated and compared with the normal control group and the CA group using the :4 propensity score matching methods. The abnormal response of MMPI was defined as a score more than one standard deviation. P<0.05 was considered statistically significant. Results: After exclusion of abnormal response set (faking-good, faking-bad, and infrequency) of MMPI,,782 SKDs and 7 CAs were included for each disease group for final analysis. The abnormal response rate of anxiety (4.6% vs. 9.9%), depression (7.6% vs. 0.6%), somatization (9.9% vs 8.7%) and personality disorder (6.8% vs. 9.7%) were higher in SKD group than matched normal control. The abnormal response rate of anxiety and depression in CA group were not different from matched normal control, but significantly lower than matched SKD group. Conclusion: Our population-based study suggests single kidney dysfunction cause psychopathological abnormality in terms of anxiety, depression, somatization, personality disorder, obsession trait. This psychopathological impact seems to be not from subclinical azotemia but from the kidney loss itself. So, for single kidney patients, counseling, screening, and prevention of psychological disease need to be indicated and psychopathological morbidity should be considered in the decision of total nephrectomy. Keywords: Single kidney, Population based study, Psychopathology 05

O-054 Development of silicone surgical guide for partial nephrectomy with 3D printing and injection molding 경윤수 2, 류제만, 최세영, 김국배 3, 송현경 3, 김남국 3, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강증진센터, 3 융합의학교실 Objects: To develop a silicone surgical guide for partial nephrectomy and demonstrate its availability of surgical incision in partial nephrectomy. Material and Methods: For this ex-vivo study, four sets of fresh postmortem kidneys of pig were prepared and 5 cc of mixture of barium contrast medium and blue dye (: in volume) was injected into kidney to mimic artificial tumor. The injected area was shown with high intensity in computed-tomography (CT) image and was recognized by naked eyes during incision (Fig. ). From CT image of the prepared kidney, the morphology shape of kidney and tumor-mimicked volume were digitally modeled by using in-house software. Because there are no materials which can be directly 3D printable with proper flexibility for enveloping soft kidney organ, we planned to make a soft guide with injection molding method with silicone.the finalized digital model was saved by stereo-lithography (STL) file format and was 3D printed (Projet CJP 460plus, 3D systems). After a post-processing procedure, silicone material was injected into the 3D printed molder. And then, the final product of silicone surgical guide can be disassembled from the molder. Results: It was verified that the tumor-mimicked kidney was well-enveloped by the silicone surgical guide. The surgeon could operate tumor incision along the guideline of surgical guide. It can be confirmed that tumor-like volume was well removed. With exception of area where the dye slowly spreads out after the injection, the incision area is same as tumor-like area. Conclusion: This is the first study of surgical guide for partial nephrectomy even though ex-vivo study. This personalized device with convergence of 3D printing technology would help to realize the precision medicine in terms of medical devices. Keywords: 3D printing, Surgical guide, Partial nephrectomy 06

O-055 부분신절제술 3D 프린팅모형의오차에대한분석 경윤수 2, 최세영, 류제만, 김국배 3, 송현경 3, 유달산, 정인갑, 홍준혁, 김남국 3, 김청수 울산대학교서울아산병원 비뇨기과, 2 건강증진센터, 3 융합의학과 Objective: Three-dimensional (3D) printing technologies have been applied to various fields of medicine. In this study, we systemically investigated morphological errors between reconstructed digital models and 3D printed phantoms using patients-specific kidney cases and reference cases. Material & Methods: Eight patient-specific cases for partial nephrectomy and three reference cases of cube, dumbbell and arbitrary kidney were evaluated (Fig. ). All the patient-specific kidney phantoms were manufactured by a 3D printer of PolyJet type with multi-materials of VeroTM color and TangoTM Family. For the comparison study, the reference phantoms were 3D printed by PolyJet type and multi-jet printing (MJP) type. We measured representative lengths of X-axis, Y-axis, Z-axis and volume, and then compared each other. Results: In the patient-specific kidney phantoms, it is shown statistical discrepancy from the digital models and to the 3DP phantoms in all the lengths and the volume (Table ); Y-axis length was elongated (p-value<0.0), but the length in X-axis and the building-directional length (Z-axis) were shorten (p-value<0.0). The volume of the 3DP phantom also showed statistically significant increased by 5.5%. The references cases also showed unconformity between the digital model and the phantoms in lengths and volume according to 3DP type and material. Conclusion: Compared to engineering applications, medical applications may not need higher accuracy, but a surgical guide of touch type should be accurate to attach the corresponding organ. Keywords: 3D printing, Nephrectomy, Analysis error 07

O-056 장기간편측요관카테터유치로인한신실질폭의변화 김희연, 이준호, 유제모, 이승주, 이동섭가톨릭대학교성빈센트병원비뇨기과학교실 Introduction & Objectives: Ureteral stents are widely used for treating obstruction of ureter caused by various pathologies, both benign and malignant. This study was conducted to find out whether kidney size changed before and after ureteral stents were instilled, and if so, what parameters were significant in the process. Material & Methods: 98 patients who had unilateral ureteral stents indwelled for more than 6 months were enrolled from two hospitals between January 200 to December 205. For measurement of kidney size, parenchymal width (PW) was measured from the coronal view of CT scans for both the stented kidney and the unstented contralateral kidney. The mean PW was calculated before and at the time of last stent change, and the % change of mean PW between the two points was calculated. Baseline patient characteristics and estimated glomerular filtrate rate (egfr) were recorded. Withdrawal Results: The mean duration of ureteral stent indwelled was 5.6±0.2 (mean±sd) months. The change of mean PW of the stented kidneys was -6.9±6.4 (mean±sd) %, whereas the change of mean PW of the unstented contralateral kidneys was 3.6±0.7%, both of which showed statistical significance (p<0.05). egfr before and at the time of last stent change did not show significant difference (p=0.294). Duration of ureteral stent indwelled was found to be inversely related to the % change of mean PW (Spearman s correlation coefficient=-0.29, p<0.00). Conclusion: In the cases of unilateral ureteral obstruction, kidney size decreased over time despite of indwelling ureteral stent, suggesting that ureteral stents may not be as efficacious in preserving renal function. This finding can be overlooked by clinicians because of the compensatory growth of the contralateral kidney and the resultant normal egfr. Keywords: Stents, CT scan, Kidney 08

O-057 생체신공여자의신적출술후만성신장질환위험예측모델 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실목적 : 생체신이식후장기관찰시공여자의잔존신장기능에대한기존연구에서기능이상소견이통계적으로유의하지않다는보고가있지만본원에서시행한신공여자의추적관찰결과신기능및추가적인합병증이발생하는경우가있었다. 본연구진은신공여자의 년후만성신장질환위험예측모델을만들고자하였다. 방법, 대상 : 본연구는본원에서 2006년부터 206년까지총 년간시행한 0 케이스중 년후추적관찰을받은환자총 437명을대상으로하였다. 상기환자의수술시간, 임상병리학적특성등이후향적으로조사되었고, 환자의개인정보를제거하고익명으로저장된자료를이용하여분석하였다. 결과 : 총 437명중 4명에서만성신장질환이발생하였으며만성신장질환이발생하였으며만성신장질환이발생한그룹에서나이가유의미하게많았으며수축기및이완기혈압이통계적으로의미있게높았다. 뿐만아니라요산및크레아티닌수치가만성신장질환발생군에서유의미하게높았으며반면칼슘수치는유의미하게낮았다. 다변량분석에서는나이, 칼슘및크레아티닌수치만의미가있었다. 다변량분석에서의미가있는이들 3변수를이용하여만성신장질환위험예측모델을설계하였다. Model Y=Exp (-0.085 ( 나이 )+0.793 ( 수술전칼슘수치 )-5.968 ( 수술전크레아티닌수치 )+.883) (Y=0~, Cut-off value: 0.700) 모델의곡선화면적 (AUC, area under the curve) 은 0.797, 정확도 7.9%, 민감도 68,6%, 특이도 78.7% 였다. 결론 : 본연구진이만들모델을이용하여 년후만성신장질환의위험이높은생체공여자그룹을매우높은정확도로예측할수있었다. 따라서해당모델을생체공여자그룹선별시참고하여선별을해야겠다. 뿐만아니라피치못하게해당그룹에대해서수술진행시술후에면밀한관리가필요하겠다. Keywords: Donor nephrectomy, Chronic kidney disease, Prediction model 09

O-058 The implication of the dominant side split renal function by diethylenetriamine penta-acetic acid (DTPA) in live kidney donor 이형호 3, 윤영은 4, 나준채, 허규하 2, 김명수 2, 김순일 2, 김유선 2, 한웅규 연세대학교의과대학신촌세브란스병원비뇨기과학교실, 2 연세대학교의과대학신촌세브란스병원이식외과학교실, 3 국민건강보험공단일산병원비뇨기과, 4 한양대학교병원비뇨기과학교실 Introduction: There are a few references about which kidney donor selected. Kidney Disease Improving Global Outcomes (KDIGO) recommends a significant (>0%) difference in split renal function between the two kidneys, the kidney with lower function should normally be used for transplantation. Our aim was to study the split renal function as measured by DTPA in live kidney donors and its impact on kidney selection decision. Methods: From January 2008 to May 205, 430 living kidney donors were enrolled. All donors underwent preoperative DTPA. We divided recessive side kidney donor group and dominant side kidney donor group. Live kidney donors who gave the dominant side were spilt into a difference of 7%, 8%, 9% and 0%. Moreover, renal function was compared according to the time Results: There were no differences in demographics and egfr between 3 groups a disparity in 7%, 8%, 9% and 0%. The renal function at 6th month were 64.02±.34, 63.98±4.00 and 64.43±5.58 in the group of 7% disparity (p=0.970). 64.02±.34, 64.45±4.5 and 62.04±7.60 in group of 8% disparity (p=0.494). 64.02±.34, 64.42±4.38 and 6.79±7.27 in group of 9% disparity (p=0.48). 64.02±.34, 64.43±4.8 and 60.85±7.32 in group of 0% disparity (p=0.338). There was no effect on renal function in dominant side kidney donor compared to recessive side. Conclusion: There was no difference in renal function after dominant side kidney donor up to 0% when determining the donor aspect with the split renal function. Keywords: Living kidney donor, Diethylenetriamine penta-acetic acid, Dominant kidney 0

O-059 비뇨기과병동에서입원전담전문의도입에따른의료진의만족도와진료의질향상인식에대한연구 이동환, 정연수, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 변석수, 이상은, 김은선 2, 김낙현 2, 온정헌 2, 장학철 2 분당서울대학교병원 비뇨기과, 2 종합내과 & 입원전담진료센터 배경 : 입원전담전문의도입을위한논의가활발하다. 미국에서는외과병동에내과입원전담전문의가상주하면서수술전후의내과적인문제에대해즉각해결할수있는 surgical co-management (SCM) 모델을도입하였다. 분당서울대병원에서는 207년3월부터비뇨기과병동에서내과입원전담전문의가근무하면서비뇨기과병동에서입원전담전문의의역할정립을위한파일럿연구를시행하였다. 방법 : 207년 3월부터 5월까지 3개월간, 총세명의내과입원전담전문의가한달씩순환근무를하였다. 내과입원전담전문의는비뇨기과병동에상주하면서입원환자중에내과적기저질환이있어수술후합병증이발생한확률이높은환자를선별하고매일회진을하였으며, 수술후내과적합병증이발생할시즉각처치를시행하였다. 3개월간입원전담전문의제도를운영한후비뇨기과의료진, 간호진에게설문조사를시행하였다. 설문조사는제도도입후의료의질향상, 환자안전에대한인식, 만족도를평가할수있도록고안하였다. 총 8명의비뇨기과교수와 6명의전공의, 총 32명의간호사가설문에응하였다. 점부터 5점까지점수를부여하였고, 5점에가까울수록좋은평가였고, 평균점수를제시하였다. 결과 : 3개월간, 총 907명이입원하였으며, 3일이상입원한 473명중에 20명 (25.4%) 에대해서내과적문제가동반되어내과입원전담전문의가진료를수행하였다. SCM 도입후입원환자가내과적문제에대해받는진료의질이매우좋은것으로인식되었다 ( 교수군 4.75점, 전공의 4.5점, 간호진 4.84점 ). 또한환자안전도가향상된것으로인식되었다 ( 교수군 4.75점, 전공의 4.5점, 간호진 4.55점 ). SCM에대한만족도가높아서향후지속했으면좋겠다는의견이지배적이었다 ( 교수군 4.75점, 전공의 4.5점, 간호진 4.76점 ). 만족하는이유에대해, 교수군은내과적진료의질향상과환자안전도향상이주된이유였고, 전공의군에서는내과적인치료에대해서배울수있다는점이었으며, 간호사군에서는병동환자의내과적문제에대한빠른검진과처치를꼽았다. 결론 : 비뇨기과입원환자의내과적인문제가발생할시에협진을의뢰하던기존시스템에비해서내과입원전담전문의가병동에상주하면서즉각적인처치를시행한수의료의질과환자안전이향상된것으로의료진의인식이있었으며, 이에따른의료진의만족도가매우높았다. 향후외과병동에서내과입원전담전문의가진료하는 surgical co-management (SCM) 모형의환자안전및질향상에대한객관적효과에대한추가연구가필요하다. Keywords: Hospitalist, Surgical co-management, Urology

O-060 스마트폰을이용한휴대용정액검사시스템의유용성 박지훈, 임미영, 류장현, 박현준, 이경민, 박민정, 박남철부산대학교병원비뇨기과학교실, 한국공공정자은행연구원 Introduction: Despite the necessity of semen analysis on diagnosis and treatment of infertile couples, male partners are hesitant to receive outpatient services for infertility claiming pressure of business, embarrassment and various personal situations. As a result, in many cases, only female partners seek examination and treatment, and are thus forced to bear a great psychological and physical burden. In response to this situation, we validated the usability of a portable computer-assisted sperm analyzer (CASA) system utilizing a smartphone as a camera and an analyzer, an app, and a microscopic lens integrated with a semen specimen chamber. Material & Methods: A total of 5 semen samples obtained from male infertility who had visited our outpatient clinic were used in automated analysis for sperm concentration and motility after obtaining written informed consent. The smartphone to be used was an iphone 6 and semen analysis was performed according to standard manual by the production company ( Recruit Lifestyle Co., Ltd., Japan) with app, "Seem". We compared the results of 5 samples among portable CASA with smartphone, Makler chamber and CASA, which was performed by urologist with technician of andrology laboratory. Results: The Pearson correlation coefficient among the results of the measurement with Makler chamber and smart CASA system, CASA with visual observation and smart CASA were 0.24 (p=0.843), 0. (p=0.859) for sperm density, respectively and 0.97 (p=0.028), 0.888 (p=0.044) for sperm motility, respectively. There were no particular problems with patient use of the system. Conclusions: We are confident that this portable CASA system plays a role in motivating infertile men to visit clinics, thus resulting in early diagnosis and treatment. It is also hoped that this system contributes to a decrease in the mental and physical burden for women on the infertility treatment, a shortening of the time required to achieve pregnancy and a decrease in medical expenses. Keywords: Smartphone, CASA, Seem 2

O-06 거세저항성전립선암의맞춤형치료전략수립을위한환자유래세포및마우스모델개발 김윤림, 김봉민, 최세영 2, 류제만 2, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 목적 : 성공적인전립선암치료를위해서는종양생물학에대한이해와효능이알려져있는여러안전한항암제의효과를연구하는것이필요로한다. 이런연구를위해서는적당한생체종양모델의개발이필요하지만, 최적의생체종양모델은아직드물다. 본연구에서는전립선암환자암조직의일차배양세포주 (patient-derived primary cells), 또는환자암조직이식마우스모델 (patient-derived xenograft 이하 PDX모델 ), 환자조직을이용한후보항암제의활용방안을제시하여환자치료가능성이높은항암제를미리선별함으로써환자맞춤형치료에도움을주고자하였다. 대상및방법 : 서울아산병원비뇨기과에서경요도전립선절제술을시행받은후전립선암으로진단받은환자의조직으로일부는일차배양을실시하였다. 조직을잘게자른후, enzyme cocktail을처리하여 strainer에흘러내려찌꺼기를걸러낸후, 암세포와많이섞여있는혈구세포와죽은세포, 과립세포를분리하였다. 걸러진암세포를세포배양접시에배양하여, 다양한항암제를처리하여 cell viability, immunostaining, western blot에의하여항암효과를검증하였다. 일부조직은잘라 NOD scid gamma (NSG) 마우스의 subcutaneous site에이식을하였다. 더불어환자의전립선종양조직과 PDX 마우스모델의종양조직이동일환자유래검체임을 immunohistochemistry를통해검증하였다. 결과 : 일차배양체에여러항암제 (docetaxel와 SAHA의병합처리, AZD6244와 GSK226458, sodium metaarsenite, biguanide derivative drug) 를처리하여농도의존적으로세포독성이증가하였으며, 세포사멸유도, AR및 AR-Vs를하향조절하는기전을확인하였다. PDX 모델의조직과환자의병리조직이동일한환자유래조직임을확인하였고, 환자의차트리뷰를통해 aggressive한종양의특징을확인할수있었으며성공적인환자의아바타모델이형성되었다. 결론 : 전립선암환자검체로부터얻은조직, 일차배양체및 PDX 모델시스템에서여러항암제에대한다양한약물반응성과암의특성을파악할수있는즉더인간에가까운실험모델을만들어테스트해볼수있는기반을마련하여효율적인환자맞춤형치료에도움이될것이다. Keywords: Patient-derived primary cell, Patient-derived xenograft mouse, Castration resistant prostate cancer 3

O-062 RNA 시퀀싱기법을활용한엔잘루타마이드저항성전립선암세포주의유전자발현특성분석및표적유전자탐색 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원 목적 : 차세대남성호르몬차단약제인엔잘루타마이드 (enzalutamide) 저항성거세저항성전립선암 (castration-resistant prostate cancer) 세포에서약제저항성의분자기전및치료표적유전자발굴을위하여차세대염기서열분석법을이용한유전자발현패턴분석및스크리닝을수행하고자하였다. 대상및방법 : Enzalutamide 저항성의 CRPC 세포주제작을위하여 LNCaP 세포주에서기원한 C4-2B 세포주를사용하였다. 세포생존및성장에대한분석을위하여 CCK-9 assay를이용한 cell viability 분석및 clonogenic assay를수행하였다. 유전자발현양에대한전사및번역수준에서의분석을위해 real-time quantitative PCR 및 western blot analysis를수행하였다. Enzalutamide 저항성 CRPC 세포주 (C4-2B EnzR) 의유전자발현패턴분석을위하여차세대염기서열분석법에기반한 QuantSeq 3 mrna sequencing 기법을이용하였다. 생물학적 3반복실험을수행하였고, 유전자발현의 fold change 값이 2배이상이면서 p-value가 0.05 미만인경우통계적으로유의한변화로정의하였다. 결과 : Enzalutamide 저항성 CRPC 세포 (C4-2B EnzR) 와대조군인 C4-2B 세포에 Enzalutamide를, 5, 0 µm의 Enzalutamide를처리하였고, C4-2B EnzR 세포가 C4-2B 세포에비해모든약제처리농도에서세포생존률이높은것으로나타났다. Clonogenic assay에서도 0, 20 µm 처리군에서 C4-2B EnzR 세포는군집이형성된반면, 대조군에서는군집형성이관찰되지않았다. AR 활성화유도체인 DHT을처리하였을때, 남성호르몬 (androgen receptor, AR) 의표적유전자인 KLK2, KLK3 및 TTMPRSS의발현양을비교한결과 Enzalutamide 처리여부와관계없이 C4-2B EnzR 세포에서 AR 표적유전자들이유의하게상승한것이관찰되었다. 또한, Enzalutamide 저항성세포에서 AR-V7의발현이상승한것을 real time-pcr 및 western blot 분석에서확인하였다. Enzalutamide 저항성 CRPC 세포주와대조군세포주에대해 QuantSeq 3 mrna sequencing을수행한결과, C4-2B EnzR 세포주에서총 590개의유전자가 DEG (differential expression gene) 으로추출되었고, 367개의유전자가발현이상승, 223개의유전자가발현이감소한것을확인하였다. DAVID에기반한분석결과발현이상승한군에서는 positive regulation of vascular endothelial growth factor production, 발현이저하된군에서는 cell division이가장순위가높은유전자온톨로지 (ontology) 로나타났다. 결론 : 본연구에서는 enzalutamide 저항성의 CRPC 세포주를안정적으로제작하였으며, 표현형및유전자수준에서 enzalutamide 저항성여부를확인하였다. RNA sequencing 기법을통해유전자발현특성을분석하였으며, 스크리닝을통해핵심표적유전자들을선별적으로가려낼수있었다. Keywords: Castration-resistant prostate cancer, Enzalutamide resistant, RNA sequencing 4

O-063 mtor 경로및남성호르몬수용체억제를통한새로운바이구아니드유도체 (IM76) 의전립선암억제효과 류제만, 유상준 2, 김윤림 3, 최세영, 김청수 울산대학교서울아산병원비뇨기과학교실, 2 서울대학교보라매병원비뇨기과학교실, 3 서울아산병원의생명연구소 Introduction: Biguanides were originally developed for the treatment of hyperglycemia and type 2 diabetes mellitus. Recently, the biguanides metformin and phenformin have been shown to exert potential anticancer effects in prostate cancer. We evaluated the anti-cancer efficacy and mechanism of IM76, a novel biguanide derivate drug on prostate cancer using prostate cancer cell lines and patient-derived castration-resistant prostate cancer cell lines. Material and Methods: Cell viability assay, annexin V-FITC apoptosis detection, microscopy with immunofluorescence staining, real-time quantitative reverse transcription-polymerase chain reaction, and western blotting were conducted. Efficacy of IM76 was also evaluated using 2 cell lines derived from castration-resistant prostate cancer patient. Results: IM76 dose-dependently inhibited cell viability in all prostate cancer cell lines at lowest IC50 concentrations (LNCaP: 8.5µM, 22Rv: 36.8 µm) compared to those of metformin, and phenformin. IM76-mediated AMPK activation caused mtor inhibition, and a decrement in the phosphorylation of p70s6k and S6. IM76 inhibited the expression of AR, AR-splice variant 7 (AR-V7) and prostate-specific antigen in LNCaP and 22Rv. IM76 induced apoptosis with increased levels of cleavage of caspase-3, and annexin V-positive/PI-positive, respectively. Moreover, IM76 inhibited cell viability at lowest IC50 concentrations in 2 cell lines derived from castration-resistant prostate cancer patient. We evaluate the relationship between AMPK-mTOR pathway and AR signaling pathway by blocking each pathway separately. After AR knockdown, phosphorylation of AMPK was significantly increased. However, AR and AR-V7 were not increased after treating AMPK inhibitor, Compound C. Conclusions: IM76 showed comparable anti-tumor effects via AMPK-mTOR pathway and AR signaling pathway with the lowest IC50 compared to other biguanide derivative drugs in prostate cancer cell lines, including patient-derived castration resistant prostate cancer cell line and may be a novel anti-cancer drug for the treatment of prostate cancer. Keywords: Prostate cancer, mtor protein, Biguanides 5

O-064 골수조혈줄기세포유래수지상세포를이용한동종이소전립선암면역세포치료제유효성평가 김봉민, 김윤림, 최세영 2, 류제만 2, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 목적 : 거세저항성전립선암환자의평균생존기간은 -2년에불과하며, 기존의호르몬치료제의경우, 약 20-40% 의환자는효과를보지못하며, 대부분의환자에게서 2차저항성을보이고있다. 새로운임상연구가진행되어기존에사용되던화학치료제인 docetaxel, cabazitaxel, 항호르몬제인 abiraterone과 enzalutamide, 세포치료제인 sipuleucel-t등신약이승인되었음에도불구하고치료효과가제한적이다. 따라서고령화사회에서치료법의제한적효과와치료에실패한환자에게적용할수있는성공적인치료법개발이절실히요구되고있다. 이미기능성대비기대이하의항암효과로면역세포시장이위축되고혁신된면역세포백신의필요성이대두되는가운데차세대수지상면역세포치료제를기반으로하는항암면역세포백신을이용하여전립선암에서항암효과를확인하고자하였다. 실험방법 : 골수로부터분리한조혈줄기세포를최적화된배양조건에서분화증식시켜 CD4+ 수지상세포아형으로분화를유도하여체외배양을실시하였으며, 자가종양세포용해액으로교육하였다. 배양한수지상세포 ( 이하 stem-dc) 로 FACS분석과 ELISA를수행하여표현형및 cytokine 분석을실시하였다. FACS를통하여표현형및 ELISA를통하여 cytokine 분석을실시하였다. 이 stem DC를주 회씩 3회에걸쳐 transgenic adenocarcinoma of the mouse prostate (TRAMP)-C 동종이소동물모델에주입하여안전성, 유효성및항원특이면역반응유도를관찰하였다. 치료용수지상세포에의한 allogeneic-t cell의증식및활성화유도도더불어확인하였다. 결과 : 분화성숙되어진 stem-dc는표현형마커인 CD4를잘발현하고 DC의기능적성숙도를나타내는 CD80/86도잘발현함을확인하였다. 또한항암면역작용에기대되는 cytokine인 IL-2, interferone-gamma를잘분비하였다. 분화성숙된수지상세포의역가를확인하였을때 T cell only group 대비 mature DC로자극된세포가잘증식되었다. 전립선암세포주 (TRAMP-C) 로 syngeneic mouse (C57BL/6) 이소모델을만든후 DC를주입하지않은대조군에비하여 0 7 DC를주입하였을때종양크기감소를확인하였으며, 종양항원특이면역실험에서 tumor antigen specific interferone-gamma와 lymphocyte 증식이대조군에비하여우수함을확인하였다. 결론 : 조혈줄기세포로부터최적화된방법으로개발된 stem-dc가전립선암의효과적인항암면역세포치료제로유효성및안정성을확인할수있었다. Keywords: Anti-cancer immunocellular therapeutics, Prostate cancer, Dendritic cell 6

O-065 전립선암환자의혈액에존재하는혈액순환암세포를바이오마커로이용하여전립선암의예후예측및치료전략발굴 김윤림, 김봉민, 최세영 2, 류제만 2, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 목적 : 전립선암은전이가빈번하여예후가좋지않은암으로알려져있다. 암이처음생겨난부위에서암세포가떨어져나와혈관을타고순환하여새로운부위로전이하게되는데, 이때혈액을순환하는암세포인혈액순환암세포 (circulating tumor cell, CTC) 가존재한다. CTC 개수는혈액에서질병의진행도와상관관계가있음을기반으로, 전립선암환자의혈액순환암세포를분석하여예후를예측하는진단바이오마커로이용할수있다. 기존의혈액순환암세포분석방법으로알려져있던 CellSearch R System을이용하지않고새로운독자적인혈액순환암세포분석방법인 CytoGen s Smart Biopsy TM System을제시한다. 대상및방법 : 서울아산병원비뇨기과의전립선비대증과거세저항성전립선암환자 6명의혈액을사용하였다. 혈액 5 ml을기준으로 CytoGen s Smart Biopsy TM System을이용하여 CTC를분리하였으며, 이후검출을위해 4종류의형광염색으로 DAPI/CD45 (leukocyte common antigen)/epcam/ar과 DAPI/CD45/EpCAM/AR-V7의 2가지의슬라이드를제작하여면역형광염색및이를분석하였다. CD45가음성인동시에, EpCAM, AR, AR-V7이양성인세포를전립선암의혈액순환암세포라고규명하였다. 결과 : CytoGen s Smart Biopsy TM System의 cut-off 수치인 2개를기준으로특이도및민감도분석을하였다. EpCAM 양성 or AR-V7 양성과 EpCAM 양성 and AR-V7 양성모두민감도는 0.80, 특이도는 0.50로동일하였다. 본결과를근거하여본연구에적용한 CytoGen s Smart Biopsy TM System 분석방법이혈액순환암세포를검출하는데충분한신뢰성이있다고판단하였다. BPH와전립선암환자혈액의 CTC를분석한결과전립선의양성및악성종양을유의미하게구분할수있음을확인하였다. 결론 : 전립선암에서혈액순환암세포가예후를판단하는바이오마커라는사실은최근많은연구결과들로인해밝혀져있다. 하지만본연구에서는기존에알려진방법이아닌새로운접근방법을통해혈액순환암세포를찾고, 기존 system에비해저렴하고쉽게접근할수있는새로운분석방법을제시하였다. 혈액순환암세포를분석함으로써전립선암의예후예측및새로운치료전략발굴을기대할수있다. Keywords: Prostate cancer, Circulating tumor cell, Biomarker 7

O-066 전립선암에서의자성나노와이어기반순환종양세포의검출 : 선행연구 김정권, 조영남 2, 김성한, 정재영, 서호경, 정진수, 이강현 국립암센터전립선암센터비뇨기과, 2 국립암센터암의생명과학과서론 : 순환종양세포 (Circulating tumor cells, CTCs) 는암환자의원발병소또는전이병소로부터떨어져나와혈액내에서순환하는작은세포를의미한다. 최근이러한 CTCs가치료를위한예후인자로재발을예측하며, 치료약제의효능평가및관찰의유용한수단이될수있다는결과들이보고되고있으며, 이를통해미세암전이의확인이가능하다는점에서유용한생체표지자로기대되고있다. 그러나, 현재의 CTCs의분리기술은혈액내극미량존재하는 CTCs를다량의혈구세포틈에서분리해야하는기술적어려움, 즉낮은검출효율이큰문제이며, 또한살아있는상태에서세포를분리하는데제한점이있다. 본기관내의연구팀이개발한자성나노와이어 (MagWires) 는 CTCs 검출을위해 5 종류의항체혼합물을나노와이어표면에부착하여혈중암세포와의상호작용을극대화시켰으며, 나노와이어의가늘고긴구조로인하여혈액내암세포와의접촉을크게향상시켜검출능력을월등하게향상시킬수있었다 (Figure ). 이전보고된선행연구에따르면, 폐암및유방암환자에서이러한 MagWires기반기술은고도의민감성과특이성을가지고혈액내존재하는극소량의 CTCs를효율적으로분리하는기술임이증명되었다. 이에본선행연구에서는이러한 MagWires 기반기술을이용하여전립선암환자의혈액에서 CTCs를분리하고자하였다. 증례 : 207년 4월부터외래내원환자중연구에동의한환자 9명을대상으로혈액을채취하여분석을시행하였다. 검출된 CTCs를면역형광염색 (ICC) 및면역조직학적 (IHC) 기법을활용하여검증하였다. 9명모두에서 CTCs가분리되었으며, 이를 ICC 및 IHC를통하여확인하였다 (Figure 2). 추후연구에서는분리된 CTCs에서암세포특이유전자를 Droplet Digital PCR 기법등을활용하여검출, 분석하여환자특이적유전체변이를관찰할것이다. Keywords: Prostate cancer, Circulating tumor cell, Magnetic nanowires 8

O-067 전립선암세포에서 CWP 29 의 ER stress 경로를통한세포고사유발에관한연구 김명, 김윤림, 박사현, 임고산, 안한종 울산대학교서울아산병원비뇨기과학교실 Purpose: ER stress induces apoptosis of tumor cells which leads to the inhibition of tumor cell growth and survival. CWP 29 is an ER stress inducer as well as an inhibitor of Wnt/β-catenin signaling pathway. In this study, we evaluated the efficacy of a novel β-catenin inhibitor CWP 29 in prostate cancer. Materials and Methods: PC3, DU 45, LNCaP, 22Rv, VCaP, and CRPC patient-derived prostate cancer cells were used to assess in vitro and ex vitro apoptotic effects of the CWP29. DU 45 and 22Rv xenograft mouse animal modal was employed to evaluate in vitro efficacy. CellTiter Glo R luminescent assay, annexin V-FICTC apoptosis detection, Western blotting and immunohistochemistry were conducted. Statistical evaluation of the results was performed by one-way ANOVA. Results: CWP29 treatment produced anti-proliferative effect on prostate cancer cells in vitro, which was comparable to docetaxel treatment. The apoptosis of prostate cancer cells was induced via endoplasmic reticulum (ER) stress with the activated pancreatic ER kinase (PERK) and protein disulfide isomerase (PDI). CWP 29 treatment induced apoptosis via caspase pathway with the cleavage of caspase-9, caspase-3, and poly ADP ribose polymerase (PARP) and demonstrated increased apoptosis by annexin V-propidium iodide straining. CWP29 treatment also significantly reduced the intracellular β-catenin expression as well. The growth inhibitory effect of CWP29 was confirmed in a DU45 and 22Rv xenograft model. In addition, CWP 29 treatment showed anti-tumor effect on the prostate cancer cells derived from CRPC patients ex vivo. Conclusions: CWP 29 induced apoptosis via ER stress and reduced β-catenin expression in prostate cancer cells, Anti-tumor effect of CWP29 on prostate cancer cells may be an effective strategy for the treatment of castration resistance prostate cancer. Keywords: Prostate cancer, ER stress, CWP 29 9

O-068 Expression of HMGB in prostate cancer: clinical and biological correlations 박용현, 정애량, 김가은, 김미영, 이지영, 이규원, 이지열 가톨릭대학교서울성모병원 Purpose: We aimed to investigate ) the role of high mobility group box (HMGB) on cellular proliferation, apoptosis, and invasion, 2) the underlying biological mechanisms of HMGB in PCa, and 3) the expression pattern of HMGB in PCa patients with different stage and grade and its prognostic importance. Materials and Methods: After transient transfection of PC3 and DU-45 cells with HMGB sirna, diverse experiments were performed to evaluate the changes in proliferation, apoptosis, invasion. To determine whether HMGB affects the receptor for advanced glycation end products (RAGE) and its down-stream pathway, immunoprecipitation experiments were carried out using anti-tlr4, or -RAGE antibody. Using the Cancer Genome Atlas (TCGA) datasets, we determined the impact of HMGB on overall survival in PCa. We further validated the prognostic importance of HMGB by immunofluorescence staining in 3 PCa patients from the Korean Prostate Bank. Results: Inhibition of HMGB expression significantly reduced cell proliferation and increased cell cycle arrest in the sub-g0 phase of PC3 and DU-45 cells. It also inhibited invasive capacity of PCa cells. It is mediated through RAGE, leading to intracellular NF-κB signaling. In TCGA data set (n=498), HMGB was altered in 6 of 498 patients (2%). Overall survival was shorter in the high HMGB expression group (medians: 5.0 months vs. not reached; P=0.0296). In the Korean Prostate Bank cohort, the positive areas of HMGB differed in patients with BPH, and low-, intermediate-, high-risk, and metastatic PCa (4.6,.9, 8.6, 9.7, and 23.4%, p < 0.00). During the median follow-up of 32 months, increased expression of HMGB was associated with a significant decrease in biochemical recurrence free survival on Kaplan-Meier analysis. Conclusions: Our findings demonstrate an important role of HMGB and novel relationship between HMGB and RAGE-dependent mechanisms in PCa. Therapy targeting HMGB-associated pathways may represent a novel therapeutic avenue for PCa. Keywords: HMGB, Prostate cancer, Prognosis 20

O-069 근치적전립선절제술후요실금및발기장애와음부신경감각유발전위와의연관성 권세윤, 박진모 2, 김기호, 서영진, 이경섭 동국대학교경주병원, 동국대학교의과대학 비뇨기과학교실, 2 신경과학교실 Purpose: Pudendal nerve somatosensory evoked potential (SSEP) has been studied in voiding and erectile dysfunctions. We aimed to evaluate correlation with pudendal nerve SSEP and functional outcome in patients undergoing radical prostatectomy. Materials and Methods: We retrospectively analyzed data from 44 patients who underwent radical prostatectomy from January 204 and December 206, with at least 6 months of follow-up. Patients were divided into 2 groups depending on the presence/absence of incontinence and erectile dysfunction, respectively. Patient demographic characteristics, preoperative evaluations, postoperative outcomes and pudendal nerve SSEP were assessed. Erectile function recovery was defined as question 2 and 3 on the Ineternational Index of Erectile Function (IIEF)-5 and continence was defined as using no pads. Results: Patients with/without postoperative incontinence were 22 and 22, respectively. Demographic characteristics and perioperative outcome were similar between 2 groups except pathologic stage (p=0.038). Patients with/ without postoperative erectile dysfunction were and 33, respectively. Demographic characteristics and perioperative outcomes were similar according to presence/absence of erectile dysfunction. Patients with erectile dysfunction were a significant increase in latency of pudendal nerve SSEP (9.4 vs 7.2 ms, p=0.06). Patients with postoperative incontinence (PPI) were a significant increase in latency of pudendal nerve SSEP (9.5 vs 7.9 ms, p=0.04) Conclusions: Our results suggest that pudendal nerve SSEP can be an effective tool in the evaluation of patients with PPI and erectile dysfunction. The test can be used to provide more definitive assessment of functional dysfunction. Keywords: Evoked potentials, Somatosensory, Erectile function, Inconinence 2

O-070 Trends of medical trevel from non-seoul residents to Seoul to seek treatment modalities for prostate cancer: Korean national health insurance system data study from 2005 to 204 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 Background: This study aims to investigate the trend of medical travel proportion among non-seoul residents to Seoul for treatment of prostate cancer, and to investigate the possible affecting factors for the shift. Methods: This study represents a retrospective cohort study using data from the Korean National Health Insurance System (KNHI) from 2002 to 205. Prostate cancer cohort (from 2005 to 204) was defined using ICD 0 code who have first prostate cancer diagnosis at relevant year without prior prostate cancer diagnosis. To define the medical travel proportion in non-seoul residents, number of patients with prostate cancer related claims were used rather than number of claim cases. Year trend of medical travel proportion according to the age group, economic status and types of treatment were analyzed. Multivariable logistic analysis was used to determine factors affecting travel to Seoul medical facilities among the non-seoul residents. Results: A total of 68,543 patients were defined as newly diagnosed prostate cancer cohorts from 2005 to 204. Medical travel proportions calculated using cases with prostate cancer related claims during st year was slightly in decreasing trend (28.0 at 2005 and 27.0 at 204, p=0.02). Average medical travel proportion seeking for radical prostatectomy was not in decreasing trend (43. at 2005 and 45.4 at 204, p=0.26). At 2007, significant affecting factors seeking for radical prostatectomy were younger age group (under 65 years old) (adjusted OR:.02 (95% CI, 0.63-.66)), the highest income level (adjusted OR: 2.38 (95% CI,.23-4.60)) and robotic surgical platform (adjusted OR:.5 (95% CI, 7.0-7.72)). At 204, significant affecting factors seeking for radical prostatectomy were younger age group (under 65 years old) (adjusted OR:.46 (95% CI,.0-.93)), the highest income level (adjusted OR: 2.25 (95% CI,.39-3.64)) and robotic surgical platform (adjusted OR: 3.7 (95% CI, 2.72-3.7)). Conclusions: General trend of medical travel proportion is in decreasing from 2005 to 204. However, still a quite proportion remained to be persisted irrespective of direct distance from Seoul. Age groups under 65 years, high economic status, and surgical treatment modalities revealed to be associated with relatively high medical travel proportions. Keywords: Prostate cancer, Medical travel, Korean national health insurance system 22

V-00 손보조복강경하신우절석술에대한증례보고 최대헌, 홍범식울산대학교서울아산병원비뇨기과학교실서론 : 경피적신장절석술 (percutaneous nephrolithotomy, PCNL) 은 2 cm 이상크기의신결석의표준치료로사용되고있다. 개복또는복강경하신우절석술은요관경이나 PCNL 등의덜침습적인수술이실패했을경우고려될수있다. 이경우에는거대녹각석, 신우의해부학적이상, 심한비만등이포함된다. 최근에는개복수술은거의시행되지않으며, 복강경하신우절석술이 PCNL의대안으로이용된다. 복강경하신우절석술의경우 PCNL에비해결석제거율이높을뿐아니라출혈및패혈증의위험성이낮은것으로알려져있다. 순수한복강경하신우절석술에비교하여, 손보조복강경하신우절석술 (hand-assisted laparoscopic pyelolithotomy, HALPL) 은결석배출및신우성형 / 봉합이용이하다. 저자들은 HALPL 에대한증례를동영상으로보고하고자한다. 증례 : 26세여환으로좌측측복통으로외부병원내원하여좌측요관과우측신장의결석이진단되었다. 좌측요관결석에대해체외충격파쇄석술후결석배출된이후본원으로의뢰되었다. 기저혈색소수치는 9.6 g/dl, egfr 은 24 ml/ min/.73 m 2 였고결석의장축길이는 6 cm이었다. 처음에는 PCNL을계획하였으나신배의 infundibulum이좁아접근이어려워 HALPL 로전환하기로결정하였다. 총수술시간은 26분이었고, 출혈량은 0 cc 이하였다. 수술후합병증없이 7 일후퇴원하였다. HALPN은선별된환자군에서안전하고효율적인선택지가될수있다. 특히신실질에손상을주지않아출혈과네프론손실을감소시킨다. Keywords: Hand-assisted laparoscopic surgery, Pyelolithotomy, Renal stone 23

V-002 단일세션양측비디오스콥역행성신장내결석수술 김종찬, 정재용, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실목적 : Videoscope 타입연성신장요관내시경을이용한결석수술중단일세션양측역행성신장내결석수술 (retrograde intrarenal surgery; RIRS) 에대한결과를보고하고자한다. 대상및방법 : 205년 월부터 207년 5월까지단독술자가시행한 Videoscopic RIRS 220례중단일세션양측역행성신장내결석수술 20명을대상으로하였다. 양측수술이나, 편측 RIRS 및반대측경성요관내시경을이용한결석제거수술환자는제외하였고, 순수양측성 RIRS만을대상으로하였다. 양측 RIRS는 URF-V와 V2 (Olympus), FLEX-Xc (KARL STORZ) 그리고 LithoVue (Boston) 로수술을진행하였다. Fluoroscopic guide 하에서 -3 Fr 또는 2-4 Fr access sheath (Uropass; Olympus) 를삽입하였다. 내시경을신장내삽입후결석을확인하였다. Lasering은 200-μm fiber를사용하였고, VersaPulse (Lumenis) 를이용하여시행하였다. 결석분쇄후 stone basket (Zerotip; Boston) 을이용하여결석을체외로 extraction하였고, 요관부목을삽입하고수술을종료하였다. 수술후 개월에 Non-contrast computed tomography를촬영하여 stone-free를확인하였다. 결과 : 20명의환자의평균나이는 58.85±4.06세이었으며, 남녀비는 3:7이었다. 양측결석중가장큰결석의최대길이의평균은.26±4.75 mm이었다. 결석의평균 mean stone density (MSD) 는 660.66±343.25 HU이었으며, stone heterogeneity index (SHI) 는 209.7±03.68 HU이었다. 전체환자의평균수술시간은 63.70±22.30분이었다. 수술후추가치료를받은환자는없었으며, 개월 stone-free rate는 95% 이었다. 수술환자중 명은 horseshoe kidney 환자로양측 stone을모두제거하였으며, 이환자를제외한 9명의환자는해부학적이상이없었다. 수술후.20±0.52일에퇴원을하였으며, 요관부목유치기간은 6.0±2.63일이었다. 수술전후혈청크레아티닌 (.3±0.75 vs.04±0.42; P=0.55), egfr (63.5±24.65 vs. 7.3±9.72; P=0.85) 및혈색소 (3.0±.86 vs. 2.52±.68; P=0.36) 는통계적으로의미있는차이를보이지않았다. 결론 : 양측 RIRS는수술시간및 stone-free rate를고려할때, 효과적인수술법이었다. 또한수술전후혈색소감소는통계적으로차이를보이지않았으며, 재원기간등을고려할때양측성결석환자에서효과적인치료방법으로생각한다. Keywords: Retrograde intrarenal surgery, Videoscope, Bilateral 24

V-003 Flexible ureteroscopic management of parapelvic renal cysts 윤영은, 정재훈, 조정기, 이형호 2, 나준채 3, 박성열, 김용태, 박해영, 한웅규 3 한양대학교병원, 2 일산병원, 3 연세대학교비뇨기과학교실 Introduction: Parapelvic renal cysts are more likely to cause hydronephrosis and pain, and their surgical treatment is considerably difficult. Laparoscopic removal is generally recommended, but it is still invasive and sometimes challenging. Herein we report our initial experiences of flexible ureteroscopic managements of parapelvic renal cysts. Methods: Three patients underwent flexible ureteroscopic marsupialization of parapelvic renal cyst from January through February 205. We included the patients who have renal colic or hydronephrosis due to the parapelvic renal cyst. Using flexible ureteroscopy, we tried to find the cyst from inside of the renal pelvis and unroof it using holmium laser. After making a considerable channel between pelvis and cyst, we inserted double-j catheter in the cyst. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted. Results: There s no intraoperative or postoperative complications. However, among 3 patients, one case required conversion to the percutaneous drainage and sclerotherapy because of difficulty in finding the cyst from renal pelvis. The other 2 cases were completed with the flexible ureteroscopic approach. The cysts were unroofed and marsupialized to the collecting system appropriately. The mean OP time was 43 minutes and estimated blood loss was 0 ml. Length of hospital stay ranged between and 2 days. After 3 months, no patient had symptom and CT scan showed decreased volume of cysts. Conclusions: Our initial experience with flexible ureteroscopic management of parapelvic renal cysts shows that the procedure is feasible and safe in selected patients. When the parapelvic cyst was relatively outbulging from renal hilum, we believe that it could be difficult to find and unroof the cyst from inside of renal pelvis. Keywords: Renal cyst, Parapelvic cyst, Flexible ureteroscopy 25

V-004 복강경폴리타노레드베터방광요관재문합술 : 요관이동을위한근위부방광절개창을방광내시경도움없이만드는술식 백민기, 김태헌, 한덕현 성균관대학교의과대학삼성서울병원비뇨기과학교실 Introduction and Objective: Previously we reported our experience of pneumovesicoscopic Politano-Leadbetter ureteral reimplantation using cystoscope during proximal neo-hiatus formation (PPL with cysto) for pediatric vesicoureteral reflux (VUR) treatment. We introduce our recent early experience of pneumovesicoscopic PL without cystoscopic guidance during proximal neo-hiatus formation (PPL without cysto). Methods: We compared the perioperative parameters of PPL without cysto ( ureteral units of 7 children, from November 206 to Feb 207) with those of PPL with cysto (25 ureteral units of 7 children, from June 203 to May 204) performed by a single surgeon. The surgical procedures of PPL without cysto are as follows: ) Ureteral mobilization should be enough not to be curved with acute angel when the ureter moved up. 2) The proximal neo-hiatus is made more widely (about cm) without cystoscopy guidance. Then we identify and pull up the ureter via the proximal neo-hiatus. 3) The other procedures are same with previous PPL with cysto technique. Results: All operations were completed successfully without any intraoperative complications or open conversion. The mean operation times of PPL with cysto versus PPL without cysto were was 2.0 versus 72.3 mins for unilateral cases, and 223.5 versus 246.4 mins for bilateral cases respectively. All the patients got PPL without cysto began oral intake on the first postoperative day. Their mean postoperative hospital stay was 2.5 days (range -3). There was no complication during postoperative follow-up (range 25-47 days). Conclusions: Our early experience of PPL without cysto shows that this surgical technique seems to be simpler than previous PPL with cysto. It is a great minimally invasive surgical option for the pediatric VUR patients. Keywords: Vesicoureteral reflux, Pneumovesicoscopy, Ureteral reimplantation 26

V-005 후부요도협착과관련된골반골절요도손상에서요도성형술 박휘준, 고광진, 성현환성균관대학교의과대학삼성서울병원비뇨기과학교실목적 : 후부요도협착은대부분골반골절요도손상 (Pelvic Fracture Urethral Injury, PFUI) 과관련하여발생하며, 빈도가높지않고술기어려움으로국내보고가적었다. 이에단일술자에의한요도성형술초기경험을보고하고자한다. 대상 : 203년 4월부터 207년 5월까지 74명환자를대상으로 8건의요도성형술을시행하였다. 이중 PFUI로인한후부요도협착으로시행된 6건의요도성형술에대해알아보았다. 재발의정의는요도협착으로추가적인시술및수술이필요한경우로하였다. 결과 : 총 5명의환자에서 6건의수술을시행하였으며평균추적관찰기간은.7개월 (.7-34), 45.0세 (2-76) 였다. 원인은교통사고 2명, 기타 3명이었다. 환자 8명에서본원요도성형술전에초기재배열이 8건, 내시경적요도절개술이 4건, 요도성형술이 3건, 간헐적요도확장 건이시행되었다. 요도손상은모두막양부요도와전립선요도사이에서발생하였고협착길이는 2.2 (.0-3.2) cm이었다. 수술은후부요도협착성형술 단계 (Urethral lengthening, n=4), 2단계 (Crural separation, n=9), 3단계 (Partial inferior pubectomy, n=3) 로이루어졌다. 수술시간은 65.9분 (99-297) 이었고출혈량은 393.8 ml (00-000) 이었다. 평균재원일수는 6.6일 (5-0) 이며문합부위누출로술후 39일후에도뇨관을제거한 건을제외한나머지에서평균 2.9일 (5-26) 에계획대로제거하였다. 수술후요도협착재발은 4건 (35.7%) 에서발생하였으며, 년무재발성공률은 68.9% 이었다. 또한요도성형술이전치료유무에따라성공율의차이를보였다 ( 그림 ). 합병증으로혈종 건, 감염 건이발생하였으며입원치료를하였다. 5명환자모두사고전발기부전은없었으나 2명은사고후발기부전이생겼으며, 수술후에도지속되었고 명에서수술후발기부전이생겼다. 모든환자에서사고전요실금이없었으나수술직후 4명에서새로발생하였고이중 2명은 년내에사라졌으며 2명은지속되어현재하루에패드 2-4장을사용하고있다. 결론 : 후부요도협착성형술은도전적수술이지만수술성공율과합병증의빈도측면에서우수하였다. 이전시행된교정술이요도성형술의수술성공율을낮출수있음을알수있었다. 향후추가적인자료수집및장기적인추적관찰을통하여더욱신뢰성이있는보고가필요하다하겠다. Keywords: Urethroplasty, Pelvic fracture urethral injury, Posterior urethral stenosis 27

O-07 과민성방광의치료에있어서보톡스주입술의위치에따른효과와안정성에대한메타분석 조정기, 정재훈, 김규식, 윤영은, 이승욱, 문홍상, 최홍용, 박성열, 박해영, 김용태 한양대학교의과대학비뇨기과학교실 Aim: We conducted this study to assess the efficacy and safety of OnabotulinumtoxinA (BoNT/A) according to site of injection for treating overactive bladder. Methods: A systematic literature review was performed to locate randomized controlled trials of OnabotulinumtoxinA for treatment of neurogenic detrusor overactive bladder and idiopathic overactive bladder in adults. We searched databases such as MEDLINE, EMBASE, and the Cochrane Controlled Trials Register using the Ovid platform. This meta-analysis was based on Cochrane Review Methods. Results: Eight studies (49 participants) were included. Trigone-including injection demonstrated significant improvements in symptom scores (SMD=-0.53, 95% CI=-.04 to -0.02, P=0.04, I2=78%). It also demonstrated a significantly higher complete dryness rate (OR=2.9 patients number, 95% CI=.32 to 3.63, P=0.002, I2=4%) and lower frequency of incontinence episodes (WMD=-0.85 numbers per day, 95% CI=-.55 to -0.6, P=0.02, I2=87%). We found a lower detrusor pressure after trigone-including injection than after trigone-sparing injection (WMD=- 2.55 cmh 2 O, 95% CI=-4.6 to -0.95, P=0.002, I2=0%) (Fig. 3A), and higher volume at first desire to void (WMD=7.54 ml, 95% CI=.00 to 34.07, P=0.04, I2=0%). There were no differences in efficacy according to injection site between intradetrusor and suburothelial injection, or in safety in terms of the incidence of vesicoureteral reflux, hematuria, general weakness, bladder discomfort, large postvoid residual, and urinary tract infection. Conclusion: Trigone-including BoNT/A injection is superior to trigone-sparing injection in efficacy, as measured by symptom score, complete dryness rate, frequency of incontinence episodes, detrusor presser, volume at first desire to void without increase of complications. However, the depth of injection does not influence the efficacy or safety of BoNT/A injections. Keywords: Neurogenic detrusor overactive bladder, Idiopathic overactive bladder, Onabotulinumtoxina 28

O-072 Safety and efficacy of BOTOX in patients with NDO or OAB: a Korean post-marketing surveillance 고광진, 정성진 2, 윤하나 3, 모교익 4, 신동길 5, 오승준 6, 주명수 7, 이규성 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 분당서울대학교병원비뇨기과학교실, 3 이화여자대학교부속목동병원 비뇨기과학교실, 4 근로복지공단인천병원비뇨기과, 5 부산대학교병원비뇨기과학교실, 6 서울대학교병원비뇨기과학교실, 7 울산대학교서울아산병원비뇨기과학교실 Purpose: To evaluate of the safety and efficacy of BOTOX R in the treatment of urinary incontinence patients with neurogenic detrusor overactivity (NDO) or overactive bladder (OAB) not adequately controlled by anticholinergics via post-marketing surveillance in Korea. Materials and Methods: Before the injection of BOTOX R, full medical histories were collected. During to 3 months after treatment, physicians assessed adverse events (AEs). And the efficacy is assessed through international consultation on incontinence questionnaire short form (ICIQ-SF) total score. Results: A total of 739 patients were enrolled and finally 686 (OAB: 525 and NDO: 6) were in the safety analysis set and 62 (OAB: 478 and NDO: 34) were included in effectiveness analysis. Mean follow-up periods were 60.±37 days. Of the safety population 78 (8.6%) AEs in 59 patients was reported [NDO: 27 (.8%) AEs in 9 patients and OAB: 5 (7.6%) AEs in 40 patients]. The most common AEs were urinary retention (.3%), urinary tract infection (.02%), and dysuria (0.73%) (Table ). After Botox treatment, 4.3% (8/436) of the patients initiated clean intermittent catheterization due to increased residuals and voiding difficulty. Due to the observational nature of the study, the AE reporting was left to the investigator s clinical assessment and might have varied according to local clinical guidelines. Of the efficacy analysis set, the mean total ICIQ-SF of NDO patients (n=34) was decreased from 4.34±4.97 to 7.5±5.83, significantly. When the efficacy was evaluated only in 35 patients with UUI in OAB patients, the mean change in total ICIQ-SF was -7.02±6.48 (p<0.00). Conclusions: In this post-marketing surveillance, no significant AEs were found compared to previously reported AEs of BOTOX R. Thus, BOTOX R is a safe and effective treatment for Korean patients with NDO or OAB in a real clinical setting. Keywords: Botox, Overactive bladder, Post-marketing survey 29

O-073 The prevalence of bladder pain syndrome in Korea 전병조, 태범식, 최훈, 박재영, 배재현고려대학교의과대학안산병원비뇨기과학교실 Background and Objectives: The international society for urinary incontinence has defined bladder pain syndrome (BPS) as a combination of urinary symptoms such as suprapubic pain and daytime and nighttime frequency without apparent cause such as urinary tract infection. We conducted prevalence BPS survey in Korea. Methods: On April 206, the prevalence of bladder pain syndrome was evaluated by telephone interview with 3000 interviewees in the general population for 30 days. Subjects were 40-79 year-old male and female from 5 cities across the country. A trained interviewers asked pelvic pain and urgency frequency questionnaire (PUF) was used as a technique for screening the bladder pain syndrome. PUF score were range from 0 to 35, and a symptom score of more than 2 points is considered to indicate BPS. Results: Overall proportion of BPS is 6% of all respondents and the prevalence was significantly higher in women (2.4%) than in men (0.7%). By age, the prevalence rates were 5.2%, 8.0%, 8.6%, and 26.0% in the 40s to 70s, respectively. In particular, the highest PUF score was found in women with 70s, and the PUF score showed positive correlations geriatric depression index score. The prevalence of BPS was 22.3% in divorce/bereavement, 5.7% in married and 2.7% in unmarried, and the prevalence of depression was higher according to the degree of depression. In the absence of depression, BPS was diagnosed only in 5.9% of the cases, while mild depression symptoms were present in 6.3%, moderate or severe cases were in 3.6% and 48.%. Conclusions: As a first prevalence report of the BPS in Korea, it has shown that BPS occurs at a quite high rate. The BPS is associated with psychological aspect demanding early diagnosis and treatment, so requires more social attentions. Keywords: Bladder pain syndrome, Depression, Prevalence 30

O-074 Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: analysis from the 2008-2009 Korean national health and nutrition examination survey 이준호, 박연원, 최기복 국립경찰병원 목적 : Obesity measured by anthropometry is a risk factor for urinary incontinence (UI). However, these anthropometry measures (body mass index and waist circumference) do not provide the exact and precise mass or percentage of body fat. With the development of body composition measurement technologies, the accurate parameters of the fat mass or distribution can be measured by dual energy X-ray absorptiometry. Therefore, we investigated the relationship between UI and obesity parameters obtained by dual energy X-ray absorptiometry. 대상및방법 : We included 5,792 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. The condition of UI was investigated by trained interviewers. Obesity was assessed using anthropometry and dual energy X-ray absorptiometry. We used the chi-square test, t-test, receiver operating characteristic curves, and logistic regression analysis for statistical analysis. 결과 : Results: Waist circumference (mean±standard deviation: 78.5±0.0 vs. 82.4±9. kg), body weight (56.9±9. vs. 58.5±8.4 kg), and body mass index (23.3±3.4 vs. 24.2±3. kg/m 2 ) were significantly higher in the UI group. Additionally, the total fat mass (mean±standard deviation: 8.5±5.3 vs. 9.4±4.9 kg), trunk fat mass (9.3±3.4 vs. 0.±3.2 kg), trunk fat/leg fat (.58±0.54 vs..73±0.50), total body fat percentage (32.3±5.4 vs. 33.0±5.0%), and trunk fat percentage (32.4±7.3 vs.33.9±6.6%) were significantly higher in the UI group. Among the parameters, the trunk fat mass/leg fat mass showed highest sensitivity (83.6%) with a cut-off value of.272. Before and after adjustment, trunk fat mass/leg fat mass>.272 was significantly related to UI and showed the highest odds ratios (ORs) among dual energy X-ray absorptiometry parameters (adjusted ORs (95% confidence interval):.807 (.343-2.43)). Anthropometry parameters, such as the waist circumference, were inferior to dual energy X-ray absorptiometry parameters in terms of the relationship with the UI. Conclusion: Obesity parameters obtained from dual energy X-ray absorptiometry are closely related to UI. Among the parameters, the trunk fat/leg fat is the strongest. Keywords: Obesitiy, Incontinence 3

O-075 Nutrient intake and urinary incontinence in Korean women: a propensity score-matched analysis from the Korean national health and nutrition examination survey data 이준호, 박연원, 최기복 국립경찰병원 목적 : A recent study investigated the relationship between dietary nutrients and female urinary incontinence (UI). However, very few data are available on this topic and the results are not consistent across studies. Therefore, we evaluated these relationships using nationally representative data from Korea. 대상및방법 : We included 8,090 women over the age of 20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We conducted a propensity-matched study by identifying women with UI. Women without UI, matched for age, body mass index, menopause, delivery history, hypertension, diabetes, hypercholesterolemia, stroke, asthma, chronic obstructive pulmonary disease, and amount of total food intake, were included as a control group at a 2: ratio (66 women with UI;,322 women without UI). Data were analyzed using the chi-square test, Mann-Whitney test, Fisher s exact test, and logistic regression. 결과 : Following propensity score matching, 66 women with UI and,322 women without UI were included; the confounders were evenly dispersed and did not differ significantly between the groups. There was no significant difference in the intake of water, fat, protein, calcium, phosphorus, iron, sodium, potassium, vitamin A, carotene, riboflavin, niacin, and vitamin C. However, carbohydrate intake was significantly higher in the UI group than in the control group (median [interquartile range]: 282.3 g/day [24.7; 352.0] vs. 267.7 g/day [22.6; 339.]; P=0.04). 결론 : High carbohydrate intake was significantly related to female UI after propensity score matching of representative Korean data. Keywords: Incontinence, Nutrients 32

O-076 최대요도폐쇄길이와전립선절제술후요실금회복과의연관성 박경기, 김성대, 김영주, 허정식제주대학교병원비뇨기과학교실 Introduction: 전립선절제후생기는요실금의원인에대한많은의견들이있고그중요도의수축력이중요하다고하여수술후에 kegel exercise를재활의한방식으로권유하고있다. 이에수술후 catheter제거시점에시행한영상의학적인방법으로요도의수축력을측정하여술후요실금의회복과의연관성을확인하고자한다. Methods: 203년 3월부터 205년 2월까지까지로봇보조전립선절제술을시행한 60명 ( 평균연령 65세 ) 을대상으로하여후향적인분석을시해하였다. 수술후 7일에유치카테터를통한방광조영술을시행하였다. 요도방광문합부위의회복을확인후환자에게골반근육수축을시도하게하였고방광목주변의요도폐쇄길이의변화를측정하였다. Results: 요도폐쇄길이는수술후 3개월의요실금유지비율에서역상관을보였다 (defined as [number of patients with continence/total number of patients on post op 3 months] (r=-0.488, P<0.05). ROC curve를이용한 optimal cutoff value인요도폐쇄길이 5 mm를기준으로그이상과이하로구분하여요실금유지비율을확인하였을때, 유의한차이를보였다 (p<0.05). Conclusion: 전립선절제술후시행되는방광조영술로확인하는수축후요도폐쇄길이는수술후 3개월의요실금회복을예상하는데도움이될것으로판단되고 6 mm 이하로관찰되는환자에서는수술후괄약근의재활및약물치료를좀더신경써야할것으로판단된다. Keywords: Prostatectomy, Urethral closing, Incontinence 33

O-077 전립선수술후발생한남성요실금의치료로 Re-adjustable male sling 수술의결과 문경태, 최재덕 2, 조희주, 조정만, 강정윤, 김정훈 2, 안승현 2, 유탁근 을지병원, 2 한전병원 Objective: 양성및악성질환에대한전립선수술후발생한남성요실금의치료로 Re-adjustable male sling (Male Remeex System) 수술의효과및안전성에대해알아보고자하였다. Materials and Methods: 203년 8월부터 206년 8월까지 2개의병원에서전립선수술후발생한남성요실금의치료로 Male Remeex System (MRS) 을시행한환자들중 3개월이상추적관찰된 7명의환자를대상으로수술후효과및안전성을후향적으로의무기록을통해조사하였다. 7명의환자중 4명은근치전립선절제술 (RARP: 0례, LRP: 3례, open RRP: 례 ) 시행후요실금이발생되었고 3명은전립선비대증수술 (HoLEP: 례, TURP: 2례 ) 후에요실금이발생하였다. 환자들의원인수술후 MRS 수술시까지의기간은평균 30.4개월이였다. 술후요실금이없거나 security 패드만필요한경우는성공, 패드사용이 50% 이상줄어든경우요실금의개선, 그리고 50% 미만의패드사용이필요한경우는실패로정의하였다. 환자의요실금으로인한삶의질만족도는 visual analog scale로측정하였다. Results: 환자들의 MRS 수술시평균나이는 73.7세, 수술후추적관찰기간은 34.6 개월이였다. 수술을시행한 7명의환자들중 5명 (29.4%) 에서성공을보였고, 7명 (4.2%) 에서는요실금의개선이있었다. 근치전립선절제술을시행한환자 4명중 5명 (35.7%) 에서성공을보였고 7명에서는요실금의개선 (50.0%) 이있었으나, 전립선비대증수술을시행한환자 3명모두에서는수술후요실금의개선이나타나지않았다. Tension re-adjustment는 6명 (94.%) 에서 회이상시행하였으며이중 4명 (23.5%) 은추적관찰기간중효과부족으로 controller의장력재조절이필요하였다. 수술중, 후방광천공, 요도미란등의합병증은관찰되지않았다. 총 5명 (29.4%) 의환자에서지속적인회음부및치골상부의통증으로호소하여 varitensor를제거하였고이중 2명은요실금의개선이있던군이였다. 술후요실금의개선이있으면서 varitensor 를유지하고있는 2명에서술후만족도 (0: 만족없음, 0점 : 매우만족 ) 는 8.2±.7점으로조사되었다, Conclusions: MRS 수술은전립선암에대해전립선적출술후발생한요실금에대해서는약 80% 이상의환자에서술후우수한결과를보여주었으나전립선비대증수술후발생한요실금의치료로는성공적인결과를가져올수없었다. 본연구는규모가작아어떤인자가 MRS 수술실패의위험인자인지밝히지는못하였으나일부환자들에서는효과부족, 지속적인회음부및치골상부통증을호소하였음으로 MRS 수술계획시에는이러한점을고려하여야할것으로사료된다. Keywords: Male remeex system, Incontinence, Prostate 34

O-078 전립선적출술후요실금의수술적치료의실패에영향을미치는인자들 : 단일기관의경험을통한개별환자에적절한수술방법선택에관한연구 김명, 최대헌, 김아람, 홍준혁, 김청수, 안한종, 주명수 울산대학교서울아산병원비뇨기과학교실 Objectives: We investigated clinical and urodynamic parameters predictive of the unfavorable outcomes of PPI surgery. Methods: We retrospectively reviewed the medical records, and urodynamic findings of PPI patients who received artificial urinary sphincter (AUS) or ARGUS R between 200 and 205. Treatment failure was defined as using more than one pad per day at last follow-up. Binary logistic regression analysis was performed to find out the predictive factors for treatment failure. Results: A total of 03 patients (AUS, 53 patients; ARGUS R, 50 patients) with a mean age of 69.9 (±5.6, SD) years were analyzed. The mean number of daily pad usage was 4.8 (±3.4). The mean maximum urethral closure pressure (MUCP) and valsalva leak-point pressure (VLPP) were 33.2 (±5.4) and 70.8 (±24.) cmh 2 O, respectively. The mean symptom duration and follow-up after PPI surgery were 46.9 (±3.) and 27. (±22.4) months, respectively. During follow-up the overall treatment success rate was 68.0%. Multivariate analysis revealed some interesting findings as followings. First of all, after adjustment of other potential risk factors, the choice of surgical modality as AUS was independently associated with the success of PPI surgery (OR=5.067, p=0.039). In addition to this, mixed type urinary incontinence (OR=0.249, p=0.043) and degree of incontinence (pad/day; OR=0.725, p=0.028) were inversely associated with the success of PPI surgery. Lastly, any of the UDS parameter could not predict the treatment outcomes (p range: 0.42-0.995). In patients who received AUS, history of neurologic disease (OR=0.073, p=0.045) and degree of incontinence (OR=0.72, p=0.08) were inversely associated with treatment success. Whereas, in patients with ARGUS R, prior history of DM (OR=0.4, p=0.05) and pelvic irradiation (OR=0.055, p=0.043) showed inverted association with treatment success. Conclusions: Treatment outcomes of PPI surgery can be compromised in patients with mixed type incontinence, and severe symptoms. Although the AUS showed the better treatment outcomes than ARGUS R, physicians should be aware that treatment outcome might be compromised in patients with neurologic disease. In patients with histories of DM or pelvic irradiation, the ARGUS R should be avoided as a treatment option for PPI. The preoperative UDS had no role in predicting treatment outcomes. Keywords: Post-prostatectomy incontinence, Artificial urethral sphincter, Sling surgery 35

O-079 Fate of overactive bladder after artificial urinary sphincter implantation 손희서, 강숭구, 김장환 연세대학교의과대학비뇨기과학교실 Introduction: The clinical course of OAB after AUS implantation is not clearly known and there is no guideline on management of post-aus OAB. We have investigated clinical course of OAB after AUS implantation. Patient and Methods: Virgin cases from August 200 to December 206 by a single surgeon (JHK) for treatment of post-radical prostatectomy incontinence (PRPI) were included. Exclusion criteria were cases requiring device revision, cases with follow-up of less than 2 weeks after device activation, and cases with insufficient data for estimation of pre-aus condition, post-aus symptom duration. OAB was defined as OAB Symptom Score (OABSS) 3 with urgency score 2. Post-AUS OAB was defined as OAB diagnosed within 2 months after device activation with Incontinence Severity Index points 8. Results: Finally, 60 patients were evaluated. Median age at AUS implantation was 73.3 (IQR 69.7-77.3), median time interval from radical prostatectomy was 3.3 (9.-52.2) months. During median follow up period of 25.5 (IQR 2.2-40.5) months, 22 (36.7%) met the criteria of post AUS OAB based on OABSS checked at median periods of 4.0 (IQR 2.2-6.4) months after device activation. 5 (8.3%) showed late occurrence of OAB at median period of 24.5 (IQR 2.3-48.7) months and these were excluded from assessment. Of 3 patients with medication, 7 showed poor responses to medication, patient was satisfied with medication, and 4 showed resolution of OAB. The outcomes were different by type of OAB. All 3 patients of De Novo OAB showed resolution of OAB after median 23.3 (6.0-3.6) months of treatment, doing well without medication afterward (P=0.04, Chi-Squared test) (Table ). Conclusions: We could observe that plenty of patients have post AUS OAB needing medical treatment. Contrary to persistent OAB, large portion of De Novo OAB showed resolution of OAB after some period of medical treatment. Proper prediction and counseling might be helpful in managing patients of post AUS OAB. Keywords: Artificial, Urinary sphincter, Overactive 36

O-080 The effect of low bladder compliance on upper urinary tract after artificial urinary sphincter implantation 손희서, 강숭구, 김명주, 김장환 연세대학교의과대학비뇨기과학교실 Introduction: Low bladder compliance (BC) has high potential of upper urinary tract (UUT) damage following continence surgery. In case of neurogenic low BC, several literatures had reported deterioration of UUT after artificial urinary sphincter (AUS) implantation. However the consequence of low BC in post-radical prostatectomy incontinence (PRPI) is not well known. We have investigated PRPI patients with low BC. Patient and Methods: Cases of AUS from May 2007 to December 206 by a single surgeon (JHK) were investigated. Urodynamic studies were performed before AUS implantation. Post AUS continence was assessed based on the incontinence severity index (ISI) introduced by Sandvik. Patient UUT was evaluated with GFR and CT or MRI findings. Results: Finally 7 patients with low BC 20 cmh 2 O/ml were evaluated. During the median follow up of 40.3 (IQR 25.7-57.0) months, 5 (29.4%) were continent, (64.7%) were mildly incontinent and one (5.9%) was incontinent with atrophy (Table ). Among 0 with available UUT image, no had morphometric deterioration with bladder filled state. When evaluating GFR, there was no significant change after AUS implantation (P=0.500 for continent patient, P=0.76 for mildly incontinent patients) (Figure ). Conclusions: We could observe tolerable outcome in continence and UUT condition. Even though this study has limitation with small number of patients and retrospective assessment, we might conclude that AUS may not be denied even for PRPI with low BC. Further study including postoperative urodynamic condition is going to be followed. Keywords: Artificial, Urinary sphincter, Compliance 37

O-08 전립선특이항원범위에따른전립선조직검사방법 (TRUS versus MRI guided) 간의암진단율차이에대한비교분석연구 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 이현무, 최한용, 박병관 2, 김찬교 2 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 Purpose: To compare the cancer detection rates of 2 cores transrectal ultrasound guided prostate biopsy (TRUS- GB) and multiparametric magnetic resonance imaging guided prostate biopsy (MRI-GB) according to the prostate specific antigen (PSA) level and to evaluate whether MRI-GB has increased detection rates of (clinically significant) prostate cancer compared with TRUS-GB in patients with PSA level<0 ng/ml. Material and Methods: We retrospectively analyzed TRUS-GB and MRI-GB patients from September 203 to March 207. A total of 2,269 patients underwent initial TRUS-GB (n=2020) and MRI-GB (n=249). MRI-GB was performed MRI/TRUS fusion biopsy or MRI-targeted biopsy or MRI cognitive biopsy for lesions corresponding to PI-RADS 4-5 on mpmri. Clinically significant prostate cancer was defined as Gleason 7 or greater. We also compared the cancer detection rates with the second biopsy in patients with initial TRUS negative biopsy and persistently high PSA. Results: Of 2,269 patients, 872 (38.7%) were diagnosed with prostate cancer. Of note, MRI-GB showed significantly higher cancer detection rates compared to TRUS -GB according to specific PSA ranges [<2.5 (50.0% vs 20.0%; p=0.06), 2.5-4 (55.% vs 8.8%; p<0.00) and 4-0 ng/ml (5.4% vs 3.%; p<0.00)]. However, there were no differences of cancer detection rates between MRI-GB and TRUS-GB in patients with PSA 0-20 and greater than 20 ng/ml. Furthermore, MRI-GB showed a higher proportion of clinically significant prostate cancer than TRUS-GB at PSA 2.5-4 (69.8% vs 49.5%; p=0.030) and 4-0 (78.6% vs 56.7%; p=0.003). Interestingly, MRI-GB also showed higher cancer detection rates at PSA 2.5-4 (56.2% vs. 20.0%; p=0.002) and 4-0 (50.0% vs 7.4%; p<0.00) in patients underwent second prostate biopsy after negative TRUS biopsy and persistently high PSA. Conclusion: Our study indicates that MRI-GB can be more valuable cancer detection tool for initial and repeat prostate biopsy, particularly for patients with PSA 2.5-0. Keywords: MRI guided prostate biopsy, Prostate cancer, PSA 38

O-082 첫번째경직장초음파전립선조직검사에서 ASAP 또는 HGPIN 이진단된환자에서두번째조직검사를시행할때생검방법 (TRUS vs MRI guided) 에따른전립선암진단율비교 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 이현무, 박병관 2, 김찬교 2 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 Purpose: To evaluate the usefulness of Magnetic Resonance Imaging (MRI) guided biopsy with repeat prostate biopsy in patients with Atypical small acinar proliferation (ASAP) or High-grade prostatic intraepithelial neoplasia (HGPIN) in initial transrectal ultrasound (TRUS) guided prostate biopsy. Material and Methods: We retrospectively analyzed prostate biopsy patients from September 203 to March 207. Of 2,97 patients, 47 patients who were diagnosed with ASAP (n=7) and HGPIN (n=30) in initial prostate biopsy were finally underwent second prostate biopsy. Patients with PSA >20 ng/ml were excluded (n=495). MRI guided biopsy was performed as MRI/TRUS fusion or MRI-targeted or MRI cognitive method for lesions corresponding to PI-RADS 4-5 on MP-MRI. Results: When we compared cancer detection rate according to the biopsy methods in patients who had ASAP or HGPIN in initial biopsy, MRI guided biopsy showed significantly higher cancer detection rate compared to those with TRUS biopsy (MRI 54.2% vs 2.7%; p=0.036). However, there were no significant differences in cancer detection rates according to initial diagnosis type, such as ASAP, HGPIN and 2 HGPIN (Fig ). Interestingly, while cancer detection rate was similar in initial ASAP patients between TRUS and MR-guided biopsy, MR guided biopsy showed a higher cancer detection pattern than TRUS biopsy in initial HGPIN patients (Table ). Conclusion: In sum, MR guided biopsy showed a higher cancer detection rate in second prostate biopsy than TRUS biopsy in patients who were diagnosed with ASAP or HGPIN in initial TRUS biopsy. Keywords: ASAP, HGPIN, MRI guided prostate biopsy 39

O-083 Serial comparison of cancer detection rate between TRUS and MRI guided initial and repeat prostate biopsy: a single center experienced 방석환, 최영효, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 김찬교 2, 박병관 2, 이현무 성균관대학교의과대학 비뇨기과학교실, 2 영상의학과교실 목적 : 본연구는경직장초음파 (Trans rectal Ultra Sound guided biopsy; TRUS) 를이용한전립선조직검사와자기공명영상 (Magnetic resonance imaging guided biopsy; MRI) 를이용한전립선조직검사에서초회및반복조직검사시두검사법간의암진단율차이에대해분석하고자하였다. 연구방법 : 본기관에서 203년 9월부터 207년 3월까지전립선조직검사를시행받은 2795명의환자를후향적으로분석하였다. 조직검사에서전립선암이진단된경우 Gleason score 7점이상을임상적으로유의한전립선암으로정의하였다. 두조직검사법간의기본임상병리학적정보및암진단률차이를비교분석하기위하여, 연속형변수의경우 Mann-Whitney U test를, 범주형변수의경우 Chi-square test를적용하였다. 결과 : 초회전립선조직검사를시행한환자군에서 MRI guided biopsy가높은진단율을보였고 [TRUS 36% (n=728/2020) vs MRI 57.4% (n=43/249); p<0.0], 차조직검사에서암이발견되지않았던 2차조직검사자에서도 MRI guided biopsy가 TRUS biopsy에비해유의하게높은진단율을보였다 [TRUS 9.6% (n=64/327) vs MRI 55.2% (n=/20); p<0.0] ( 그림 ). 차및 2차조직검사에서음성으로나온 3차조직검사자에서도역시 MR guided biopsy가유의하게높은암진단율을보이는것으로분석되었다 [TRUS 5.4% (n=0/65) vs MRI 56.0% (n=42/75); p<0.0] ( 그림 ). 그러나,,2,3차에서음성이었던 4차검사자에서는두조직검사법간에유의한차이를보이지않았다 ( 그림 ). 특히, Gleason score 가 7점이상인임상적으로유의한전립선암의경우 차및 2차조직검사에서 MRI guided biopsy 에서더높은진단율을보였던반면 (TRUS vs MRI ; 72.2% n=426/728, 77.7% n=/43 p<0.0 ; 차 ) (TRUS vs MRI ; 45.3% n=6/0, 70.0% n=8/ p<0.0 ; 2차 ), 3차및 4차조직검사인경우두군간의차이는유의하지않았다. 결론 : 본연구에서, 초회및반복생검에서 3차전립선조직검사까지 TRUS biopsy에비해, MRI guided biopsy 검사의진단율이더우수한결과를보였다. 따라서, 전립선조직검사의경우 MRI guided biopsy가임상적으로보다유용한조직검사방법이될수있을것으로생각한다. Keywords: Prostate biopsy, TURS, MRI 40

O-084 이전음성전립선조직검사에대한자기공명영상융합전립선조직검사의영향 : 경직장초음파유도전립선생검과비교 변경현, 김진우, 박경민, 이유진, 정재욱, 하윤석, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 구자윤 2, 하홍구 2, 최석환 경북대학교의과대학비뇨기과학교실, 2 부산대학교의과대학비뇨기과학교실 Purpose: Transrectal ultrasound (TRUS) guided prostate biopsy is considered as a first method of prostate cancer diagnosis. Due to random sampling error, negative biopsy does not mean the absence of cancer in patients with persistent PSA levels elevation. Recently prostate cancer diagnostic reliability of multi-parametric magnetic resonance imaging (mp-mri) has been confirmed in many studies. We performed the study to check effectiveness of MRI fusion prostate biopsy by comparing with TRUS guide prostate biopsy in patients with previous negative prostate biopsy Materials and Methods: We retrospectively reviewed patients who underwent repeat prostate biopsy, from 20 to May 207 in KNUH and from 202 to May 207 in BNUH. The patients who had at least one previous negative TRUS biopsy were divided into two groups (repeat TRUS guide prostate biopsy and MRI fusion biopsy). Men with PSA>0 were excluded. Patients characteristics including age, prostate specific antigen (PSA), PSA density (PSAD), prostate volume, results for pathologic finding and detection rate between the two groups were analyzed. Results: There are no differences in patients characteristics except the number of previous prostate biopsy (p=0.007) between the two groups. Of the 26 patients with MRI fusion biopsy, 2 (46.2%) were found to have cancer and 24 (33.8%) of 7 in TRUS biopsy were diagnosed with cancer. The detection rate of prostate cancer with MRI fusion biopsy in 6.6%, 70.0%, and 75.0% patients of suspicious lesions of highest PI-RADS score 3, 4, and 5, respectively. Conclusion: Even though prostate cancer detection rate was higher in MRI fusion biopsy group, prostate cancer detection rate and Gleason score was not statistically different between the groups. But there is correlation between high PI-RADS score and detection rate. If the patients have PI-RADS score of 4 or higher, MRI fusion biopsy should be considered. Keywords: MRI fusion, Prostate biopsy 4

O-085 이전음성환자의전립선조직재생검에서자기공명 - 경직장초음파융합생검법의가치 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 변석수, 이상은, 홍성규 분당서울대학교병원비뇨기과학교실 Aim: To investigate validity of magnetic resonance imaging-transrectal ultrasound fusion target biopsy (Fusion-Bx) compared with transrectal ultrasound-guided biopsy (TRUS-Bx) by evaluating detection rate of prostate cancer (PCa). Methods: Medical records of 376 patients with prior negative TRUS-Bx who underwent repeat biopsy from Aug. 205 to Apr. 207 were retrospectively reviewed. The cohort was stratified into two groups (TRUS-Bx and Fusion-Bx) and assessed target/non-target cores in each group to analyze clinical and biopsy characteristics pattern. Results: There were total 95 and 8 patients in TRUS-Bx and Fusion-Bx group, respectively. The overall cancer detection rate was slightly higher in Fusion-Bx group, but no statistical significance was observed (24.6% vs 28.7%, p=0.367). Fusion-Bx group showed significantly greater detection rate in target core analysis (5.0% vs 7.7%, p=0.044). In confirmed positive biopsy patients, Fusion-Bx group had higher rate of clinically significant prostate cancer cases, but no statistical significance was seen (85.4% vs 92.3%, p=0.27). In the patients with highly or very highly suspicious MRI (maximum image grade 4-5) findings, malignancy was positive in 38 out of 00 men (38.0%). A strong relationship existed between target image grade and biopsy yield (Fig. ). Conclusion: Fusion-Bx showed better clinical significance including detection rate in repeat biopsy applied to prior negative patients. A further study with larger patient pool and prospective design is needed to confirm the validity of Fusion-Bx. Keywords: Prostate, Cancer, Fusion biopsy 42

O-086 MR-U/S fusion prostate biopsy 의유용성 : 단일기관연구 박경기, 김영주, 김성대, 허정식제주대학교병원비뇨기과학교실 Introduction: 임상적으로의미있는전립선암을진단하기위한방법으로 MR-U/S fusion biopsy의유용성이대두고있다. 이에본원에서시행하였던결과를가지고그유용성을알아보고자한다. Materials and Methods: 206년 9월부터 207년 6월까지전립선암이의심되어전립선조직검사를시행하였던환자중조직검사전 MRI를시행한 07명의환자를대상으로하였다. PSA는최소 2주간격을두고 2번이상측정하여추가적인하강이관찰되지않는경우연구에포함하였고 20 nl/ml 이상으로관찰된경우는연구에포함하지않았다. Pre biopsy prostate MRI는 T2, Diffusion이포함되었다. PIRADs 3점이상에서는 MRI-U/S fusion은 Percunavtm을이용하여이미지를병합하여의심되는소견이보인병변을지름 0.5 cm 크기의구형 target으로설정하여 3 core biopsy를하였고이후전립선크기에맞추어서 0-2 core biopsy를시행하였다. PIRADS 2정이하의병변은 systemic biopsy만진행하였다. Results: 환자의평균연령은 67세이고평균 PSAlevel은 8. ng/ml였다. PIRADS 3점이상에서시행한 fusion biopsy의 overall positive rate은 55.8% 였고, Gleason sum 6점및 low volume Gleason 3+4를제외한임상적으로유용한전립선암의 detection rate은 PIRADS 4점에서는 52%, 5점에서는 75% 로상승하였다. Systemic biopsy와 MR-U/S fusion biopsy 의일치율을비교하였을때좀더많은임상적으로유의한전립선암을찾아내는것을확인할수있었다. 가장많은위양성을보이는요인은 PIRADS 3점병소가되겠다. Conclusions: MR-U/S fusion biopsy의경우임상적으로유용한전립선암을 systemic biopsy보다더잘찾아내고있었고, PIRADS 3점병변의경우위양성병변이많아정확한영상의학적인판독이필요할것으로판단된다. Keywords: MRI, Ultrasound, Prostate biopsy 43

O-087 Initial experience with magnetic resonance imaging/transrectal ultrasound-fusion biopsy for prostate cancer detection performed by urologists 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 Purpose: Although navigation devices can be used for Magnetic resonance imaging-target biopsy (MRI-TBx), prostate distortion due to the end-fire technique can reduce accuracy. To reduce this risk, we adopted a fusion technique using transrectal ultrasound (US) embeded side-fire method (BK Medical, Peabody, MA, USA) and image-based fusion program (BioJet; GeoScan, Lakewood Ranch, FL, USA). We announced the initial experience of MRI/US-fusion-TBx technique by urologists. Methods: From Jan 207 and May 207, the patients who were scheduled for a MRI/US-fusion-TBx for suspected PCa were enrolled in this study. The TBx protocol in Gangnam Severance Hospital was performed 2 core systemic biopsy in addition to TBx. We performed 3 core TBx, consisted with 2 core from MRI/US-fusion-TBx and from MRI-cognitive-TBx, on each suspicious lesion in MRI by a urologist experienced MRI-cognitive-TBx. The prostate MRI protocol involved diffusion-weighted MRI in addition to the imaging sequences obtained using T2W MRI. Two b-values (0-000) were used, and diffusion restriction was quantified via apparent diffusion coefficient (ADC) mapping. The patients who underwent MRI at another hospital were included. Results: Of 3 patients with 37 lesions (median age=69.2, median PSA=6.62 ng/ml), TBx yielded the detection of prostate cancer in 8 patients (58.%) and 4 lesions (37.8%). Significant prostate cancer detection reported higher rate with increasing PI-RADS. Higher Gleason score ( 7) were found in MRI-TBx (7.4%) than systemic biopsy (65.0%) (p<0.00). Conclusions: MRI-TBx can be utilized to better detect clinically significant prostate cancer. Keywords: MRI, Prostate, Biopsy 44

O-088 능동적감시대상의전립선암환자에서수술전 MRI 의 PI-RADS score 와수술후병리결과상의암의위치와의상관관계 김휘우, 이원철, 한재현, 박사현, 임고산, 김명, 안한종 울산대학교서울아산병원 Objective: To assess the accuracy of PI-RADS scoring system on preoparative magnatic resonance imaging (MRI) in patients who were indicated for active surveillance (AS). Methods: Total of 08 patients who met the AS criteria of Johns Hopkins, but received radical prostatectomy (RP) were analyzed. All patients were received multiparametric preoperative MRI. We assessed whether the lesions on MRI ( 4 points of PI-RADS score) are well correlated with the cancer found on surgical pathology at 2 loci of the prostate. Result: The average patient age was 64.2 years (range, 45-79), and mean preoperative PSA and PSA density were 4.67 ng/ml and 0.0 ng/ml/gm, respectively. Mean number of biopsied core was.8. One-core tumor positive was noted in 77 patients (7.2%), and two-core tumor positive in 3 patients (28.7%). When the 296 loci of 08 prostate specimens were assessed, overall sensitivity and specificity of MRI for predicting an actual tumor at correlated locus was 4.2% and 72.9%. At apex, sensitivity and specific were 56.% and 59.9, respectively. At midgland the sensitivity and specificity were 38.5% and 68.5%, and at base, those were 28.6% and 88.6%, respectively. MRI was more sensitive for anterior prostatic lesions (46.2%) than posterior prostatic lesions (32.6%). Conclusion: The PI-RADS scoring system on preoparative MRI demonstrated relatively low sensitivity. But the specificity of PI-RADS scoring system was relatively high. Therefore, physician should be aware that disease characteristics may have been underestimated in AS patients with visible lesion on MRI. Keywords: Prostate cancer, PI-RADS score, Active surveillance 45

O-089 자기공명영상이적극적감시기준에합당한전립선암환자들에서병리학적결과를예측하는데도움이되는가? 박사현, 임고산, 김명, 유달산, 정인갑, 송채린, 홍준혁, 김청수, 안한종 울산대학교서울아산병원 Purpose: We aimed to evaluate whether multiparametric MRI using Prostate Imaging Reporting and Data System (PI-RADS) was helpful to predict unfavorable prostate cancers eligible for active surveillance. Materials and Methods: From January 204 to December 205, a total of 86 patients eligible for Prostate Cancer Research International Active Surveillance (PRIAS) criteria (Biopsy GS 6, PSA 0, PSA density<0.2, clinical Tc/ T2, and the positive cores 2) were analyzed. All patients underwent multiparametric MRI with PI-RADS scoring and radical prostatectomy. PI-RADS scoring was performed divided into 2 zones (right/left, anterior/posterior, and base/mid/apex). Results: Of 86 patients, 2 (.3%) patients had upstaging and 98 (52.7%) patients had upgrading. Upstaging/ upgrading cancers had lower prostate volume (47 cc vs 38 cc), higher PSA density (0.5 vs 0.2), and higher % tumor volume (7.2% vs 3.%) than favorable cancers (GS 6 and pt2). Index tumors of upgrading/upstaging cancers were located more predominantly in anterior zone than posterior zone (63.4% vs 36.6%). A total of 2232 sites were evaluated to identify diagnostic accuracy of PI-RADS scoring using whole mount section analysis. Overall sensitivity/specificity of PI-RADS were 52.0%/73.0%. The sensitivity/specificity of anterior site and posterior site were 47.8%/77.8% and 57.4%/68.6%. In multivariate analysis, PI-RADS score 4/5 lesions 2 was the independent predictor (HR=2.9, p=0.026) for upgrading/upstaging in patients eligible for active surveillance. Conclusions: Multiparametric MRI using PI-RADS scoring system had low sensitivity in prostate cancers eligible for active surveillance criteria. However, 2 or more PI-RADS score 4/5 lesions are associated higher risk of upgrading and upstaging. Keywords: Prostatic neoplasms, Magnetic resonance imaging, Diagnostic imaging 46

O-090 초저위험군과저위험군전립선암환자에서적극적추적관찰의 8 년간의결과 최창일, 강민용, 전황균, 성현환, 정병창, 전성수, 이현무, 최한용, 서성일성균관대학교의과대학삼성서울병원 Purpose: To compare clinical outcomes and treatment principles in the patients of very low and low risk prostate cancer (PCa) managed with active surveillance (AS) and changed into other treatments after AS. Methods: The retrospective cohort study was performed by the medical records of Samsung medical center from February 2008 to November 206 with a mean follow-up of 26.66 months. Follow-up evaluations were by PSA measurement at every 6 months, MRI every year, and surveillance-biopsies at year and then every 2-3 years if the patients agreed. Results: A total of 86 men have been managed with AS with mean age of 68±7.7. Of them, 4 patients discontinued AS for various reasons (treatment change into radical prostatectomy (RP) (n=), follow-up loss (n=3)). The rest 82 patients continued AS and out of these patients, 9 patients (23.2%) had progression and the mean duration to progression of those was 8.2 months (range: 0.5-35.6). Among 82 patients with AS, 45 patients (54.9%) underwent the surveillance biopsy at the mean 7.6 months (range 0.3-53.4). In this biopsy, no cancer was found in 6 patients (35.6%), 3 patients (28.8) had the same Gleason score with previous biopsy result and 6 patients (35.6%) did not meet the AS criteria (up-grade in patients, up-volume in 5 patients). Of the 6 progressed patients, 2 patients underwent RP, patient had androgen deprivation therapy (ADT), and 3 patients were loss from follow up. In the rest 37 patients (35.5%) who continues AS, the surveillance biopsy was not performed as clinically unindicated or rejected by the patients. They only had follow up by PSA and MRI. Of them, 3 patients (8.%) had positive finding in MRI. Treatments were changed into RP in 2 patients and ADT in patient. To date, no overall and cancer-specific mortality have been reported in both groups. Conclusions: AS is the safe and excellent treatment option for very low and low risk PCa. A surveillance-biopsy and repeat MRI could help to identify whether patients should continue AS or not. Keywords: Active surveillance, Prostate cancer, Outcomes 47

V-006 크기가큰낭성신문부종양에대한로봇보조부분신절제술 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수분당서울대학교병원비뇨기과배경 : 복잡도가높은낭성신종양을부분적으로절제하는것은높은수준의수술적기술을요구한다. 신문부에위치하고크기가큰낭성신종양을로봇으로절제하는비디오를통해서복잡도가높은낭성신종양을보다효과적으로부분절제하는기술을공유하고자한다. 증례 : 54세여성으로복부통증을주소로내원하여시행한컴퓨터단층촬영에서좌측신장전면부를대체하고있는 3 cm 크기의낭성병변을확인하였으며조영증강되는고형병변이있어낭성신장암의가능성이높을것으로판단하여보조신부분절제술을시행하였다. 통로배치는본원의독창적인방식을그대로이용하였는데네번째팔이환자의머리쪽중앙선근방에서들어와수술중당김기로서역할을충실히수행하는것이특징적이다. 낭성신종양은파열의위험성이있어세심한수술이필요하지만비교적정상신실질과육안적으로경계가잘구분된다는유리한점이있다. 절제시경계가잘확인되는부분에서시작하여종양의가성피막을따라섬세하게박리하는것이필요하다. 큰종양의경우종양을잘절제하는것도중요하지만절제후정상실질의단면이크게노출되기때문에절제전부터봉합방법에대해미리계획을세워야한다. 특히신문부종양의경우중요한구조물들로인해단면의봉합이제한되므로절제시주변의해부학적구조물을확인하고보존하면서종양을관통하는혈관을결찰하여이후불필요한단면봉합의필요성을줄이는것이필요하다. 종양을절제하고난이후에는노출된집뇨시스템과정맥에대한봉합을적절하게시행하고가능하다면조기디클램프 (early declamp) 하여허혈시간을최소화하고출혈의위치와정도를확인해보는것이필요하다. 이를통해단면을완전히닫아주는것이꼭필요한지여부를가늠해볼수있는데, 단면을완전히닫아주는것이주요구조물을물리적으로, 또기능적으로보존하는데끼치는영향을고려해야한다. 또한출혈조절에대한안전성까지종합적으로감안하여완전히봉합할지, 아니면단면을노출한상태에서단면부의출혈만조절할지여부를결정하면된다. 단면에빈공간이발생할경우필요에따라서지혈제를적용할수있다. 본증례의온허혈시간은 24분이었고, 술후 4일째합병증없이퇴원하였으며최종병리결과는투명세포신장암으로확인되었다. 수술후 6개월째촬영한단일광자방출전산화단층촬영에서좌측신기능이잘보존됨을확인할수있었다. 결론 : 본원에서는신종양환자에서부분절제술이가능할것을판단되는경우에는로봇수술법을적극적으로활용하고있다. 낭성종양이거나높은복잡도의종양의경우에도로봇수술을원활하게시행하고있으며, 선택된증례에서개복수술과비견할만한수술적결과를보이고있다. Keywords: Robot assisted surgery, Complex renal mass, Partial nephrectomy 48

V-007 거대복합낭종성신장종양에대해로봇을이용한부분신절제술을시행한보고 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실서론 : 부분신절제술은종양학적으로근치적신절제술과동등한예후를보인다고생각되면서신기능보존에더유리하여, 최근크기가작은신장종양에대하여표준술식으로자리잡고있다. 하지만종양이크기가크거나기술적으로어려운위치에있을경우부분신절제술을시행하기어려운경우가있다. 저자들은신혈관및신우에접해있는거대복합낭종성신장종양에대하여시행한로봇을이용한부분신절제술에대하여보고하고자한다. 증례 : 환자는 45세여성이었으며맹장수술받은과거력이외에특이과거력없었다. 수술전 CT에서좌측신장하부에 4.6 cm 크기의복합낭종성신장종양 (Bosniak III) 이관찰되었으며신문에접해있었다. 좌측신우의팽창소견이관찰되었고, 종양으로인해신우-요관폐색의심되었다. 신장동-정맥의분지가종양앞쪽으로접하여주행한후신장으로들어가는양상이었다. 로봇을이용한복강경부분신절제술을시행하였으며, 콘솔시간 74분, 허혈시간 29분, 출혈량 20 cc였다. 조직병리결과 multilocular cystic renal neoplasm of low malignant potential이었으며종양절제경계에서암이관찰되지않았다. 수술도중과수술후합병증없이퇴원하였으며, 3개월후시행한 CT에서요관폐색이호전된소견외특이사항없었다. Keywords: Robotic partial nephrectomy, Huge complex cystic renal mass 49

V-008 4 cm 보다큰신장종양에대한 Xi 다빈치수술시스템을이용한로봇단일공복강경 (LESS) 신장부분절제술의최초보고 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 단일공수술 은배꼽주위의단일절개를이용하는복강경수술기법을지칭한다. 복강경단일공수술을위해새로운기구들이개발되었지만, 이들은대개동작범위가제한되고기구들끼리충돌하여수술의난이도를높인다는선천적인단점이있다. 이러한단점을극복하기위해본원에서는다빈치수술시스템 (Intuitive Surgical Inc., Sunnyvale, CA, USA) 을이용한로봇단일공복강경수술을보고한바있다. 일부제한적관절움직임이허용되는새로운 Xi 시스템을사용한단일공복강경수술로봇기구가개발됨에따라서이를활용하여처음으로 4 cm보다큰신장종양에대하여복강경단일공부분신절제술을시행하였고이를소개하고자한다. 방법 : 환자의자세는일반로봇부분신장절제술과동일하다. 제대의상방변연을 2.2 cm 절개한후단일공포트를삽입하였다. 단일공포트는한개의 8.5 mm 복강경용투관침과두개의 5 mm 부속투관침을다중채널에위치시킨후고정시켜서확립하였다. 보조를위해 2 mm 투관침을단일공다중채널포트옆에위치시켰다. 로봇을도킹한후수술방법은기존의 multi-port 로봇부분신절제술과유사하였다. 결과 : 환자는 52세남성이었으며, CT에서신세포암이의심되는 4.7 cm 크기의신종양이우측신장에관찰되었다. 콘솔시간은 20분이고허혈시간은 30분이었다. 출혈량은 00 ml 가량이었으며, 수술도중과수술후합병증은없었다. 진단병리결과 clear cell type, Fuhrman grade 3였으며종양의절제경계에서암이관찰되지않았다. 결론 : 새로개발된 Xi 다빈치시스템의로봇단일공복강경 (LESS) 을사용하여신장부분절제술이구현가능하며안전하다는것을보여주었다. Keywords: Robotic LESS partial nephrectomy, Single-site surgery, Large renal tumor 50

V-009 신세포암에서 double loop tourniquet 을이용한복강경하하대정맥혈전제거술 정현철, 성재우, 양종협, 조신제, 강성민, 문형우, 이규원, 배웅진, 박용현, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교서울성모병원비뇨기과학교실 Introduction: Renal cell carcinoma (RCC) with vascular involvement in renal vein or inferior vena cava (IVC) can be seen 4% to 36% of cases. Despite advances in laparoscopic surgery, IVC thrombectomy using laparoscopy is still a technically challenging. In our study we report a case of IVC thrombectomy with double loop tourniquet technique. Materials and Methods: 6-years old female presented with incidental renal mass. The CT scan showed 8 cm sized exophytic, markedly heteorgenous enhancing mass involves right lower pole, extending to the right renal vein and infradiaphragmatic IVC. There were multiple slightly enlarged lymph nodes in the retrocaval and aortocaval space.all procedures were performed transperitoneally. Bowel was mobilized and renal artery was ligated. Thrombus was managedby sequential clamping of the lower IVC, contralateral renal vein, and cephalad IVC,along with mobilization of the IVC and occlusion of lumbar veins, allowing for vascularisolation.vascular clamping was performed with double-looped vessel loops and clips around vessels, double loop tourniquet. Radical nephrectomy was completed with standard laparoscopy. Results: The operative time was 40 minutes and IVC clamping time was 7 minutes. Estimated blood loss was 200 cc. Hemodynamics were stable during IVC clamping and there were no perioperativecomplications. The patient was discharged well on POD 5. The pathology showed pt3bn0m0, Fuhrman grade was III, and cell type was clear cell RCC. Surgical margin was negative. Conclusion: Laparoscopic IVC thrombectomyis stilla complex and technicallydemanding surgery. Double loop tourniquet technique is safe and effective method for laparoscopic IVC thrombectomy to improve the perioperavie outcomes in selected patients. Keywords: Renal cell carcinoma, Thrombectomy, Laparoscopy 5

V-00 단일신환자에서로봇보조복강경하부분신절제술의증례보고 서영은, 유영동, 황진호, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수분당서울대학교의과대학비뇨기과학교실 For the management of patients with small renal tumor, robot-assisted laparoscopic partial nephrectomy (RALPN) provides similar oncological control as radical nephrectomy (RN) and is superior to RN especially in single kidney patients by preventing hemodialysis, which can deteriorate patient s quality of life significantly. The main obstacle of RALPN is to resect the tumor in a bloodless field within a limited warm ischemia time (WIT), followed by hemostatic renorrhaphy under restricted area. Therefore, RALPN remains challenging to even highly experienced surgeon. Here we report a case of 55-year-old man, who underwent right radical nephrectomy due to renal cell carcinoma (RCC), referred to the urology department because of a 4.8 cm size left mid pole renal mass that was found incidentally by computed tomography (CT) during the routine examination. The renal mass was diagnosed as renal cell carcinoma with negative surgical margin in pathological exam. The WIT was 23 minutes and no complications or reoperations were observed after operation. The aim of this report is to present our case of RALPN in a single kidney patient. Keywords: Robotic, Solitary kidney, Partial nephrectomy 52

O-09 소아수신증평가에서 3 차원자동화초음파부피계산프로그램 (SonoAVC) 과 2 차원초음파영상계산방법의예비비교연구 송상훈, 김휘우, 이종필, 이상민, 안동현, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실 목적 : 신장초음파검사에서발견되는수신증정도와등급평가를위해서다양한객관적인측정방식이소개된바있다. 이연구에서는 3차원자동화초음파부피계산기 (SonoAVC) 를이용한수신증정도의평가가능성을알아보고기존의 2차원적인평가방식과비교하고자한다. 대상및방법 : 본원에서신장 / 복부초음파를시행받는환자중다양한정도의수신증을보이는 0명의소아를대상으로 3 차원자동화방식을사용하는 SonoAVC (Automatic Volume Calculation: GE Healthcare, Milwaukee, WI) 프로그램을이용하여 3차원초음파검사를시행하였다 (Figure ). 2차원적인수신증의평가는 SFU 등급, 신실질대수신증면적비 (renal parenchyma to hydronephrosis area ratio, RPHR) 를이용하여평가하였다. SonoAVC로측정된신장내수신증부피를 Virtual Organ Computer Aided AnaLysis (VOCALTM) 프로그램을이용하여측정한신장부피로나누어신장부피대비신장내수신증부피의비율 (hydronephrosis to kidney volume, HKV) 을구하였다. SonoAVC 평가의재현성은 intraclass correlation coefficients (ICC) 로계산하였다. 결과 : 대상환아 0명의연령중위수는 2.5개월 ( 출생 일-24개월 ) 이고모두남아였다. SonoAVC로 2번이상반복측정한 0개의부피세트를대상으로구한 ICC 는 0.990 (p<0.000) 로매우높은신뢰도를보였다. 수신증 SFU 등급대비 RPHR 과 HVK의분포는 Figure 2와같았다. 결론 : SonoAVC를이용한소아수신증의부피측정은재현성이매우높으며수신증의정도를쉽고빠르게직관적으로시각화및수치화하여보여주므로의료진간의의사소통및환자보호자에대한객관적설명에도움이될수있는방식으로판단된다. 향후수신증평가에유용한방식으로받아들여지기위해서는다양한수신증환자를대상으로한추적관찰연구가필요하겠다. Keywords: Hydronephrosis, Three-dimensional ultrasound, Kidney, SonoAVC 53

O-092 신우요관성형술후초기수술적평가및관리에신실질대수신증면적비 (renal parenchyma to hydronephrosis area ratio) 의역할 한재현, 이상민, 이종필, 안동현, 김휘우, 김건석, 송상훈 울산대학교서울아산병원비뇨기과학교실 목적 : 신우요관협착으로신우성형술을받은후요로폐색및신기능을평가하는것은매우중요하다. RPHR이수신증의평가를하는정확한도구로신우성형술시행한후초기수술성적평가에기여하는지의여부에대해서알아보고자한다. 대상및방법 : 본원에서 200년부터 206년 6월까지신우요관협착에대해서신우요관성형술을시행받은 20세미만의환자는 203명이었다. 이중수술전후배설성신주사검사 (MAG3 renal scan) 를시행하고 6개월이상초음파로추적관찰을시행하였으며방광요관역류가없고단일신이아닌환자 86명을대상군으로하여수술전, 수술후 3개월, 수술후 6 개월, 수술후 2개월의신장초음파를비교하였다. RPHR은 PACS 프로그램을이용하여신장의평형면에서장축을중심으로측정한수신증의면적을신실질의면적으로나눈비율로계산하였으며수신증인덱스 (HI), SFU 등급, 신우전후직경으로수신증의호전을함께평가하였다. 결과 : 전체환자는 86명으로남아는 45명 (74.4%) 이었고 35명 (70.7%) 이산전수신증을진단받았다. 술전수신증의등급은 SFU 3등급이 35명 (8.8%), 4등급이 5명 (8.2%) 이었으며평균상대신기능은 43.2% (5.5-87.5) 였다. 술전및술후추적관찰에서평균상대신기능은 43.3% 에서 2개월후 44.3% 로큰차이가없었으나신주사반감기는 20분이상의신주사지연반감기를보이는환아가 9.4% 에서 4.% 까지감소하였다. 환아의수술후실패를수술후배설성신주사검사로시행한상대신기능이수술전보다 0% 이상감소하였을때로규정하였을때 20명의환자 (0.8%) 가수술실패에포함되었다. RPHR 및 SFU 등급, 신우전후직경, 수신증인덱스의역수로수술실패에대한예측력으로서 ROC 곡선을확인하였을때수술전 RPHR이수술실패를상대적으로잘예측할수있었다 (AUC 0.73; 95% CI, 0.63-0.84) (Fig). RPHR 의 Cut off value는.27로특이도와민감도는 72.7%, 64.8% 이었다. 이분형로지스틱회귀분석으로치료실패에영향을주는요인을분석하였을때수술전 RPHR이치료실패를결정하는유의한인자로확인되었다 (p=0.006, Exp(B)=2.050). 결론 : RPHR은전통적인 SFU 등급및신우전후직경등보다신우성형술을시행한후초기수술적치료결과에관한예측인자로서유용하게사용될수있다. Keywords: RPHR, Pyeloplasty, Hydronephrosis 54

O-093 세미만신우성형술에서술전역행성조영술의가치 백민기성균관대학교의과대학삼성서울병원 Introduction and Objectives: There is variability among surgeons in the use of retrograde pyelography (RGP) during pediatric pyeloplasties. Pyeloplasty for infants is performed usually in open technique with a small incision, thus associated ureteral anatomy which influence the surgical outcome might not be detected through the small incision. Our aim was to review the impact of RGP during open pyeloplasty in infants. Methods: We retrospectively reviewed the perioperative parameters of pediatric patients who underwent RGP and pyeloplasties by a single surgeon from February 206 to April 207 with emphasis on the ureteral anatomy. Results: From a total of 2 pediatric open pyeloplasties during this time period, 2 cases were analyzed after the exclusion of re-do case. All of 20 cases included pre-operative RGP s. Ureteral abnormalities were noticed in 3 of 20 RGPs (5.0%), which included concomitant ureterovesical junction narrowing (n=), multiple narrowing segments at upper ureter (n=), and marked redundancy of ureter (n=). The success rate as defined by decreasing hydronephrosis was assessed with post-operative follow-up of at least month was 95.0% (9/20). The one failure case was associated with the marked redundancy of ureter on preoperative RGP. Conclusions: Preoperatively diagnosed ureteral abnormalities were seen in 5.0% of infant pediatric pyeloplasty cases. Peri-operative RPG s provide anatomical ureteral anatomy details that were not previously seen. Keywords: Ureteropelvicjunction obstruction, Retrograde pyelography, Pyeloplasty 55

O-094 신우요관이행부협착소아환자에서신우성형술중역행성신우충만을통해확인한교차성혈관의특징분석 강숭구, 김성훈 2, 이초녕 2, Gilbert Khoyo Marabi, 김상운, 한상원, 이용승 연세대학교의과대학비뇨기과학교실, 2 세브란스어린이병원소아비뇨기과 목적 : 교차혈관의존재는소아및청소년의신우요관이행부폐쇄의흔한원인이다. 하극신으로지나가는신동맥이주요원인으로알려져있으나, 신우와요관은요량에따라크기와모양이변할수있으므로영상의학적진단에는어려움이있다. 또한, 수술중신우요관이행부근처를지나는혈관이있는경우에도, 그혈관이폐쇄를일으키는혈관임을확진하는방법은존재하지않았다. 본연구진은신우성형술중역행성으로신우를충만시키면서교차혈관에의해신우요관이행부에폐쇄가생기는지여부를확인하고있으며, 이에대한분석을통해교차혈관의특징을분석하려한다. 대상및방법 : 205년 월부터 207년 6월까지본원소아비뇨기과에서단일술자에의해만 2-8세에복강경혹은로봇신우성형술을시행받은환자를대상으로후향적분석을하였다. 수술전역행성신우요관조영술을시행한후, 중부요관에요관카테터를위치시킨후, 복강경혹은로봇수술도중, 요관카테터를통하여역행성으로식염수를주입하여신우가팽창하는모양을확인하였다. 이때혈관에의해신우요관이행부가꺾이는경우, 교차혈관으로정의하였으며, 혈관의특성을분석하였다. 결과 : 해당기간중, 50명의환자가수술을받았으며, 수술연령의중위값은 7.세 (IQR 5.7-9.2) 였다. 수술의적응증은수신증의악화나분리신기능비의감소가 7명 (34%), 반복된요로감염이 3명 (6%), 반복적측복통의존재가 30명 (60%) 이었다. 술중역행성식염수주입시, 25명 (50%) 이교차혈관에의한신우요관이행부협착으로확인되었다. 25명중 4명 (56%) 에서는하극신으로가는동맥에의해, 명 (44%) 에서는생식선동맥-정맥다발에의해신우요관이행부가꺾이는것이확인되었다. 교차혈관이확인되었던 25명중, 술전 CT나 MRI가시행되었던경우는 6명있었으며, 이중 6명 (37.5%) 에서교차혈관이의심되었었다. 또한 25명의환자중, 출생후수신증으로추적을받던중수술을하게된경우는 4명 (56%) 이었으며, 수신증이처음발견되었던환자는 명 (44%) 이었다. 결론 : 교차혈관을수술전영상의학적으로진단하는것은어려우며, 술중신우를팽창시키는방법은교차혈관의존재를확인하는데에도움이될것으로판단된다. 하극신으로지나가는신동맥뿐아니라, 생식선동맥-정맥다발에의한교차혈관도높은빈도로관찰이되었다. Keywords: Hydronephrosis, Ureter, Kidney 56

O-095 양측신우성형술시행후장기추적결과 임영재, 박관진서울대학교의과대학비뇨기과학교실목적 : 양측신우요관이행부협착으로신우성형술을시행한환아들은신장관련합병증의위험성이더높을것으로예상되나, 아직까지는이에대한보고는없는실정이다. 저자들은영유아시기에양측신우성형술을시행한환자들의장기추적결과를알아보고자하였다. 대상및방법 : 986년 월부터 2002년 2월까지양측신우요관이행부협착으로양측신우성형술을시행한 2명의환자를후향적으로분석하였다. 각각의환자에서수술후상대적신기능의변화, 고혈압및단백뇨발생유무에대해평가하였다. 결과 : 2명중양측신우성형술후 0년이상추적관찰이가능했던환자는총 2명이었다. 남아가 0명이었고, 처음신우성형술로우측을시행한환아가 6명이었다. 첫번째신우성형술시행시평균나이는 5.5개월 (0.2-9.0) 이었고, 두번째신우성형술시행시평균나이는 9.8개월 (3.2-3.8) 이었다. 두번째수술시행후평균추적관찰기간은 8.4년 (3.-28.3) 이었다. 2명중고혈압이발생한환자는 3명 (25%) 이었고, 단백뇨도 3명 (25%) 에서발생하였다. 2명에서는고혈압과단백뇨가같이발생하였다. 고혈압이나단백뇨가발생한환자군 (4명) 과정상환자군 (8명) 을비교하였을때, 첫번째수술시행나이, 두번째수술까지의간격은유의한차이가없었다 (p=0.674, 0.59). 첫번째신우성형술을시행한신장의수신증등급 (SFU) 은고혈압-단백뇨군에서 3.8, 정상군에서 3.5로역시차이가없었다 (p=0.453). 한편첫번째수술전, 두번째수술전그리고두번째수술후혈중크레아티닌수치를확인한결과고혈압-단백뇨군에서는각각 0.67 mg/dl, 0.57 mg/dl, 0.55 mg/dl였고, 정상군에서는각각 0.5 mg/dl, 0.5 mg/dl, 0.66 mg/dl로모두유의한차이는없었다 (p=0.208, 0.75, 0.638). 수술후더많이감소된상대적신기능수치는고혈압-단백뇨군에서평균 28.5% 였고, 정상군에서 33.9% 로 5% 이상의차이를나타냈지만, 통계적인유의성은없었다 (p=0.577). 특징적으로고혈압-단백뇨환자 4명중 2명에서재수술을시행했으며, 명에서는첫번째수술전, 동측의신장에신루설치술을시행하였다. 반면에정상환아 8명중 3명에서신루설치술을시행했는데, 첫번째신우성형술과반대측신장에신루설치술을시행하였다. 결론 : 양측신우성형술을시행받은환자들은편측신우성형술환자보다고혈압과단백뇨가발생할확률이상대적으로높게나타났다. 이에영향을주는인자들은아직까지명확하지않으나신루설치술과재수술여부가중요한인자가될것으로생각된다. 결론적으로양측신우성형술을시행한경우에는혈압측정및소변검사와함께장기적인추적관찰이반드시필요하다. Keywords: Pyeloplasty, Hypertension, Proteinuria 57

O-096 Impacts of asymptomatic pyuria and vesicoureteral reflux (VUR) grade on the developing of post-voiding dystourethrogram (VCUG) urinary tract infection (UTI) Jeong Hoon Oh, Sumin Son, Ji Won Ryu, Seong Jong Eun, Jong Bum Kim, Yang Hyun Cho, Myung Soo Kim, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Sun-Ouck Kim 전남대학교의과대학비뇨기과학교실 Introduction: Voiding cystourethrography (VCUG) is gold standard test to identify the anatomical causes of urinary tract infection (UTI) in children. However, exact criteria in terms of pyuria on urine analysis before performing VCUG is not established. In this study, we evaluate the impact of asymptomatic pyuria and vesicoureteral reflux (VUR) grade on the developing post-vcug UTI. Methods: We retrospectively reviewed medical records of 430 children<2 years of age who underwent VCUG and diagnosed as VUR. Pyuria was defined as the presence of 5 or more white blood cell (WBC) per high-power field of the urine collected. Post-VCUG UTI was defined as the presence of 00,000/mL or more colonies of single bacteria at urine culture with fever. Prophylactic antibiotic (Cefprozil dry syrup (5 mg/kg) per 2 hrs, 3 days from test day) was used to every patient before performing the VCUG. Results: Pyuria was found in 8 children and 349 children showed clean urine. Post VCUG-UTI was developed in 42 children. Age, gender, laterality, VUR grade and pyuria at VCUG were not significantly associated with post-vcug UTI (P>0.05). Conclusions: Asymptomatic pyuria and VUR grade were not associated factor with post-vcug UTI. Therefore, VCUG is considered to be safe in children with non-symptomatic pyuria in terms of developing post VCUG-UTI. Keywords: Voiding cystourethrography, Pyuria, Vesicoureteral reflux 58

O-097 방광요관역류로수술받은환아들에서신반흔과돌파요로감염의위험인자들 변혜진, 신택준, 하지용, 정원호, 김병훈, 박철희, 김천일계명대학교의과대학비뇨기과학교실 Purpose: To determine risk factors provide predicting renal scar and preoperative breakthrough urinary infection (UTI) in patients underwent anti-reflux procedures for primary vesicoureteral reflux (VUR). Material and Methods: We retrospectively reviewed the medical records of 78 patients who underwent operation for VUR at out institution between January 2002 and December 206. Clinical parameters for the statistical analysis included following variables: gender, age at surgery, VUR grade, laterality, presence of constipation, occurrence of breakthrough UTI during the preoperative period, and presence of abnormal renal scan by 99mTc dimercaptosuccinic acid (DMSA). Anti-reflux procedures included endoscopic injection and ureteral reimplantation. These parameters were analyzed according to the renal scar presence and preoperative breakthrough UTI (table). Withdrawal Results: The mean age was 20.9±4 months (4-60) and the male to female ratio was founded 64/4. There were DMSA abnormalities in 46 of the 78 patients (58%). Cortical defects occurred more frequently in children with constipation (p=0.020). However, VUR grade was not associated with renal scarring (p=0.404). Female gender (p=0.027), young age (p=0.049), presence of constipation (P=0.03) were founded as the predicting factor for breakthrough UTI. Conclusions: Renal scar and breakthrough UTI affect the decision of surgery in patients treated for VUR. Renal scar rates increases with presence of constipation while breakthrough UTI increases with female gender, young age, presence of constipation. These risks should be considered while planning the treatment for VUR. Keywords: Vesicoureteral reflux 59

O-098 Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in pediatric patients with ureteroceles 송상훈, 이동현, 김휘우, 이종필, 이상민, 안동현, 박성찬 2, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 2 울산대학교병원, 울산대학교의과대학비뇨기과학교실 Purpose: We aimed to determine the impact of de novo VUR on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. Materials and Methods: We retrospectively reviewed the medical records of 34 patients with ureteroceles treated endoscopically. Pre- and post-operative radiological and clinical data regarding de novo VUR, UTI and renal function were analysed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, or deterioration of renal function. Results: Of the 34 patients (36 renal units), 22 had a duplex system (6.%). Preoperative VUR was noted in 8 patients (22.2%), including 3 patients without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 29 patients (85.2%). De novo VUR developed in 8 renal units (50%) post-operatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes by univariate or multivariate analyses. Even after selecting for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 4 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes. Conclusion: After endocopic ureterocele puncture, de novo VUR is highly prevalent, but not significantly associated with postoperative UTI or renal functional deterioration in the long term. It may not therefore be necessary to perform lower urinary tract reconstruction routinely to correct de novo VUR after endoscopic puncture of the ureterocele. Keywords: Ureterocele, Vesicoureteral reflux, Endoscopy, Punctures, Urinary tract infections 60

O-099 정계정맥류수술중시행한정맥조영술에서 bahren system 을이용한수술실패의주요원인분석 오경택, 김성훈 2, 이초녕 2, Gilbert Khoyo Marabi, 김상운, 한상원, 이용승 연세대학교의과대학비뇨기과학교실, 2 세브란스어린이병원소아비뇨기과 목적 : 청소년환자의정계정맥류수술에서, 내정계동맥을보존하는방법은고환의보상성비대측면에서장점이있을수있으나수술성공률이떨어질수있다는단점이있다. 이러한단점을극복하기위하여술중역행성정맥조영술을시행하기도하는데, 이는육안으로확인하지못한정맥을확인하거나, 정맥여부가확실치않은동맥, 임파선등을판별할수있는방법이다. 정계정맥수술중시행한정맥조영술을통하여, 수술실패의주요원인을분석하고자한다. 대상및방법 : 2005년 월부터 206년 2월까지본원에서, 만 20세이전에정계정맥류로수술을시행받고, 6개월이상추적받은환자들을대상으로후향적분석을시행하였다. 내정계정맥을결찰한후시행한술중정맥조영술을통하여, 결찰되지않고남아있는정맥을 Bahren type으로분류하였다. 결과 : 해당기간총 56명에서정계정맥류수술중정맥조영술이시행되었다. 47명 (94.2%) 은일차수술이었으며, 9명 (5.8%) 은재수술이었다. 이중개복수술은 5명의술자에의해 07명 (68.6%) 에서, 복강경수술은 명의술자에의해 49명 (3.4%) 에서시행되었다. 수술시연령은평균 3.5±2.5 세였다. 50명 (32.%) 에서정맥결찰후시행한술중정맥조영술에서남아있는정맥이관찰되었다. Bahren type 3의경우가 45명 (90.0%), Bahren type 4의경우가 5명 (0.0%) 에서관찰되었다. Bahren type 3는내정계정맥과평행하게주행하는정맥들이남아있는경우이고, Bahren type 4는좌측신장으로주행하는외정계정맥이존재하며내정계정맥과연결이있었던경우이다 (Fig ). 한편, 수술후재발은총 5명 (3.2%) 에서있었고, 그중술후지속되었던경우가 명 (0.6%), 재발되었던경우가 4명 (2.6%) 였다. 본원혹은타병원에서일차수술을받고, 재수술한 9명에서 Bahren type 4는관찰되지않았으며, 전례에서내정계정맥이관찰되어결찰하였으며, 다시재발하는경우는없었다. 결론 : 정계정맥류수술에서수술실패의가장큰원인은내정계정맥을남겨두는것이며, 이는원위부에서수술을하거나, 숙련도가높아지면서극복될수있는문제로판단된다. 상부에서내정계정맥과합쳐지는외정계정맥의존재는약 3.2% 에서존재하며, 이것은정맥조영술을시행하지않으면, 확인되기어려운구조로판단되며, 이에대한임상적의의에대해서는추가연구가필요하다. Keywords: Varicocele, Phlebography, Testis 6

O-00 Pathologic analysis of the testis in patients with postpubertal cryptorchidism 정재민, 이승수, 이동훈, 한지연, 남종길, 박성우, 정문기, 이상돈 부산대학교의과대학비뇨기과학교실 Purposes: It has been difficult to establish an optimal treatment strategy for postpubertal cryptorchidism. Unlike cryptorchidism in children, postpubertal cryptorchidism is associated with an increased probability of neoplasms, which has led orchiectomy to be the recommended treatment. To better understand the pathology associated with the postpubertal cryptorchidism, we reviewed our experience regarding the pathologic analysis of the postpubertal cryptorchidism. Materials and Methods: A retrospective review was performed of all consecutive patients with postpubertal cryptorchidism undergoing orchiectomy at our hospital between 2009 and 207. Patients who have congenital cryptorchidism were included in this analysis. Patients who have secondary cryptorchidism or performed orchiopexy were excluded in this analysis. Results: Eight patients underwent orchiectomy for the postpubertal cryptorchidism. Patient age ranged from 25 to 60 years. 5 patients (62.5%) had left side cryptorchidism. Total excised mass volume ranged from 0.27 to 38.9 ml. 5 patients (62.5%) had inguinal testis, 2 patients (25%) had intraabdominal testis and patients (2.5%) had streak testis. Testes were excised by 2 inguinal incisions and 2 laparoscopic operations. In 7 of the specimens (87.5%), we identified testis tissue. However, 4 testes had no viable germ cell elements, 2 azoospermia and arrest of spermatogenesis. None of the excised tissue had malignant degeneration. Conclusions: In our review, we identified that there was no benefit to fertility in the testis of postpubertal cryptorchidism. Therefore, if the patient anticipates no beneficial effect on fertility and is expected to have an increased risk of cancer, orchiectomy is recommended. Keywords: Testis, Pathology, Postpubertal 62

O-0 한국에서침습적방광암을가진여자환자에서근치적방광전절제술의추세 김승빈, 심지성, 홍범식 2, 구자현 3, 정병창 4, 서호경 5, 강석호 ; UCART (urothelial cancer-advanced research and treatment group in Korea) group 고려대학교안암병원비뇨기과학교실, 2 울산대학교서울아산병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 성균관대학교의과대학삼성서울병원비뇨기과학교실, 5 국립암센터비뇨기과학교실 Purpose: 방광암은남성에서흔하며, 이에여성에서근침윤성방광암에대한근치적방광절제술은남성보다드물다. 근 치적방광절제술은기술적으로어렵고오래걸리며술후합병증률이높아주로 high volume center에서이루어지고있는실정이며특히 female cystectomy에대한자료는많지않다. 이에국내 5개병원을대상으로하여최근 0년간시행된 female cystectomy에대한전반적인 trend를조사하였다. Materials and Methods: 2007년 월부터 206년말까지국내 5개의기관에서근치적방광절제술을시행받은총 285 명의여성환자들의자료를후향적으로분석하였다. 기본적인특성, 수술과관련된세부사항들, 합병증등을분석하였다. Results: 근치적방광절제술을시행받은여성들의평균나이는 66.7세였으며증상이발생하여비뇨기과병원에서첫방광경을시행하기까지의평균시간은약 5.7개월이었다. 흡연을한비율은 5.6% 였고, 평균재원기간은 2.8일로나타났으며술전항암치료를시행한비율은 6.8% 였다. 0년간대부분의수술은개복수술로이루어졌으며 (88.4%), 요로전환술식은 ileal conduit이 86.3% 로가장많았으며정위성방광대술은.9% 였다. organ sparing cystectomy의비율은 5.6% 였다. 03명 (36.%) 에서합병증이보고되었으며 70명은 달이내에발생했고 33명은 3달이내에발생하였다. Clavien grade 3 이상의 significant한합병증은 4명 (4.4%) 에서발생하였으며 wound관련합병증이 4건, anastomis site leakage or stricture가 0건, hernia가 7건순이었다. Conclusion: 본연구에서근치적방광절제술을시행받은여성환자의경우증상이발생하여비뇨기과에서방광경을시행하기까지의기간이길었고남성에비해흡연비율이낮았다. 대부분 ileal conduit을시행하였고술전항암치료의비율이나합병증비율은남성근치적방광절제술과유사하였다. Keywords: Bladder cancer, Female, Cystectomy 63

O-02 근치적방광절제술을받은방광암환자에서시행한조기회복프로그램 : 단일기관경험 최창일, 강민용, 전황균, 성현환, 서성일, 전성수, 이현무, 최한용, 정병창 성균관대학교의과대학삼성서울병원 Purpose: To describe our experience with enhanced recovery program (ERP) for the patients who underwent radical cystectomy (RC) associated with high morbidity and longer length of stays than other urological surgeries. Methods: From January 205 to November 206, an ERP after RC was applied on 92 consecutive patients who underwent RC in Samsung medical center. The patients who had prolonged postoperative intubation, and those who underwent extra surgery, nonconsenting patients were excluded from study. We focused on avoiding bowel preparation and nasogastric tube, preoperative nutritional support, early oral nutrition and postoperative analgesia. The outcomes were assessed including time to initiate ambulation, to pass gas out and to initiate normal regular diet (NRD) and length of stay (LOS). Complications are divided by Clavien-Dindo classification. Results: A total of 84 patients with the median age of 67 years (interquartile range [IQR] 60-74 years) at diagnosis were included in analysis. Sixty-seven percent of patients had a bowel movement by postoperative day 3. The mean surgical time was 3.9±.6 hours, and the mean estimated blood loss was 620. ml. The mean time to ambulation was.4±0.60 days, to flatus was 3.3±.26 days and to initiate NRD was 6.67±.32 days and the mean LOS was 22±8.6 days. The mean clinical T stage was 3.8±0.93, clinical N stage was.8±0.70 and Grade was 2.65±0.83. Thirty-five patients (4.7%) underwent neoadjuvant chemotherapy before RC. Three different techniques of RC were performed as open RC in 64 patients, laparoscopic RC in 3 patients, and robot assisted RC in 7 patients. The types of diversion were ileal conduit in 52 patients, orthotropic ileal neobladder in 29 patients, and ureterocutaneostomy in 2 patients. There was no significant difference of the time to NRD and LOS among different methods of RC and diversion. The 30-day minor and major complication rates were 38.% and 0.7%, respectively. Of the total 4 complications, 9 were major (defined as Clavien grade 3) and 32 were minor (Clavien grade or 2). The most common complication was gastrointestinal problems in 9 patient and ileus was occurred in 5 patients. To date, no overall mortality has been reported. Withdrawal Conclusions: The introduction of an ERP was successful to our patients who underwent RC associated with low complication rates. Keywords: Enhanced recovery program, Radical cystectomy, Bladder cancer 64

O-03 방광세척과카테터설치를간소화한신방광조형술의가능성및안전성 윤현석, 김광현, 송완, 윤하나, 정우식, 심봉석, 이동현이화여자대학교의과대학비뇨기과학교실목적 : 근치적방광조형술후신방광조형술을시행하는경우많은카테터로인하여술후관리가어려울뿐만아니라, 술후시행하는방광세척과정에서요로감염등이발생할가능성이있다. 본연구에서는신방광조형술에서비위관, 요관부목, 방광루를설치하지않고, 술후방광세척을간소화하는방법의가능성및안전성에대하여연구해보고자하였다. 대상및방법 : 202년 월부터 207년 2월까지단일술자가근치적방광절제술및신방광조형술을시행한 254명을대상으로하였다. 모든환자는방광루를설치하지않았으며, 202년부터 204년 7월까지시행한 60명의환자 (group ) 에서는비위관및요관부목을삽입하고술후하루 3회술후방광세척을하였다. 204년 7월부터 205년 2월까지시행한 80명의환자 (group 2) 에서는수술직후비위관을제거하였으며요관부목을설치하지않고술후하루 3회방광세척을시행하였다. 206년 월부터시행한 4명의환자 (group 3) emfdms 방광세척을최소화한방법을이용하였는데, 보호자에게규칙적으로도뇨관을펌핑하게교육하고, 3시간에 00 cc 이하로소변량이배출되는경우에만선택적으로방광세척을시행하였다. 각그룹간의수술전후변수및합병증등을조사하여비교하였다. 결과 : 세그룹간술전나이, 성별, 체질량지수등의차이는관찰되지않았으나, 수술시간이유의하게감소하였으며, 수술중출혈량및수혈빈도가유의한차이를보였다. 장마비의빈도, 정상식이까지의시간이나재원기간의차이는관찰되지않았으며, Clavien-Dindo grade 3 이상의주요합병증의빈도또한유의한차이가없었다 (6.7% vs. 7.5% vs..4%, P=0.493). Group 3 환자들중 78% (89/4) 는도뇨관제거전까지방광세척을하지않았고, 추가방광세척을진행한 25명중 3회이상방광세척을진행한환자는 8명이었다. Group 3는요누출이증가하였으나 (.7% vs.3% vs 7.9%, P=0.042). 다른두군에비해술후 30일이내열성요로감염이감소하는경향을보였다 (22.0% vs..4%, P=0.07). 결론 : 신방광조형술시행시도뇨관을제외한비위관, 방광루, 요관부목을모두설치하지않고, 술후방광세척을간소화하는방법을사용했을때술후주요합병증이나경과에유의한차이가관찰되지않았다. 술후방광세척을간소화한경우요누츨의빈도는증가하였으나, 열성요로감염을줄이는효과를기대할수가있었다. Keywords: Bladder cancer, Ileal neobladder, Urinary tract Infection 65

O-04 근치적방광절제술후비스테로이드소염진통제기반통증자가조절적용에의한위장관기능회복효과 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대학교병원비뇨기과학교실 Aim: To evaluate the effects of ketorolac, one of the most commonly used non-steroidal anti-inflammatory drugs (NSAIDs) as patient controlled intravenous infusion analgesia (PCIA) for the patients underwent radical cystectomy (RC) due to bladder cancer regarding several post-operational indices of recovery. Methods: Total seventy patients underwent radical cystectomy for the treatment of bladder cancer and 35 patients received ketorolac as PCIA (NSAIDs group) while the other 35 patients had conventional morphine infusion as PCIA (morphine group). Pain intensity, bowel function recovery and length of hospital stay were evaluated. Dose of ketorolac was initial 60 mg bolus with 5 mg/h continuous basal intravenous (IV) infusion and morphine dose was initial 5 mg bolus with 2 mg/h continuous basal IV infusion. Results: Dermographic characteristics were similar between two groups. NSAIDs groups showed significant reduction in postoperative vomiting (7% vs 39%, p=0.03), time to bowel movement (3.73 vs. 5.72, p=0.03) and length of hospitalization (9.50±2. vs. 9.50±2., p=0.03) compared with morphine group. There were no statistically significant differences observed between two groups in blood transfusion requiring postoperative bleeding. For 48 hours after RC, pain relief was slightly better in morphine group, but number of patients satisfied to pain management were similar between two groups (85% vs. 84%, p=0.29). Conclusions: Ketorolac as PCIA is relatively safe and effective in pain management. It also provided better gastrointestinal recovery with shorter length of hospitalization after radical cystectomy compared with conventional morphine based PCIA. Keywords: Bladder neoplasm, Radical cystectomy, Postoperative analgesia 66

O-05 근치적방광절제술및인공방광형성술후장폐색을예방할수있는효과적인방법 : bowel suspension technique 송완, 윤현석, 김광현, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 Purpose: To investigate the impact of bowel suspension technique (BST) on paralytic ileus and intestinal obstruction after radical cystectomy with orthotopic ileal neobladder Materials and Methods: We retrospectively reviewed 30 patients who underwent radical cystectomy with orthotopic ileal neobladder for bladder cancer between October 200 and April 207. After formation of Studor orthotopic neobladder, ileal continuity was restored by end-to-end stapled anastomosis. And then, we suspended it on the posterior peritoneum not to be dropped into the pelvic cavity. Clinocopathologic characteristics of patients were examined, and onset of paralytic ileus and intestinal obstruction were identified. Logistic regression analysis was used to identify predictors associated with paralytic ileus and intestinal obstruction. Results: Of the total 30 patients, paralytic ileus and intestinal obstruction were identified in 00 (32.3%) and 5 (4.8%) patients. When patients were divided into two groups (BST [-] vs. BST [+]), paralytic ileus was not significantly different (64/205 [3.2%] vs, 36/05 [34.3%], P=0.585). However, intestinal obstruction that required adhesiolysis was significantly decreased (4/205 [6.8%] vs, /05[.0%], P=0.024). On multivariate logistic regression analysis, older age was commonly associated with paralytic ileus and mechanical obstruction (P=0.008 and P=0.06). BST was inversely associated with mechanical obstruction (95% CI: 0.0-0.85, P=0.034), but not related to paralytic ileus. Conclusions: BST significantly reduced intestinal obstruction without increasing paralytic ileus after radical cystectomy with orthotopic ileal neobladder. These findings might be used as useful technique to reduce severe bowel complications. Keywords: Bowel suspension, Ileal neobladder, Intestinal obstruction 67

O-06 근치적방광절제술및인공방광형성술후방광요관역류를줄일수있는개선된방법 : reposition of orthotopic ileal neobladder 송완, 윤현석, 김광현, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 Purpose: To investigate the impact of reposition of orthotopic ileal neobladder on development of vesicoureteral reflux (VUR) after radical cystectomy Materials and Methods: We retrospectively reviewed 66 patients who underwent radical cystectomy with orthotopic ileal neoblader and videourodynamic examination between January 202 and January 207. After formation of Studor orthotopic neobladder, reposition was achieved by counterclockwise rotation to the left side, thereby the afferent limb passed from left to right wrapping ileal neoblader. Clinical characteristics of patients and videourodynamic results were examined. Logistic regression analysis was used to identify predictors associated with VUR Results: Of the total 66 patients, VUR was identified in 56 (33.7%) patients. When patients were divided into two groups (reposition [-] vs. reposition [+]), VUR was significantly different (30/68 [44.%] vs. 26/98 [26.5%], P=0.08). On videourodynamic examination, patients with VUR showed higher maximum filling pressure than those without VUR (48.5 vs. 38.6 cmh 2 O, P=0.004). On multivariate logistic regression analysis, maximum filling pressure was significantly associated with VUR (95% CI:.0-.05, P=0.006). However, reposition of orthotopic ileal neobladder was inversely associated with VUR after radical cystectomy (95% CI: 0.22-0.85, P=0.06). Conclusions: Reposition of orthotopic ileal neobladder significantly reduced VUR after radical cystectomy. Further studies are required to evaluate its effects on renal function Keywords: Ileal neobladder, Reposition, Vesicoureteral reflux 68

O-07 The incidence of robot-assisted radical cystectomy complications according to body mass index: multicenter study from Korea 성재우, 양종협, 조신제, 이규원, 정현철, 최진봉, 박용현, 권태균 2, 나군호 3, 이영구 4, 정병창 5, 강석호 6, 이지열 가톨릭대학교서울성모병원비뇨기과학교실, 2 경북대학교병원, 3 연세대학교의과대학신촌세브란스병원, 4 한림대학교강남성심병원, 5 성균관대학교의과대학삼성서울병원, 6 고려대학교안암병원 Objective: The objective of this study was to describe the complications after robot-assisted radical cystectomy (RARC) according to body mass index (BMI) using the modified Clavien Classification System. Materials and Methods: We retrospectively analyzed 396 patients with bladder cancer undergoing RARC with urinary diversion using multicenter data from Korea. The Korean Society for the Study of Obesity recommends the use of the following BMI ranges: underweight (under 8.5); normal weight (8.5 to 22.9); overweight (23 to 24.9); and obese (over 25). The bivariate relationships between BMI categories and clinical parameters were assessed using the Mantel-Haenszel chi-square test. Multivariate adjusted Cox regression analysis was conducted to examine the hazard ratio (HR) and 95% confidence interval (CI) for the association between the complications and body mass index (BMI). Results: Median follow-up for the cohort was 36 months. Mean BMI was 23.66±2.99. Compared to patients with a normal BMI, overweight and obese patients had increased operative times. When examining the diversion type, obese patients (33.8%) were less likely to have an ileal-conduit compared to patients in normal and overweight BMI. However, the longest operative times and the lowest percentage of ileal-conduit in diversion were observed in underweight patients. Conclusion: There were no significant differences in complications among the BMI categories after RARC. So, robotic-assisted radical cystectomy can be considered for patients of all body mass indexes regardless of post-operative complications. Keywords: Radical cystectomy, Body mass index Withdrawal 69

O-08 Differential complications following radical cystectomy between the irradiated and nonirradiated pelvis 남종길, 이동훈, 김태남, 박성우, 정문기 양산부산대학교병원 Purpose: Radical cystectomy in patients with a past history of pelvic irradiation is often a challenging procedure. We report complication rates in patients undergoing cystectomy and urinary diversion after pelvic irradiation. Materials and Methods: We analyzed data on 67 patients at our institution that underwent radical cystectomy and urinary diversion for bladder cancer or pelvic malignancies involving the bladder between 2009 and 207 and were observed at least 6 months (mos) postoperatively. Of these patients received 60Gy or greater pelvic irradiation before surgery. Patients medical records were retrospectively reviewed and any complications were graded using the Clavien-Dindo system. Results: Median patient age was 67.7 years and median follow up duration was 37.7 mos. Of the patients 6.6% ( of 67) underwent radiation therapy before radical cystectomy. There was no statistically significant difference in the incidence of complications (Table ). However, above grade 3 complications were more common in irradiated group. Conclusions: Irradiated bladder is a relative contraindication to radical cystectomy. However salvage cystectomy of irradiated bladder is associated with acceptable morbidity, although above grade 3 complication rates tend to be slightly higher than nonirradiated bladder. Keywords: Cystectomy, Irradiation, Complication 70

O-09 근치적방광적출술후장기적신기능에영향을미치는인자들 : 최소 3 년이상추적환자대상연구 신정현, 이동현 2, 김명, 송채린, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 국군수도병원 Objectives: We investigated clinical factors which affecting the long-term (>36 months) renal function predictors after radical cystectomy for bladder cancer. Materials and Methods: Total of 284 patients who received radical cystectomy a single surgeon were analyzed. Patients with short-term follow-up (<36 months), malignant ureteral obstruction, and preoperative chronic kidney disease (CKD; GFR<60 ml/min/.73 m 2 ) were excluded. Cox proportional hazard model were performed to identify the independent factors affecting the postoperative CKD development. Results: Total of patients met our inclusion criteria. Mean age was 6.5 years and mean follow-up was 83.9 months. Postoperative CKDs were developed in 22 (9.8%) patients including 8 patients with orthotopic ileal substitutes and 4 with ileal conduits. Patients who developed CKD were significantly older (65.8±6.9 vs. 60.5±9.7) and diabetic (3.8% vs. 0.%). The ureteral stricture was more frequently observed in postoperative CKD patients (.% vs. 9.%). Mean preoperative glomerular filtration rate (GFR) of was higher in postoperative CKD group than in non-ckd group (89.2 vs. ad 80.9 ml/min/.73 m 2 ), respectively. On multivariate analysis, old age (age 60-69, HR 5.433, p=0.024; age 70, HR 5.57, p=0.003) and diabetes (HR 4.354, p=0027) were risk factors of CKD development. Type of diversion was not associated with development of CKD (p=0.36). In patients with orthotopic ileal substitutes, old age (age 60-69, HR 0.736, p=0.03; age 70: HR 34.985, p=0.002), high BMI (HR.2, p=0.00), and diabetes (HR 3.948, p=0.03) were significant predictors of CKD development. Conclusions: Old age, high BMI and diabetes are predictors of CKD development in long-term follow-up after radical cystectomy with orthotopic ileal substitute. Ileal conduit should be considered to preserve renal function in those patients. Keywords: Cystectomy, Glomerular filtration rate, Urinary diversion 7

O-0 Factors that predict neutropenia in Korean patients with advanced urothelial cancer after cisplatin-based systemic chemotherapy 권휘안, 오태훈, 이재환, 서일영, 박승철 원광대학교의과대학비뇨기과학교실 Purpose: The aim of this study was to identify factors that can be used to predict severe neutropenia (grade 3 or higher) in patients with advanced urothelial cancer after cisplatin-based systemic chemotherapy. Materials and Methods: The study examined 79 Korean patients with advanced urothelial cancer who were treated with several cycles of cisplatin-based systemic chemotherapy from May 2006 to May 205. Risk factors for neutropenia (grade 3 or higher) and for the occurrence of neutropenia (grade 3 or higher) during the first cycle of chemotherapy were examined. Results: Thirty-six out of the 79 patients (45.6%) developed neutropenia at grade 3 or higher during the first cycle of cisplatin-based systemic chemotherapy: 8 (22.7%) of these experienced grade 3 neutropenia and 8 (22.7%) experienced grade 4. Multivariate analysis identified pretreatment neutrophil counts (p=0.00) as the only significant factor predictive for severe neutropenia. Conclusions: The pretreatment neutrophil count was found to be the factor that poses a significant and independent risk in development of severe neutropenia induced by applying cisplatin-based systemic chemotherapy to patients with advanced urothelial cancer. Keywords: Neutropenia, Urothelial cancer, Cisplatin 72

O- 신세포암세포주의 clear cytoplasm 증가유도후 PGC 활성을통한약물감수성변화및 mitochondria 활성변화 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 신장암세포주들을 Clear Cytoplasm Induction (CCI) 시켰을때이러한변화가세포약물감수성에미치는영향및세포내변화에대해알아보고자한다. 대상및방법 : Caki-과 Caki-2에지방세포유도배지를이용하여 CCI를유도했다. Temsilolimus, Sunitinib에대한세포독성실험을 CCK-8을이용하여시행하였다. CCI의변화가 Mitochondria 활성에영향을줄수있는지보기위해 Peroxisome proliferator-activated receptor gamma coactivator -alpha (PGC), VDAC, p-ampk 의발현정도를 Western blotting 및 confocal microscopy로측정했으며, mitochondria의기능을관찰하기위해 membrane potential 측정하는 JC- 염색실험을시행하였다. RCC환자 7명및환자에서유래한 primary cell에서 mitochondria 의관련유전자들의발현을 Real-Time PCR로분석하였고, 발현정도를확인하고자 Immunohistochemistry stain 및 confocal microscopy로측정하였다. 결과 : Temsilolimus와 Sunitinib의 anti-cancer drug에대한약물감수성을증가시켰다 (Fig-). PGC의 upstream인 p-ampk 의활성역시관찰되어 CCI에서 PGC의활성증가로인한 Mitochondria biogenesis가증가됐음을알수있다 (Fig-2). 환자유전자를분석한결과, PGC를비롯한대표적인 mitochondria의유전자들이 down-regulation되어있으며, mitochondria를분해하는 initiator로알려진 BNIP-3은 RCC환자에서높게발현되는것을확인할수있다 (Fig-3A,B). 이러한 BNIP-3의발현은 CCI시에는 caki-에서감소됨으로세포내 mitochondria 의증가를도울수있는것으로여겨진다 (Fig-3C). 결론 : 신세포암세포주에서 clear cytoplasm 을증가시켜형태적변화시, 약물감수성이높아지고 mitochondria의활성이증가됨을확인했다. CCI를유도함으로 mitochondria biogenesis inducer 인 PGC는증가되는반면, BNIP-3는감소하는것으로보아 CCI는 PGC 및 mitochondria를활성을통해 RCC의치료의단서를줄것이라고판단된다. Keywords: Renal cell carcinoma, Clear cytoplasm, Mitochondria 73

O-2 신장암에서메트포르민과에버로리무스의효과 윤영은, 정아라, 조정기, 이형호 2, 나준채 3, 한웅규 3, 김용태, 박해영, 박성열 한양대학교병원비뇨기과학교실, 2 일산병원비뇨기과학교실, 3 연세대학교비뇨기과학교실 Introduction and Objective: To investigate the antitumor effect of metformin combined with everolimus on renal cell carcinoma cell lines. Materials and Methods: The water-soluble tetrazolium salt (WST) cell viability assay and colony formation assays was performed to investigate the effects of metformin, everolimus and their combination on normal kidney epithelial cells (HK-2, LLC-PK) and RCC (Caki, Caki2) cell growth. Signaling molecules involved in mtor signaling was analyzed by immunoblot analysis of various proteins including mtor, AMPK, 4EBP, p70s6k. Results: WST cell viability assay showed that both metformin and everolimus reduced cell viability of normal kidney cells and renal cancer cells in a dose-dependent manner. And metformin combined with everolimus had a synergistic inhibitory effect in a dose-dependent manner. In Caki-2 cell, metformin combined with everolimus effectively inhibits colony formation. Metformin and everolimus inhibited mtor down signaling molecules, AMPK, 4EBP, p70s6k in Caki-2 cell. And these results were more maximized when metformin was combined with everolimus. Conclusion: The study indicated the synergic antitumor effects between metformin and everolimus, which may be a prospective therapy strategy to achieve potent antitumor effects on renal cell carcinoma. Keywords: Metformin, Everolimus, Renal cell carcinoma 74

O-3 TRPM7 유전자 downregulation 은신장암세포주의 migration 과 invation 을 Src 와 Akt 신호전달체계의불활성을통해억제한다 하윤석, 김연용, 전소영, 이유진, 정재욱, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균 경북대학교병원 Purpose: The transient receptor potential melastatin member 7 (TRPM7) is highly related to distinct human malignancies, but its role in renal cell carcinoma (RCC) has not been investigated. The objective of this study was to determine whether TRPM7 regulate RCC cells migration and invasion through linkage with one or more signal transduction pathways. Methods: The human RCC cell lines ACHN and SN2C were selected for this study. Western blot analysis and small interfering RNA (sirna)-based knockdown were used in order to investigate the possible molecular mechanisms. Wound healing migration assay and transwell invasion were conducted to evaluate the effect of TRPM7 knockdown on RCC cells. Results: Silencing TRPM7 with RNA interference resulted in a significant decrease in migration and invasion capability of ACHN and SN2C RCC cells. We found that the phosphorylation level of Src significantly decreased after silencing TRPM7 compared with control in ACHN and SN2C cells. In ACHN cell, the phosphorylation level of Akt was also significantly reduced by transfection with TRPM7-specific sirna. After treating Src and Akt inhibitors, reduced activities of migration and invasion were found in RCC cells. Conclusions: Our findings that TRPM7 modulates migration and invasion of ACHN and SN2C RCC cells through the Src and Akt pathway suggest that depressing this signaling pathway or/and the TRPM7 channel protein may be beneficial in treating RCC patients (206RCB080, NRF-205RCAA0053509, 205RDA3A03020378, 204RAA3049460, NRF-204M3A9D3033887). Keywords: Renal cell carcinoma, TRPM7, sirna 75

O-4 TFE3 양성신세포암의포괄적유전학적특성분석 정창욱, 이모제 2, 조재소 2, 최무림 2, 송채린 3, 구자현, 곽철, 김현회 서울대학교의과대학 비뇨기과학교실, 2 의과학과, 3 울산대학교서울아산병원비뇨기과학교실목적 : MiT 패밀리치환신세포암 (MiT family translocation RCC) 은 Xp.2/TFE3 치환및 t(6;)/tfeb 치환을특징으로하는드문신세포암이다. 이중 Xp.2 치환신세포암은비교적어린나이에호발하며예후가불량한것으로알려졌으나병인론이나유전학적특성이거의알려지지않았다. 본연구는면역화학염색을통해 TFE3 양성인신세포암들의포괄적인유전학적특성을분석하고예후와의상관관계를분석하고자하였다. 방법 : 서울대학교병원과서울아산병원에서면역화학염색을통해 TFE3 양성으로임상적 Xp.2 치환신세포암진단을받은환자중동결신선종양조직과정상 DNA를확보할수있었던총 9명을대상으로하였다. Whole exome sequencing (WES) 을통해변이유전자및유전자복제수변이 (copy-number variation: CNV) 를확인하였다. 정상환자의신장조직 4개와투명세포신세포암조직 7개와함께 RNAseq 분석을시행하였다. RNAseq을통해 TFE3 fusion partner 확인및 cluster 분석을시행하였다. 결과 : 전반적으로체세포돌연변이비율 (somatic mutation rate) 이낮았으며 COSMIC 변이는거의없었다. SNV (single nucleotide variants) 이드물지만대부분 chromatin remodeler 등과관련있었다. CNV은 3p, 6q, 22p의손실과 2번의획득이관찰되었다. 일부의종양에서는 WES으로도 TFE3 fusion partner를추정할수있었고, RNAseq을통해확인할수있었다. RNAseq을통해 NONO, RBM0, SFPQ, ASPSCR, PRCC 등의기존에알려진 fusion partner를확인할수있었고, 새로운 fusion partner로 NTRK을확인하였다. TFE3 fusion partner를확인할수없었던종양중 Cluster 분석을통해 5개의종양은 TFE3의치환이없었으며투명세포신세포암의유전형질과유사성을보였다. RNAseq에서 metabolic pathways, TCA cycle, oxidative phosphorylation, respiratory electron transport, cell surface interaction at vascular wall과관련된 pathway들이상향조절되어있음을확인하였다. 결론 : TFE3 과발현이확인되어도실제 Xp.2와치환되지않은종양이드물지않았고, Xp.2의확진에는 FISH나 RNAseq 로확인이필요한것으로보인다. Xp.2 치환신세포암의경우투명신세포암과유전자변이와 RNA 발현에서상당한차이를보였다. Aerobic respiration 등의 pathway들의상향조절등이 Xp.2 치환신세포암의나쁜예후와관련이있을것으로추정된다. 향후 ChiPseq 분석및추가의분자학적실험을통해보다자세한병인론을검증할계획이다. Keywords: Renal cell carcinoma, TFE3, Genetics 76

O-5 SIC 을발현시킨재조합 BCG 의방광암세포내내재화효과연구 김명주, 황영미, 지병훈, 문영태, 김경도, 명순철, 김태형, 김진욱, 장인호중앙대학교병원비뇨기과학교실 Purpose: BCG is one of the standard treatment options for non-muscle-invasive bladder cancer, yet the reduced internalization rate of BCG in bladder cancer cells by BCG-induced antimicrobial peptides (AMPs) remain the biological defense mechanisms against BCG as unmet needs. In this study the internalization of BCG in human bladder cancer cells, BCG was genetically engineered to secrete recombinant secreted protein of Streptococcus pyogenes (SIC) under control of the mycobacterial heat shock protein 60 promoter (pmv306hsp). Materials and Methods: Synthesized SIC was inserted into the pmv306hsp vector, and transfected into BCG using an electroporator. Recombinant BCG (rsic-bcg) was cultured in 7H9 both media and selected by kanamycin. rbcg expression was confirmed by RT-PCR after cdna synthesis. Internalization of rbcg was evaluated in bladder cancer cells (T24 and 5637 cell lines) using FITC-immunofluorescence and real-time PCR. Release of AMPs was measured by ELISA after treatment with rsic-bcg or BCG in T24 and 5637 bladder cancer cells. Results: Bladder cancer cells exhibited different sensitivity to BCG or rsic-bcg treatment, which was associated with increased rsic-bcg internalization. Release of antimicrobial peptides in rsic-bcg treated bladder cancer cells was reduced compared with BCG treated cells, resulting in an avoiding innate immune response to AMPs. Coclusion: rsic-bcg increased internalization of BCG in bladder cancer cells, which is involved in abolishing AMPs release through SIC-induced degradation of AMPs. Therefore, rsic-bcg may be a significant tool for blockage of AMPs release to enhance the immunotherapeutic response of BCG treatment. (NRF-205RAAA05000 and NRF-205RA2AA5054364 to I.H.C., NRF-206RDAB03933826 to Y.M.W., and the Korea Health Technology R&D Project HI7C070 to C.I.H.) Keywords: Bladder cancer, BCG, SIC 77

O-6 Urinary Cell-free microrna ratio with mir-624/mir-45 can discriminate bladder cancer from benign hematuria 변영준, 박현미, 김예환, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 Purpose: Although hematuria is the most common symptom in bladder tumor (BT), not all hematuria patients were diagnosed with BT. To identify a clinically applicable discriminating method of BT from non-cancer hematuric patients, the present study explored differences of urinary cell-free micrornas (mirnas) in urine samples of BT and non-cancer hematuric patients. Materials and Methods: Urine samples derived from 626 patients included 334 BT, 223 hematuria, and 69 pyuria in this study. A urine-based mirna microarray analysis and real-time polymerase chain reaction (RT-PCR) suggested the presence of differentially expressed two urinary mirnas in BT patients, and these were further validated in two cohorts using RT-PCR. Results: The expression level of mir-624 was significantly higher in BT urine and mir-45 was down-regulated in BT urine compared with non-cancer hematuria and pyuria. The ratio of mir-624 to mir-45 was considerably higher in BT urine than in non-cancer hematuria and enabled the discrimination of BT from non-cancer hematuric patients at a sensitivity of 79.%, specificity of 70.3% with an area under the curve 0.76 (p<0.00). Furthermore, compared to voided urine cytology, urinary mir-624 to mir-45 showed better sensitivity for detecting BT in any grade (p<0.00). Conclusion: Expression ratio of mir-624/mir-45 in urine could be a non-invasive promising tool for BT diagnosis among hematuric patients. Keywords: Non-invasive biomarker, mirna, BT, Hematuria 78

O-7 방광암에서소변의세포유리 DNA 와소포체 DNA 를이용한유전분석 : 액상생검 pilot 연구 김광현, 송완, 윤현석, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실 목적 : 방광암은폐암, melanoma 등과함께 genomic alteration이많은암중의하나로혈액, 소변등의 cell free DNA등의분석을통한액상생검의활용가능성이높다. 특히소변은비침습적방법으로쉽게얻을수가있는장점이있어비뇨기암에서액상생검의검체로연구가치가있다. 본연구에서는방광암환자의소변에서세포유리 DNA (cfdna) 와소포체 DNA (exodna) 의분리및유전분석을통하여방광암의 genomic profiling을해보고자하였다. 대상및방법 : 본원에서방광암으로근치적방광절제술을시행받은 9명의환자를대상으로하였다. 암조직과혈액을 tumor-normal match로하고, 수술전소변에서 cfdna와 exodna를분리한후방광암에호발하는 9 gene target exome sequencing및 low depth whole genome sequencing (ldwgs) 을시행하였다. Target exome sequencing을통하여 somatic mutation을확인하였고, ldwgs을통하여 copy number variation (CNV) 을조사하였다. 방광암조직의 genomic alteration이 urinary cfdna와 exodna에반영되는지확인하였다. 결과 : Urinary cfdna와 exodna의 whole genome mapping ratio는 90.9-94.2% 였으며, whole genome의영역에고르게 mapping되는소견이보였다. Target exosome sequencing에서방광암조직에서확인된 2개의 somatic mutation 중 urinary cfdna와 exodna에서각각 9개, 0개가확인되었다. Allele frequency는.2-83.2% (median: 66.4%) 였으며, urinary cfdna, exodna의 target 영역의 mean depth는 x56이었다. ldwgs에서방광암에서대표적인 CDKN2A, RB, NCOR의 deletion, ERBB2 amplification이방광암조직과 urinary cfdna, exodna에서공통적으로관찰되었다. 또한 cancer related gene뿐아니라 whole genome영역에서 tissue, cfdna, exodna의 CNV가유사한패턴으로관찰되었다. 결론 : Urinary cfdna, exodna은대부분 contamination되지않은 human DNA였고, whole genome영역을 coverage할수있었다. 또한이들 DNA에서방광암에특이적인 genomic alteration을확인할수있었다. 특히, ldwgs을통한 urinary DNA분석은적은비용 / 데이터로 whole genome영역의 tumor DNA 특성을반영할수있어향후액상생검을통한방광암의진단, 재발에사용될수있는잠재력이있다. Keywords: Bladder cancer, Liquid biopsy, Genomic alteration 79

O-8 LKB 발현여부에따른방광암세포에대한 BCG 의항암효과에관한연구 황영미, 김명주, 지병훈, 문영태, 김경도, 명순철, 김태형, 김진욱, 장인호중앙대학교병원비뇨기과학교실 Purpose: Although LKB is a tumor suppressive serine/threonine kinase, loss of LKB leads to mitochondrial dysfunction and accumulation of autophagy-related proteins as a result of altered mitophagy, resulting in enhanced sensitivity to drug treatments. BCG is the most widely used for bladder cancer immunotherapies in the world, and autophagy for the nonspecific protective effects of BCG have even exploit autophagy mechanisms for the benefit of infection. Therefore, our goals were to test that loss of LKB sensitizes bladder cancer cells to aberrant autophagy or mitophagy induced by treatment with BCG. Materials and Methods: shrna LKB knockdown cells were treated with BCG for 48 h. Cells were analyzed by MTT for cellular growth inhibitory effect and were subjected to Western blot for autophagy-related proteins. Cells were seeded in 96-well plates and treated with 0 MOI BCG for 6-8 h. Intracellular ADP/ATP ratio was measured using a bioluminescent ADP/ATP Ratio Assay Kit according to the manufacturer s instructions. Mitochondrial membrane depolarization was determined using the JC- fluorescence probe. Results: LKB-deficient cells exhibited enhanced sensitivity to BCG treatment that was associated with stimulation of autophagic pathways. Knockdown of LKB altered the cellular response to BCG treatment, resulting in an increase in autophagic response and mitochondrial defect. Expression of LKB exhibited highly induced cargo receptor NEIGHBOR OF BRCA (NBR), which was accompanied by a decrease in levels of p62 and an accumulation of PPAR-γ. Conclusions: These findings may have significant implications for the design of novel BCG treatments that target dysregulated autophagic pathways in LKB-deficient tumors (NRF-205RAAA05000 and NRF- 205RA2AA5054364 to I.H.C., NRF-206RDAB03933826 to Y.M.W., and the Korea Health Technology R&D Project HI7C070 to C.I.H.). Keywords: Bladder cancer, BCG, LKB 80

O-9 거세저항성전립선암에서 docetaxel 과 HDAC 저해제병용처리에의한안드로젠수용체과그변이체신호억제 박상은, 김윤림, 황정진, 김청수 2 서울아산병원의생명연구소, 2 울산대학교의과대학비뇨기과학교실 목적 : 거세저항성전립선암 (CRPC) 은안드로젠수용체 (AR) 를가지고있지만, 안드로겐차단요법 (androgen deprivation therapy, ADT) 에반응하지않는다. 도세탁셀이표준치료로사용되고있으나치료가제한적이므로새로운치료법개발이요구되고있다. 본연구진은 AR 단백질을발현하지않는 DU45와 PC3에서도세탁셀과히스톤아세틸화효소저해제 (HDACI) 병용처리효과를보고한바있다. 최근안드로겐수용체에서리간드결합부위가사라진변이체 (AR-V) 가 CRPC 에서 ADT 저항성의원인임이밝혀짐에따라본연구에서는 AR과 AR-V를발현하는 CRPC에서이두약물의병용처리효과를 AR 신호기전을중심으로확인하고자하였다. 대상및방법 : 22Rv, VCaP CRPC 세포주와 CRPC 환자 차세포배양체에서 HDACI (vorinostat과 CG200745) 와도세탁셀병용처리에의한생존율을측정하고, 세포자살과 AR 신호의변화를 Western Blotting, 유세포분석, 면역형광염색을통하여검증하였다. 결과 : 도세탁셀과 HDACI의병용처리는각약물의단독처리보다세포사멸유도에효과적이었으며, AR과 AR-V, PSA, Mcl- 및 Bcl-xL 발현을낮추고 capspase-3 활성화를통하여 PARP의분해를촉진시켰다. Annexin-V와 PI 염색후유세포분석을수행한결과병용처리에의하여세포자살이유도됨을확인하였다. 면역형광염색결과, 도세탁셀과 HDACI의병용처리에의해 tubulin 아세틸화의증가와다발 (bundle) 형성을관찰할수있었으며이로인한 AR과 AR-V의 tubulin과의결합증가와핵으로의이동감소를확인하였다. 세포질과핵의단백질을분리하여각분획에존재하는 AR과 AR-V7의양을비교한결과병용처리에의하여핵에서의 AR과 AR-V 감소를재확인할수있었다. 결론 : 본연구는 CRPC 세포주에서도세탁셀과 HDACI의병용처리가각약물의단독처리보다효과적으로 AR 뿐만이니라 AR-V7의발현과핵으로의이동을억제하며, 세포의성장을저해하고세포사를유도함을보여주었다. CRPC 환자의 차세포배양체에서도동일한효과를확인하였다. 이러한결과는 CRPC에서 HDACI와도세탁셀의병용치료의효과와기전에대한새로운가능성을보여주었다. Keywords: Castration-resistant prostate cancer, Docetaxel, Histone deacetylase inhibitor 8

O-20 The expression of androgen receptor and its variants in human prostate cancer tissue according to disease status Jeong Woo Lee, Jung Hee Kim, Seung Soo Lee, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital Objectives: To evaluate the changes in expression of androgen receptor (AR) and its variants (ARV) in Korean prostate cancer (PCa) patients according to disease status. Methods: A total of 49 cases were evaluated which included 29 localized PCa, 8 metastatic PCa, and 2 cases of benign prostatic hyperplasia (BPH). Samples from patients who underwent radical prostatectomy or transurethral resection of prostate were collected and stored in ethically approved tissue banks. Polymerase chain reaction (PCR), western blot (WB), and Immunohistochemistry (IHC) were performed for AR and ARV7. Histopathological evaluation was done to determine the type of lesion including Gleason scoring. One fresh tissue block was divided into 3 sections, both ends were made into paraffin blocks for IHC, and the middle section was divided into two sections for WB and PCR. Each tissue was confirmed as a cancer tissue (more than 80%) using HE stain at both ends paraffin block. Using PCR, WB, and IHC, the expression of AR and ARV7 were compared according to disease status (BPH vs localized vs metastatic PCa) and Gleason score (7 vs 8-0). Results: After pathological review, 4 cases among the localized PCas were excluded for PCR and WB because of low volume in cancer (<80%). PCR results showed that expression of AR and ARV7 was higher in metastatic PCa than in localized PCa and BPH (p<0.00). The expression of AR in WB was high in metastatic PCa, however, not statistically significant. The expression of ARV7 in WB was not different in all groups. The nuclear expression of AR in IHC was uniformly high in all groups. The positivity of ARV7 in IHC was more common in metastatic PCa than in localized PCa. This tendency has been shown in adjacent non-cancerous tissue as well. There was no significant statistical association between the AR or ARV7 expression and Gleason score in localized PCa. Conclusions: Although AR nuclear expression was higher in human metastatic PCa tissue, it was consistently present in all BPH and PCa tissue. The expression of ARV7 was heterogeneous specifically in cases of PCa. Although mrna of ARV7 is increased in human metastatic PCa tissue, protein is not. When the expression of ARV7 was positive in certain cancer tissues, it was also positive in adjacent benign tissues. Keywords: Prostate, Cancer, Androgen 82

O-2 고혈압을동반한전립선비대증환자에서 naftopidil 의임상적유효성과와안정성 : 전향적, 공개표지연구 정문수, 윤병일, 이승환 2 가톨릭관동대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실 Purpose: To investigated the efficacy and safety of naftopidil for benign prostatic hyperplasia (BPH) patients mainly focusing on changes of blood pressure (BP). Materials and Methods: Of a total of 8 patients, 90 normotensive (NT) and 28 hypertensive (HT) patients were randomly assigned into naftopidil 50 mg or 75 mg group for a 2-week, once-daily treatment. The safety and efficacy were assessed by analyzing changes from baseline in systolic/diastolic BP and total International Prostate Symptom Score (IPSS) at 4 and 2 weeks. Adverse events (AEs), obstructive/irritative subscores, QoL score, Qmax, and BSW questionnaire were also analyzed. Results: Naftopidil treatment decreased the mean systolic BP by 8.7 mmhg for HT 50 mg group (p<0.00) and by 8.3 mmhg for HT 75 mg group (p<0.00) and the mean diastolic BP by 7.5 mmhg for HT 50 mg group (p<0.00) and by 4.7 mmhg for HT 75 mg group (p=0.022). However, in the NT groups (both naftopidil 50 mg and 75 mg), naftopidil caused no significant changes in BP from baseline values. After 2 weeks, both naftopidil 50 mg and 75 mg groups showed significant improvements in IPSS scores (total, obstructive/irritative subscores, QoL score) and Qmax from baseline. AEs were reported in 7.8% of patients (50 mg group) and in 2.9% (75 mg group). In both the 50 mg and 75 mg group, >86% of all patients agreed to continue their current medications. Conclusion: Our results suggest that naftopidil treatment in BPH patients with hypertension has the additional benefit of optimal management of BP within the normal range. Keywords: BPH, Hypertension, Naftopidil 83

O-22 전립선비대증환자에서 naftopidil 및 tamsulosin 의방광저장관련증상개선효과에대한비교 : 전향적, 다기관연구 권세윤, 이경섭, 유탁근 2, 정재일 3, 이지열 4, 홍준혁 5, 서성일 6, 정태영 7, 곽철 8, 강택원 9, 윤석중 0 동국대학교경주병원, 동국대학교의과대학비뇨기과학교실, 2 을지대학교병원, 을지대학교의과대학비뇨기과학교실, 3 부산대학교병원, 부산대학교의과대학비뇨기과학교실, 4 가톨릭대학교서울성모병원, 가톨릭대학교의과대학비뇨기과학교실, 5 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 6 성균관대학교의과대학삼성서울병원, 성균관대학교의과대학비뇨기과학교실, 7 중앙보훈병원비뇨기과, 8 서울대학교병원, 서울대학교의과대학비뇨기과학교실, 9 전남대학교병원, 전남대학교의과대학비뇨기과학교실, 0 충북대학교병원, 충북대학교의과대학비뇨기과학교실 Objective: To compare the efficacies of naftopidil and tamsulosin in terms of reducing storage symptoms in patients with BPH. Material & Methods: This prospective randomized study was performed at 0 centers. Ninety-four patients that had been taking tamsulosin for more than 8 weeks, but had an OABSS of greater than 3 points were initially enrolled. After a week washout period, patients were divided into two groups. Forty-five patients were treated with tamsulosin 0.2 mg daily and 49 patients were treated with naftopidil 75 mg daily for 8 weeks, respectively. Total IPSS, storage symptom scores, nocturia times, OABSS, maximal flow rates (Qmax), and post-void residual volumes (PVR) were checked before and after the 8-week treatment period. Results: Mean patient ages in the tamsulosin and naftopidil groups were 64.8 and 66.0 years, respectively. Baseline characteristics were not significantly different. In tamsulosin group, mean total IPSS fell from 9. to 5. after the 8-week treated period (p=0.00), and in naftopidil group, mean total IPSS fell from 6.9 to 3. (p=0.00). Mean storage symptom scores reduced in tamsulosin and naftopidil groups from 8.0 to 6.6 (p=0.002) and from 7.6 to 6. (p=0.00),respectively. Mean nocturia times in naftopidil groups decreased significantly from 2.5 to.9, respectively (p=0.00), and mean OABSS reduced from 7.7 to 6.0 (p=0.00) and from 7.4 to 6.0, respectively (p=0.00). Conclusions: Total IPSS, storage symptom scores, nocturia times and OABSS were significantly more reduced by naftopidil and tamsulosin. Moreover, the naftopidil group showed better improvements in nocturia than tamsulosin group. Keywords: Naftopidil, Tamsulosin, Prostate hyperplasia 84

O-23 전립선비대증환자에서실로도신의효과 : 코크란체계적문헌고찰및메타분석 정재흥,2,3,4, Roderick MacDonald 5, 김지예 2,6, 김명하 2,7, Philipp Dahm 3,4 연세대학교원주의과대학 비뇨기과학교실, 2 근거중심의학연구단, 3 Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, 4 Department of Urology, University of Minnesota, Minneapolis, Minnesota, 5 General Internal Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA, 연세대학교원주의과대학 6 성형외과학교실, 7 의학도서관 Purpose: Alpha-blockers have been widely used as first-line therapy for the patients with lower urinary tract symptoms secondary to BPH (LUTS/BPH). Silodosin which has a high binding ratio for Aa receptor may therefore induce a therapeutic effect with less cardiovascular side effects. We therefore assessed the effects of silodosin compared to placebo or other medical treatments in men with LUTS/BPH. Materials and Methods: We conducted a Cochrane review based on an a priori, protocol that included published and unpublished randomized controlled trials in any language. Review outcomes were urologic symptom scores, quality of life (QoL), and treatment withdrawals for any reason, cardiovascular adverse events, and sexual adverse events. We performed meta-analysis using RevMan 5.3 and rated the quality of evidence (QoE) using GRADE. Results: Of 649 studies identified through our search, we included 4 studies. Compared to placebo, silodosin may have a small effect which may not represent an important reduction in the urologic symptom scores (mean difference [MD] -2.65, 95% confidence interval [CI] -3.23 to -2.08; low QoE) and QoL (MD -0.42, 95% CI -0.7 to -0.3; moderate QoE). Silodosin may result in little or no difference in the treatment withdrawals for any reason (risk ratio [RR].08, 95% CI 0.70 to.66; low QoE). Compared to tamsulosin, silodosin may result in little or no difference in the urologic symptom scores (MD 0.2, 95% CI -.28 to.70; low QoE) and QoL (MD -0.0, 95% CI -0.53 to 0.34; low QoE). We are uncertain about the effect of silodosin on treatment withdrawals for any reason (RR 0.90, 95% CI 0.49 to.64; very low QoE). Silodosin may increase sexual adverse events compared to placebo (RR 26.07, 95% CI 2.36 to 54.97; low QoE) and tamsulosin (RR 6.5, 95% CI 3.2 to.79; low QoE) with similar cardiovascular adverse events rates. Conclusion: Silodosin on average appears to have a small effect in the urologic symptom scores and QoL with similar treatment withdrawals rates for any reason compared to placebo. Compared to tamsulosin, silodosin may be similar in the urologic symptom scores and QoL, but we are uncertain about the effect of silodosin on treatment withdrawals for any reason. Silodosin may increase sexual adverse events rates with similar cardiovascular adverse events rates compared to placebo and tamsulosin. Keywords: Prostatic hyperplasia, Silodosin 85

O-24 신체활동정도및착석시간과하부요로증상발생과의연관성 정재용, 편종현, 박창후 2, 장유수 3, 유승호 3, 박흥재 성균관대학교의과대학강북삼성병원비뇨기과, 2 울산대학교의과대학강릉아산병원비뇨기과, 3 성균관대학교의과대학강북삼성병원직업환경의학과 Objective: The goal of this study was to examine the association of sitting time and physical activity level with the incidence of lower urinary tract symptoms (LUTS) in a large sample of Korean men. Material and Method: A cohort study was performed for 69,795 Korean men free of LUTS at baseline, who were followed-up annually or biennially. Physical activity level and sitting time were assessed using the validated Korean version of the international Physical Activity Questionnaire Short Form. LUTS was assessed using the International Prostate Symptom Score (IPSS) and clinically significant LUTS was defined when IPSS score was 8 or higher. Result: Of the 75,80.4 person-years, 9,27 developed LUTS (incidence rate, 39.0 per 000 person-years). Physical activity levels were negatively associated with the incidence of LUTS. The multivariable-adjusted hazard ratios (95% CIs) for incident LUTS comparing minimally active and HEPA groups to the inactive group were 0.94 (0.89-0.99) and 0.93 (0.87-0.99), respectively (P for trend<0.00). The hazard ratios (95% CIs) for LUTS comparing 5-9 and >9 h/day sitting time to<5 h/day were.08 (.00-.24) and.5 (.06-.24), respectively (P for trend<0.00). Conclusion: Prolonged sitting time and decreased physical activity level were positively associated with the development of LUTS in a large sample of middle-aged Korean men, supporting the importance of both reducing time spent sitting and promoting physical activity for preventing LUTS. Keywords: Sitting time, Physical activity, Lower urinary tract symptoms 86

O-25 야간뇨를동반한전립선비대증환자를대상으로 silodosin 의유효성및안전성을평가하기위한 2 주, 단일군, 공개, 전향적, 다기관, 제 4 상연구 조강준, 이정주 2, 송윤섭 3, 최종보 4, 김대경 5, 김용태 6, 김준철 가톨릭대학교부천성모병원, 2 부산대학교병원, 3 순천향대학교병원, 4 아주대학교병원, 5 을지대학병원, 6 한양대학교병원 목적 : 야간뇨는전립선비대증환자에서가장불편한하부요로증상중하나인데, 알파차단제는야간뇨개선에유효한효과를보이는것으로알려져있다. 이에본연구에서는야간뇨를동반한전립선비대증환자에서 αa-adrenoceptor subtype-selective antagonist인 silodosin의유효성및안전성을평가하고자하였다. 대상및방법 : 2주, 단일군, 공개, 전향적, 다기관연구로, 50세이상의전립선비대증을가진남성중 3일간배뇨일지상야간뇨가 일평균 2회이상이고, 국제전립선증상점수 (IPSS) 8점이상, 삶의질점수가 3점이상인환자를대상으로하였다. PSA >0 ng/ml, 신경인성방광, 방광암, 방광결석, 요도협착환자, 급성요폐병력이있는경우, 개월이내요로감염이있는경우, 전립선암병력이있는경우, 전립선수술을받았던환자, 2주이내알파차단제, 항무스카린제복용한경우, 6개월이내 5알파환원효소억제제를복용한경우는제외하였다. 연구에참여한모든환자에게 silodosin 8 mg을 일 회 2주간경구투여하였다. 일차평가변수로는기저치대비 2주후배뇨일지상야간뇨발생횟수의변화량을조사하였다. 이차평가변수로는기저치대비 2주후 IPSS 총점의변화량, 삶의질점수, 배뇨증상항목, 배뇨후증상항목, 저장증상항목, 과민성방광증상점수 (OABSS) 의변화량과 2주후야간뇨발생감소율이 25% 이상인환자의비율, 2주후 IPSS감소율이 25% 이상인환자의비율을조사하였다. 안전성평가로이상반응및이상약물반응의발현율을조사하였다. 결과 : 총 35명이본연구에참여하였으며, 안전성평가분석대상군은 8명이포함되었고, 유효성분석은 Full analysis set 분석대상군을대상으로 2명이포함되었다. 일차유효성평가변수인 silodosin 투여 2주후야간뇨발생횟수의변화량은 -.2±.05회로통계적으로유의하게감소하여전립선비대증으로인한야간뇨에대해개선효과를보였다 (p<0.000). 이차유효성평가변수인 IPSS 총점변화량, 배뇨증상항목, 배뇨후증상항목, 저장증상항목변화량도통계적으로유의하게감소되었다. 또한 2주후 IPSS 삶의질점수변화량, OABSS 변화량, ICIQ-N 변화량도통계적으로유의하게감소되었다. silodosin 투여 2주후야간뇨발생감소율이 25% 이상인시험대상자의비율과 IPSS 감소율이 25% 이상인시험대상자의비율은각각 73명 (65.8%), 7명 (63.39%) 이었다. 안전성평가상 4건 (.86%, 4/8) 의이상약물반응이발생하였는데, 이중에서사정관련부작용이 9건 (7.63%, 9/8) 으로가장많았으며, 약제와관련한중대한이상반응은발생하지않았다. 결론 : 야간뇨가동반된전립선비대증환자에서 silodosin 은야간뇨개선에있어서유효하며, 안전한약제임을확인하였다. Keywords: Benign prostatic hyperplasia, Nocturia, Silodosin 87

O-26 야간뇨를호소하는 55 세이상의만성불면증환자에서서방형멜라토닌의치료효과 안순태, 정형국, 박태용, 김종욱, 오미미, 박홍석, 문두건 고려대학교의과대학비뇨기과학교실 Objective: Nocturia is a common cause of sleep disruption in older people and the sleep disturbance impaired patient s quality of life (QoL). Several hypnotics have been reported the effectiveness for nocturia however they have a risk of addiction. Thus we herein investigated the effect of melatonin, an antioxidant and sleep inducer free of addiction, on sleep quality (SQ) and nocturia in elderly patients as a pilot study. Material Method: We conducted male patients over 55 years old who had two or more episode of nocturia per night and diagnosed with chronic insomnia according to ICSD-3 (International Classification of Sleep Disorders). Melatonin 2 mg (Circadin R ) was administered orally 2-3 hours before bedtime for 2 weeks. All patients were assessed the Pittsburgh Sleep Quality Index (PSQI) and frequency volume (FV) chart at baseline and 2 weeks after starting melatonin. Results: Overall, 50 patients were completed the study. Total of 30 of them (60%) showed poor SQ defined as a score of 6 or more on the PSQI global score at baseline. In this group global PSQI score (from 0.5±2.9 to 7.2±4.0, p=0.0) and several components score significantly improved whereas 20 patients (40%) with good SQ did not (Table ). The number of nocturia episodes significantly decreased in poor SQ group (from 2.6±. to.6±0.8, p<0.00) and superior to good SQ group (Figure ). Three patients had dizziness; the remaining patients had no adverse drug-related events. Conclusion: Melatonin could be a treatment option for reducing nocturia in elderly men with sleep disorder. Keywords: Nocturia, Sleep quality, Melatonin 88

O-27 전립선비대증환자에서 5-ARI 의간헐적사용시전립선크기변화에대한고찰 최귀복, 조인창, 민승기국립경찰병원비뇨기과 Introduction: 5α-Reductase inhibitors ( 이하 5-ARI) 는알파차단제와함께양성전립선비대증 ( 이하 BPH) 환자의약물치료의양대핵심중하나로 dihydrotestosterone ( 이하 DHT) 의생성을억제하여전립선의상피세포에작용, 6개월이상장기복용시전립선의부피를평균 20-25% 감소시킨다. 그러나 5-ARI의장기사용은연구에따라발기부전, 성욕감퇴, 사정액감소및우울증상의부작용을발생시킨다. 이에우리는 5-ARI의부작용발생을감소시키는방안중하나로약제를일정기간씩간헐적으로복용할경우발생하는전립선의크기변화를연구하였다 Material and Methods: 우리는 2009년 3월부터 207년 5월까지 BPH로본원외래를방문한환자들중 6개월이상 5-ARI를사용후경직장전립선초음파 ( 이하 TRUS) 를통해전립선전체와이행대의크기를확인하였다. 이중전립선전체크기가 20% 이상감소한환자들을대상으로최저 년간 5-ARI를중단하였다. 다시감소한크기의 50% 이상회복된환자들을선별하여 2차로 5-ARI를복용시작, 년뒤전립선의전체와이행대의크기를확인하였다. 마지막으로 차 5-ARI 복용후와 2차복용후각각의전립선전체및이행대의크기를 pair T-test를시행하여변화의유의성을확인하였다 Results: 표본기준을만족하는환자는총 60명으로치료전전립선의크기는평균 32.3 g, 이행대의크기는 4.4 g이었다. 차로 5-ARI 를복용한뒤이는각각 23.5 g, g으로평균 26.6%, 9.8% 크기감소를보였다. 이후 년이상복용을중단한뒤시행한 TRUS 에서전립선전체의크기는평균 34.9 g, 이행대는 8.2 g으로증가하였으며 2차로복용시작후 년뒤에는전체크기 27.2 g, 이행대 3.8 g으로각각 2%, 7.4% 크기감소를보였다. 차 5-ARI 복용후와 2차복용후의전립선전체및이행대의크기를 pair T test 시행한결과전체크기는 차복용후평균 23.5 g에서 2차복용후평균 27.2 g으로, 이행대의경우 차복용후 g에서 2차복용후 3.8 g으로증가하였으며양쪽모두통계적으로유의한 (p<0.0) 차이를보였다. Conclusion: 본연구결과에서 5-ARI를간헐적으로사용할경우전립선의크기는중단하기전보다통계적으로유의한정도의크기증가를보였다. 그러나약제를같은기간동안지속적으로복용한경우와직접적으로비교한것은아니므로양용법의우열관계를확인할수는없었다. 향후추가적인연구를통하여 5-ARI의적절한사용및중단기간을확인하여환자들의부작용피해를최소화하는데기여할수있을것으로기대된다. Keywords: Benign prostate hypertrophy, 5α-reductase inhibitor 89

O-28 PSA 2.5 이하남성형탈모환자에서저용량피나스테라이드와두테스테라이드장기복용이혈청 PSA 에미치는영향 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 Purpose: This retrospective cohort study aimed to assess the effect on PSA concentrations of low-dose finasteride or dutasteride treatment for male androgenetic alopecia whose baseline serum PSA<2.5 ng/ml. Patients and Methods: The cohort consisted of all consecutive male patients who were treated for androgenetic alopecia with finateride.25 mg daily or dutasteride 0.5 mg every 3 days in 2002-202 and underwent PSA measurements at baseline and at least once thereafter. Patients whose baseline or follow-up PSA level after prescription exceeded 2.5 ng/ml were excluded. Patients were stratified according to age, baseline PSA concentration, medication type, and treatment duration. Results: In the,379 patients, overall PSA levels declined from baseline by 27.8%. Most patients (n=,094, 79.3%) showed PSA declines (average=40.8%). The remaining 285 (20.7%) patients showed stable or increased PSA levels (average=24.2% increase). Closer analysis showed that, largely, only patients with baseline PSA levels of 0.5 ng/ ml exhibited treatment-related PSA declines. On multivariate logistic analysis, low baseline PSA levels was associated significantly with stable/increased PSA levels. Low-dose dutasteride and finasteride reduced PSA levels to similar degrees (3.% vs. 25.%). Marked PSA declines (26.0%) were observed even after short-term (3-6 month) treatment. Longer-term treatment associated with similar declines. Conclusions: Dutasteride and finasteride reduced PSA levels to similar degrees. This effect was observed soon after commencing treatment. In patients with low baseline PSA levels, PSA levels can remain stable or even increase. These findings are limited to men with baseline PSA<2.5 ng/ml. Keywords: PSA, Androgenetic alopecia, 5-alpha-reductase inhibitor 90

O-29 전립선비대증환자에서 5α-Reductase inhibitor 치료중단시전립선크기회복에대한영향인자 최귀복, 조인창, 민승기 국립경찰병원비뇨기과 Introduction: 5α-reductase inhibitors ( 이하 5-ARI) 는 testosterone의 DHT로의전환을감소시켜비대된전립선의크기를감소시킨다. 그러나약제복용을중단할경우 DHT 의농도가다시증가하게되고이는전립선을다시비대시키게된다. 우리는 5-ARI를복용후중단시전립선이얼마나빨리크기를회복하고이와관련된요인이무엇인지연구하였다. Materials and Methods: 2009년 3월부터 207년 5월까지 5 ARI 를 6개월이상사용한환자들중크기감소가최초크기의 20% 이상인환자들을대상으로최저 년간 5-ARI를중단하였다. 그리고중단후 년뒤의전립선의크기증가정도를이전크기감소와비교하여유지군 ( 최초크기감소의 20% 미만회복 ), 중간군 (20% 이상 80% 미만회복 ), 복귀군 (80% 이상회복 ) 의세군으로나누었다. 그리고각군의환자의나이, 5-ARI 복용전전립선크기, 5-ARI 사용후크기감소비율, 그리고전립선특이항원 ( 이하 PSA) 수치와의관계를분석해보았다. Results: 전체환자중표본기준을만족하는대상은 47명으로표 로요약하였다. 크기회복정도에따라나눈환자군은유지군은 6명 (0.9%), 중간군은 48명 (32.7%), 복귀군은 83명 (56.4%) 이었다. 각군별로분류된요소는표 2에정리하였다. 연령과 5-ARI 사용후크기감소비율이클수록복용중단시크기가회복되는정도도커지는경향을볼수있었으나통계적으로유효하지는않았다. 그외 5-ARI 복용전전립선크기, PSA 는크기회복정도와유효한관계를찾을수없었다. Conclusion: 본연구에서는환자의연령과 5-ARI 복용후크기감소비율이클수록복용중단후회복정도가커지는경향을보였으나통계적으로유의한인자를찾지는못하였다. 향후대규모의전향적연구를통하여약제중단시전립선의크기회복을예측할수있는인자를찾을수있을것으로기대된다. Keywords: Benign prostate hypertrophy, 5α-reductase inhibitor, Withdrawl 9

O-30 연령에따른 Tadalafil 에의한전립선이행대혈행변화 김진욱, 지병훈, 장인호, 명순철, 문영태, 김경도, 김태형중앙대학교병원비뇨기과학교실 Introduction: The effect of PDE5 inhibitors on lower urinary tract function has been maintained for several years, despite the lack of concrete physiological evidence. Most studies have not scrutinized whether PDE5 inhibitors actually accompanied relevant hemodynamic change, its primary pharmacological function, before assessing more complex voiding symptomatic. The study aims to assess persistent increased microvascular flow via measurement of prostatic capsular blood flow as an indicator of treatment responsiveness in patients receiving low dose tadalafil daily therapy. Methods: Patients with LUTS receiving tamsulosin 0.2 mg were prospectively recruited to offer additional daily tadalafil 5 mg. As age may be a significant factor confounding tadalafil responsiveness, patients younger or older than 70 years of age were matched evenly to 0 patients per sub group, totaling 40 patients overall. Pretreatment IPSS, transrectal ultrasound with measurement of capsular artery and TZ doppler ultrasonographic parameters were taken and compared with those following 8 weeks of treatment. Results: Mean RI of capsular arteries and TZ vessels were not significantly different in all comparing subgroups (old vs. young, tamsulosin alone vs. tadalafil add-on). However, mean PSV of TZ arteries in young patients receiving tadalafil and tamsulosin increased significantly from baseline from mean 22.07±2.99 cm/s to 4.2±5.59 cm/s (p<0.0). No other subgroups displayed significant change. LUTS symptoms assessed by 3 day voiding diary for frequency, FBC and nocturia also failed to show changes in all subgroups. Conclusion: Tadalafil daily add on to tamsulosin showed significant increase in PSV for younger patients. While this did not carry over to an added benefit in LUTS symptoms, tadalafil does increase prostatic blood flow, a benefit lost in older patients. This may depict an age related change of tadalafil responsiveness when treating LUTS. Keywords: PDE5 inhibitor, Tadalafil, Prostate blood flow 92

O-3 발기부전치료에서저에너지충격파치료와중배엽줄기세포통합치료로 autophagy 와 angiogenesis 의효과적인촉진작용 Guanqun Zhu, 정현철, 전승환, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교서울성모병원 Purpose: To investigate the mechanism of action and fate of MSCT and ESWT in a rat model ofdmed induced by streptozotocin (STZ). Materials and Methods: Sprague-Dawley rats (n=40) were randomly divided into 4 groups. (N = 0 per group): DM group, 2 DM+ESWT group, 3 DM+MSCT group, 4 DM+ESWT+MSCT group, and the normal group (N=0, without STZ) is the control group.erectile function and other expression experiments were carried out after STZ injection of 8 weeks. Immediately afterrecording of intracavernous pressure (ICP), the penis was then harvested for histologic analysis, ELISAand western blotting.mscs were labeled with a fluorescent dye before treatment. Results: The ratio of ICP/MAP was significantly higher in the ESWT+MSCT group than in the ESWT and MSCT groups (P<0.05).The quantitativeresult of the ESWT+MSCT group is very close to the result of the control group. ESWT+MSCT Stimulate Angiogenesis and Vasodilatation in DMED Corpus Cavernosum. The result was significantly higher in the ESWT+MSCT group than in the ESWTorMSCT groups (P<0.05), which proved that ESWT+MSCT could stimulate the angiogenesis and vasodilatation, significantly. ESWTincrease the quantity of MSCs in the corpus cavernosum and also induce MSCs to express more VEGF in vitro and vivo. VEGF activate the PI3K/AKT/mTORand NO/cGMPsignaling pathway in the corpus cavernosum. ESWT+MSCT can stimulate autophagy and decrease apoptosis in the corpus cavernosum. ESWT can promote the MSCs recruitment by inducing penile tissues to express more SDF- and PECAM. Conclusions: Combination of LI-ESWT and MSCT can get a better result than a single way by expressing more VEGF which can take part inautophagy by triggeringthe PI3K/AKT/mTORsignaling pathway.eswt can drive homing of MSCs in corpus cavernosum. Keywords: Erectile dysfunction, Stem cell, ESWT 93

O-32 Effects of controlling oxygen release from hollow microparticles for prolonged stem cell survival and improved erectile function 박용현, 정애량, 김가은, 김미영, 이지영, 이규원, 이지열 가톨릭대학교서울성모병원 Purpose: Postprostatectomy erectile dysfunction (ED) is the major problem for patients with prostate cancer. Recently, tissue-engineering approach has been attempted for postprostatectomy ED, but survival of stem cells until the ingrowth of blood vessels is one of the most important challenges in tissue engineering. In this study, we introduced perfluorooctane emulsion-loaded hollow microparticles (PFO-HP) for controlled oxygen delivery to facilitate a sustained and localized application into the cavernous nerve. Materials and Methods: We prepared the PFO-HP (oxygen supply) and PBS-loaded HP (PBS-HP, non-supply of oxygen), and compared in vitro proliferation and differentiation of human adipose-derived stem cell (hadscs) on the PFO-HP and PBS-HP in hypoxic condition. We also investigated the efficacy of hadscs on the PFO-HP or PBS-HP on the cavernous nerve in a rat model of bilateral cavernous nerve crush injury (BCNI). Four weeks after surgery, erectile function was assessed by detecting the intracavernous pressure (ICP)/mean arterial pressure (MAP) level. Results: In hypoxic condition, the number of hadscs on the PFO-HP increased for 5 days and then it gradually decreased. However, the initial cell number on the PFO-HP remained constant for up to 0 days, while the number of cells on the PBS-HP was rapidly decreased over time. After neuronal differentiation for 4 days, β-tubulin-iii expression was significantly different between hadscs on the PFO-HP and PBS-HP. In animal experiments, the ICP/MAP ratios in the PBS-HP and PFO-HP groups were significantly increased compared to those in the BCNI group. The ICP/MAP ratios between the PFO-HP and PBS-HP groups were not significantly different at week after surgery, however, the ICP/MAP ratios in the PFO-HP group was significantly higher compared to those in the PBS-HP group at 2 and 4 weeks after surgery. PFO-HP group showed significantly increased smooth muscle/ collagen ratio, nnos content, phospho-enos protein expression, and cgmp level, compared with the BCNI and PBS-HP groups. Conclusions: hadscs on the PFO-HP can improve erectile function in a rat model of BCNI, in terms of controlled oxygen release from the PFO-HP for a sufficient time period, and prolonged stem cell survival until the ingrowth of new blood vessels. Keywords: Erectile dysfunction, Stem cell, Controlling oxygen release 94

O-33 TGF-β/Rho-kinase/LIMK 경로가일측성요관폐색랫드모델에서신장사구체와세뇨관사이질의섬유화에미치는영향 : preliminary study 송상훈, 한재현, 류채민 2, 김휘우, 이종필, 이상민, 안동현, 주명수, 김건석 울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실, 2 서울아산병원의생명연구소 목적 : 일측성요관폐색랫드모델에서신장사이질의섬유화에작용하는 TGF-β/Rho-kinase/LIMK 경로의활성화를확인하고폐색정도와신장사구체와세뇨관사이질섬유화정도및이경로의활성화화의상관관계를확인하고자예비실험을시행하였다. 대상및방법 : 8주령의 Sprague-Dawley 계수컷랫드 42마리를 Sham 대조군 (C), 일측성요관부분폐색군 (MO), 일측성요관완전폐색군 (SO) 으로나누었다. 일측성요관폐색모델은랫드를마취후복부를횡절개하여좌측신장과요관을확인하고신우요관이행부의요관에서 2.5 mm (MO군) 또는 mm (SO군) 두께의 guidwire를요관과함께 6-0 blacksilk로결찰하였고, C군은정상랫드로서각손상군의실험일정에맞추어개복후요관을확인하는과정까지만실험을병행하였다. C, MO, SO군에서 6마리씩을대상으로 N-acetylcysteine 를투약하고이를각각 C+NAC, MO+NAC, SO+NAC군으로하였으며, MO, SO군에서 6마리씩을대상으로 LIMK inhibitor를투약하여각각 MO+LI, SO+LI 군으로정의하였다. 각실험군에서요관폐색수술후, 2주에각군당 3마리씩체중을확인하고신장을채취하여신장의무게를측정하고 0% formalin에밤새보관한이후 paraffin block을제작하였다. 파라핀포매된조직절편을 4 um 두께로절단하고 Masson trichrome 및 Sirius Red염색으로 collagen staining 시행하고 H&E로대조염색시행하였다. ROCK 및 LIMK2의발현을사구체및신장사이질조직에서확인하였다. 결과 : 술후 주와 2주째 MO군과 SO군의평활근 / 콜라겐비율은모두 C 군에비해유의하게감소하였다. MO+NAC, SO+NAC, MO+LI, SO+LI 군에서는각각, MO, SO 군에비해평활근 / 콜라겐비율의감소가호전되었다. 면역조직화학염색결과 ROCK과 p-limk2의단백발현정도는 주째와 2주째 C군에비해 MO군및 SO군에서유의하게증가하였으나, NAC 및 LIMK inhibitor 를투약한후에는 S군에비해통계적인차이를보이지않았다 (Figure ). 결론 : 본실험결과일측성요관폐색후발생하는신장사구체와세뇨관사이질의섬유화에 ROCK/LIMK2 체계가연관되어있는것으로생각된다. 추후이신호체계의활성과억제가요관폐색으로인한신장사구체와세뇨관사이질의섬유화에미치는장기적인영향에대해서추가적인실험이필요할것으로생각된다. Keywords: Fibrosis, Ureteral obstruction, Rho kinase, LIM kinase 95

O-34 간질성방광염 / 방광통증증후군 (IC/BPS) 환자에서유전자발현프로파일의특성규명및섬유형성의주요조절자로서의 WNT2B 의연구 한주영, 류채민, 유환열, 최대헌, 김아람 2, 신동명, 주명수 울산대학교서울아산병원, 2 건국대학교병원 Aims of Study: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a distressing and chronic inflammatory bladder disorder. Many IC/BPS patients experience severe pelvic pain that can be exacerbated by bladder filling and is often associated with urinary frequency. Although denudated urothelium, increased inflammation, mast cell infiltration, and tissue fibrosis have been considered as pathological features for IC, the crucial genes responsible for the IC pathogenesis remain to be determined. Here, we show that WNT2B play a crucial role on preventing fibrotic damage of bladder tissues in IC/PBS patients. Study Design, Materials and Methods: A total of 3 patients, including 6 NHIC (non-hunner-type IC), 9 HIC (Hunner-type IC), and 6 non-ic (control) cases, were enrolled. Employing quantitative RT-PCR, we examined the expression of two categorized genes in patients with bladder IC/BPS and in controls (non-ic); i) biomarkers characteristic to IC/BPS patients in previous reports, and ii) sonic hedgehog (Shh) and WNT family genes which mediated therapeutic effect in our preclinical studies. The significance of each gene was evaluated by infection of lentivirus containing its specific shrna into HBIEpC, a normal human bladder epithelial cells. Results: In our gene expression data, IC/BPS patients characteristically up-regulated the some of Shh (GLI- and PTC-) and WNT (WNT2B and WNT5A), concomitantly with altered expression in several IC/BPS biomarkers (e.g., CCR2, HB-EGF, ARF, and CHT). Particularly, the expression of WNT2B in the bladder tissue was characteristically increased in HIC patients, compared with NHIC and control patients. Silencing of WNT2B in HBIEpC cells resulted in the fibrotic changes evidenced by fibrotic morphology and induction of genes related to epithelial mesenchymal transition (EMT) process. These fibrotic changes in the WNT2B silenced cells also activated the transforming growth factor-b (TGF-b) signaling, evidenced by the localization of phospho-smad2 or -Smad3 proteins. Concluding Message: Our data demonstrated that the expression of a subset of Shh-WNT signaling cascade is altered in the bladder tisssues of IC/BPS patients. Particularly, down-regulation of WNT2B critically impaired the balance between bladder epithelial regeneration and tissue fibrosis in IC/BPS patient, thus WNT2B based therapy could be a plausible approach to Keywords: Interstitial cystitis/bladderpain syndrome (IC/BPS), Fibrosis, WNTpathway 96

O-35 마우스에서면역조직화학염색을통한방광신경 - 혈관구조의 3 차원영상이미지구축 응웬낫민, 최민지, 송강문, 칼얀가탁, 권미혜, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 Purpose: Functional interaction between nervous and vascular system in urinary bladder plays an important role in normal bladder function and the disruption of these structures is known to be related to many diseases, such as bladder pain syndrome and diabetic bladder dysfunction. In this study, we established the technique to determine neurovascular structures in the mouse urinary bladder by using immunohistochemical staining with three-dimensional reconstruction. Methods: The bladder was harvested from 8-week-old C57BL/6 male mouse. Bladder submucosa was dissected for whole mount staining and thick-cut (50-μm) sections were prepared for full-thickness bladder staining. Immunofluorescent staining of bladder tissue was performed with antibodies against CD3 (an endothelial cell marker), smooth muscle α -actin (a smooth muscle cell marker), NG2 (a pericyte marker), βiii-tubulin (a neuronal marker), or tyrosine hydroxylase (TH, a sympathetic nerve maker). We reconstructed three-dimensional images of bladder neurovascular system from stacks of two-dimensional images, which allows volume rendering and provides reliable anatomic information. Results: Three-dimensional images clearly provided good anatomic information about neurovascular structures in the three layers of bladder, such as mucosa, submucosa, and detrusor muscle. Whole mount imaging of submucosal layer also clearly delineated relationship between nervous and vascular systems. Conclusion: Our study for immunofluorescent staining with three-dimensional reconstruction will allow a better understanding of the bladder neurovascular anatomy and may constitute a standard technique to evaluate pathologic changes in a variety of urinary bladder diseases. Keywords: Urinary bladder, Three-dimensional reconstruction, Immunohistochemistry Figure. (a-f) 3D images of thick-cut sections of urinary bladder. (g, h) Whole mount images of submucosal layer. DAPI (blue color, nuclear marker). 97

O-36 인간의신장교감신경섬유의해부학적분포분석및 3D 생체모델링 : 신장적출조직을이용한연구 송원훈, 최원석 2, 예은비 3, 박성민 3, 최의근 2, 정창욱 서울대학교병원비뇨기과, 2 서울대학교병원내과, 3 포항공과대학교창의 IT 융합공학과 연구배경 : 저항성고혈압환자에서효과적인신경차단술을위하여, 살아있는인간의신장주위동맥교감신경섬유들의상세한해부학적분포를신장적출조직을이용하여분석하고자하였다. 방법 : 신장적출술을시행받은 00명을대상으로신장동맥의근위부를결찰하여주동맥조직에서건강한조직상태와시편제작이잘된 3명의환자의조직을선택하였다. 주변연조직을포함하여동맥말단분기점으로부터 3 mm 간격으로연속절개하고, 면역조직화학염색을한후, 신경섬유의수와크기, 신동맥의내강표면 / 중심 / 외벽으로부터각신경섬유들의중심까지의거리를측정하였다. 해부학적정보를시각화하고향후전자기역학및열역학의시뮬레이션을통한열치료효과검증을위해대표적인조직을 40 μm 간격으로 74장의조직슬라이드를제작하였고, 현미경으로영상을캡쳐하고 Sim4Life 소프트웨어패키지 ver 3.2 (Zurich MedTech AG, Germany) 를이용하여최종 3D 생체모델을완성하였다. 결과 : 환자의평균연령은 62.±2.세였으며남성이 70% 를차지하였다. 신장동맥의평균외경은 4.50±.47 mm, 내경은 2.40±.22 mm였다. 동맥의분지부근처 ( 원위부분절 ) 부터분지부의 9 mm 근위부 ( 근위부분절 ) 까지의 4개의각분절에존재하는신경섬유의평균개수는각각 42.4개, 36.3개, 32.8개그리고 35.3개였고, 총개수는평균 46.8개였다. 30 μm 미만의작은신경섬유들을제외한각분절의신경섬유의평균개수는각각 34.4개, 30.3개, 28.0개그리고 26.0개였고, 총개수는평균 8.7개였다. 원위부분절에서근위부분절까지각분절당신경섬유의평균직경은각각 08.3±46.6 μm, 4.5±60.6 μm, 22.7±62.9 μm 그리고 83±89.34 μm였다. 신장동맥내강표면에서각신경섬유의중심까지의거리는, 90% 이상이 4.0 mm 이내였다. 원위부분절에서근위부분절로갈수록, 신경섬유의평균직경은더굵었고, 신경의개수는더적은경향을보였다. 신경분포와 3D 생체모델링은그림, 2와같다. 결론 : 신장동맥주위신경들의 90퍼센트가동맥내강에서 4.0 mm 이내에위치하였다. 동맥의여러분절에따른신경섬유의공간적분포에는유의한차이가없었지만, 신경섬유의총수는근위부보다원위부에서더많았다. 상세한추가분석결과와인체시뮬레이션을바탕으로보다효과적인신장신경차단술의전략을수립할계획이다. Keywords: Anatomical distribution of renal sympathetic nerve fibers, Denervation, 3D modeling 98

O-37 저활동성방광을재현하기위한죽상동맥경화증유발골만만성허혈쥐모델의개발에관한연구 김명, 유환열 2, 최대헌, 김아람, 유채민 2, 한주영 2, 신동명 2, 주명수 울산대학교서울아산병원 비뇨기과학교실, 2 의생명과학교실 Purpose: To our best knowledge, animal models reproducing detrusor underactivity (DUA) are scarce. Previous studies suggested that atherosclerosis, a common aging-associated disorder, has a role in the pathogenesis of lower urinary tract dysfunction, such as DUA. We tried to develop a rat model of atherosclerosis-induced chronic bladder ischemia and investigate the effect of chronic bladder ischemia on voiding behavior and bladder function. Methods: Adult male rats were divided into four groups. The arterial injury (AI) group underwent endothelial injury of the iliac arteries (AI-0, 0 times of injury at each iliac artery; AI-30, 30 times) and received a 2% cholesterol diet. The sham group underwent sham operation and received a 2% cholesterol diet. The control group received a regular diet. After 8 weeks, a metabolic cage study and cystometry were performed without anesthesia. Histological examination of the iliac arteries and the bladder was performed. The bladder was also processed for organ bath study. Results: The metabolic cage study showed that in the AI-30 group, micturition interval, voided volume, and residual volume were significantly increased. Cystometry showed that the frequency of reflex bladder contractions and micturition pressure were significantly lower in the AI-30 group. Histological study showed that in the AI group alone, atherosclerotic occlusion occurred in the iliac arteries as well as in the downstream bladder microvessels. Contractile responses of bladder strips to various stimuli in AI-30 group were significantly less than in sham group (Figure). Conclusions: Pelvic arterial occlusive disease plus vascular endothelial dysfunction may cause progressive vascular damage resulting in bladder dysfunction that develops the detrusor underactivity Keywords: Detrusor underactivity, Arterial injury, Chronic bladder ischemia 99

O-38 간질성방광염백서모델에서내장과민성에대한인간배아줄기세포유도체의효과 최대헌, 유환열,2, 류채민,2, 한주영,2, 김아람 3, 신동명 2, 주명수 울산대학교서울아산병원 비뇨기과학교실, 2 의생명과학교실, 3 건국대학교병원비뇨기과학교실 Purpose: To investigate the effect of multipotent mesenchymal stem cells (M-MSCs) therapy for modulating visceral hypersensitivity in interstitial cystitis (IC) rat model. Materials and Methods: IC rat model was induced in 0-week-old female Sprague-Dawley rats via the instillation of 0.M hydrochloric-acid or phosphate-buffer saline (PBS; sham). After week, 0 6 M-MSCs derived from human embryonic stem-cells (hescs) was directly injected into the submucosal layer of the bladder. After week of transplantation of M-MSCs, we performed histological and gene expression analysis of bladder tissue in each group. Results: The bladder tissues in the IC rat group exhibited markedly increased mast cell infiltration in urothelium and denudated urothelium compared with the sham group. M-MSC administration significantly reversed mast cell infiltration and denudation in urothelium (Figure a). Infiltrated mast cells were frequently observed nearby nerve fibers in IC rat bladders, however the anatomical interaction between mast cells and nerve fibers was significantly reduced by M-MSC therapy (Figure b). Furthermore, gene expression analysis indicated that the bladder tissues in IC rats were characterized by the increased expression of nerve growth factor (Ngf) and other genes (e.g. Tumor necrosis factor-α; Tnf-α and tachykinin receptor ; Tacr) associated with visceral hypersensitivity, however the administration of M-MSCs significantly restored their induction in bladder tissues. Conclusion: These results demonstrate that M-MSC therapy relieves the anatomical interaction between the mast cells and nerve fibers and up-regulation of a subset of genes associated with visceral hypersensitivity. Thus, we suggest that M-MSC therapy could be beneficial on controlling visceral organ crosstalk and severity of abdominal pain or discomfort in IC/BPS and visceral hypersensitivity, such as irritable bowel syndrome patients. Keywords: Interstitial cystitis, Visceral hypersensitivity, Stem cell therapy 200

O-39 신경인성방광백서모델에서 immortalized 중간엽줄기세포의치료효과 전승환, GuanQun Zhu, 정현철, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅가톨릭대학교의과대학비뇨기과학교실 Objectives: To investigate therapeutic efficacy of Immortalized mesenchymal stem cells (immscs) application injured pelvic nerve in a rat model of neurogenic bladder (NB). Materials and Methods: Sprague-Dawley rats (n=60) were randomly divided into 5 groups. (N = 2 per group): sham operation group (control group), nerve injury group, nerve injury matrigel group, nerve injury immscs group, and nerve injury engineering immscs group. The mean intravesical pressure and other expression experiments were carried out at the 4th week after the procedure. Immediately after recording of mean intravesical pressure, bladder and major pelvic ganglion then harvested for histologic analysis and western blotting. immscs were labeled with a fluorescent dye before treatment. Results: After treated by immscs injection significantly improved intravesical pressure compared to the other experimental group. immscs had significantly increased bladder smooth muscle/collagen ratio and β-iii tubulin expression of the pelvic nerve. Conclusions: immscs had a positive effect on restoration of injured nerves and improved the mean intravesical pressure of NB rats. Keywords: Pelvic nerve, Immortalized mesenchymal stem cells, Neurogenic bladder 20

O-40 The comparison of therapeutic efficacy of CHA MSC and ADMSC and evaluate the therapeutic mechanism in a chronic interstitial cystitis rat model 이영은, 홍재엽, 최경화 CHA 의과학대학교분당차병원비뇨기과학교실 Objective: To compare the therapeutic effects of mesenchymal stem cell (CHA) and adipose derived mesenchymal stem cell (ADMSC) and evaluate the effective mechanism on damaged bladder tissue in a chemically induced chronic interstitial cystitis (IC) rat model. Methods: Female 0-week-old Sprague-Dawley rats were used for induction of chronic IC model. Chronic IC model was induced with single intravesical instillation of protamine sulfate (0.5 ml of PS, 30 mg/ml) and lipopolysaccharide (0.5 ml of LPS, 2.25 mg/ml) for month. 35 rats were divided into five groups (N=7): sham operation group, chronic IC receiving a single bladder submucosal injection of phosphate-buffered saline (20 ml, IC) or IC+ CHA (5 0 5 cells/20 μl, IV) or IC+ ADMSC (5 0 5 cells/20 μl, IV) and intravesical IALURIL R instillation (40 μl, 40min). Two weeks after treatment, voiding spot was obtained using 6 hr metabolic cage and analyzed with Image J program. The bladder was harvested for histologic examinations and toluidine blue staining for mast cell. Microarray analysis was done to evaluate the therapeutic mode of action. Results: Rats in the IC group showed increased voiding frequency (3.5 vs 3.8) and decreased the spot size (3.6 vs.2 unit) compared with sham group. Significant improvement of voiding spot pattern in frequency (4.8 and 5.) and size (3.2 and 3.5 unit) was observed in both CHA and ADMSC, however, there was no difference between the two groups and the result was comparable with IALURIL R group. Histological examination revealed a significant decrease in the total number of infiltrated mast cells in CHA and ADMSC group compared with the IC rats, and there was no difference between the two stem cell groups. Hematoxylin/eosin staining demonstrated that loss of urothelial integrity and increased neutrophil infiltration in IC group was restored both in CHA and ADMSC group. Microarray analysis using DAVID and KEGG pathway for CHA cells notes several enriched pathways including, various cellular response, metabolic process, nucleic acid binding and oxidative phosphorylation. Conclusion: CHA and ADMCS showed comparable therapeutic efficacy in terms of improvement of voiding pattern and histological restoration in chronic IC model. And CHA MSC might produce therapeutic effects through multiple mechanisms. Keywords: Interstitial cystitis, CHA mesenchymal stem cell, Adipose derived mesenchymal stem cell 202

O-4 종사지방종환아들의수술전, 후요역동학검사분석 신상희, 김수연, 김상운 2, 이용승 2, 한상원 2 세브란스어린이병원, 소아비뇨기과, 방광요도재활실, 2 연세대학교의과대학비뇨기과학교실목적 : 종사지방종은척수견인증후군을유발할수있는선천성척추이상이다. 증상발현후수술경과는대게 50% 정도에서증상호전을보인다고알려져있다. 이연구에서는종사지방종수술전과수술후장기추적시의요역동학검사및비뇨기계증상유무를확인하고자하였다. 대상및방법 : 2005년 월부터 206년 8월까지종사지방종으로진단된환아 353명의기록을후향적으로분석하였다. 종사지방종으로수술한환아들의종사지방종확진의계기, 동반질환과수술전, 후의요역동학검사를분석하였다. 요역동학검사결과는 Meyrat 등에의해개발된 Urodynamic scoring system를이용하여 Urodynamic study (UDS) scrore를분석하였는데, 이는순응도 (4점), 용적 (5점), 배뇨근활동성 (5점), 괄약근조화 (3점) 등의점수를합산한지표이다. 결과 : 해당기간에총 353명이종사지방종을진단받았으며방광기능에영향을줄수있는요도하열, 배설강이상, 항문폐쇄증등이있는 38명과수술을시행하지않은 58명을제외한환아는 87명이었다. 이중남아는 04명 (55.6%) 이었고수술당시나이는평균 20개월 (-235) 이었다. 엉치뼈함몰로발견한 7명의수술당시나이는평균.2개월 (-09) 이었고비뇨기계증상으로발견한 5명은 76개월 (35-03), 근골격계증상으로발견한 명은 3개월 (3-235) 이었다. 수술전 UDS score는평균 3.7이었으며, 수술후마지막추적요역동학검사는수술후평균 22.4개월 (9-64) 후에이루어졌으며 UDS score는평균 2.3으로수술전에비하여유의한감소를보였다 (p<0.00). 배뇨증상은 4명에서요실금을동반한과민성방광증상, 명에서요폐가있어발견하였으며이들의평균수술전 UDS score는 5.2, 수술후 UDS score는 4.4였고 3명은증상의부분호전, 2명은호전을보이지않았다. 결론 : 종사지방종으로수술받은 87명은수술관련합병증없이모두좋은경과를보였으며요역동학검사결과수술전, 후 UDS score 모두정상범위를보였다. 이미증상이발현된후수술한경우평균연령이높았으며대부분증상이호전되지않았다. Keywords: Filum terminale lipoma, Urodynamic study, Prophylactic surgery 203

O-42 신경인성방광에서초음파탄성영상을이용한방광유순도측정의초기경험 임영재, 김기원 2, 최영훈 3, 이지연 4, 박관진 서울대학교의과대학 비뇨기과학교실, 2 재활의학교실, 3 영상의학교실, 4 신경외과학교실목적 : 신경인성방광의치료및예후를결정함에있어가장중요한요소가방광의유순도이다. 하지만, 현재까지는요역동학검사를통해서만방광유순도를평가할수있다. 저자들은초음파탄성영상을이용하여측정한탄성계수와실제방광유순도와의상관관계를알아보고자하였다. 대상및방법 : 206년 월부터 207년 6월까지신경인성방광으로요역동학검사를시행한 8명의환아를대상으로전향적연구를진행하였다. 신경인성방광의원인으로는척수수막류 2명, 지방척수수막류 4명, 척수종양 명, 꼬리퇴행증후군이 명이었다. 각각의환아에서요역동학검사를시행하여방광유순도를측정하였고, 동시에초음파탄성영상을통해탄성계수를측정하여비교분석하였다. 결과 : 8명중남자가 4명이었고, 요역동학검사시평균나이는 8.9세 (5-5) 였다. 요역동학검사에서측정된방광유순도가0 ml/cmh 2 O 이하로매우저하된그룹과 (4명), 20 ml/cmh 2 O 이상으로정상인그룹 (4명) 으로나누어탄성계수값의차이를비교하였다. 방광유순도가저하된환자군의평균유순도는 5. (.7-8.9) ml/cmh 2 O였다. 예측방광용적대비방광의충만정도 (0%, 25%, 50%, 75%, 00%) 에따라탄성계수를측정한결과요역동학검사시작시에는방광유순도저하군이 9.05 kpa, 정상군이 9.4 kpa로차이가없었고 (p=0.94), 25% 충만시에는저하군이 3.2 kpa, 정상군이 7.74 kpa로차이를보였지만통계적유의성은없었다 (p=0.2). 한편, 방광유순도저하군에서는 50% 충만시평균탄성계수가 3.34 kpa, 75% 충만시 5.46 kpa, 00% 충만시 22.03 kpa로지속적으로상승한반면에정상유순도군에서는 50% 충만시 4.85 kpa, 75% 충만시 5.53 kpa, 00% 충만시 8.5 kpa로, 두군에서모두통계적으로의미있는차이를나타냈다 (50% p=0.006, 75% p=0.003, 00% p=0.05). 결론 : 초음파탄성영상을이용한탄성계수는방광유순도와밀접한상관관계를나타내며, 탄성계수가 0 kpa 이상이면실제방광유순도가상당히저하된것으로판단할수있다. 한편, 초음파탄성영상은비침습적이며누구나쉽게시행할수있는검사로써, 향후요역동학검사의역할을상당부분대체할수있으리라생각된다. Keywords: Neurogenic bladder, Elastography, Compliance 204

O-43 약물불응성야뇨증에대한경요도방광내보툴리늄독소주입술의초기치료경험 박관진, 송원훈, 임영재서울대학교병원비뇨기과목적 : 치료불응성과민성방광에대해사용할수있는침습적인방법으로경요도방광내보툴리늄독소 ( 보톡스 ) 주입술이있고성인에서는그효용성이잘알려있지만야뇨증과동반된방광과활동성이기존치료에대해저항을보이는경우이방법이야뇨증에어떤효과를보일지조사된연구결과는거의없다. 연구자들은과민성방광을보이는치료저항성야뇨증에대한경요도방광내보톡스주입술의효과와 년이상의추적결과를보고하고자한다. 대상및방법 : 기존약물및요로치료에대한반응을보이지않고지속적으로야뇨를보였던일차성야뇨증환자 7명에서비디오요역동학검사를시행하여방광과활동성을확인한다음전신마취로전환하여경요도로방광내에보톡스 (0 IU/ml) 를 20-30부위에최대 300 IU까지주사하였다. 치료후 개월, 3개월, 6개월, 9개월까지야뇨증증상, 절박뇨, 배뇨일지에서의평균배뇨량의변화를 ICCS 기준으로치료전과비교하였다. 결과 : 평균연령은 4세 (8-2) 였고남자가 5명이었다. 주입술전정중치료기간은 9개월 (3-28) 이었고모든환자가일주일에 3회이상의야뇨를보였다. 배뇨일지에서평균방광용적이예상최대방광용적의 38% (24-77) 정도로방광용적이감소되어있었다. 요역동학검사에서배뇨근과활동성은보인경우는 4명이었고 3명은방광유순도의감소를보였다. 주입술직후유의한배뇨곤란이나요로감염은없었다. 술후 2주내에모든환자에서효과를보였으며배뇨일지에서평균방광용적의유의한증가를보였다. 술후 개월에 5명은야뇨증의 Complete Response (CR) 를보였고 2명은항콜린제투여로일주일의한번이하의 Partial Response (PR) 를보였다. 모든환자들에게서 9개월이상의추적을시행한결과 4명은 CR의상황이유지되었고 3명은증상의악화가있었지만항콜린제투여로 PR을유지하였다. 결론 : 과민성방광으로인한치료불응성야뇨증을보인소아환자에서보톡스의방광내주입술은안전하고효과적이며일회주사만으로도상당수의환자에서호전된증상을 9개월이상유지하는결과를보였다. Keywords: Enuresis, Overactive bladder, Botulinum toxin 205

O-44 요도하열교정술후배뇨기능의평가 : 요속검사와환아의배뇨를촬영한동영상간의상관관계 류제만, 송상훈, 김건석 울산대학교서울아산병원비뇨기과학교실 Introduction: Although urine flow rate is a common method used to measure patient voiding function, maximal urinary flow rate (Qmax) is occasionally not accurate in pediatric patients because Qmax is mainly related to the voided volume. To evaluate voiding function of pediatric patients after urethroplasty for hypospadias, we assessed the value of videos recording the voiding of pediatric patients comparing with uroflowmetry (UFM) parameters. Materials and Methods: Among pediatric patients who underwent hypospadias repair between 2005 and 205 in our institution, 57 patients documented about video recording of the voiding after surgery were included in this study. Serial postoperative UFM profiles at follow-up visits were assessed and divided into the following postoperative time interval endpoints: the age of 3, 4-6, and 7 years. When the results of uroflowmetry were not compatible with voiding symptoms, we evaluated voiding function using videos which had been recorded at home and divided into good and bad voiding function. In addition, we assessed the impact of the evaluation of video on the decision of visual internal urethrotomy (VIU). Results: Mean age of patients at operation was 7 months old and those with anterior, middle, and posterior hypospadias were 9 (5.8%), 22 (38.6%), 26 (45.6%), respectively. Of total 57 patients, 45 (78.9%) underwent tubularized incised plate repair and the others underwent other types of repair. During mean follow-up duration of 53 months, 8 patients underwent VIU once or more. In the result of postoperative UFM, mean maximal urinary flow rate (Qmax) was 5.0, 5.3, and 7.8 ml/s in the age of 3, 4-6, and 7 years, respectively. Of 39 patients with Qmax<0 ml/s, we assessed 32 (82.%) patients actually had a good voiding function after evaluating the videos. We performed total 20 VIU for 8 patients. Of those, 5 (75%) patients underwent VIU because of low Qmax, while 5 (25%) underwent VIU after evaluating only video and voiding symptoms. Conclusions: In addition to uroflowmetry, videos recording voiding of pediatric patients can be helpful to evaluate voiding function after hypospadias repair. Keywords: Hypospadias, Uroflowmetry, Urethroplasty 206

O-45 일측성서혜부탈장 / 음낭수종남아에서반대측개방성칼집돌기와관련된수술전초음파검사에서의반대측서혜부내륜형태의예측가치 박현식, 신현빈, 조현욱, 유대선, 박진성, 김대경, 우승효 을지대학교의과대학비뇨기과학교실 Aim: To assess the predictive value of preoperative ultrasound (US) findings with correlating the results of transinguinal laparoscopy for the detection of contralateral patent processus vaginalis in boys with unilateral indirect inguinal hernia/hydrocele. Materials and Methods: Two hundred seventy-nine boys (mean age 43.8 months, range 2-78 months), with unilateral condition without the evidence of contralateral hernia sac or hydrocele by physical examination or plain ultrasound underwent transinguinal laparoscopy for the presence of contralateral patent processus vaginalis (CPPV) during ipsilateral operation. We prospectively assessed whether the beaky or beaded shape of contralateral inguinal ring on ultrasound, especially morphological variation at Valsalva maneuver was valuable through validation with laparoscopic results.. Results: The incidence of CPPV was 37.6%. In univariate analysis, age and the beaky/beaded shape of inguinal ring on US were statistically significant risk factor for CPPV and others (laterality, disease type, sac type) were not. In multivariate regression analysis, the beaky/beaded shape of internal ring only had significant predictor for CPPV. However, included the morphological variation of these shape at Valsalva maneuver, the beaky/beaded shape parameter was insignificant and morphological variation was only independent predictor for CPPV (p<0.00, OR 83.67, C.I. 7.45-40.). This study suggests that US offers the significant information for the presence of CPPV preoperatively, and can also provide surgeons the considerations for surgical treatment. Keywords: Ultrasound, Inguinal hernia, Risk factors 207

O-46 고령에서발생한급성신우신염의연령에따른임상적특징과항생제감수성 : 다기관연구 김웅빈, 조규형 2, 김기홍 3, 이상욱, 양희조 3, 두승환 4, 김재헌 4, 윤종현 2, 김두상 3, 양원재 4, 이광우, 김준모, 이창호 3, 김영호, 송윤섭 4, 전윤수 3, 김민의 순천향대학교 부천병원, 2 구미병원, 3 천안병원, 4 서울병원 Background: 급성신우신염은전연령대의여성에서비교적높은유병율을보이는요로감염질환이지만노인환자에서발생한경우연령이증가할수록증상이더심하고치료의반응및예후도나쁘다. 저자들은다기관연구를통해노인에서발생한급성신우신염을연령에따라분류하여임상적특징및항생제감수성에대해조사하여비교하였다. Methods: 202년부터 206년까지지역별 3차의료기관 4곳에서급성신우신염으로입원치료를받은환자중 65세이상의노인환자,028명 (75.0±7.세) 를대상으로하였다. 환자를나이에따라 3군으로분류하여각각의임상증상, 혈액및요검사, 기저질환, 항생제감수성을비교분석하였다. Result: Young-old군은 530명 (67.4±2.9세), old-old군 363명 (78.2±3.0세), oldest-old군 26명 (87.6±2.8세) 이었다. APN으로인한입원기간과발열지속일수는나이가많은군일수록증가하였으나최대체온은군간에차이를보이지않았다. 혈액검사상 ESR과 CRP는연령이높은군일수록증가하였다. 환자의기저질환에서당뇨와만성신질환은그룹간의차이가없었으나, 뇌혈관질환과울혈성심부전은나이증가에따라이환율이높았다. 요로결석질환의여부는그룹별로차이는있었으나연령증가에따른차이는없었다. 나이가높은환자일수록최근 년내 UTI가있었던경우가많았다 (Table ). ESBL 생성병원균의동정은그룹간에유의한차이를보이지않았다. Cabapenem계열의 ertapenem과 imipenem에대한감수성은나이가많은그룹에서통계적으로유의한감소를보였으며, amikacin도높은연령군에서낮은감수성을보였다. Ciprofloxacin은연령증가에따라감수성의감소가매우크게관찰되었다 (Table 2). Conclusion: 고령환자들에서발생한급성신우신염은나이별로임상경과와검사결과의차이및주요항생제의감수성에차이를보였다. 따라서급성신우신염환자의치료시연령을고려한항생제의선택이중요하다. Keywords: Elderly, APN, Susceptibility 208

O-47 요관경하결석제거술후발생하는전신염증반응증후군의발생율및위험인자 김웅빈, 이상욱, 이광우, 김준모, 김영호, 김민의순천향대학교의과대학비뇨기과학교실 Purpose: 내시경및결석제거용레이저기술의발달로요관경하결석제거술이많이시행되고있으나수술후심각한감염합병증이발생할수있다. 저자들은요관경하결석제거술후발생하는 SIRS 및 urosepsis의유병율및위험인자를조사하여분석하였다. Meterial and Methods: 203년부터 206년까지 48개월동안단일기관에서요로결석으로요관경하결석제거술을시행받은환자중수술전요로감염의증상을보인환자를제외한,356명의환자를후향적으로조사하였다. 환자를 SIRS 발생군과 SIRS 비발생군으로나누어두군간의차이를줄수있는위험인자를분석하였다. Results: 요관경하결석제거술이시행된,356명의환자중 96례 (7.%) 에서수술후 SIRS가발생하였고, 이중 37례 (2.7%) 가 urosepsis로진단되었다. SIRS 발생군과 SIRS 비발생군간에나이, 성별, performance status, 수술전 pyuria 여부, 결석크기, 수술시간, 수술중레이저의사용등이통계적으로의미있는차이를보였으며, comorbidity index, BMI, 이전결석과거력, 수술전항생제사용여부, 결석의위치, 감염석여부, 수술후요관스텐트유치등은차이를보이지않았다 (Table ). Urosepsis가진단된 37명의환자는여성이남성보다높은발생율을보였고 (male: 8, female: 29, p<0.05) 항생제사용기간과입원기간이각각.4±3.7일, 3.9±3.6일로조사되었다. ESBL 양성병원균은 5례 (3.5%) 에서배양되었다 (Table 2). Conclusion: 요관경하결석제거술후발생할수있는감염합병증을예방하기위해합병증이발생할가능성이높은환자에서는수술시간을최소화하는노력과예방적항생제의사용이고려되어야할것이다. Keywords: URS, SIRS, Urosepsis 209

O-48 요로결석을동반한발열성요로감염환자에서미생물학적특징과경험적항생제내성균발생의예측인자 조석, 김형석 2, 박민구 3, 이건철, 조성용, 이정우 2 인제대학교일산백병원, 2 동국대학교일산병원, 3 인제대학교서울백병원 목적 : 요로결석을동반한발열성요로감염환자에서소변및혈액배양검사에서동정되는균의종류와경험적항생제내성균발생의위험인자에대해알아보고자하였다. 대상및방법 : 20년 월부터 206년 2월까지요로결석을동반한발열성요로감염으로국내 3개대학병원을방문한 203 명의의무기록을후향적으로분석하였다. 환자의성별, 나이, 체질량지수, 기저질환, 요로결석관련정보와소변및혈액배양에동정된균주의종류와항생제감수성검사를확인하였다. 결과 : 203명의요배양검사상배양검사결과음성인경우가 5건 (25.%), E. coli가 67건 (33.0%), 그외 enterococci가 8 건 (8.9%), Proteus가 3건 (6.4%), 여러균주가배양된경우가 건 (5.4%), S. agalactiae가 0건 (4.9%), Klebsiellar가 8건 (3.9%), pseudomonas가 7건 (3.4%), S. epidermidis가 6건 (3.0%), Serratia가 4건 (2.0%), Enterobactre와 Acinebacter 가각각 건 (0.5%), 그외균주가배양된경우가 6건 (3.0%) 였다. Fluoroquinolone 저항균발생인자는단변량분석결과심혈관계질환 (p=0.034), 당뇨 (p=0.009), 신경학적질환 (p=0.03), 병상생활 (p=0.08), 3개월이내항생제치료병력 (p=0.02), 병원관련감염 (p=0.003), 재발성요로감염 (p=0.002), 다발성요로결석 (p=0.005) 였으며, 다변량분석결과다발성요로결석이 Fluoroquinolone 저항의독립적예측인자였다 (p=0.008). Cefotaxime에대한저항균발생인자는단변량분석결과나이 (p=0.08), 신경학적질환 (p=0.024), 호흡기계질환 (p=0.008), 병원관련감염 (p=0.020), 재발성요로감염 (p=0.005), 다발성요로결석 (p=0.025) 였으며, 다변량분석결과재발성요로감염이 Cefotaxime 저항의독립적예측인자였다 (p=0.04). 결론 : 요로결석을동반한발열성요로감염환자에서경험적항생제로써 Fluoroquinolone은부적절하고, Cefotaxime 단독요법을추천한다. 그중재발성요로감염인경우에는높은내성률로 Cefotaxime 단독요법보다는병합요법을추천한다. Keywords: Antibiotics resistance, Calculus, Urinary tract infection 20

O-49 Prevalence of fluoroquinolone resistant rectal flora in patients undergoing transrectal ultrasound guided prostate needle biopsy: a prospective multicenter study Seong Jong Eun, Ji Won Ryu, Taeju Park, Jong Bum Kim, Yang Hyun Cho, Myung Soo Kim, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Sun-Ouck Kim, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Seung Il Jung 전남대학교의과대학비뇨기과학교실 Purpose: To estimate the prevalence of fluoroquinolone resistant rectal flora in patients undergoing transrectal ultrasound guided prostate needle biopsy (TRUS Bx) and identify the high risk groups. Materials and Methods: From January 205 to March 206 rectal swabs of 557 men from 5 institutions undergoing TRUS Bx were obtained. Results: The incidence of FQ-R and extended-spectrum beta-lactamase (ESBL) production was 48.% and.8%, respectively. The most common FQ-R bacteria was E. coli (8% of total FQ-R bacteria, 39% of total rectal flora), and 6 (2.9%) patients had infectious complications. Univariable and multivariable analysis of clinical parameters affecting FQ-R showed no factor associated with FQ resistance of rectal flora. The clinical parameters associated with infectious complications after prostate biopsy were operation history within 6 months (RR 6.60; 95% CI.99-2.8, p=0.002) Conclusions: The prevalence of FQ-R rectal flora from the rectum before TRUS Bx was 48.% and most common FQ-R bacteria was E.coli (39%), however, FQ resistance of rectal flora was not predicted by clinical factors. These results suggest that risk based approach cannot be recommended and physicians should consider targeted antibiotic prophylaxis or extended antibiotic prophylaxis for patients undergoing TRUS Bx. Keywords: Biopsy, Fluoroquinolone, Prostate 2

O-50 술전포비돈요오드좌약투여의경직장전립선조직검사시행후합병증예방효과연구 : 전향적무작위대조군연구 이인재, 이상철, 권오성 2, 강민용 3, 이상은 분당서울대학교병원비뇨기과학교실, 2 성균관대학교삼성서울병원비뇨기과학교실, 3 한림대학교강남성심병원비뇨기과학교실 목적 : 경직장전립선조직검사는전립선암의진단에있어표준적으로사용되는진단법이다. 하지만경직장전립선조직검사는침습적인술기로서감염, 패혈증등의심각한합병증을초래할가능성이있다. 또한최근연구에따르면경직장전립선조직검사후 0.8-3.6% 의환자가감염성합병증으로재입원한다고보고되었으며, 이에조직검사후감염증예방을위해시술전포비돈요오드좌약의사용의유용성을확인하려한다.. 방법 : 204년 2월부터 206년 5월까지만 8세이상의 276명의경직장전립선조직검사환자를대상으로진행하였다. 환자는시술전포비돈요오드좌약을사용한치료군 (n=38), 좌약을쓰지않은대조군 (n=38) 으로구분하였으며각군의비율이 :이되도록무작위로배정하였다. screening을위해 blood lab및 IPSS, SHIM, EORTC QLQ-C30 questionnaire 를작성하여평가를진행하였으며, 조직검사 -2시간전 glycerin enema를시행후포비돈요오드좌약 200 mg을삽입하였다. 모든환자에게조직검사 30분-시간전 ceftriaxone 2 g 회 IV로투여하였으며, 이후추가적항생제처방은없었다. 조직검사시행 주후외래방문을통해발열성합병증및포비돈요오드좌약관련합병증발생여부에대해면담을시행하였으며설문지작성을통해시술전후의주관적차이를평가하였다. 발열성합병증의기준은 38도이상의고열및이로인한의료기관을방문하여치료받은경우로정의하였다. 조직검사는영상의학과전문의 명에의해시술이진행되었다. 결과 : 전체환자 276명중 26명이탈락하여치료군 20명, 대조군 30명을대상으로평가하였다. 평균연령은치료군에서 66.6±8.6세, 대조군에서 65.2±9.세, 평균전립선부피는치료군에서 42.37±9.85 ml, 대조군에서 40.54±7.23 ml, 검사당시의평균 PSA는치료군에서 2.60±.78 ng/ml, 대조군에서.58±3.7 ng/ml로보고되었다. 암양성율에있어두군간의명확한차이는보이지않았으며 ( 치료군 : 33.3%, 대조군 : 28.5%, p=0.00), 감염성합병증및포비돈요오드좌약관련부작용은본연구에서보고되지않았다. 또한시술전설문지작성을통해얻은 IPSS, SHIM, EORTC QLQ-C30 questionnaire score에서두군간의명확한차이는보이지않았으며, 전후 questionnaire score 변화량에서도의미있는차이가보이지않았다 (p>0.05). 결론 : 치료군및대조군모두에서감염합병증이발생하지않았기때문에, 경직장전립선조직검사전포비돈요오드좌약의유용성은평가하기어렵다. 하지만시술전 60분이내로 3세대세팔로스포린항생제 회투여만으로도경직장전립선조직검사후감염합병증을충분히예방할수있다. Keywords: TRUS Bx, Infection, Povidone-iodine suppository 22

O-5 한국인전립선암환자의 0 년간 (2005-04) 치료패턴과의료비용변화연구 : 건강보험데이터베이스를이용한전수조사 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 Purpose: A complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for PCa in Korea over a 0-year retrospective period using data from the Korean National Health Insurance System (KNHI). Materials and Methods: Reimbursement records for 874,924 patients diagnosed between 2002 and 204 with primary PCa according to the International Classification of Disease (ICD) 0th revision code C6 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 3 December 204 were evaluated. Results: From 2005 to 204, the total number of PCa patients showed a 3-fold increase. The rate of radical prostatectomy (RP) and androgen deprivation therapy (ADT) remained unchanged at 40% each. RP monotherapy increased from 23.5% in 2005 to 39.4% in 204. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 204. Average total treatment costs in US dollars in the 2 months post-diagnosis were around $8330. Average annual treatment costs thereafter were around $4000. Out-of-pocket expenditure was highest in the first year post-diagnosis (6.% in 2005 and 22.% in 204), and ranged from 2% to 6% thereafter. Conclusion: Between 2005 and 204, a substantial change was observed in the national practice pattern for PCa in Korea. While total treatment costs and outof-pocket expenditure in the first year after diagnosis showed a slight increase, average treatment costs remained stable thereafter. Keywords: Prostatic neoplasms, Prostatectomy, Radiotherapy, Costs, National health insurance 23

O-52 로봇보조전립선적출술후 MRI 로확인한 neurovascular bundle 보존여부와성기능의상관관계 최원석, 유달산, 정인갑, 송채린, 홍범식, 김청수, 안한종, 홍준혁 울산대학교서울아산병원 Objective: The neurovascular bundle (NVB) plays an important role in erectile function. Urologists try to preserve it as much as possible in patients receiving prostatectomy. The neurovascular bundle can be observed in MRI and thus can be tracked with the same MRI postoperatively. We investigated the relationship between this neurovascular bundle observed in MRI and the potency after robot-assisted laparoscopic prostatectomy. Materials and Methods: 33 patients with prostate cancer who underwent robotic prostatectomy and had postoperative MRI were analyzed from 203 to 205. We compared the colorized T2 axial images of the prostate cancer patients with better contrast and tracked the neurovascular bundle (NVB) before and after surgery. Potency was obtained through the IIEF-5 questionnaire prior to surgery, and postoperative erectile capability was assessed at the outpatient clinic. Aforementioned 33 patients were divided into group (n=26) and group 2 (n=7). Group patients had good preoperative potency, received nerve-sparing prostatectomy, and had good postoperative erection. Group 2 was the opposite with poor preoperative potency, no nerve-sparing during prostatectomy and no postoperative erection. Results: Group had a mean age of 60.0 years (47-65) whereas group 2 had mean age of 73.8 years (range 66-8). In their MRIs, we could confirm that the neurovascular bundle was connected to the anastomosis site in group whereas the NVB was mostly disconnected in group 2. The difference between the two findings was clearly reconstructed in color to have better contrast. Group patients who had sustained NVB on MRI had good postoperative erectile function with shorter recovering time in potency. There was no postoperative erection in group 2 patients. Conclusion: We could confirm the preservation of the patient's NVB objectively by using MRI after robot-assisted laparoscopic prostatectomy and thus predict the postoperative potency, which will help us decide whether to treat the erectile problem in the future. Keywords: Prostate cancer, Neurovascular bundle, Potency 24

O-53 근치적전립선절제술후양성절제연을예측하는 P.R.O.S.T.A.T.E scoring system 과 D' amico 및 NCCN 분류와의비교연구 백승룡, 강병진, 김경환, 박지훈, 이경, 이찬호, 구자윤, 이정주, 하홍구 부산대학교의과대학비뇨기과학교실 Introduction: A study had shown a novel scoring system, called P.R.O.S.T.A.T.E scoring system in 207. We applied scoring system to us and compared with D amico and NCCN classification to predict positive surgical margin (PSM) after radical prostatectomy (RP). Material & Method: We retrospectively reviewed medical records of 58 patients who underwent RP by a single surgeon. In P.R.O.S.T.A.T.E scoring system, eight preoperative characteristics of PCA patients were measured (Table ). Patients were divided into three groups (low-risk group: score of 0 to 4, Intermediate-risk group: score of 5 to 9 and high-risk group: score of 0 to 5). Receiver operating characteristic curve was conducted to comparison of each classification. Results: Median follow-up period was 23.4 (95% CI 2.8-25.) months. PSM was present in 90 of total 58 (36.6%). Of the patients in low, intermediate and high risk groups, 5 of 66 (22.7%), 53 of 46 (36.7%) and 22 of 36(6.%) on P.R.O.S.T.A.T.E scoring system, of 22 (4.5%), 6 of 50 (2.0%) and 83 of 446 (4.0%) on D amico classification, of 22 (4.5%), 56 of 274 (20.4%) and 33 of 222 (59.9%) on NCCN classification had PSM (Table 2). AUC on ROC curve were 0.568 (p value=0.0), 0.58 (p value<0.00) and 0.722 (p value<0.00), respectively. Conclusions: The results of our study show that the P.R.O.S.T.A.T.E scoring system was not superior to D amico and NCCN classification to predict PSM after RP. NCCN classification is most highly predictive risk classification of PSM after RP. Keywords: Positive surgical margin, Scoring system, Prostate cancer 25

O-54 로봇보조근치적전립선적출술을시행한환자에서전립선피막절개의의미 김대희, 유달산, 정인갑, 송채린, 홍범식, 김청수, 안한종, 홍준혁울산대학교의과대학비뇨기과학교실 Purpose: Recently nerve sparing technique is often performed in radical prostatectomy, especially robot-assisted radical prostatectomy (RARP) and capsular incision (CI) was reported in.3-34.3%. But its impact on oncological outcome is not obvious yet. So we evaluated the significance of CI into tumor at RARP specimen in patients who had pathological T2 stage. Materials and Methods: Between January 20 and June 20, 33 patients with follow-up for at least 36 months, who had neither extraprostatic extension nor seminal vesicle involvement on prostatectomy specimen, were included. Patients with neoadjuvant therapy were excluded. CI was defined as tumor extending into the inked margins, at sites except the apex of the prostate and without documented extraprostatic extension. Biochemical recurrence (BCR) was defined as two consecuitive increases in PSA of 0.2 ng/ml or greater. Results: The mean age of the patients were 63.38±7.04 and mean follow-up period was 64.77±8.82 months. There were 02 patients with organ-confined disease and negative surgical margins (Group), 2 with CI into tumor (Group2), 0 with organ-confined disease and an apex-only positive (Group3). There were no statistical difference among each group in age, Gleason score and pre-operative PSA. CI was commonly occurred lateral region (37.5%) and posterolateral region (29.2%). 5-year BCR-free rate for each group was 95.8% for Group, 65.5% for Group2 and 90.0% for Group3 (p 0.0). The risk of BCR with CI into tumor was worse than confined tumor with negative surgical margin (HR: 6.98, 95% CI.45-33.608) (p=0.05), but the risk with margin positive in only apex was not significantly different from others. The risk of BCR with each pathological T2 substage were not significantly different. Conclusions: CI into tumor was also significant predictor of BCR in patient who were performed RARP and had pathological localized tumor. It should be taken care during operation to avoid CI. Keywords: Capsular incision, Robot-assisted radical prostatectomy, Biochemical recurrence 26

O-55 전립선첨단부형태에따른근치적전립선절제술후첨단부절제변연양성율의변화 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실 Aim: To evaluate the effects of prostatic apex shape variations on positive apical margin rate (PAM) after radical prostatectomy (RP) by undertaking comparative study of robot-assisted laparoscopic radical prostatectomy (RALP) versus open radical prostatectomy (ORP). Methods: Total 3,324 cases of RP (,004 ORP, 2,320 RALP) from January 2004 to May 207 were retrospectively reviewed. All patients underwent preoperative magnetic resonance imaging (MRI) and stratified into 4 categories according to prostatic apex shape at mid-sagittal plane. Between ORP and RALP groups, age, BMI, preoperative PSA, biopsy and pathologic Gleason score (GS), clinical and pathologic stage and prostatic apex shapes were compared. Logistic regression analyses were performed to evaluate independent predictors of PAM. Propensity adjustments were undertaken before statistical analysis to minimize selection bias. Results: ORP and RALP groups showed no significant difference in age, BMI, PSA, biopsy and pathological GS, clinical and pathologic stage as well as prostatic apex shape variations. ORP group showed PAM of 2.3% that was significantly higher than.75% of RALP group (p<0.00). Both groups showed the highest PAM with apex type 3, which is apex covering posterior aspect of membranous urethra (ORP 34.6%, RALP 4.8%). Logistic regression analysis showed prostate apex type 3 was a significant independent predictor of PAM but other apex types were not. Conclusions: Prostate apex type 3 was a significant independent predictor of PAM. RALP group showed better outcomes in PAM compared to ORP group. Keywords: Robotic-assisted surgery, Positive margins, Radical prostatectomy 27

O-56 전립선암환자에서근치적전립선절제술시수술중동결절편검사가종양학적결과에미치는영향 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 Purpose: We aimed to evaluate the impact of intraoperative frozen section analysis (IFSA) and further resection following positive IFSA on biochemical recurrence (BCR) after RP. Also, we tried to identify when IFSA and further resection would be helpful. Materials and Methods: From March 998 to December 205, a total of 2023 patients who underwent RP and IFSA were evaluated. Median (range) follow-up was 64.7 (3.6-234.6) months. IFSA was performed in anterior, posterior and both lateral sides of the apex and the base. Further resections were performed when IFSA showed positive findings. Results: IFSA findings were initially negative in 739 (86.0%), converted negative by further resection in 37 (6.8%), and positive in 47 (7.3%) patients. PSM rates in converted negative IFSA group were lower than positive IFSA groups (50.4% vs 76.2%, p<0.00). Among three groups, overall 5-year and 0-year BCR-free survival rates were the highest in initially negative IFSA group (76.% and 63.2%). And converted negative IFSA group showed longer 5-year and 0-year BCR-free survival than positive IFSA group (62.3% vs 40.2% and 53.4% vs 8.2%, each p<0.00). By pathological stage, converted negative IFSA group showed longer 5-year and 0-year BCR-free survival rates than positive IFSA group (85.4% vs 72.2% and 64.0% vs 34.%, p=0.07) only in pt2 tumors. In initially positive IFSA patients, negative conversion by further resection was the independent perioperative predictor for BCR (HR=0.557, p=0.003). Conclusions: Converted negative IFSA by further resection groups had longer BCR-free survival than positive IFSA group in overall prostate cancers. A negative conversion by further resection was identified to prolong BCR-free survival after RP. IFSA and a further resection for negative conversion should be considered in every RP as possible, especially in suspected organ-confined prostate cancers. Keywords: Prostatic neoplasms, Prostatectomy, Frozen sections 28

O-57 다중전립선생검의영향 : 근치적전립선절제술후수술전후합병증및생화학적재발위험성 강준구, 하헌, 정재욱, 신택준 2, 권세윤 3, 장현찬 4, 하윤석, 최석환, 이준녕, 김병훈 2, 김범수, 김현태, 김재수 4, 유은상, 권태균, 이경섭 3, 김천일 2, 김태환 경북대학교의과대학비뇨기과학교실, 2 계명대학교의과대학비뇨기과학교실, 3 동국대학교의과대학비뇨기과학교실, 4 대구파티마병원비뇨기과학교실 Objectives: We verified whether there is an association between number of prior biopsies and perioperative complications, biochemical recurrence (BCR) after RP. Methods: Total 2 patients who underwent RP between January 2009 and April 206 at 4 different centers were included in this study. We divided these patients into two groups, group of patients those who underwent only biopsy and patients those who underwent 2 or more biopsies. The association between number of prior biopsy and perioperative complications was analyzed. Results: Of 2 patients, 046 patients (94.%) underwent only biopsy, 66 (5.9%) underwent 2 or more biopsies. There were no significant differences in preoperative PSA (.8 versus 2.0 ng/ml, p=0.883). There were no significant differences in operation time, blood loss, hospital stay (all p>0.05). Patients who underwent multiple prostate biopsies had significantly more often a localized tumor (p=0.003). Gleason score and rate of positive surgical margin was significantly lower in patients with multiple biopsies (p=0.002, p=0.00). Cox proportional hazards model showed that there was no association between number of prior prostate biopsy and BCR (p=0.20). Kaplan-Meier curve analysis showed that biochemical recurrence free survival between two groups were similar (p=0.7). Conclusions: Multiple prostate biopsies are not associated with an increased risk of perioperative complication rate or adverse pathological outcome or higher rates of BCR in patients undergoing radical prostatectomy. Keywords: Radical prostatectomy, Prostate biopsy, Perioperative complication, Biochemical recurrence 29

O-58 Conditional probability of biochemical recurrence free survival following radical prostatectomy Jung Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital Purpose: Conditional survival is defined as the likelihood of subsequent survival, given the pre-condition of having already survived a certain length of time. It has been reported in various malignancies. We evaluated whether biochemical recurrence (BCR) free duration is associated with conditional probability of BCR free survival (C-BCRFS) following radical prostatectomy (RP) according to D Amico risk classification. Methods: Between January 2009 to December 206, 605 cases that had complete clinico-pathologic and follow-up data were included. Using the Kaplan-Meier estimation, the probabilities of C-BCRFS following RP were estimated in each population who did not recur biochemically, instead of survival itself, at 0-3 follow-up year. The C-BCRFS was analyzed according to D Amico risk classification and compared using the log-rank test. Results: Median follow-up was 30 months (IQR 6, 56) and median age was 67 years (IQR 62, 7). The 5-year C-BCRFS rates in high risk group rose from 40.4% at baseline, to 69.7%, 82.8%, 93.4, and 96.0% after recurrence free -4 year, respectively (Figure). Elapsing 3 years without biochemical recurrence, there is no significant difference in 5-year C-BCRFS between low and high risk group (log rank test, p=0.507). Conclusion: In high risk group, the C-BCRFS markedly improved as number of elapsed years without BCR increased after RP. There is no difference in C-BCRFS between low and high risk groups after recurrence free 3 years after RP. This is not only useful for patients counseling but also to optimize postoperative follow-up strategies. Keywords: Prostate, Cancer, Survival 220

O-59 Significance of surgeon experience as a predictor of biochemical failure and continence after robot-assisted laparoscopic prostatectomy 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 Purpose: Surgeon experience is thought to affect prostate cancer surgical outcomes. However, few studies identify an experience threshold for performing robot-assisted laparoscopic prostatectomy based on oncologic and functional outcomes with long-term follow-up of >500 cases. Methods: A total of 58 consecutive patients with prostate cancer treated with robot-assisted laparoscopic prostatectomy from May 2007 to April 206 by surgeon were enrolled. Patients were categorized into 3 risk groups (low-intermediate-high). Oncologic outcomes and continence were evaluated using biochemical failure and pad use. Discrimination was assessed by evaluating survival rates after adjustment for confounding effects. Results: Of 58 patients (mean prostate-specific antigen=0.47 ng/ml, mean follow-up=43.5 months), 82 (35.%) experienced biochemical failure. The proportions of pathologic Gleason score ( 8) and stage ( T3) were 4.6% and 45.4%, respectively. After adjusting for the confounding effect of biochemical failure, surgeon experience (>200) (HR=0.44, p=0.00) was identified as a prognostic factor. Surgeon experience was a predictor of biochemical failure in patients with intermediate-high risk prostate cancer. No experience threshold was found for low-risk patients. Pad-free survival rates at, 3, 6, and 2 months were 3.0%, 55.0%, 77.7%, and 97.4%, respectively. Surgeon experience (>250) (HR=.27, p=0.08) was the significant predicting factor after adjustment for covariates. Conclusions: Surgeon experience was strongly associated with oncologic and functional outcomes after robot-assisted laparoscopic prostatectomy for patients with prostate cancer. Experience significantly affected biochemical failure only in intermediate and high-risk groups. Keywords: Patient outcome assessment, Prostate, Prostate cancer, Prostatectomy, Prostatic neoplasms 22

O-60 국소전립선압의초점또는부분 brachytherapy 의단기추적관찰결과 김종녕, 노주현, 김문성, 임건우, 이태호, 정재호, 최경화, 박동수차의과학대학교의과대학비뇨기과학교실 Aim: To compare the short-term outcomes of focal or partial low-dose rate (LDR) brachytherapy (FP) with whole gland implantation (WI) in localized prostate cancer (PCa) patients. Methods: From January 205 to January 207, total 60 patients with transrectal biopsy proven localized PCa received I-25 LDR-brachytherapy (FP: 30, WI :30). All patients were evaluated with pre-operative multiparametric MRI. The indications of focal or partial implantation are as following; T2a/T2b with PSA<0 ng/ml+gleason score (GS) 6, T2a/T2b with PSA >0 ng/ml+gs 6 or T2c (tumor occupying greater than 50% of one lobe with less than 25% of contralateral lobe) with PSA<0 ng/ml+gs 6 or any T2 with GS 7(3+4). Implantation prescription dose was 45 Gy with a seed activity of.43 MBq in WI group and FP group. Phoenix criteria (PSA-nadir+2.0 ng/ml) was applied to define biochemical recurrence (BCR). Potency, urinary and rectal morbidity were analyzed by incorporating International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and radiation therapy oncology group (RTOG) toxicity criteria, respectively. Results: There was no significant difference between FP and WI group in terms of age, PSA, preoperative total IPSS, IIEF-5, body mass index and prostate volume. Mean follow time of FP group about 0 month (0±6.3). In biopsy GS, FP group had predominance with GS 6 (76.7%) but WI group had the most of patients (83.3%) with GS 7. No patient with GS 8, clinical stage T2c or high risk PCa underwent focal or partial implantation. No patient with clinical stage Tc, T2a or low risk PCa were included in WI group. All FP group patients received LHRH agonist after implantation but WI group had only 33.3% received. WI group had significantly greater number of I-25 seeds implanted compared to FP group (p=0.002). 0 months post-implantation outcomes showed FP group had better voiding function and potency (IPSS: p=0.035, IIEF-5: p=0.048) with statistical significance. Both group had no BCR case at 0 months after implantation. Conclusions: Focal or partial LDR-brachytherapy in localized PCa showed significantly less urinary, rectal and erectile complications with comparable short-term oncologic outcomes. Keywords: Brachytherapy, Lower urinary tract symptoms, Prostate cancer 222

O-6 Does uneven geographic distribution of urologists affect bladder and prostate cancers mortality? - national health insurance data in Korea from 2007 to 20 김재헌, 선화연, 김현정 2, 박재영 3 순천향대학교의과대학비뇨기과학교실, 2 고려대학교의과대학예방의학교실, 3 고려대학교의과대학안산병원비뇨기과학교실 Introduction: The relationship between distribution of urologists and mortality of bladder and prostate cancers has not been clearly established. The aim of this study was to investigate the relationship between uneven distribution of urologists and urologic cancer specific mortality at country level. Materials and Methods: Data from the National Health Insurance Service and National Statistical Office in Korea from 2007 to 20 were analyzed in this ecological study. Univariate and multivariable regression analyses were performed to determine risk factors for age standardized mortality rates (ASMR) of bladder and prostate cancers. Results: Linear regression analysis showed a markedly (p<0.00) uneven distribution of urologists between metropolitan and non-metropolitan areas. There was no significant difference in cancer specific ASMRs for either bladder cancer or prostate cancer. Univariate analysis after adjusting for time showed that country area, urologist density, and income were significant factors affecting bladder cancer incidence (p<0.00, p=0.03, and p<0.00, respectively). It also showed that the number of training hospitals was a significant factor for prostate cancer incidence (p=0.002). Although country area showed borderline significance (p=0.056) for ASMR of bladder cancer, urologist density was not related to ASMR of bladder cancer or prostate cancer. Conclusions: Although there was a marked difference in urologist density between metropolitan and non-metropolitan areas for these years analyzed, mortality rates of bladder and prostate cancers were not significantly affected by country area or urologist density. *This research was supported by a grant (No. 205M3D5A065926) of the Next-generation Medical Device Development Program for Newly-Created Market of the National Research Foundation (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP), Republic of Korea. It was also supported by Soonchunhyang University Fund. *The article based on this abstract was published on Oncotarget. 207 May 20. Keywords: Bladder cancer, Prostate cancer, Mortality, Urologist density 223

O-62 2 차경요도방광종양절제술후 T0 에서의방광내 BCG 치료의효과 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현서울대학교병원비뇨기과 Purpose: To evaluate of prognostic impact of BCG and BCG maintenance therapy in patients with T0 after repeat TURB. Material and Methods: We retrospectively 427 patients who underwent repeat TURB within 6 weeks after initial TURB between 979 and 206. Repeat TURB was performed in patients with high risk group criteria. There was no additional treatment in some patients with T0 after repeat TURBT, and intravesical BCG therapy was performed in some patients. We divided the groups into three groups: non-bcg, BCG induction, and BCG maintenance group. Results: 06 patients with T0 after repeat TURB were included. Median follow up is 63 months. There was no significant difference in T stage between the three groups. High grade ratio (p=0.00) and concomitant CIS ratio (p=0.037) were significantly higher in the maintenance group. The recurrence rates were 46.2%, 28.3% and 9.2% in the non-bcg, BCG induction and BCG maintenance group, respectively (p=0.043). Recurrence free survival was significantly higher in the BCG maintenance group than in the BCG induction group (p=0.032). Progression free survival was also higher in the BCG maintenance group than in the BCG induction group, but not significant (p=0.056). Multivariate Cox regression analysis showed that only intravesical BCG maintenance therapy was significantly associated with recurrence (HR 0.06, p=0.06). Conclusion: In Even T0 after repeat TURB in high-risk groups, intravesical BCG maintenance therapy is needed to reduce recurrence. Keywords: Bladder cancer, Repeat TURB, BCG 224

O-63 재경요도방광종양절제술의시행양상및환자군의임상병리학적특징및무재발생존양상분석 서윤석, 김성한, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과 목적 : 재경요도방광종양절제술 (re-turbt) 의시행양상및 re-turbt를시행받은환자군의임상병리학적특징및무재발생존양상을분석해보고자한다. 대상및방법 : 200년 5월부터 207년 2월까지단일기관에서방광암으로 re-turbt를받은환자 62명을대상으로한후향적연구이다. Re-TURBT는처음시행한경요도방광종양절제술 (TURBT) 에서조직검사상요로상피세포암으로진단되고 T 혹은 high grade를보이거나불완전 TURBT를한경우, 또는조직검사상근육층이포함되지않은경우에시행하였다. Re-TURBT의시행양상의변화를보기위해시행연도에따라 re-turbt 대상이되는환자에서의 re-turbt 시행율을분석하였고, re-turbt를시행받고잔존암이없는환자군 (returca-) 과잔존암이있는환자군 (returca+) 의인구학적, 임상병리학적정보및재발여부, 방광암진단부터재발까지의기간을조사하였다. 무재발생존분석을위해 Kaplan-meier analysis 및 Log-rank test, re-turbt 후방광암양성인경우의예측인자분석을위해 Cox 비례위험모형을분석하였다. p-value 0.05인경우, 통계학적으로유의하다고판단하였다. 결과 : Re-TURBT 시행율은연도에따라증가하는추세를보였다 ; 2008년이전 26.8% (/4), 2006-2008년 30.6% (/36), 2009-20년 53.2% (25/47), 202-204년 64.7% (44/68), 205-207.02 85.5% (7/83). ReTURCa-군 (58.4%, 90명 ) 및 returca+ 군 (4.6%, 64명 ) 의평균나이는각각 63.8세, 67.9세였으며 (p=0.035), 평균추적기간은각각 4.4개월, 30.0개월이었다. 양군간에나이를제외한성별, 체질량지수, 고혈압, 당뇨, TURBT시 stage는유의한차이가없었다 (p>0.05). 무재발생존은 returca-군이 returca+ 군에비해유의하게양호한양상을보였다 (p=0.034). 그러나단변량및다변량분석에서 returca+ 의유의한예측인자는없는것으로나타났다. ReTURCa-군및 returca+ Ta, returca+ T 세군으로 subanalysis 시, 역시 ReTURCa-군에서무재발생존이유의하게양호한양상을보였다 (p=0.003). 결론 : Re-TURBT 시행율은증가하는추세에있으며, TURBT 시행후 Ta high grade 및 T 병기인환자의약 40% 에서잔존암이남아있을가능성이있음을확인하였다. 또한 Re-TURBT 시행후잔존암이없는경우에무재발생존이양호함을확인하였다. 따라서 TURBT 시행시근육층을포함한충분한절제를시행하여정확한병기의확인및가능한한종양을완전히제거하는것이중요하며, Ta high grade 및 T 병기로확인되는경우적극적으로 re-turbt를시행하는것이무재발생존에도움이될것이다. Keywords: Bladder tumor, Recurrence, Transitional cell carcinoma 225

O-64 한국여성환자에서의근치적방광절제술종양학적인성적 윤성구, 심지성, 홍범식 2, 구자현 3, 정병창 4, 서호경 5, 강석호 고려대학교안암병원, 2 울산대학교서울아산병원, 3 서울대학교병원, 4 성균관대학교의과대학삼성서울병원, 5 국립암센터 Purpose: 근육층을침범한방광암의표준치료는방광절제술과골반림프절절제술그리고요로전환술이다. 장시간이소요되는술기의특성상수술적치료는주로 high volume center에서이루어지고있는실정이며특히 female cystectomy에대한자료는많지않다. 이에국내 5개병원이참여하여최근 0년간시행된한국에서의 female cystectomy의 oncologic outcome에대하여조사하였다. Materials and Methods: 2007년 월부터 206년말까지국내 5개의기관이참여하였다. 후향적연구로진행되었으며근치적절제술을시행받은여성환자 285명의종양학적성적과 Kaplan-Meier곡선을통한무재발생존율등을분석하였다. Results: 조직학적인결과는 urothelial carcinoma가 83.9% 를차지했으며절제면양성률은 5.6% 로나타났다. 림프절절제개수는 8.8개로나타났으며 Initial clinical stage에비해서 pathologic tumor stage는모두증가되는양상을보였다. 5 년째추적관찰에서전체생존율, 암특이생존율, 무재발생존율은각각 67.%, 68.2%, 58.9% 로나타났다. Conclusion: 본연구에서여성환자의근치적방광절제술의종양학적결과, 진단당시진행된병기가높았으며예후는남성환자의근치적방광절제술과유사한결과를보였다. 향후좀더많은환자를대상으로전향적인연구가필요할것으로사료된다. Keywords: Bladder cancer, Female patients, Oncologic outcome 226

O-65 근치적방광절제술을받은 T2 이하의환자에서신보조화학요법이예후에미치는영향 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현 서울대학교병원비뇨기과 Introduction: To evaluate the prognostic value of neoadjuvant chemotherapy (NACH) in T2 or less patients who underwent radical cystectomy. Methods: 566 patients with less than T2 who underwent radical cystectomy. Patients were divided into 3 groups: those who did not receive NACH and those who received less 3 cycles and 3 cycles (Non-NACH, Partial NACH and complete NACH). Results: Median follow up was 54.6 (0-3) months. In patients with pt2 or less, recurrent free survival (RFS) was significantly higher in the non-nach group than in the complete NACH group (p=0.04). Overall survival (OS) was significantly higher in the non-nach group than in the complete NACH group (p=0.039). There was no significant difference between the partial NACH group and the complete NACH group. In patients with T0, OS was not different but RFS was significantly higher in the non-nach group than in the complete NACH group (p=0.023). In the univariate and multivariate analysis, recurrence was significantly related to the number of LN removed and the number of positive LN (p=0.00 and p=0.002). Survival was significantly related to the number of removed LNs and the presence of NACH (p=0.000 and p=0.026). Conclusion: In patients with pt2 or less, there was better clinical outcome when neoadjuvant chemotherapy was not performed. And there was no difference in clinical outcome between partial and complete NACH. Keywords: Bladder cancer, Neoajuvant chemotherpay, Radical cystectomy 227

O-66 방광암으로근치적방광절제술과골반임파절절제술을시행받은환자에서신보조화학요법이수술에미치는영향 : propensity score matching 연구 김정권, 김성한, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과 목적 : 술전화학요법또는방사선요법은조직의부종및섬유화변성을일으키는것으로알려져있다. 본연구에서는근치적방광절제술과골반임파절절제술을시행받은환자에서신보조화학요법이수술에미치는영향을알아보고자하였다. 대상및방법 : 2004년부터 206년까지본기관에서방광암으로근치적방광절제술과골반임파절절제술을시행받은총 206명의환자를후향적으로분석하였다. 이중 62명 (30.%) 의환자가신보조화학요법을시행받았으며, 두군간의차이를보정하기위해서술전임상병리학적인자를기반으로 Propensity score matching (:) 을시행하였다. 신보조화학요법이예후에미치는영향을알아보고자 Kaplan-Meier 및 Log-rank 분석을시행하였다. 또한, 수술에미치는영향을분석하기위해서술후임상병리학적인자인수술시간, 출혈량, 재원기간, 절제된임파절개수및양성임파절개수등을조사하였다. 결과 : 평균연령은 72.4±9.9세였으며, 평균추적기간은 44.0개월 (0-82) 이었다. 총 85명 (4.3%) 의환자에서전체사망이보고되었으며, 55명 (26.7%) 의환자에서종양특이사망이보고되었다. Propensity score matching 결과각군당 6명의환자가배정되었다. 이들중신보조화학요법을시행받은환자군및그렇지않은군에서각각28명및 27명의전체사망이보고되었으며 (Log rank, p=0.824), 각각 8명및 6명의종양특이사망이보고되었다 (Log rank, p=0.837). Kaplan-Meier 분석에서도전체생존률및종양특이생존률에서는두군간에차이가없는것으로나타났다. Propensity score matching 을시행한후에도, 경요도방광종양절제술시행후근치적방광절제술시행까지의기간은보정되지않았다 (.52 vs. 4.36 개월, p=0.006). 두군간의술후인자들에대한비교분석을시행하였을때, 수술시간, 출혈량, 재원기간, 절제된임파절개수및양성임파절개수모두에서유의한차이를보이지않았다 (Table ). 결론 : 신보조화학요법은근치적방광절제술과골반임파절절제술의안전성및용이성에미치는영향이없는것으로나타났다. 본연구에서는신보조화학요법이예후에미치는영향이없는것으로나타났으나, 이에대해서는추후추가적인연구가필요할것으로사료된다. Keywords: Neoadjuvant, Radical cystectomy, Bladder cancer 228

O-67 림프혈관및신경주위침윤이근침윤성방광암에서근치적방광절제술후종양학적예후에미치는영향 유영동, 황진호, 서영은, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 이상은, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실 Aim: To analyze the association of lymphatic invasion (LI), vascular invasion (VI) and perineural invasion (PI) with oncologic outcomes of muscle invasive bladder cancer (MIBC) post radical cystectomy (RC). Methods: Total 247 patients with MIBC that consists of pure urothelial carcinoma, who underwent RC were retrospectively reviewed. Statistical significance of LI, VI and PNI were estimated by evaluating overall survival (OS) and cancer specific survival (CSS) through Multivariate Cox regression analyses and Kaplan-Meier analyses. Results: Among the cohort, 9 (36.8%) patients without LI, VI or PI were assigned as the reference, 68 (27.5%) had LI only, 8 (7.3%) had VI only, 5 (6.0%) had PI only, 3 (.2%) had LI and VI, 36 (.5%) had LI and PI, (0.4%) had VI and PI, and 5 (6.%) patients had all three invasion types. Regional lymph node positivity showed significant association with LI but not VI and PI (LI: p<0.00, VI: p=0.4, PI: p=0.08). In multivariate analysis of lymph node negative patients, LI and VI were independent predictors of CSS with statistical significance, but PI was not associated with CSS (LI: p=0.00, VI: p<0.00, PI: p=0.62). LI and VI were also significantly associated with OS while PI did not show association (LI: p<0.00, VI: p<0.00, PI: p=0.68). In lymph positive cases, only LI was an independent predictor of OS and CSS (OS: p<0.00, CSS: p=0.00). Conclusions: In the patients who underwent RC, LI and PI were significantly associated with CSS and OS when lymph node metastasis was positive. In node negative cases, only LI was an independent predictor of OS and CSS. Keywords: Bladder neoplasm, Radical cystectomy, Lymphovascular invasion 229

O-68 방광암으로방광절제술을시행받은환자에서상피분화와선분화가생존율에미치는영향 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 이상철, 정성진, 홍성규, 변석수, 이상은, 오종진 분당서울대학교병원비뇨기과학교실 Aim: To investigate the impact of variant histologic differentiation of patients with urothelial carcinoma (UC) of the bladder on survival after cystectomy. Methods: Total 286 patients who underwent cystectomy for UC of the bladder from 2003 to 207 were retrospectively reviewed. 229 (80.%) cases of pure UC and 57 (9.9%) cases of UC mixed with squamous and/or glandular differentiation (UCD) were included. Among the variant histology cases, 37 had squamous differentiation, 7 glandular and 3 had mixed type of squamous and glandular features. Kaplan-Meier analysis and Cox proportional hazard regression analysis were applied to analyze cancer-specific survival (CSS) and overall survival (OS). Results: Median follow-up was.0 years. UCD rate was higher in female (0% vs 22.8%, p=0.009). Patients with UCD were more likely to have advanced tumor stage than those with pure UC (pt3/t4: 34.9% vs 50.9%, p=0.027). UCD group also showed significantly higher perineural and venous invasion. Both groups showed no significantly different lymph node invasion rate. UC with squamous and glandular differentiation group showed significantly less CSS compared to pure UC group in subgroup analysis of UCD (p=0.09)(fig.). Yet, UCD was not significantly associated with the lethal risk of bladder cancer after adjusting for clinicopathological features (HR.58, p=0.582). Conclusion: Patients with UCD had a greater tendency of extravesical tumors invasion, yet they showed no difference in survival compared to pure UC patients. A further study with bigger cohorts is needed for the future analysis. Keywords: Bladder, Cancer, Variant differentiation 230

O-69 전방광절제술후조직학적변이가종양학적으로미치는영향에대한연구 한재현, 유상준, 최세영, 류제만, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수울산대학교서울아산병원 Objectives: Histologic variation of bladder cancer are reported in a variety of prognostic factors and clinical reports in bladder cancer patients. We evaluated the oncological outcome of histologic variant in bladder cancer patients who underwent radical cystectomy. Materials and Methods: We identified 393 bladder cancer patients who had radical cystectomy at Asan Medical Center from January 2007 to August 204. Patients were divided into 4 groups according to histologic types: pure urothelial cell carcinoma, squamous variant, micropapillary variant and other variants. The impacts of oncological outcome depending on the existence of variant component were assessed using the univariate and multivariate Cox regression analysis. Survival was assessed using Kaplan-Meir analysis. Results: Among 393 patients, 03 patients had bladder cancer with the variant histologic component (28.2%). 38 patients (9.7%) were with squamous variant, 26 patients (6.6%) with micropapillary variant and 3 patients (3.3%) with sarcomatoid variant. The 5year recurrence free survival rate of the squamous variant group was 5.3% (p=0.049, log-lank test), 44.2% (p=0.596, log lank test) in micropapillary variant group and 34.0% (p=0.005, log lank test) in other variant group. The 5-year overall survival rate was 87.8% (reference) for pure TCC and 42.8% (pure TCC: reference, p=0.005) for squamous variant. The 5-year survival rate of the micropapillary variant was 44.0% (pure TCC; reference, p=0.35) and the survival rate of the other variant group was 5.4% (pure TCC; reference, p=0.099). The factors affecting recurrence free survival when adjusting factors identified in univariate analysis were pathologic T stage and nodal stage. Variant histology in bladder cancer patients was not a significant prognostic factor influencing recurrence free survival or overall survival. Conclusion: In patients who underwent radical cystectomy, histologic variants were more detected in the higher nodal stage and T stage. If histologic variants are present in patients with bladder cancer, detailed staging work up and early radical cystectomy should be performed. Keywords: Bladder cancer, Histologic variant, Radical cystectomy 23

O-70 침습성요로상피암의방광보존치료 : 항암치료후부분방광절제술 한재현, 이종필, 최대헌, 안한종, 홍범식울산대학교서울아산병원비뇨기과학교실 Objectives: Chemotherapy with partial cystectomy has been considered a reasonable treatment option in well-selected patients instead of radical cystectomy for muscle-invasive patients. We investigated the histologic differences and the effect of chemotherapy in patients who underwent partial cystectomy after invasive urothelial cell carcinoma. Materials and Methods: We retrospectively reviewed 25 patients with invasive urothelial cell carcinoma who underwent partial cystectomy from 20 to June 207. We favorably selected patients with whose tumor location was on lateral, anterior, posterior, and dome. Bladder preservation protocol in this series mostly consisted of maximal transurethral resection of tumor (TURBT) follwed by systemic cisplatin-based chemotherapy, and then open partial cystectomy. Primary endpoint were pathologic T stage in groups between with or without chemotherapy. Results: 3 of the 24 patients underwent partial cystectomy and nephroureterectomy due to concomitant upper tract cancer. Clinical stage was T2 or higher in all patients. TURBT confirmed muscle invasiveness in 9 patients (79.2%). Tumor location accounted for 48% of bladder lateral wall, followed by dome with 2%. Among 7 patients who received systemic chemotherapy, were pt0 and 4 were pt or lower. In 7 patients without chemotherapy, 3 showed pt0 and 4 showed pt2 or higher. Among 3 patients who underwent post-chemotherapy TURBT, 0 patients (76%) had complete response (R0). Conclusion: Preoperative chemotherapy in patients with invasive bladder cancer showed more pathologic complete response when partial cystectomy was performed. Systemic chemotherapy followed by partial cystectomy is a reasonable strategy in highly selected patients with invasive bladder cancer. Keywords: Partial cystectomy, Muscle invasive bladder cancer, Bladder preservation 232

O-7 신세포암의바이오마커로혈청 PHD3 와 ESM- 의임상적의미 김광현, 나준채 2, 이형호 3, 윤영은 4, 김숙영 2, 윤민지 2, 김경섭 5, 홍성준 2, 한웅규 2 이화여자대학교의과대학비뇨기과학교실, 2 연세대학교의과대학비뇨기과학교실, 3 국민건강보험일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실, 5 연세대학교의과대학생화학분자생물학교실 Purpose: Most cases of renal cell carcinoma (RCC) are detected incidentally and patients with advanced RCC have unfavorable oncologic and renal function outcomes. Development of a clinically useful RCC biomarker is therefore needed. We aimed to determine the suitability of serum prolyl hydroxylase-3 (PHD3) and endocan as a diagnostic or monitoring biomarker for RCC. Methods: Between October 203 and March 205, we prospectively recruited participants.the RCC group consisted of 56 patients who underwent radical or partial nephrectomy. The control group included 56 healthy kidney donors and 3 patients with benign renal masses. Blood was sampled prior to surgery and month postoperatively in RCC patients. Serum PHD3 and endocan levels were measured via enzyme-linked immunosorbent assay and compared between RCC patients and controls. Preoperative and postoperative serum PHD3 and endocan (ESM-) levels were also compared. Area under the curve (AUC) was determined using receiver operating characteristic analysis. Results: RCC patients had higher serum PHD3 and ESM- levels than controls (PHD3; 0.79±0.7 ng/ml vs. 0.73±0.09 ng/ml, p=0.023) (ESM-; 0.59±0.07 ng/ml vs. 0.53±0.09 ng/ml, p<0.00) (Figure). AUCs for PHD3 and ESM- were 0.668 and 0.684, respectively. In subgroup analyses of RCC patients with tumor size >2 cm (n=40), the AUCs for PHD3 and ESM- were 0.709 and 0.730, respectively. In patients with RCC, both serum PHD3 and ESM- at month postoperative decreased significantly (PHD3; p=0.050, ESM-; p=0.047) Conclusions: Serum PHD3 and ESM- could be a novel RCC biomarker that provides acceptable diagnostic performance. Both serum markers might also be useful for monitoring RCC after surgery. Keywords: Renal cell carcinoma, Biomarker 233

O-72 Personalized 3D anatomic kidney model produced by rapid prototyping method and its usefulness in clinical applications Hakmin Lee, Sung Il Hwang 2, Hak Jong Lee 2, Jong Jin Oh, Sangchul Lee, Sung Kyu Hong, Sang Eun Lee, Seok-Soo Byun Departments of Urology, 2 Radiology, Seoul National University Bundang Hospital, Seongnam, Korea Introduction: Novel techniques such as three-dimensional (3D) printing have been introduced in several industrial fields. We tried to evaluate the clinical usefulness of 3D-printed renal anatomy model in patients treated by partial nephrectomy (PN). Materials and Methods: We prospectively produced the personalized renal model of kidney and tumour using 3D-printing methods from preoperative computed tomography (CT) images. The experienced professional group includes two urologists and one resident and there were 20 medical university students who did not have any prior experience in interpreting CT images composed non-professional group. Two groups independently judged the clinical usefulness of 3D-model by using different questionnaires. Results: The 3D-model was created in total of 0 patients. The non-professional group divined the location of renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p<0.00). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p<0.00) when they utilized 3D-models. The professional group gave highly positive responses in asking clinical usefulness of 3D-model among partial nephrectomy (understanding personal anatomy: 8.9/0, preoperative surgical planning: 8.2/0, intraoperative tumor localization: 8.4/0, further utilization plan in near future: 8.3/0, clinical usefulness in complete endophytic mass: 9.5/0). Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both experienced and unexperienced groups. Keywords: 3D printing, Partial nephrectomy, Renal cell carcinoma 234

O-73 최소침습부분신절제술 (minimally invasive surgery (MIS) partial nephrectomy) 와개복부분신절제술 (open partial nephrectomy) 의초기임상결과와삶의질전향적코호트비교 윤민영, 정창욱 서울대학교병원비뇨기과학교실 목적 : 신세포암환자에서최소침습부분신절제술과개복부분신절제술에따른초기임상결과와삶의질을전향적코호트를이용하여비교하였다. 대상및방법 : 206년 3월부터 206년 2월까지서울대학교병원에서수술한전형적인신세포암환자 24명 ( 최소침습부분신절제술 46명, 개복부분신절제술 43명 ) 의 SUPER-RCC-Nx 코호트에서수술후 6개월이상외래추적진료한 65명의환자들을대상으로분석하였다. 결과 : 전체환자의평균나이는 57.5±.8세 (SD) 였고성비는남자가 65±48% (SD), 체질량지수는 25.8±3.7 kg/m 2 (SD), 평균종물크기는 3.46±.98 cm (SD) 이었다. Clinical T stage와 N stage의분포는 Ta (47%), N0 (56%) 이가장많았다. 나이, 성비, 체질량지수, 종물크기, Clinical T, N stage에있어서두수술군간의유의한차이는없었다 (p>0.063). 수술시간은최소침습부분신절제술의경우 3.7±35.5분 (SD) 으로개복부분신절제술 03.9±37.3분 (SD) 보다유의하게길었으나 (p=0.003) 재원기간은최소침습부분신절제술의경우 4.2±0.78일 (SD) 로개복부분신절제술 5.48±3.2(SD) 일보다유의하게짧았다 (p=0.020). 하지만추정출혈량은두군간의유의한차이가없었다 ( 최소침습부분신절제술 275 cc, 개복부분신절제술 302 cc, p=0.672). 수술전혈색소수치는유의한차이가없으나 ( 최소침습부분신절제술 3.3, 개복부분신절제술 3., p=0.08) 의수술후혈색소수치은최소침습부분신절제술의경우 2.6로개복부분신절제술.9보다유의하게높았다 (p=0.039). 수술전후 Cr의변화에있어서는수술전 ( 최소침습부분신절제술 0.879, 개복부분신절제술 0.940, p=0.367) 과수술후 ( 최소침습부분신절제술.030, 개복부분신절제술.2, p=0.28) 모두유의한차이가없었다. 삶의질에서는 FSKI-5의경우수술전최소침습부분신절제술이더좋은만족도를보여주나 (p<0.09) 수술후에는일부항목에서만최소침습부분신절제술이더좋은만족도를보여준다 ( 체중유지, 양호한호흡, p<0.029). EQ-5D-5L 의경우에도수술전최소침습부분신절제술이더좋은만족도를보여주나 (p<0.043) 수술후에는일부항목에서만최소침습부분신절제술이더좋은만족도를보여준다 ( 활동성, p=0.09). 수술후 일째와 3일째통증 VAS는유의한차이가없었다 ( 수술후 일째 VAS (3.85:3.42), 수술후 3일째 VAS (3.06:2.97), p>0.054). 수술합병증은개복부분신절제술에서만 6.% 일어났다 (p<0.00). 결론 : 최소침습부분신절제술은수술시간, 재원기간, 수술후혈색소수치, 수술전삶의질 (FSKI-5, EQ-5D-5L), 수술후삶의질일부항목 (FSKI-5, EQ-5D-5L), 수술합병증에서개복부분신절제술에비해우위를보여주었다. Keywords: Minimally invasive surgery (MIS) partial nephrectomy, Early outcome, QoL 235

O-74 ct2a 이하의내인성신세포암의수술방법에따른임상결과비교 : 부분신적출술대근치적신적출술 육형동, 윤민영, 정창욱, 구자현, 김현회, 곽철 서울대학교병원비뇨기과 Introduction: To evaluate the clinical outcomes of endophytic renal cell carcinoma (RCC) according to the difference of surgical methods. Methods: We retrospectively analyzed 567 endophytic RCC cases from 990 to 206. Patients were divided into two groups based on surgical methods: radical nephrectomy (RNx) and partial nephrectomy (PNx) groups. Only patients with clinical stage T2a or less were included in the study. Results: The RNx group had shorter operation time and less perioperative complication (p=0.022 and p=0.032). The rate of complications in the PNx group was high, but there were no life-threatening complications. In the pathologic stage, T2a and Tb were 26.2% and 6.0% in the RNx group and 7.7% and 0% in the PNx group, respectively (p=0.000). There was no difference in recurrence rate between two groups, but the RNx group was significantly higher in cancer mortality (p=0.050). There was no significant difference in cancer specific survival, overall survival, and recurrence free survival between the two groups. Conclusion: There is no significant difference in clinical outcomes between partial nephrectomy and radical nephrectomy in endophytic RCCs below T2a. Keywords: Renal cell carcinoma, Partial nephrectomy, Endophytic 236

O-75 병리학적 T 과 T2 신장암에서수술전혈소판증가증이예후에미치는영향 : 다기관종합연구 박경민, 하윤석, 정재욱, 전소영, 최석환, 이준녕, 김범수, 김현태, 김태환, 변석수 2, 황은창 3, 강석호 4, 홍성후 5, 정진수 6, 곽철 7, 김용준 8, 권태균 경북대학교의과대학비뇨기과학교실, 2 서울대학교의과대학분당서울대병원비뇨기과학교실, 3 전남대학교의과대학비뇨기과학교실, 4 고려대학교의과대학비뇨기과학교실, 5 가톨릭대학교의과대학비뇨기과학교실, 6 국립암센터비뇨기과학교실, 7 서울대학교의과대학비뇨기과학교실, 8 충북대학교의과대학비뇨기과학교실 Background: The prognostic significance of preoperative thrombocytosis (TC) in renal cell carcinoma (RCC) is not without some debate. The aim of the present multi-institutional study was to determine the association of preoperative TC with the clinicopathological features and prognosis of localized RCC patients who underwent surgery in a large cohort. Methods: A study involving 8 institutions, and 4,376 patients with pt and pt2 RCC from the Korean renal cell carcinoma (KORCC) database, was conducted. TC was defined as a platelet count 400,000/μL. Patients were divided into 2 groups based on the presence of preoperative TC. Clinicopathological variables and survival rates were compared between the 2 groups. Results: Out of the 4,376 patients in the study, 06 (2.4%) had preoperative TC. Compared to patients without TC, these patients had a lower body mass index. Additionally, these patients had more advanced stage tumors with a higher Fuhrman grade, and higher incidence of symptoms at the time of diagnosis. Kaplan-Meier curves revealed that patients with TC had a significantly lower rate of recurrence free survival (RFS) (Figure ). Furthermore, a lower rate of overall survival (OS) was exhibited amongst patients with TC. Multivariate analysis revealed that TC was an independent prognostic factor in terms of the RFS and OS (Table ). Conclusions: TC appeared to be an important prognostic determinant in localized RCC. Furthermore, preoperative platelet count may be clinically useful for risk stratification of patients with surgically treated localized RCC. Keywords: Renal cell carcinoma, Prognosis, Thrombocytosis 237

O-76 차표적치료제를시행받은전이성신장암환자에서치료전아스파르트산아미노전이효소 / 알라닌아미노전이효소비율의예후적가치 유지웅, 강민용, 성현환, 전황균, 정병창, 박세훈 2, 전성수, 이현무, 최한용, 서성일 성균관대학교의과대학삼성서울병원 비뇨기과학교실, 2 내과학교실혈액종양내과 Purpose: To examine the prognostic role of the pretreatment aspartate transaminase/ alanine transaminase (AST/ ALT) or De Ritis ratio in patients with metastatic renal cell carcinoma (mrcc) receiving first-line tyrosine kinase inhibitor (TKI) therapy. Materials and Methods: We searched the medical records of 579 patients with mrcc who visited our hospital from January 200 through August 206. After excluding 20 patients, we analyzed 369 patients who received first-line TKI therapy. Cancer-specific survival (CSS) and overall survival (OS) were defined as the primary and secondary endpoints, respectively. A multivariate Cox proportional hazards regression model was used to identify independent prognosticators of survival outcomes. Results: Patients with a higher pretreatment De Ritis ratio (.2) had worse CSS and OS outcomes, compared to those with a lower De Ritis ratio (<.2). Notably, a higher De Ritis ratio was found to be an independently poor predictor of both CSS (HR=.49) and OS (HR=.67) in multivariate analyses. When we assessed the prognostic impact of the De Ritis ratio according to the MSKCC risk criteria, we found no significant differences in survival outcomes among patients in the favorable and poor risk groups. Among patients with an intermediate risk group, however, a higher pretreatment Di Ritis ratio was a poor prognosticator of CSS (HR=.53) and OS (HR=.50). Conclusions: Our findings indicate that the pretreatment De Ritis ratio can provide valuable information about the survival outcomes of mrcc patients receiving first-line TKI therapy. Keywords: Metastatic renal cell carcinoma, Tyrosine kinase inhibitor, AST/ALT (De Ritis) ratio 238

O-77 조직형이투명세포형으로분류되지않은전이신장암환자에대한표적치료의효과 : 대한비뇨기종양학회신암연구회 database 를이용한분석 김정권, 서윤석, 김성한, 송미경 2, 주정남 2, 서성일 3, 곽철 4, 정창욱 4, 송채린 5, 황의창 6, 서일영 7, 이학민 8, 홍성후 9, 정진수 ; 대한비뇨기종양학회신암연구회 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방교실바이오메트릭스교실, 3 성균관대학교의과대학비뇨기과학교실, 4 서울대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 전남대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 서울대학교의과대학비뇨기과학교실, 분당서울대학교병원, 9 가톨릭대학교의과대학비뇨기과학교실 목적 : 표적치료시대의조직형이투명세포형으로분류되지않은전이신장암환자의예후에대하여알아보고자하였다. 대상및방법 : 국내다기관신장암코호트인대한비뇨기종양학회신암연구회 Database에서조직형이투명세포형으로분류되지않은환자 346명을대상으로후향적분석을시행하였다. 질병진행의정의는 RECIST v..의 progression disease로하였으며, 질병무진행생존률 (PFS) 중 total PFS는마지막질병진행발생을사건으로간주하여분석하였다. Median survival time은연구대상자중 50% 에서사건이발생했을때의시점으로정의하였다. 3rd line 치료까지의결과를분석하였으며, 각단계에서의 PFS 및 total PFS, 종양특이생존률 (CSS) 를분석하였다. 또한, 전이발생양상, 조직학적유형, 신장전절제술시행여부및치료약제에따른차이를분석하였다. Kaplan-Meier 및 Log-rank 분석을통하여유의성을확인하였다. 결과 : 전체환자군중 235명 (68.%) 의환자에서질병진행이보고되었으며, total PFS의 median time은 7개월 (6-9) 로보고되었다. 치료단계별로 PFS를분석하였을때, ST line PFS가 2nd 및 3rd line PFS보다상대적으로 median survival time 이긴것으로보고되었다 (6 vs. 5 vs. 4 months). 종양특이사망은 245명 (70.8%) 에서보고되었으며, CSS의 median time은 2개월 (6-28) 로보고되었다. 전이발생양상에따라유의한예후의차이가나타났으며, synchronous보다 metachronous 가좀더좋은예후를보였다 (total PFS, 5 vs. 3개월 ; CSS, 0 vs. 46개월 ; all, P<0.00). 또한조직학적유형에따라 st PFS 및 total PFS에서유의한차이가보고되었으며, 다른유형에비해 chromophobe가좋은예후를보이는것으로보고되었다 (Table ). 신장전절제술또한 PFS 및 CSS의유의한예측인자로보고되었다 (st PFS, 4 [No] vs. 7 [Yes] 개월 ; total PFS, 4 vs. 9개월 ; CSS, 8 vs. 66개월 ; all, P<0.05). 치료약제의경우 TKI가 mtori에비해 ST PFS (median time, 9 vs. 4개월 ; p=0.000) 및 total PFS (median time, 0 vs. 4개월 ; p=0.000) 측면에서유리한것으로보고되었다. 결론 : 국내다기관신장암코호트인비뇨기종양학회신암연구회 Database를통해표적치료시대의투명세포형으로분류되지않은전이신장암의예후에대하여알아보았으며, 전이발생양상, 조직학적유형, 신장전절제술시행여부및치료약제에따른예후의차이를확인하였다. Keywords: Non-clear cell type, Metastatic renal cell carcinoma, Prognosis 239

O-78 비투명세포형환자군에서 MSKCC 와 Heng risk criteria 의질병무진행생존률및종양특이생존률에대한중간위험군과고위험군에서의예후감별력연구 : 신암연구회 database 를이용한후향적다기관연구 김정권, 서윤석, 김성한, 송미경 2, 주정남 2, 서성일 3, 곽철 4, 정창욱 4, 송채린 5, 황의창 6, 서일영 7, 이학민 8, 홍성후 9, 정진수 ; 대한비뇨기종양학회신암연구회 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방교실바이오메트릭스교실, 3 성균관대학교의과대학비뇨기과학교실, 4 서울대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 전남대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 서울대학교의과대학비뇨기과학교실, 분당서울대학교병원, 9 가톨릭대학교의과대학비뇨기과학교실 목적 : 표적치료를받은투명세포형전이신장암에서 MSKCC와 Heng risk criteria는예후감별력이입증이된도구이지만아직까지비투명세포형에대한예후감별능력여부는공식적인연구를통해확인이되지못하였다. 이에본연구에서는두예후기준인 MSKCC와 Heng criteria를비투명세포형전이신장암환자에적용했을때의중간위험군과고위험군의예후감별력에대하여분석해보았다. 대상및방법 : 국내다기관신장암코호트인대한비뇨기종양학회신암연구회 Database에서 224명의조직형이투명세포형으로분류되지않은전이신장암환자중 papillary, chromophobe, collecting duct, Xp.2t 등으로조직학적진단이확인되고, 추적관찰및예후결과를알고, 임상병리인자가모두확보되어 MSKCC와 Heng criteria parameter들을모두확인할수있었던 40명 (Heng/MSKCC중간위험군 26 (65%)/23 (57.5%) 명, 고위험군 4 (35%)/7 (42.5%) 명 ) 의비투명세포형환자들을대상으로후향적분석을시행하였다. 질병무진행생존률 (PFS) 중 st PFS와 total PFS 그리고종양특이생존률 (CSS) 에대해중간위험과고위험군의예후가감별되는지를비교해보았다. 결과 : 전체 40명의환자중 33명 (82.5%) 이징병진행을하였고 26명 (65%) 이연구시점시사망한상태였다. MSKCC와 Heng criteria 모두에서 first PFS, total PFS, CSS는중간위험군에서는각각 4.0, 5.0, 32.0개월이었고, 고위험군에서는 2.0, 3.0, 7.0개월이었으며, 중간위험군과고위험군의 first PFS, total PFS, CSS 모두에서두군은유의한차이의감별점을볼수없었다 (p>0.05). 하지만 224명의조직형이투명세포형으로분류되지않은전이신장암환자들을모두포함시키면이들중 07명 (43.9%) 이표적치료에도불구하고질병진행을보였고, 26명 (5.6%) 이연구시점사망한상태였다. MSKCC, Heng criteria의중간과고위험군의 PFS, CSS의감별능력을분석했을때는유의한감별능력을보였다 (p<0.05). 결론 : 표적치료를받은비투명세포형전이신장암환자에서 MSKCC와 Heng criteria는중간과고위험군에서 PFS, CSS의감별능력이없었다. 하지만조직형이불투명한환자군에서는유의한감별능력을보여불투명조직형에대해추가연구를통한조직형진단이필요할것으로본다. Keywords: Non-clear cell type, Metastatic renal cell carcinoma, Progression, Survival, Criteria 240

O-79 Preoperative cholesterol level as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma Hakmin Lee, Wun-Jae Kim 2, Eu Chang Hwang 3, Seok Ho Kang 4, Sung-Hoo Hong 5, Jinsoo Chung 6, Tae Gyun Kwon 7, Cheol Kwak 8, Hyeon Hoe Kim 8, Jong Jin Oh, Sangchul Lee, Sung Kyu Hong, Sang Eun Lee, Seok-Soo Byun, Korean Renal Cell Carcinoma (KORCC) Group Department of Urology, Seoul National University Bundang Hospital, Seongnam, 2 Department of Urology, Chungbuk National University College of Medicine, Cheongju, 3 Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, 4 Department of Urology, Korea University School of Medicine, Seoul, 5 Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, 6 Department of Urology, National Cancer Center, Goyang, 7 Department of Urology, Kyungpook National University College of Medicine, Daegu, 8 Department of Urology, Seoul National University Hospital, Seoul, Korea Objectives: To investigate the correlation between preoperative cholesterol level (PCL) and survival outcomes in patients with metastatic renal cell carcinoma (mrcc). Materials and Methods: We analysed the data of 244 patients initially treated with cyto-reductive nephrectomy after being diagnosed with mrcc. Patients were stratified into two groups according to the PCL cut-off level of 70 mg/dl. The postoperative survival rates were compared using Kaplan-Meier analysis and the possible predictors of patients cancer-specific survival (CSS) and overall survival (OS) were tested using multivariate Cox-proportional hazard models. Results: The low cholesterol group showed significantly worse postoperative CSS (p=0.03) and OS (p=0.009) than the high cholesterol group. On multivariate analysis, low PCL was revealed as an independent predictor of worse CSS (hazard ratio [HR],.876; 95% CI,.0-3.96; p=0.02) and OS (HR,.89; 95% CI,.54-3.098; p=0.0). Subsequent subgroup analysis showed that these results were maintained in the clear cell subgroup but not in the non-clear cell subgroup. Conclusion: Decreased PCL was significantly correlated with worse survival outcomes in patients with mrcc treated with cytoreductive nephrectomy. The underlined mechanism is still uncharted and requires further investigation. Keywords: Cholesterol, Renal cell carcinoma, Prognosis 24

O-80 전이신장암환자에서세포감퇴신적출술의예후적가치에대한분석 : 단일기관의경험 최창일, 강민용, 전황균, 성현환, 정병창, 전성수, 이현무, 최한용, 서성일 성균관대학교의과대학삼성서울병원 Purpose: To evaluate the prognostic role of cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal cell carcinoma (mrcc) Methods: We analyzed a total of 294 patients with synchronous mrcc by reviewing the electric medical records of Samsung medical center from January 2005 to December 205. Primary and secondary end pointes were overall survival (OS) and cancer specific survival (CSS), respectively, which were estimated by the Kaplan-Meier method. To identify the independent predictors of survival outcomes, we performed a multivariate Cox regression analysis. Results: Among overall population of synchronous mrcc patients, 89 (64.3%) patients were underwent CN. Compared to mrcc patients without CN, those who underwent CN were younger, have a better ECOG performance status and lower grade tumor and the higher rates of clinical N0 disease. Notably, we found that patients receiving CN had a better OS and CSS outcomes compared to those without CN (Fig ). Furthermore, we identified BMI, CN, Heng risk score as the significant predictive factors of OS, respectively after adjusting various clinical and pathological variables (Table ). Conclusions: In summary, our study showed the prognostic significance of CN in patients with synchronous mrcc, and CN in addition to BMI, CN, Heng risk score were finally proved as independent prognostic factors of survival outcomes in these patients. Keywords: Cytoreductive nephrectomy, Metastatic renal cell carcinoma, Survival 242

O-8 대사이상질환과혈중테스토스테론의상관관계에관한연구 김명, 안태영울산대학교서울아산병원비뇨기과학교실 Objectives: Metabolic syndrome (MetS) which is a constellation of insulin resistance, hyperglycemia, hypertension, low high-density lipoprotein cholesterol (HDL), and increased low-density lipoprotein (LDL) and triglyceride (TG) levels. It is one of the main threats for public health in the 2st century with its associated risk of cardiovascular disease. Several studies have shown a higher prevalence of MetS in subjects with low testosterone. But the evidence of association is not sufficient for the Korean population. This study evaluated an association between testosterone and MetS in Korean population. Methods: This observational study was performed using the regular health checkup cohort of Asan Medical Center consisting of 7,53 subjects. MetS was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATP III). The associations between MetS and testosterone were evaluated using linear mixed model and generalized estimating equation model. Results: Of all subjects, the prevalence of MetS was 30.%. After considering covariates such as age, body mass index (BMI), smoking, alcohol consumption and physical exercises, the risk of MetS defined by NCEP-ATP III criteria decreased by 3.0% with -standard deviation increase in total testosterone (TT). Metabolic component specific analysis showed that TT were inversely associated with several components of MetS including fasting blood sugar (FBS), waist circumference, serum HDL, TG, and blood pressure Conclusions: Serum testosterone was inversely associated with MetS in Korean populations. But the evidence of association is not sufficient for the causation of MetS by low testosterone and long-term studies are needed to confirm whether T deficiency is the cause or is a feature of MetS. Keywords: Testosterone, Metabolic syndrome, Korean population 243

O-82 Association between handgrip strength and erectile dysfunction in older men: a cross-sectional study 류지원, 손수민, 김태희, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 강택원, 건동득, 박광성 전남대학교의과대학비뇨기과학교실 Introduction and Objective: To evaluate the association between handgrip strength and erectile dysfunction (ED) in community-dwelling older men. Methods: This cross-sectional study included 77 participants of the Dong-gu Study. Handgrip strength was measured with a handheld dynamometer. ED was assessed with the Korean version of the International Index of Erectile Function (IIEF). ED was categorized as none to mild (IIEF-EF scores of 3-30) and moderate to severe (IIEF-EF scores of 0-2). Multivariable logistic regression was conducted with adjustment for potential confounders. Results: The proportion of men with moderate to severe ED was 48.8%.The age-adjusted erectile dysfunction score increased with increasing quartile of handgrip strength (.0, 2.4, 3.4, and 4.0in the lowest, second, third, and highest quartiles, respectively). After adjustment for potential confounders, greater handgrip strength was associated with a lower risk of ED (odds ratio [OR]: 0.82 per 5 kg; 95% confidence interval [CI]: 0.74-0.90). In addition, a high level of moderate to vigorous physical activity was associated with a lower risk of ED (OR: 0.75; 95% CI: 0.6-0.93). Conclusions: In this study, aging men with greater handgrip strength had a lower risk of ED. This result suggests that reduced physical functioning may contribute to ED in aging men. Keywords: Handgrip strength, Erectile dysfunction (ED) 244

O-83 남성갱년기환자에서천연추출물구기자가증상개선에미치는영향 : 무작위배정, 위약대조, 양측눈가림, 평행투약 배상락, 전승환 2, 권은비 4, 오현아 4, 정현철 2, 최세웅 2, 배웅진 2,3, 김수진 2, 조혁진 2, 하유신 2, 홍성후 2, 이지열 2, 황성연 4, 김세웅 2,3 가톨릭대학교 의정부성모병원, 2 서울성모병원, 3 가톨릭양한방융합연구소, 4 한국전통의학연구소 목적 : 일반인에서구기자천연추출물을이용하여남성갱년기향상효과를인체실험을통해알아보고자하였다. 대상및방법 : 남성갱년기증상을호소하는만 40세이상일반건강인남성 78명중중도탈락등을제외한 74명을대상으로하였다. 대상자는치료약물투여군과위약투여군 ( 대조군 ) 으로나누었으며, 각각치료전남성갱년기증상설문 (AMS), 남성호르몬혈청농도및관련혈청지표를측정후, 매일 일 2회시험제품또는위약을 8주간복용하여복용 개월및 2 개월추적관찰후증상개선효과를확인하였다. 모든환자에서활력징후및신체검진, CBC 및 LFT, RFT, 지질및호르몬, PSA 등의혈청학적검사, AMS, ADAM, IIEF를포함한설문지등에서의변화등을알아보았다. 결과 : 모든대상자에서치료전과후활력징후, CBC 및 LFT, RFT, 요검사등에서는유의한차이를보이지않았다. AMS 설문지총합에서대조군은기저치대비치료 4주및 8 주후평균값의유의한변화가없었고, 치료군에서는각각 2.63, 2.69만큼통계적유의한감소를보였다 (p=0.09, p=0.038). AMS subscale 분석에서 psychological subscale 및 somatic subscale에서는유의한차이가없었으나, sexual subscale에서는구기자군에서.07로통계적으로유의한감소가나타났다. IIEF와 ADAM 총합은두군간에유의한차이를보이지않았다. Triglyceride, total cholesterol, LDL, HDL 등은치료군에서대조군과비교하여치료전과후유의한차이를보이지않았으며, 두군사이에도유의한변화는관찰되지않았다. 치료군과대조군사이에 PSA, serum testosterone 은실험전과후유의한변화를보이지않았다. 결론 : 구기자의투여는남성갱년기질환을호소하는환자에게성욕저하, 발기능감소, 지적활동, 인지능력의감소, 수면장애, 근력의감소, 내장지방증가, 골밀도감소등의증상을호소하는갱년기질환에도움을주는약물인것을확인할수있었다. 이중성관련질환, 즉성욕저하나발기능등에특히도움을줄것으로예상된다. 또한 PSA 등가나 testosterone 증가등을보이지않아기존치료와는다른기전으로갱년기증상을완화시킬수있을것으로사료된다. Keywords: Andropause, Natural extracts, Lycium 245

O-84 남성갱년기증후군환자에서두타스테리드병용투여가남성호르몬보충요법의치료효과에미치는영향 박현준, 이경민, 박민정, 박남철 부산대학교병원 Objectives: 5ARIs have sexual side effects, including erectile dysfunction (ED), loss of libido and ejaculatory dysfunction due to their action mechanism which decreases serum DHT levels. We examined whether concomitant dutasteride reduced the efficacy of testosterone replacement therapy (TRT) in men with late-onset hypogonadism. Material and Methods: This was a 24-week, randomized, parallel study of the clinical outcomes in men age >40 years with symptomatic benign prostatic hypertrophy (BPH; International Prostate Symptom Score (IPSS) 2), prostate volume 30 ml, and testosterone level<300 ng/dl with aging male symptoms, who were taking stable doses of alpha-blockers 4 weeks before participation. Eligible patients received a combination of dutasteride 0.5 mg once daily and a transdermal gel containing 0 g testosterone (T) (DT group, n=30) or the transdermal gel alone (T group, n=30). The primary outcomes were the change in the aging male symptom (AMS) score, sexual desire (question 7, AMS score), and erectile function (International Index of Erectile Function-5). Secondary outcomes were the post-treatment IPSS, peak urinary flow rate, post-void residual urine volume (PVR), and prostate volume. Results: Both groups showed significant improvements from baseline in all primary outcome parameters. However, there were no significant differences in the changes in the AMS total score (DT -5.2 vs. T -5.0; p=0.55), sexual desire (DT -2.5 vs. T -2.3; p=0.23), and IIEF-5 score (DT -2. vs. T -.9; p=0.3) between groups. The extent of IPSS improvement from baseline to 24 weeks was the same in both groups (DT -.2 vs. T -.0; p=0.64). In addition, the changes in Q(max) and PVR from baseline were very similar in both groups. However, prostate volume decreased significantly (p<0.0) in the DT group (DT -2. cc vs. T +0.6 cc). Conclusions: Concomitant dutasteride did not reduce the effect of testosterone replacement therapy in men with late-onset hypogonadism. Otherwise it would be helpful to prevent the progress of prostate size by TRT. Keywords: 5ARI, Testosterone, Late onset hypogonadism 246

O-85 남성갱년기환자에서테스토스테론치료중단후치료효과지속에영향을미치는인자 박민구, 여정균 인제대학교의과대학비뇨기과학교실 Objective: For patients with testosterone deficiency (TD) who benefit from testosterone treatment (TRT), there is no conclusive evidence whether discontinuation of treatment is possible or whether treatment must continue for the rest of their lives. Therefore, predictive factors for maintenance of efficacy of TRT after stopping treatment were investigated in this study. Material and Methods: From 20 to 206, among 720 hypogonadal patients, 5 men in whom TRT was effective and who were available for follow-up over 6 months after the discontinuation of TRT were included in this study. The type of TRT was consisted of oral testosterone undecanoate(tu), 2% testosterone gel, injection of testosterone enanthate, and injection of TU. Baseline serum total testosterone (TT) levels, the highest TT levels during TRT, and the recent TT levels at 6 months after discontinuation of TRT were investigated with the patients medical records including age, BMI, waist circumference (WC), comorbidities, life styles, period and type of TRT. Maintenance of response was determined by the recent serum TT levels and the answer of patients to global assessment question about the TD symptoms compared with the baseline. Results: 92 patients (group I) failed to show maintenance of response, and 59 patients (group II) maintained the response over 6 months after the stopping TRT. In comparison between two groups, there was no significant difference in age, comorbidities, WC, and BMI. There was also no significant difference in the type of TRT between the two groups. However, group II showed a significantly longer duration of TRT (0.7 vs 5.2 months) and the peak TT levels during the TRT of group II was significantly higher than the group I (73.7 vs 546. ng/dl). Also, the ratio of regular exercise (>3/wk for 30 minutes) was significantly higher in group II compared to group I (45.8 vs 9.8%). The multivariate analysis by logistic regression model revealed that exercise and the duration of TRT were independent predictive factors for maintenance of response. Conclusion: In hypogonadal men in whom TRT was effective, the longer period of treatment can improve the durability of response after stopping TRT, regardless of the type of testosterone treatment. Regular exercise can also lead to 0-fold increase of probability of maintaining the response after cessation of TRT. Keywords: Testosterone deficiency, Exercise, Period of treatment 247

O-86 남성에서갑상선기능저하증이하부요로증상, 남성호르몬및성기능에미치는영향 제성욱, 윤솔, 도정모, 서덕하 2, 이신우, 이천우 2, 최세민, 감성철 2, 정기현 2, 화정석, 현재석 경상대학교의과대학 비뇨기과학교실, 2 창원병원비뇨기과학교실 배경및목적 : 갑상선호르몬이여성성선기능에미치는영향에대해서는잘알려져있지만, 남성성기능이나남성호르몬에미치는영향에대해서는연구가부족한실정이다. 우리는남성환자에서갑상선기능저하증이하부요로증상이나성기능혹은남성호르몬에미치는영향에대해서평가해보았다. 대상및방법 : 203년 월부터 206년 6월까지남성종합건강검진을위해내원한 095명을대상으로 Thyroid function test를시행하였고 TSH가 4초과인경우갑상선기능저하증이있다고진단하였다. 환자를정상군과갑상선기능저하증군으로나누어 IPSS설문지점수, 전립선크기, PSA, IIEF설문지점수, total testosterone, MSHQ-Ejd설문점수, 사정시간을비교해보았다. 결과 : 총환자중갑상선기능저하증은 90명 (8.22%) 였다. 정상군과비교해볼때갑상선기능저하증이있는군에서 PSA 가더높았고, 전립선비대증도더심했다 (P=0.025 and P=0.00). 하지만이런차이는나이를보정한분석결과통계적으로유의하지않았다 (P=0.390 and P=0.070). 성기능관련비교분석결과, 갑상선기능저하증군에서 IIEF-Sexual Desire 점수, IIEF-Overall Score 점수, 그리고혈청남성호르몬수치가더낮았고 (P=0.020 P=0.029 and P=0.003), 나이를보정한다변량분석에서도혈청남성호르몬과 IIEF-Sexual Desire 점수가갑상선기능저하증과유의한연관성이있는것으로나타났다 (P=0.02 and P=0.046). 조루증과관련성평가위해 MSHQ-Ejd설문점수와사정시간을비교하였는데두군간의유의한차이는없었다. 결론 : 우리연구에서갑상선기능저하증은성욕을감소시키고남성호르몬을감소시키는것으로나타났다. 따라서실제임상에서남성갱년기환자를치료할때갑상선기능저하증여부를확인하고치료하는것이중요하다고생각된다. Keywords: Thyroid hormone, Testosterone, Sexual function, Hypogonadism 248

O-87 페이로니씨병에서백색막절개후복재정맥이식이음경혈류에미치는영향 이준호, 유제모, 김희연, 이승주, 이동섭가톨릭대학교성빈센트병원비뇨기과학교실 Introduction & Objectives: Erectile dysfunction is a bothersome problem after graft surgery for correction of Peyronie s disease. However, there is little information of vascular state before and after graft surgery in Peyronie's disease. We evaluated vascularity using doppler ultrasonography before and 6 months after vein graft in Peyronie s disease. Methods and Materials: 2 patients diagnosed as Peyronie's disease were evaluated before and 6 months after the surgery. All patients underwent plaque incision and saphenous vein graft for correction of Peyronie s disease. Inclusive criteria were ) penile curvature over 60º or hourglass deformaty and 2) duration over 6 month. The degree of curvature, peak systolic velocity (PSV) on doppler sonography, and end-diastolic velocity (EDV) on doppler sonography were evaluated before and 6 months after the surgery. A questionnaire (International index of erectile function; IIEF-5) also checked before and after the surgery. Patients with pre-operative erectile dysfunction (IIEF item score: 0 or ) was excluded. Results: Mean age and duration of curvature were 60.7±5.8 (years) and.0±2.3 (months), respectively. The mean degree of curvature was 75.0 o ±2. o, pre-operatively and the curvature was improved as 5.0 o ±5.4 o (p=0.002), postoperatively. In IIEF-5, only item (confidence of erection) was decreased (from 3.03±0.90 to 2.30±.00, p=0.005) and others were not changed. In doppler ultrasonography, the mean values of peak systolic velocity and end diastolic velocity were not significantly changed. However, mean resistive indices at 0 minutes (from 0.84 to 0.89, p=0.07) and 20 minutes (from 0.8 to 0.86, p=0.043) after intracavernosal injection were higher in postoperative state than preoperative state. Conclusion: Vascularity may not be changed or be enhanced after the vein graft surgery for correction of Peyronie's disease. That is, vein graft surgery would not worsen vascularity and the vascularity may not be a causative factor in lowering the 'confidence of erection' in early postoperative period. Keywords: Erectile dysfunction, Peyronie's disease, Doppler ultrasonography, Saphenous vein 249

O-88 당뇨에의한역행성사정환자에서 imipramine, pseudoephedrine 약물병합치료의임상적의의 김대근, 김동석 2, 양승철 2, 송승훈 2 CHA 의과학대학교 서울역센터비뇨기과학교실, 2 강남차병원비뇨기과학교실 Objective: To investigate the efficacy of imipramine, pseudoephedrine dual therapy in retrograde ejaculation patient. Materials and Methods: Thirty retrograde ejaculation caused by diabetes mellitus (DM) patients treated with imipramine+pseudoephedrine between Jan 205 and May 207 were investigated. All patients had a semen analysis and post-ejaculatory urine analysis before and after medical treatment. The treatment protocol included 25 mg imipramine every 2 hours and pseudoephedrine 60 mg for every 8 hours given daily for 2 weeks. The primary end point was sperm concentration and semen volume after medical treatment. Results: Of the 8 complete retrograde ejaculation patients treated with imipramine+pseudoephedrine, 2 patients (66.6%) recovered spermatozoa in antegrade ejaculation with mean total sperm count of 43.7±73.5 million. Mean increase of semen volume in complete retrograde ejaculation group was 0.37 cc. Of the 2 partial retrograde ejaculation patients, 6 patients (50%) had a >50% increase in the antegrade total sperm count with mean total sperm count of 54.4±60.4 million. Mean increase of semen volume in partial retrograde ejaculation group was 0.8 cc. Conclusion: Imipramine+pseudoephedrine medical treatment is effective to establish antegrade ejaculation in patients caused by DM, therefore providing chance for pregnancy either through intercourse or assisted reproductive technology by antegrade ejaculated semen. Keywords: Retrograde ejaculation, Imipramine, Pseudoephedrine 250

O-89 남성형탈모에있어서김치추출유산균음료의효과에대한 pilot study 이효석, 최진호, 이중식, 서주태단국대학교제일병원비뇨기과 Introduction: 최근탈모는일련의노화현상뿐만아니라, 유전적요인, 스트레스, 식습관, 영향의불균형등으로인하여진행이되는것으로보고되고있다. 탈모중에가장많이진단되는탈모증은원형탈모, 안드로젠성탈모, 휴지기탈모등이있으며, 이들중, 안드로젠성탈모가발생빈도가가장높다. 이증상은사춘기이후의남성과여성에서발생되는가장흔한유형의탈모증으로남성에게는남성형탈모증또는대머리, 여성에게서는여성형탈모증으로알려져있다. 현재탈모의치료에있어서는미녹시딜과피나스테리드등이사용되고있으나, 각각의약물에부작용이동반되기도한다. 유산균제제는모발의성장기를유도하는 VEGF를증가시키고, 모발의퇴행기를유발하는 TGFβ을감소시키며, 체내의 Nitric oxide 를증가시켜혈류를증가시키고, 혈관을이완하여발모를촉진하는것으로보고되고있다. 본연구는유산균음료를복용후발모에어떠한영향을미치는지살펴보았다. Method and Materials: 본원외래에내원한환자를대상으로하였다. 전향적으로환자를모집하였으며, pilot study를진행을위하여 20세이상의남성 23명, 여성 23명을모집하였다. 이전에탈모관련시술을받은적이있거나, 최근 3개월내에탈모관련약물을복용을한자, 심혈관계질환을앓고있는자, 흡연을하는자, 임신을계획하고있거나, 임신한자는연구대상에서제외하였다. 206년 2월부터 207년월까지연구를진행하였으며, 초기방문에정수리, 앞이마사진촬영, KC technology사의 Triple Scope System을이용하여모발의개수, 굵기를측정하였고, 복용후 개월, 4개월에같은방법으로측정을시행하였다. Result: 총 46명의피험자가모두검사를완료하였다. 피험자의평균연령은 45.35±0.3세 ( 남성 : 46.52±0.4, 여성 : 44.7±0.20) 이었다. 복용중부작용은보고되지않았다. 모발의개수는유산균음용전에는 85.98±20.54개이었으며, 음용 달후, 4달후에는 90.28±6.3개, 9.54±6.29개 (p<0.00) 로측정되었다. 모발의두께는음용전 0.062±0.0 mm이었으며, 음용 달, 복용 4달후에는 0.068±0.008 mm, 0.066±0.009 mm (p<0.00) 이었다. 총 46명의피험자중제품복용 4달후모발의개수및두께의변화가없는피험자는 3명이었으며, 개수만증가한피험자는 8명, 두께만증가한피험자는 0명, 모두호전된피험자는 25명이었다. Conclusion: 김치, 청국장유산균음료는남성형탈모및여성의탈모에있어서효과가있는것으로관찰되었으며, 추가적인연구를위하여좀더많은수의피험자가필요할것으로생각된다. Keywords: Hair growth, Lacto bacillus 25

O-90 가임기남성에서탈모치료를위한 5-AR 저해제의사용이가임력에미치는영향 송승훈, 김동석, 김대근 2, 양승철, 권성원 차의과학대학교강남차병원비뇨기과, 2 서울역센터비뇨기과 Purpose: Finasteride is a 5a-reductase inhibitor that blocks the conversion of testosterone (T) to dihydrotestosterone (DHT) and has been has been approved to treat androgenic alopecia. There have been concerns about the potential negative effects of this hormonal agent on male reproductive function. Androgens are well known to play a vital role in the control of spermatogenesis. We investigated the effect of finasteride usage on the reproduction function in male partners of married couples. Materials: We compared the reproductive function between those who takes finasteride more than 6 months and no medication group, who visited our andrology center for fertility evaluation. Each group consisted of 27 cases. In addition to basic fertility evaluation, semen and reproductive hormone data were compared between two groups. Semen samples were collected with abstinence period of more than 48 hours. Patients with varicocele, previous scrotal surgery, underlying medical disease were excluded. Results: The mean patient age was 37 years (range: 30-5 years). All of the study group was taking lowdose (-.25 mg) finasteride for androgenic alopecia. The mean duration of treatment with finasteride was 33.6 months (range: 6-20 months). There was no significant difference between two groups in regards to semen parameters (semen volume: 2.07±.6 vs 2.53±0.96 ml, p=0.2; sperm concentration: 2.74±78.60 0 6 /ml vs 84.93±43.0 0 6 /ml, p=0.; sperm motility: 42.30±.0% vs 45.93±9.98%, p=0.2; sperm strict morphology: 4.9±.0% vs 4.4±.22%, p=0.50, respectively). There was no significant difference in regards to serum reproductive hormonal level between groups. One patient complained of weak ejaculation and reduced semen volume while taking finasteride. Conclusions: Our study suggests that low dose finasteride does not have a negative effect in regards to male reproductive function. However, further large scale investigation is warranted. Keywords: Finasteride, Androgen, Reproductive function 252

O-9 Expereice of Korean surgical robot REVO-I: first clinical trial 장기돈, 알리압델라힘, 함원식, 최영득, 나군호연세대학교의과대학비뇨기과학교실 Introduction: The objective of this present study is to determine the safety and efficacy of REVO-I during Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) surgery. Methods: After ethical approval of the Korean Food and Drug Administration (KFDA) for using REVO-I in human a prospective observational study was carried out on patients with clinically localized prostate cancer (PCa) underwent RS-RARP using with REVO-I platform. Results: Mean patient s age was 69 years old. Mean Operative time (min), docking time (min), console time (min), and urethrovesical anastomosis time (min) were 80.7±36.8, 9.6±4.6, 08.8±29., and 28.4±8. minutes, respectively. Regarding intraoperative findings, the mean estimated blood loss (EBL) was 32.3±332.2 ml. No intraoperative organ injury was present. One patient received intraoperative blood transfusion due to increased intraoperative EBL and concomitant hypotension. Postoperatively, two patientsreceived blood transfusion (Clavien-Dindo classification ), and there was no other serious complications (Clavien-Dindo classifica Conclusions: The first clinical trial in treating male patients with localized PCa using REVO-I robotic surgical system was successful. Further clinical studies on larger cohort of patients are warranted to confirm our results before the wide application of REVO-I. Keywords: Korean surgical robot, Clinical trial, Prostate 253

O-92 Xi 다빈치수술시스템을이용한단일술자의로봇단일공복강경 (LESS) 신장부분절제술의초기경험 나준채, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 함원식, 나군호, 최영득, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 단일공수술 은배꼽주위의단일절개를이용하는복강경수술기법을지칭한다. 복강경단일공수술을위해새로운기구들이개발되었지만, 이들은대개동작범위가제한되고기구들끼리충돌하여수술의난이도를높인다는선천적인단점이있다. 이러한단점을극복하기위해본원에서는다빈치수술시스템 (Intuitive Surgical Inc., Sunnyvale, CA, USA) 을이용한로봇단일공복강경수술을보고한바있다. 일부제한적관절움직임이허용되는새로운 Xi 시스템을사용한단일공복강경수술로봇기구가개발됨에따라서이를활용한복강경단일공부분신절제술을시행하였고이에대한초기경험을소개하고자한다. 방법 : 환자의자세는일반로봇부분신장절제술과동일하다. 제대의상방변연을 2.2 cm 절개한후단일공포트를삽입하였다. 단일공포트는한개의 8.5 mm 복강경용투관침과두개의 5 mm 부속투관침을다중채널에위치시킨후고정시켜서확립하였다. 보조를위해 2 mm 투관침을단일공다중채널포트옆에위치시켰다. 로봇을도킹한후수술방법은기존의 multi-port 로봇부분신절제술과유사하다. 결과 : 세명의환자를대상으로로봇단일공복강경 (LESS) 신장부분절제술을시행하였다. 수술당시의평균나이는 50세였고, 평균 BMI는 25. kg/m 2 였다. 평균수술시간, 콘솔이용시간, 허혈시간과봉합시간은각각 95.3분, 32.7분, 27.0분, 9.7분이었다. 환자들은수술후합병증없이퇴원하였다. 콘솔이용시간은순차적으로 77분, 33분, 그리고 88분으로점차감소하였다. 모든종양의절제경계에서암이관찰되지않았다. 결론 : 새로개발된 Xi 다빈치시스템의로봇단일공복강경 (LESS) 의가장큰장점은제한적관절운동이가능한 needle driver 장비로기존 multi-port 로봇장비와비견해도거의차이없이봉합등의까다로운수술기술재연이가능하다는것과긴팔로활동범위가 Si 다빈치시스템의로봇단일공복강경 (LESS) 에비해서활동범위가넓고체외기계간충돌이적어졌다는것이다. 본연구의 Xi 다빈치시스템의로봇단일공복강경 (LESS) 신장부분절제술의초기경험을통해서본술기가구현가능하며안전하다는것을보여주었다. Keywords: Robotic LESS partial nephrectomy, Single-site surgery, Kidney cancer 254

O-93 Long-term results of the plugging method with regard to the prevention of a postoperative inguinal hernia after robot-assisted laparoscopic prostatectomy 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 Purpose: We previously introduced a plugging method to prevent inguinal hernia development in patients undergoing robot-assisted laparoscopic prostatectomy for localized prostate cancer. The present study aimed to analyze the long-term outcomes of this plugging method. Patients and Methods: A total of 026 groins were reviewed between May 2007 and March 206. The plugging method was prospectively applied to patients with a patent processus vaginalis since May 20. Of the 29 groins with a patent processus vaginalis, 67 (57.4%) underwent the plugging method. For patients with inguinal discomfort, ultrasonography was used to evaluate inguinal hernia development. Results: An inguinal hernia developed postoperatively in 35 (3.4%) groins at a median time of 22.0 months during a median follow-up of 4 months. On analyzing the inguinal hernia-free survival rate after adjustment for potential predictors, the presence of a patent processus vaginalis without the preventive procedure was a major risk factor for a postoperative inguinal hernia. No prognostic difference in inguinal hernia development was noted between the group without a patent processus vaginalis and the group with a patent processus vaginalis that underwent the plugging method. Body mass index ( 23.0 kg/m 2 ) and presence of a patent processus vaginalis were independent predictors for inguinal hernia development in groins that did not undergo the plugging method. For groins that underwent the plugging method, previous operation history (yes) was an independent predictor. Conclusions: The plugging method is effective for prevention of a postoperative inguinal hernia in the long term in patients undergoing robot-assisted laparoscopic prostatectomy. Keywords: Inguinal hernia, Patent processus vaginalis, Prostatectomy 255

O-94 Report of pneumoscopic vesicovaginal fistula repair 전병조, 태범식, 최훈, 박재영, 배재현고려대학교의과대학안산병원비뇨기과학교실 Purpose: We report the feasibility and effectiveness of pneumovesicoscopic vesicovaginal fistula repair. Material and Method: Pneumovesicoscopic fistula repair was performed to 8 patients diagnosed with vesicovaginal fistula after gynaecological surgery. Cystoscopy was performed in modified lithotomy position and the fistula was inspected. A 5mm endoscopic port was placed into the bladder under cystoscopic view in the midline and two more working ports were placed 5 cm laterally. Then pneumovesical space was made by using nelatone catheter and suction. The fistular was excised into the vaginal space and the defect was repaired with 4-0 SAS layer by layer. Results: The all pneumovesical fisula repair was accomplished without intraoperative complication and open conversion. Average patient age was 48.4. The mean operative time was 06.5 minutes, and blood loss was minimal. The mean postoperative hospital stay was 9.5 days and the average time of catheterization was 4.25 days. At follow-up visit after 2 months, the recurrence of vesicovaginal fistula was not noted in any case. Conclusions: Pneumovesicoscopic vesicovaginal fistula repair is technically safe and feasible with no recurrence of fistula. Considering the main advantages of less morbidity and safety in non peritoneal approach, our vesicoscopic technique may be an alternative option of surgical methods of vesicovaginal fistula. Keywords: Vesicovaginal fistula, Laparoscopy, Layered repair 256

O-95 신장및요관질환의진단, 치료를위한양방향구동이가능한외경 2.85 mm 이하연성요관신우경의생체내, 임상실험 김대희, 최세영, 유달산, 김청수, 박형근 울산대학교의과대학비뇨기과학교실 Purpose: The domestic flexible ureteroscope (dfurs) was developed. It showed acceptable quality in in-vitro test. We perfomed in-vivo animal study and clinical test in 4 stone patients. Materials and Methods: The dfurs has been developed by Hyunjoo in-tech (Seoul, Korea) and the project is granted by Ministry of Trade, Industry and Energy. In-vivo test was performed using female pig (n=5) under general anesthesia. Two urologists compared 6 parameters for performance with URF-P6 (Olympus, Tokyo, Japan) (insertion, controls, maneuverability, rigidity, image, overall score). After confirmation of the safety in in-vivo test, we performed retrograde intrarenal surgery (RIRS) in 4 patients who had cm or larger renal stones. Surgical success was defined that a patient was stone-free status after surgery. And it was evaluated by KUB and CT in a month. Three parameters for performance was compared with commercially available flexible ureteroscope (CO- BRA, Wolf, USA) (irrigation, convenience, maneuverability) (5:much better, 4:little better, 3:no difference, 2:little worse, :much worse). Results: The performance measured during in-vivo test was as follows; (dfurs/urf-p6) insertion (8.0/9.0), controls (8.5/9.0), maneuverability (7.5/8.5), rigidity (9.0/9.0), image (7.5/9.5) and overall score (8.0/9.0). In clinical test, the mean longest diameter of renal stones was 3.0±5.9mm, and total volume of renal stones was 998.7±7.8 mm3. One patient had renal stone in renal pelvis, one patient in mid calyx and two patients in lower calyx. In two patients we achieved surgical success (50%). One patient had 4.0 3.0 3.0 mm sized remnant stone (39.8% of pre-operative total stone volume). And the other patient had 8.0 7.0 0.0 mm sized remnant stone (6.2% of pre-operative total stone volume). No patient had immediate procedure-related complication. The deflection angle of dfurs was 270/270 degrees and well maintained in clinical test. There was no significant injury to the dfurs during operation. The mean score of performance was as follows; (dfurs) Irrigation (.25), convenience (2.25), maneuverability (2.75). Conclusions: Newly developed dfurs showed acceptable quality and safety in in-vivo and clinical test. But it still needs to be upgraded in performance. Keywords: Ureteroscope, Renal stone 257

O-96 A multicenter, prospective, observational study to investigate feasibility of the disposable flexible ureterorenoscope (Lithovue ) in patients with renal stones 조성용, 이주용 2, 신동길 3, 서일영 4, 유상준, 박형근 5 서울특별시립보라매병원, 2 연세대학교의과대학신촌세브란스병원, 3 부산대학교병원, 4 원광대학교부속병원, 5 울산대학교 서울아산병원 Introduction: This study investigates the feasibility of disposable flexible ureterorenoscopy (Lithovue R ) in patients with renal stones in a prospective, multicenter, observational study. Materials and Methods: Sixty two patients who underwent unilateral ureterorenoscopic stone surgery by Lithovue at five institutions were included. Surgeons using a numerical scale, evaluated the maneuverability of the scopes and general perceptions of visibility related to the monitor and irrigation systems as follows: (very good), 2 (good), 3 (not different), 4 (poor), and 5 (very poor). General pain and fatigue scores were evaluated and compared to existing scopes. Results: Mean patient age was 57.3±3.9 years and mean stone size was 5.4±5.4 mm. Clinical success of overall stone removal was 82.3%. Complications occurred in 4 cases of the Clavien classification grade I in a single case and II in 3 cases. Comparative parameters of maneuverability, perception of the monitor system and perception of the irrigation channel were 2.5, 2.5, and 3.0, respectively. The most favorable evaluation of physical strain was about shoulder fatigue and hand fatigue. However, unfavorable evaluations were recorded for wrist stiffness and thumb fatigue. Maximal deflection angles were preserved in 53 cases (85.5%). Four out of 62 cases (6.5%) showed less than 20 degrees postoperatively. Conclusions: Lithovue generally showed good maneuverability and good perception scores for the monitor and irrigation systems. Strong points were maneuverability and the monitor system while the weakness was related to situations requiring efficient irrigation which can be managed by appropriate surgical methodology. Keywords: Disposable equipment, Ureterorenoscopes, Urinary calculi 258

O-97 후행적신장내결석제거술전선택적알파차단제를사용함으로써, 요관진입집의요관진입압력을줄이고이차적요관손상을예방할수있는가?: 무작위대조군연구 구교철, 윤준호 2, 박노철 2, 안현규, 이광석, 김도경, 하윤수, 정병하, 홍창희 연세대학교의과대학비뇨기과학교실, 2 연세대학교공과대학기계공학부 Purpose: Excessive bulking force during primary access of the ureteral access sheath (UAS) may induce ureteral injury. To investigate the efficacy of preoperative α-blockade for reducing UAS insertion forces (UASIF) and to determine the upper limit required to avoid ureteral injury. Materials and Methods: In a randomized controlled trial, 35 patients from a single institution, who had ureteropelvic junction or renal pelvis stones and were planned to undergo retrograde intrarenal surgery (RIRS), were prospectively enrolled from December 205 to January 207. Patients were randomly assigned to the control (n=4) or the experimental group that received preoperative α-blockade (n=42). Pre-stented patients were separately assessed (n=2). A homemade UASIF measurement device was developed to measure the maximal UASIF. Results: Our UASIF measurement device showed excellent reproducibility. Higher UAS insertion velocity resulted in greater maximal UASIF. Maximal UASIF in the α-blockade group was significantly lower than that in the control group at the ureterovesical junction (p=0.008) and proximal ureter (p=0.036). Maximal UASIFs in the α-blockade group were comparable to those in pre-stented patients (Fig). Female patients and patients aged 70 years exhibited lower maximal UASIFs than their counterparts. Ureteral injury ( Grade 2) rates were lower in the α-blockade group than controls (p=0.038), and did not occur in any cases in which UASIF did not exceed 600 g. Conclusions: Preoperative α-blockade and slow sheath placement may reduce maximal UASIF. If UASIF exceeds 600 g, a smaller diameter sheath may be an alternative, or the procedure can be terminated and followed later by pre-stented RIRS. Keywords: Alpha-adrenergic antagonist, Ureter, Ureteroscopy 259

O-98 연성내시경하신장결석수술에서수술전요관부목삽입의효과 육형동, 윤민영, 정창욱서울대학교병원비뇨기과 Purpose: Placing the stent before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and removal of stones. The purpose of this study was to investigate the effect of preoperative ureteral stenting on access and surgery. Material and Methods: We retrospectively analyzed RIRS cases from October 203 to June 206. Patients were divided into two groups based on preoperative ureteral stent insertion. The character of stone (size, number, density, location) and access sheath success rate, balloon dilatation rate, perioperative complication, operative time, hospitalization time, period with stent, postoperative urinary tract infection rate, stone free rate, and additional treatment rate were analyzed. Results: Overall, 22 patients were included in the study (73 pre-stented and 49 non-stented). Median stone size was 4.5 mm and overall stone free rate was 87.7%. The preoperative estimated glomerular filtration rate was relatively higher in patients who underwent preoperative ureteral stenting, compared with those who did not (68.8 vs 79.0, p=0.042). Preoperative ureteral stenting improves the success rate of access sheath insertion (97.3% vs 87.8%, p=0.038) during surgery. Although not significant, the balloon dilatation rate was relatively low. There was a significant difference in operation time when the diameter of the stone was smaller than.3 cm (p=0.09). However, there was no significant difference in postoperative urinary tract infection rate, additional treatment rate, and stone free rate. Conclusion: Preoperative ureteral stenting helps preserve preoperative glomerular filtration rate, and facilitates successful insertion of access sheath. Keywords: Ureter stent, Assess sheath, RIRS 260

O-99 7.5 Fr. nephroscope 를이용한 ultra-mini perculaneous nephrolithotomy 의초기경험및합병증 고경태, 임송원, 김성용, 최낙규, 양대열 한림대학교강동성심병원 목적 : 2 cm 이상의신결석에서표준치료인 Conventional Percutaneous Nephrolithotomy (PCNL) 은높은결석제거율을보이지만, 수술중출혈, 집뇨계의손상등의합병증이있고, nephrostomy tube 설치로인하여입원기간이긴단점이있었다. 또한, 최근결석진단에 CT가많이이용되면서상대적으로크기가작은신결석이많이진단되고있다. 이에저자는, 기존 PCNL의단점을보안하고작은신결석치료에맞게개발된 7.5 Fr. nephroscope를이용하여 Ultra-mini PCNL (UMP) 시행한초기경험및합병증을소개하고자한다. 방법 : 206년 5월부터 207년 5월까지본원에서신결석으로진단받고 UMP을시행받은 5명의환자를대상으로하였다. 초기 6례는 8.5/9.5 Fr. Working sheath를이용하였으며, 이후에는 /2 Fr. Working sheath를이용하여수술하였다. Shoulder rotated supine position을취하였으며, Holmium laser (550 nm fiber) 를 lithotripter로사용하였다. 수술후설치한 D-J catheter는 -2주뒤제거하였다. 결과 : 환자들의평균나이는 6세였고, 남자환자가 0명여자환자는 5명이었다. 신결석의평균크기는 2.84±.06 cm 이었고, 양측이 명, 우측이 7명, 좌측이 7명이었다. 5명의환자중, 9명의환자 (60%, 2.47±.08 cm) 에서결석이완전히제거되었다. 6명의환자중남은신결석의크기가 0.5 cm 미만인환자 4명은추가치료로 ESWL을시행하였으며, 0.5 cm 이상인 2명의환자는 Flexible ureteroscopic surgery를추후에시행하였다. 평균수술시간은초기 8.5/9.5 Fr Working sheath를이용했을때는 06분이소요되었으며, 이후 /2 Fr. Working sheath를이용하였을때에는 73분이소요되었다. 모든환자에서수술중출현은최소한으로측정되었으며신우의손상등다른합병증도없었다. 수술중기계의고장 / 손상은없었지만, 명의환자에서 one-step dilator 삽입의실패가있었다. 5명의환자중 7명 (47%) 의환자에서수술후발열이있었으며정맥용항생제를포함한보존적요법으로치료가되었다. 결론 : UMP는수술과관련된합병증이적으며, 단일신결석인경우 2 cm 이상의결석에서도좋은치료결과를보였다. 다만, UMP 이후발생하는요로감염을줄이기위한노력이지속적으로필요하겠다. Keywords: Renal stone, Percutaneuous nephrolithotomy, Complication 26

O-200 변형된앙와위자세에서경피적신결석제거술시행시유도철사견인을이용한신루확장술의효용성 하헌, 이유진, 정재욱, 하윤석, 김태환, 최석환, 이준녕, 김현태, 유은상, 정성광, 권태균, 김범수 경북대학교의과대학비뇨기과학교실 Purpose: Although percutaneous nephrolithotomy (PCNL) has been traditionally performed in the prone position, recently, it is also being performed in supine or modified supine position. Although supine PCNL has several advantages, such as reducing risk of cardiopulmonary complications and allowing simultaneous retrograde approach, It is more difficult to make nephrostomy tract in supine position due to more movable kidney. To overcome this limitation, we used modified nephrostomy dilation technique using guide wire traction and analyzed the efficacy of this technique comparing with conventional method. Materials and Methods: From January 20 to April 207, a total of 44 patients underwent PCNL in modified supine position. Of these patients, modified nephrostomy tract dilation technique was performed in 73 patients. All the PCNL was performed in the Galdakao modified Valdivia supine position and PCN was placed the day before operation. For the conventional technique, two hydrophilic guide wires were antegradely placed into the ureter through PCN catheter and nephrostomy tract was made using 30F balloon catheter. For the modified dilation techinique, two hydrophilic guide wires were placed into the bladder and were extracted through the urethra, then both proximal and distal tips were pulled to the opposite side with tension for the easy placement of fascia cutting needle and balloon catheter. Patients characteristics and perioperative surgical outcomes, including success rate, operation and radiation exposure time, and complications were compared betweeng the two groups. Results: There were no differences in patients gender, age, stone size and number between the two groups. The number and site of renal puncture was also not statistically different. Overall operation time (89.6 vs 89.2 min), mean Hb drop (2.2 vs 2.6 mg/dl), hospital stay (6.7 vs 7.0 days), success rate (73.0 vs 64.0%), and complication rates (7.0 vs 7.0%) were not significantly different between both groups. However intraoperative radiation exposure time was significantly shorter in modified dilatation technique group (93.0 vs 233.0 sec, P<0.00). Conclusion: This study demonstrated that modified nephrostomy tract dilation technique can be effectively and safely performed for PCNL in modified supine position and it can be more helpful to reduce intraoperative radiation exposure time. Keywords: Percutaneous nephrolithotomy, Galdakao modified valdivia supine position, Modified nephrostomy tract dilation technique 262

O-20 고농도히알루산과콘드로친산의요관부목삽입에따른요로증상에서의효과에관한다기관한쪽가림임의배정연구 조정기, 정재훈, 김규식, 김용태, 박성열, 최홍용, 문홍상, 이승욱, 김재헌 2 한양대학교의과대학비뇨기과학교실, 2 순천향대학교의과대학비뇨기과학교실 Purpose: Many patients with receive a ureteral stent develop significant urinary symptoms and pain. Treatments with narcotics, alpha-blockers, and/or anticholinergics have inconsistent outcomes. This multicenter randomized single-blinded controlled trial investigated the effect of instilling highly concentrated hyaluronic acid (HA)/chondroitin sulfate (CS) on the ureteral stent-related pain, urinary symptoms, and quality of life (QoL) of patients who underwent ureteroscopic lithotripsy for ureter stones followed by ureteral stent placement. Materials and Methods: Eligible patients were randomly allocated to receive intravesical instillation with HA/CS or normal saline just after ureteral stent placement. Just before stent removal on postoperative day 7, the patients completed the Urinary Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS) QoL question, and pain Visual Analogue Scale (VAS). Results: In total, 92 patients (46 each in the treatment and control arms) completed the study. The two groups did not differ in terms of age or stent indwelling time. Compared with the control group, the treatment group had significantly lower total USSQ scores (67.8 vs. 86.2; p<0.00) and urinary domain USSQ scores (p<0.00), better I-PSS QoL (p=0.08), and lower pain VAS scores (p<0.00). They also had lower total pain and discomfort scores (p=0.00) and less pain and discomfort caused by urinary tract infections (p=0.0), and were less likely to need antibiotics (p<0.0) and additional hospital visit(s) (p<0.0). Conclusions: Highly concentrated HA/CS effectively improved urinary symptoms and pain and reduced the need for additional medication or procedures. Keywords: Ureteral stent, Hyaluronic acid, Discomfort 263

O-202 Therapeutic effects of endoscopic ablation of hunner lesions in interstitial cystitis/bladder pain syndrome patients 고광진, 이규성,2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 2 삼성융합의과학원의료기기산업학과 Purpose: To prospectively investigate the efficacy of endoscopic ablation of Hunner lesions (HLs) in patients with Interstitial Cystitis/ Bladder Pain Syndrome (IC/BPS) and to find predictors of early recurrence of HLs. Materials and Methods: A prospective observational study was performed for IC/BPS with HLs patients who underwent endoscopic ablation. Enrolled patients underwent transurethral ablation with a bipolar loop. We repeated endoscopic ablation when HLs recurred during the follow-up period. O Leary-Sant IC symptom index (ICSI) and problem index (ICPI), pelvic pain and urgency/frequency (PUF) patient symptom scale, visual analogue scale (VAS) for pain, and 3-day voiding diary were assessed at each visit after the first operation. The primary endpoint was recurrence-free survival time. Secondary end points were a change from baseline in the mean number of frequency, nocturia, and urgency episodes noted in a 3-day voiding diary and changes in VAS for pain and other symptom indices at follow-up visits. Results: A total of 72 patients were analyzed. The median follow-up period was 29.5 (IQR, 9.8-36.8) months. After primary ablation treatment, HLs recurred in 75.0% (54/72) of subjects, and the mean recurrence-free survival time was 7.7±.6 months. HLs occurred in 44.0% (22/50) of individuals after the second operation, and the mean recurrence-free survival time was 23.3±2.9 months. There were significant improvements in the VAS for pain, ICSI, ICPI, and PUF after endoscopic ablation treatment. Twenty-eight patients (38.9%) experienced HL recurrence in the 2 months after the first ablation and lower maximal cystometric capacity (OR.0, CI.00-.03; p=0.07) was the only factor that predicted early recurrence. Conclusions: Endoscopic ablation is an effective and safe treatment option for HLs and significantly reduces pain and improves voiding symptoms. Although the recurrence rate is not negligible after endoscopic ablation, HLs do not recur for at least 8 months. In addition, repeated ablation when symptoms worsen results in consistent improvement in symptoms and pain relief. The risk of early recurrence is relatively low except in patients with low bladder capacity. Therefore, endoscopic ablation should be performed periodically in cases where recurrence of HLs causes symptoms. Keywords: Interstitial cystitis, Pain, Therapeutics 264

O-203 Effects of apolipoprotein A- and alpha-fetoprotein on the development of benign prostatic hyperplasia and lower urinary tract symptoms: results from a large retrospective study 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 Purpose: To investigate risk factors for development of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in healthy men. Methods: The study included a total of,222 healthy men who underwent transrectal ultrasonography at our hospital during routine health examinations. Those who underwent prior biopsy or surgery for prostate disease, who had suspected urinary tract infection, or who were taking BPH medication were excluded. BPH/LUTS was defined as an International Prostate Symptom Score (IPSS) 8 and prostate volume (PV) 30 cm 3. Results: Subjects had a mean age of 5.7 years, a PV of 28.8 cm 3, prostate-specific antigen (PSA) level of.7 ng/ ml, and IPSS of 9.9. The annual PV growth rate was 0.48 cm 3 /year. PSA level, PSA density, PV, transitional zone volume (TV), and transitional zone index (TZI) increased significantly with age. PSA level, fat mass, apolipoprotein A-, creatine level, and urine ph were significant predictive factors for both PV and TV. For men aged >40 years, alpha-fetoprotein (AFP) level (>2.0 vs. 2.0 ng/ml) (Odds ratio [OR]=0.76, p=0.025), PV (OR=.49, p<0.00), and IPSS (OR=.92, p<0.00) were predictors of BPH/LUTS at the initial health check-up. AFP level (>2.0 vs. 2.0 ng/ml) (OR=0.79, p=0.033), TZI (OR=.0, p<0.00), and total IPSS (OR=.05, p<0.00) were significant risk factors for development of BPH/LUTS within 5 years. Conclusions: Apolipoprotein A- is a major component of high-density lipoprotein cholesterol and was associated with PV. AFP was a risk factor for the development of BPH/LUTS within 5 years in healthy Korean men. Keywords: Benign prostatic hyperplasia, Lower urinary tract symptoms, Apolipoprotein A-, Alpha-fetoprotein 265

O-204 Urolift: 전립선비대증치료를위한최소침습 intra-prostatic implant - 국내파일럿연구 정현철, 성재우, 양종협, 조신제, 최세웅, 배웅진, 김수진, 조혁진, 하유신, 홍성후, 이지열, 김세웅 가톨릭대학교서울성모병원 Purposes: As a minimal invasive device for benign prostatic hyperplasia (BPH) treatment, Urolift is widely accepted in the worldwide but it is not widely used in Korea. We investigated the short-term efficacy of urolift for patients with BPH. Materials and Methods: Seven patients with BPH who were taking a blockers were treated with urolift under local anethesia with sedation. Foley urethral catheter was placed post operation and removed on the same day. Whenever possible, patients were scheduled to be discharged on the day, but someone was admitted to the hospital due to the patient's personal reason. IPSS and maximum urinary flow rate and post voiding residual urine were evaluated preoperatively and month later. Results: Mean age was 68.7±7.27 years old and mean prostatic volume was 36.27±6.62 g. No severe adverse event was observed postoperatively. Preoperative total IPSS and QOL were 22.2±2.93 and 3.8±.09. Total IPSS was significantly improved to 8.72±7.2 (p=0.043) after treatment, but QOL was 3.57±.5 and it was statistically not different. Voiding subscore of IPSS was significantly improved (p=0.04) but storage subscore was not improved significantly. And post voiding residual urine were improved after treatment significantly 62.66±83.9 to 7.66±3.2 (p=0.03) however no significant improvement in Qmax that was 0.8±3.44 and 9.93±8.5 respectively. Mean hospital day was.7±0.48. No patient reported retrograde ejaculation. Conclusions: We evaluated short-term efficacy of Urolift, a new minimally invasive device for BPH treatment in Korea, and showed improvement of IPSS, especially voiding symptoms. Long term follow-up is needed, but it is expected that not only the improvement of voiding symptom but also the preservation of sexual function is possible. Keywords: Urolift, BPH, Minimal invasive 266

O-205 홀뮴레이저전립선절제술 (HoLEP) 시행의적절한타이밍을예측할수있는가? 김승빈, 태종현, 윤성구, 김재윤, 심지성, 강성구, 강석호, 천준, 김제종, 이정구고려대학교안암병원비뇨기과학교실 Purpose: It is known that long term partial bladder obstruction induced detrusor contractile dysfunction. Actually, persistent voiding dysfunction following the HoLEP is not uncommon. The aim of this study is to predict the proper timing of the HoLEP through variable parameters. Materials and Methods: A total of 20 patients who underwent HoLEP between 202 and 206 were retrospectively reviewed. According to treatment results, the patients were divided into 2 groups (Group I - improvement in IPSS) + Qmax value >2 ml/s and PVR >00 ml; Group II - no improvement in IPSS + Qmax value 2 ml/s or PVR 00 ml). The improvement of IPSS was defined as the shift between grades. We evaluated the predicting risk factors of voiding dysfunction following HoLEP. Results: In the analysis of subjective symptom score (IPSS subscores and total score), there were significant differences between two groups (P<0.00). Also, in the analysis of urodynamic parameters, maximum detrusor pressure, detrusor pressure at peak flow rate, compliance, bladder contractility index, bladder outlet obstruction index also showed significant differences (P<0.05). In the logistic regression analysis, bladder contractility index and IPSS storage subscore were risk factors for voiding dysfunction following HoLEP. Conclusion: Reduced detrusor contractility was associated with poor treatment results. Urodynamic parameters, indicating detrusor contractility could be a good diagnostic tool for predicting voiding dysfunction after HoLEP. The relatively high symptom score could suggest better treatment results. Keywords: Holmium laser enucleation of prostate, Benine prostatic hyperplasia 267

O-206 What is different according to prostate size following holmium laser enucleation of the prostate in men with benign prostatic hyperplasia? 이정우, 이승수, 이동훈, 한지연, 남종길, 정문기, 박성우 양산부산대학교병원비뇨기과학교실 목적 : 전립선비대증 (BPH) 환자에서수술적치료중홀렙 (HoLEP) 수술은전립선크기에관계없이효과적이라고하나, 수술후경과나만족도에는차이가있을수있다. 본연구는전립선크기에따른 HoLEP 후배뇨증상, 합병증, 및추가치료의경향이어떻게다른지조사해보았다. 대상및방법 : 2009년부터 206년까지단일술자에의해 BPH로 HoLEP 수술을시행받은환자중 3개월이상추적관찰한 93명의자료를분석하였다. 수술전경직장초음파검사로측정한전립선크기에따라 40 gm, 40-80 gm, 80 gm 를각각, 2, 및 3군으로분류하였다. 각군에서환자의나이, 국제전립선증상점수 (IPSS), 삶의질 (QoL), 과민성방광증상점수 (OABSS), 최대요속 (Qmax), 평균요속 (Qave) 및잔뇨량 (PVR) 을조사하였다. 수술후 3개월, 년째 IPSS, QoL, Qmax, Qave, 및 PVR을추적관찰하였고, 합병증및항콜린제복용여부도조사하였다. 결과 : 환자수는, 2, 및 3군에서각각 65명, 08명, 및 20명이었다. 전립선크기는각군에서 33 gm, 52 gm, 및 98 gm였다 (p<0.00). 각군의환자나이, 수술전 IPSS, QoL, OABSS, Qmax, Qave, 및 PVR 등은세군에서유의한차이는없었다 (Table). 모든지표들은수술후모든군에서호전되었다 (p<0.00). 수술후 3개월째 IPSS, QoL, OABSS, 및 Qave는 3군에서가장우수하였으며, 군에서가장좋지못했다 (p<0.00, 0.03, 0.05, 0.028). 수술후 년째에는 IPSS, QoL, OABSS, Qmax, 및 Qave 등이 3군에서 군보다우수하였다. 수술후요실금은각군에서 4명 (6.2%), 0명 (9.3%), 및 2명 (0%) 였고, 항콜린제복용비율은각군에서 3개월째 4명 (2.5%), 8명 (6.7%), 4명 (20%) 였으며, 년째에는 군및 2군에서각각 4명 (0.8%) 및 3명 (5.6%) 였다. 수술후합병증은요도협착이각군에서 8명 (4%), 2명 (3%), 및 2명 (2%) 였으며, 퇴원후카테터재삽입은 군및 2군에서각각 명 (.8%) 및 5명 (5.3%) 였으며, 방광경부협착은 2군에서만 명 (.%) 조사되었다. 결론 : HoLEP 수술은전립선의크기에상관없이수술전증상을호전시키나, 전립선의크기가작을경우, 큰경우에비해수술후요속및배뇨증상의개선과만족도가떨어졌는데, 특히방광자극증상의호전이적었다. 이로인해수술후오랜기간동안항콜린제등의약물복용을할가능성이높았다. Keywords: Prostate, BPH, Surgery 268

O-207 전립선절제술후배뇨증상변화를통한배뇨근저활동성진단지표의효용성비교 김상원, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광 경북대학교의과대학비뇨기과학교실 목적 : 고령인구에서보다흔하게나타나는하부요로기능이상인배뇨근저활동성 (detrusor underactivity; DU) 은표준적인진단기준이정해져있지않다. 또한남성배뇨장애환자에게전립선비대증뿐만아니라 DU가동반된경우를종종볼수있는데, 이는전립선비대증의수술적치료후에도배뇨증상개선효과감소의원인이되기도한다. 따라서전립선비대증환자에서술전 DU의진단은필수적이며, 이에대한몇가지진단지표가개발되어있다. 본연구에서는각각의진단지표에따라분류된환자를대상으로전립선절제술시행후배뇨증상개선여부에따른진단지표의효용성에대해분석하고자하였다. 대상및방법 : 203년 월부터 206년 2월까지홀뮴레이저를이용한전립선절제술 (HoLEP) 을시행받은환자중술전요역동학검사를시행하고술후 3개월이상추적관찰을시행한환자를대상으로하였다. DU 진단기준은 bladder contractility index (BCI), Abrams-Griffith (AG) number, pdetqmax<30 및bladder voiding efficiency (BVE)<90% criteria를활용하였다. 술전요역동학검사를토대로각진단기준에따라전체환자를대조군과 DU군으로분류한후수술전후국제전립선증상점수 (IPSS) 및요속검사를이용하여배뇨증상개선정도를비교하였다. 결과 : 전체 93명의환자가본연구에포함되었으며, BCI, AG number, pdetqmax<30 및 BVE<90% criteria에따른 DU의유병률은각각 3.2 (29/93), 2.9 (2/93),.8 (/93), 및 9.7 (9/93)% 였다. 각각의지표에따른분류에서술후총 IPSS, IPSS-storage, 삶의질점수, 최대요속및잔뇨량의개선정도는모든분류에서두군간에유의한차이가없었으나, BVE<90% criteria에따른분류에서는 DU군이대조군에비해술후 IPSS-voiding 점수개선정도가유의하게낮았다 (5.0 vs 0.3, p=0.08). 결론 : DU를동반한전립선비대증환자들에서도 HoLEP은술후유의한배뇨증상개선효과가있을것으로보이나, BVE<90 criteria에따라 DU로분류된환자들은배뇨증상개선효과가낮을것으로예상된다. Keywords: BPH, Prostate enucleation, Urodynamic study 269

O-208 LUTS/BPH 환자의 HoLEP 수술후골반통의호전 : 전향적연구 윤민영, 김병수, 오승준서울대학교병원비뇨기과학교실목적 : LUTS/BPH에서불특정한 genitourinary discomfort or pain (GUDP) 이나골반통이흔히동반된다. 이전에저자들의제한된연구에의하면 GUDP가 HoLEP수술후호전되었다는것을알수있었다. 이에우리는이러한결과가일반화될수있는지좀더많은환자들을대상으로알아보고자하였다. 대상및방법 : 202년 5월부터 206년 4월까지 HoLEP수술을받은 45세이상 LUTS/BPH 환자를대상으로하였다. 악성종양이나감염, 외상, 비뇨생식기수술, 신경인성방광, 요도협착이있는환자들은모두제외하였으며모든환자들은자세한병력청취와신체검진, IPSS, PSA, 요류검사및잔뇨측정술, 경직장초음파검사, 요역동학검사를시행하였다. 0점만점의 visual analogue scale로표시된통증정도와부위를표기한설문지를수술전, 수술후 3, 6개월에시행하였다. GUDP의정도는시계열로통계분석하였고 GUDP와다른임상척도들간의관계도분석하였다. 결과 : 전체 69명의환자의평균나이는 69.세 (±6.9, SD) 였고그중술전 GUDP가있는환자는 27명 (35.%) 이었다. 술전 IPSS score와 IPSS QoL score를제외하고는 GUDP군과아닌군사이에의미있는차이가없었다 (p<0.05). 주요한통증부위는음경원위부가 67명 (54.0%), 치골상부 47명 (37.9%), 회음부 7명 (5.6%), 항문 2명 (.6%), 기타부위 명 (0.8%) 순이었다. 통증정도는중등도가가장많았다. IPSS score, Qmax, PVR volume을포함한모든척도들이 HoLEP후의미있게호전되었다 (Table). GUDP를호소하던환자수가수술 3개월째 67명, 6개월째 37명으로극적으로줄어드는양상을보였다. GUDP 통증정도도의미있게감소되었다 (p<0.00). 그러나수술 6개월후 7명 (2.7%) 환자들에서는 de novo GUDP가발생되었다. 단변량분석에서기저 IPSS score만이기저 GUDP와유의하게관련되어있었다 (HR.96; 95% CI.55-2.48 in IPSS total score). BOO index는 GUDP와관련이없었다. 결론 : 우리연구는 GUDP가 LUTS/BPH환자들의 LUTS와밀접한관계가있다는것을보여주었다. GUDP가있는대부분의환자들에서 HoLEP 수술후호전양상을보여주었다. 우리결과는 LUTS/BPH가있는환자들의막연한골반통에대한수술전상담에유용한자료가될것으로생각한다. Keywords: LUTS/BPH, HoLEP, Pelvic pain 270

O-209 요역동학검사방광출구폐색모호군으로진단된환자에서홀뮴레이저를이용한전립선절제술이후증상호전에관한예측인자분석 한지연, 이정우, 이승수, 이동훈, 남종길, 정재민, 박성우, 이상돈, 정문기 부산대학교의과대학양산부산대학교병원비뇨기과학교실 목적 : 하부요로증상을호소하는남성의술전요역동학검사에서방광출구폐색 (BOO) 로진단된경우전립선비대수술후증상호전을기대할수있다. 그러나전립선비대소견은있으나요역동학검사에서 BOO 정도가모호군으로진단되는경우치료결정에어려움이있다. 이에저자들은하부요로증상으로홀뮴레이저를이용한전립선절제술 (HoLEP) 시행받은환자들중술전요역동학검사에서 BOO 모호군으로진단된환자들에서술후증상호전에관한예측인자를알아보고자하였다. 대상및방법 : 본원에서 206년 3월부터 2월까지본원에서 HoLEP 시행받은환자들중술전요역동학검사에서 BOO 모호군으로진단된환자들을의무기록을바탕으로후향적으로분석하였다. 요역동학검사에서 BOO 모호군은방광출구폐색지수 (PdetQmax-2*Qmax) 가 20 이상 40 미만으로정의하였으며수술의성공은술후 3개월째전립선증상점수 (IPSS) 의삶의질항목이 0 ( 만족 )-2 ( 대체로만족 ) 점으로정의하였다. 수술성공군과그렇지않은군과의환자들의나이, 전립선용적, IPSS, 요속검사, 배뇨후잔뇨및요역동학검사소견을비교분석하였으며요역동학검사에서배뇨근저활동성 (Wmax<7 W/m 2 또는방광수축력지수 (PdetQmax+5*Qmax)<00) 여부를비교분석하였다. 결과 : 대상환자들은총 24명이었으며환자들의평균나이는 67.5±9.7세 (5-88), 전립선평균용적은 42.7±2.4 (20-97.9) mg, IPSS 총합의평균은 20.9±9.4 (6-32), 배뇨증상항목평균점수는 2.7±6.5 (3-20) 이었으며요속검사에서평균최대요속은 0.2±4.8 (4-5.8) ml/s이었다. 이중 6명 (66.7%) 에서술후증상이호전되었다. 술후증상이호전된군과호전되지않은군간환자들의나이, 전립선용적, IPSS, 배뇨증상항목점수, 요속검사에서의최대요속, 평균요속, 배뇨후잔뇨및요역동학검사에서최대요속, 평균요속, 배뇨후잔뇨, 최대요속시배뇨근압력은차이가없었다. 배뇨근저활동성지표중 Wmax 7 W/m 2 인경우수술성공과유의한관련이있었다 (p<0.00) 결론 : 하부요로증상으로 HoLEP 시행받은환자들중술전요역동학검사에서 BOO 모호군에서배뇨근수축력이수술성공과유의한관련이있었다. Keywords: Bladder outlet obstruction, Detrusor contractility, Urodynamics 27

O-20 술전급성요폐가홀뮴레이저전립선절제술에미치는영향 정준세, 박지운, 배상락, 박봉희, 이용석, 강성학, 한창희가톨릭대학교의정부성모병원비뇨기과학교실목적 : 급성요폐는전립선비대증환자에서수술적치료를고려하는중요한요인이된다. 이런한급성요폐의기왕력이홀뮴레이저전립선절제술의결과에미치는영향을알아보고자하였다. 대상및방법 : 203년 3월부터 207년 5월까지전립선비대증과동반된하부요로증상으로인하여홀뮴레이저전립선절제술을시행받은환자들을대상으로술전급성요폐기왕력을확인하고이에따른술전, 수술중, 수술후변수들에대하여후양적으로의무기록을통하여분석하였다. 모든환자에서기본적인환자정보및신체검사, 초음파및혈중 PSA 수치, 동반질환여부, 술전및술후요속검사및잔뇨량측정, IPSS 설문지, 각종수술지표등에대하여분석하였다. 결과 : 전체 34명의환자중술후경과관찰이이루어지지않았던환자 7명을제외하고, 297명에대하여분석하였다. 297 명중급성요폐의기왕력이있었던환자가 09명, 급성요폐가없었던환자가 88명이었다. 평균연령및체질량지수는두군간에차이가없었으며, prostate volume, PSA 등도차이를보이지않았다. 술전요속검사에서배뇨량은비요폐군에비해요폐군에서유의하게적은것으로확인되었으며 (94.7 cc vs. 30.9, p=0.04), 및잔뇨량은유의하게많았다 (93 cc vs. 54.3 cc, p=0.06). 술전 IPSS의각 domain 점수및 voiding, storage 증상점수는두군간에차이를보이지않았다. 수술중평균에너지사용량은요폐군에서유의하게높게나타났다 (74J vs 22.5J, p=0.044). 술후 개월째시행한 IPSS 에서는요폐군이비요폐군에비해배뇨관련증상점수및총점, 저장증상점수모두낮은것으로확인되었으며, 술후요속검사및잔뇨량등에서는두군간에차이를보이지않았다. 결론 : 급성요폐기왕력이있는환자의경우수술중높은에너지사용량이있으나, 술후증상개선효과가기왕력이없는환자에비해우수한것으로나타났다. 요폐환자에서술후보다수술의효과및만족도를기대할수있어수술을권유함에있어용이함등이있을것으로사료된다. Keywords: Acute urinary retension, BPH, HoLEP 272

I-00 A novel training model for laparoscopic ureteroureterostomy using urechis unicinctus Yinan Zhang, Xunbo Jin Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China Purpose: To create a model for laparoscopic ureteroureterostomy training using the urechis unicinctus. Within the laparoscopic training box, this model simulated the procedures of the laparoscopic ureteroureterostomy, which was also helpful for the improvement of laparoscopic suturing skills. Materials and Methods: In this training model, urechis unicinctus were simulated the ureters. The the preserved salted urechis unicinctus were ordered online, and could be well preserved in 75% alcohol in the -8 refrigerator for 3 months. When using this model, the urechis unicinctus were soaked in the warm water for one minute. And then, the selected urechis unicinctus were positioned in the laparoscopic training box. The third step was to preform a laparoscopic ureteroureterostomy procedure. 3 urologists with laparoscopic procedure experiences were trained with this model. The procedure time was recorded and the quality of anastomosis was evaluated preliminarily. Results: Each urologist performed 2 consecutive procedures within one month, and 36 cases were performed in total. The mean operative time were 25., 2.2, and 22.6 minutes, respectively. The operative time curve showed a clear decrease from the 3rd case, but varied from case to case since then. The anastomosis qualities were improved from the 4 th to 6 th cases. At the 2 th case, all 3 urologists completed a qualified anastomosis with a mean time of 8.5 minutes, ranged from 7. to 9.4 minutes. Conclusion: Laparoscopic ureteroureterostomy is a procedure required high laparoscopic suturing skills, which highly demanded sufficient training. This training model using the urechis unicinctus, is not only cost-effective with a good construct validity, but provides an easy-to-use method for the constant and repeatable training as well. Figure. The operation time curve of 3 urologists trained by this training model. 273

I-002 Comparative analysis of early outcomes and QoL in the radical nephrectomy vs partial nephrectomy: a prospective cohort study 윤민영, 정창욱 서울대학교병원비뇨기과학교실 목적 : 신세포암환자에서근치적신절제술과부분신절제술에따른초기임상결과와삶의질을전향적코호트를이용하여비교하였다. 대상및방법 : 206년 3월부터 206년 2월까지서울대학교병원에서수술한전형적인신세포암환자 24명 ( 근치적신절제술 46명, 부분신절제술 78명 ) 의 SUPER-RCC-Nx 코호트에서수술후 6개월이상외래추적진료한 76명의환자들을대상으로분석하였다. 결과 : 전체환자의평균나이는 57.6±.3세 (SD) 였고체질량지수는 25.7±3.8 (SD) kg/m 2, 평균종물크기는 3.86±2.32 (SD) cm이었다. 종물크기에있어서는근치적신절제술의경우 6.48±3.30 (SD) cm으로부분신절제술의경우 (3.36±.70(SD) cm) 보다유의하게컸다 (p=0.008). Clinical T stage에서도부분신절제술의경우 Ta (7.9%) 가가장많았지만근치적신절제술의경우는 Tb가 33.3% 로가장많았다 (p<0.00). 수술시간 (p=0.642) 과추정출혈량 (p=0.64), 재원기간 (p=0.38), 수술후 Cr (p=0.59) 은유의한차이가없었으나수술후혈색소수치는부분신절제술의경우 3.54±2.05 (SD) 로근치적신절제술의경우 (2.±.89 (SD)) 보다유의하게높았다 (p=0.028). 수술후 일째와 3일째통증 VAS도유의한차이가없었다 (p=0.088). 삶의질에서는 FSKI-5의경우일부하위항목에서수술후부분신절제술에서더좋은것으로나타났다 (p<0.06) ( 생활의즐거운정도와식욕 ). 하지만 EQ-5D-5L에서는두수술간의유의한차이가없었다. 결론 : 근치적신절제술과부분신절제술은성비, 종물크기, clinical T stage, 수술후혈색소수치, 일부삶의질평가에서유의한차이가있었으나수술시간과추정출혈량, 재원기간, 수술후 Cr, 대부분의삶의질평가, 수술후, 3일째통증 VAS 에서는유의한차이가없었다. 이는환자가느끼는삶의질이나술후통증은두수술간에큰차이가없다는경향을보여줬다. 이후장기적인신기능등을포함한경과관찰이필요하다. Keywords: RCC, Nephrectomy, QoL 274

I-003 Long-term functional and oncological outcomes of robot-assisted versus open partial nephrectomy for treatment of totally endophytic renal tumors Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine Purpose: Data about long-term outcome of totally endophytic renal tumors is lacking. Our aim was to report the long-term oncologic and functional outcomes of patients with endophytic masses following robot-assisted partial nephrectomy(rapn) and open partial nephrectomy (OPN). Methods: This is a retrospective analysis of 89 patients with totally endophytic renal tumors treated with RAPN (n=52) and OPN (n=37) in a tertiary center from 2005 to 207. Longevity of follow-up was measured from date of operation until last clinical follow-up. Patient and tumor characteristics, operative, postoperative,functional, and oncological outcomes were compared between groups. Chronic kidney disease free survival (CKDFS) and cancer specific survival (CSS)were calculated and compared between groups using Kaplan Meier analysis. Results: Apart from a higher prevalence of high complex tumors among RAPN cases (RAPN, 5.7% vs OPN, 2.4%; P=0.005), and lower median preoperative egfr (RAPN, 86 vs OPN 96; p=0.032), the remaining demographic characteristics were similar between the groups. RAPN was associated with shorter WIT (24 min vs 30 min; p=0.002), and better trifecta achievement rate (% vs %; p=0.044) compared to OPN. There were no statistically significant differences among the groups in terms of local tumor recurrence (p=0.568) and distant metastasis (p=0.46). The 5-yr CKDFS was 96.2% vs 94.6% (log-rank, p=0.746), while CSS was 00%vs 97.% (log-rank, p=0.236) when stratified by RAPN and OPN. Conclusion: Despite the higher prevalence of high complex renal tumors and the lower renal function in the RAPN group, trifecta achievement was similar between OPN and RAPN technique, as well as, RAPN achieves 5 years equivalent long-term oncologic control and functional outcome in treatment of patients with totally endophytic renal tumors. Keywords: Long-term outcomes, Partial nephrectomy, Endophytic tumors 275

I-004 Does lymph node dissection during robot-assisted radical prostatectomy affect urinary incontinence? Ahmed Elghiaty, Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Trung Van, Won Sik Ham, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine Purpose: To evaluate risk factors of urinary incontinence (UI) following robot-assisted radical prostatectomy (RARP) at high volume robotic center. Methods: All patients with clinically localized PCa T3aN0M0 who underwent RARP in our urology department between 2005 and 202 were analyzed. All surgeries were performed by single expert robotic surgeon. We included patients with minimum follow-up of year, patients with incomplete data and those who receive early adjuvant and/or salvage therapy were excluded. UI was defined as (no pad or safety pad usage), and was assessed for all patients at, 3, 6, and 2 months following surgery. Patients were classified into 2 groups according to continence function at 2 months (continent, n=723) and (incontinent, n=3). The primary endpoint was to compare clinical and pathological variables between the groups, while the secondary end point was to evaluate predictors of persistent UI at year. Results: Patients who were incontinent at 2 months had higher BMI>25 kg/m 2 (p=0.002), larger prostate volume (p=0.002), higher prevalence of adverse pathological features including Gleason s score (p=0.008), T3b (p<0.00), and pn+ve (p=0.005) compared to the continent patients. Regarding pelvic LND, the median LN yield was higher 23 vs 6 (p<0.00) and the prevalence of LN yield >30 LN retrieved 4.2% vs 4.% (p<0.00). Multivariable logistic regression analysis showed that BMI>25 (OR: 2.756, p=0.004), pt3b (OR:.947, p=0.009), and LN yield >30 (OR: 5.380, p=0.004) were the predictors of urinary incontinence at 2 months. Furthermore, multivariable analysis according to the LN region showed that resection of the common iliac LN was a predictor of persistent UI at 2 months (OR: 2.457, p<0.00). Conclusion: Our study showed that LN yield >30 and resection of the common iliac LN are associated with higher incidence of UI at 2 months following RARP. Keywords: Lymph node, Radical prostatectomy, Urinary incontinence 276

I-005 National practice patterns and direct medical costs for prostate cancer in Korea across a 0 year period: a nationwide population-based study using a national health insurance database 강호원, 윤석중, 정재일 2, 최훈 3, 김재현 4, 유호송 5, 하윤석 6, 조인창 7, 김형준 8, 정현철 9, 고준성 0, 김원재, 박종혁, 김소영, 이지열 2 충북대학교병원비뇨기과학교실, 2 인제대학교부산백병원비뇨기과학교실, 3 고려대학교안산병원비뇨기과학교실, 4 순천향대학교병원비뇨기과학교실, 5 전남대학교병원비뇨기과학교실, 6 경북대학교병원비뇨기과학교실, 7 국립경찰병원비뇨기과학교실, 8 건양대학교병원비뇨기과학교실, 9 연세대학교원주기독병원비뇨기과학교실, 0 가톨릭대학교부천성모병원비뇨기과학교실, 충북대학교의과대학예방의학교실, 2 가톨릭대학교서울성모병원비뇨기과학교실 Purpose: A complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for PCa in Korea over a 0-year retrospective period using data from the Korean National Health Insurance System (KNHI). Materials and Methods: Reimbursement records for 874,924 patients diagnosed between 2002 and 204 with primary PCa according to the International Classification of Disease (ICD) 0th revision code C6 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 3 December 204 were evaluated. Results: From 2005 to 204, the total number of PCa patients showed a 3-fold increase. The rate of radical prostatectomy (RP) and androgen deprivation therapy (ADT) remained unchanged at 40% each. RP monotherapy increased from 23.5% in 2005 to 39.4% in 204. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 204. Average total treatment costs in US dollars in the 2 months post-diagnosis were around $8330. Average annual treatment costs thereafter were around $4000. Out-of-pocket expenditure was highest in the first year post-diagnosis (6.% in 2005 and 22.% in 204), and ranged from 2% to 6% thereafter. Conclusion: Between 2005 and 204, a substantial change was observed in the national practice pattern for PCa in Korea. While total treatment costs and out-of-pocket expenditure in the first year after diagnosis showed a slight increase, average treatment costs remained stable thereafter. Keywords: Prostatic neoplasms, Prostatectomy, Radiotherapy, Costs, National health insurance 277

I-006 Percutaneous nephrolithotomy versus ureteroscopic lithotripsy for the management of impacted, proximal ureteral stones: multi-center prospective randomized controlled trials Yan Song ShengJing Hospital of China Medical University Objective: To investigate the difference and relative advantages between percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) for the treatment of large, impacted, proximal ureteral stones. Methods: Patients with single large, impacted, proximal ureteral stones greater than.5 cm in diameter were included in this randomized controlled trial, conducted between August 205 and December 207. Eligible patients were randomized into two groups, based on whether they received PCNL or URSL. Demographic and perioperative data, complication rate, stone free rate, cost, and hospital stay were evaluated. Results: 67 patients (83 in the PCNL group, 84 in the URSL group) were included in this study. No significant difference was detected between two groups concerning the baseline characteristics (age, sex, body mass index, side, et al.). Total operative time was significantly shorter in the PCNL group (65.60±23.07 min vs. 73.64±22.8 min, p=0.03) and the one-step stone free rate was significantly higher (p=0.007) in the PCNL group compared to URSL group (92.88% vs 68.82%). After the ancillary treatments, the final SFR at 3 months was 98.97% in PCNL group and 85.8% in URSL group (p=0.038). Postoperative hospital stay was longer in the PCNL group (5.2±. and 3.8±0.8 days, P<.00), Overall, complication rate is low in both groups and no statistical difference was found in regards to the clinical complications between the two groups (p=0.609). The mean cost of URSL group was significantly higher than that of the PCNL group (US $4936.32±$070.07 vs. US $458.3±$880.44, p=0.08). Conclusions: Both PCNL and URSL are effective and safe surgical options for patients with single large proximal ureter stone. PCNL is a more effective method with a shorter operative time, higher stone free rate compared with URSL. Both techniques are comparable with regards to complication; although URSL had the advantages of shorter postoperative hospital stays the cost is higher with URSL. We suggest that only after discussing and understanding the stone-free success rate, cost-effectiveness, and postoperative complications of these two different treatments with the patients, could we choose the optimal therapeutic modality for large, impacted, proximal ureteral stones. 278

I-007 Low hertz holmium laser enucleation of the prostate 한병규, 문기혁, 정해원, 한준현 2, 장현석 대한비뇨기과의사회장비연구회, 2 한림대학교의과대학비뇨기과학교실목적 : 기술의발전으로많은의료장비들이개발되어다양한임상분야에서이용되고있다. 이에대한비뇨기과의사회에서는장비들의효과적인이용및새로운임상적용분야개발을위해장비연구회를조직하여활동중이다. 그일환으로국내기술로추간판탈출증치료를위해개발된낮은출력 (0 Hz-3.0 J, 30 watt) 의홀뮴레이저를이용한전립선적출술 (HoLEP) 의시행가능성을알아보고자본연구를진행하였다. 대상및방법 : 207년 4월 일부터 6월 7일까지저자들이집도한 HoLEP수술환자를대상으로하였다. 기존의고출력장비인 VersaPulse PowerSuite 00 W (Lumenis Inc. USA) 와저출력장비인 Holinwon 30 (Wontech, Korea) 을이용하여, 통상적인 50 Hz-2.0 J, 00 watt를이용한군 (50 Hz Group, n=22) 과 0 Hz-2.0 J, 20 watt를이용한군 (0 Hz Group, n=23) 으로구분하여수술과관련된인자들을비교하였다. 결과 : 모든환자에서수술은정상적으로완료하였고, 수술중홀뮴레이저장비를교체한경우는없었다. 50 Hz Group 과 0 Hz Group의평균나이는각각 69.3±7.세, 68.±9.세 (p=0.252) 였고, 평균전립선크기는각각 52.4±29.2 g, 57.5±3. g (p=0.873), 평균이행대용적은각각 27.2±24.7 g, 30.9±25.3 g (p=8.8), 평균혈중 PSA는각각 3.8±4.7 ng/ml, 3.3±2.9 ng/ml (p=0.407) 였다. 수술시작부터 Morcellation 전까지시간 (enucleation time) 은 50 Hz Group이평균 38.2±8.0분, 0 Hz Group이 57.2±35.7분으로유의한차이 (p=0.006) 을보였다. 50 Hz Group과 0 Hz Group의적출된선종의평균무게는각각 23.5±2.5 g, 27.5±23.g (p=0.749), 수술전과비교한수술후 일째혈색소의감소수치 (Hb. loss) 는각각 0.9±0.52 g/dl, 0.8±0.67 g/dl (p=0.658) 로유의한차이를보이지않았다. 수술후회복기간동안지연출혈로 clot retention이있었던경우는 50Hz Group에서 례발생하였다. 결론 : 0 Hz-2.0 J, 20 watt의낮은출력의홀뮴레이저를사용하여도전립선선종을분리하고충분한지혈효과를얻을수있었다. 다만, 기존의고출력장비에비해적출시간이유의하게오래필요한만큼, 사전에환자선택에신중해야할것으로판단된다. 또한처음 HoLEP 술기를시작하는술자들에있어낮은출력의장비가학습곡선에미치는영향에관한추가적인연구가필요할것으로생각된다. Keywords: Low hertz, HoLEP, BPH 279

I-008 Could MOTILIPERM improve on acute use of finasteride induced infertility? Keshab Kumar Karna, Kiran Kumar Soni, Bo Ram Choi, Hye Kyung Kim 2, Yu Seob Shin, Jong Kwan Park 전북대학교병원, 2 경성대학교약학대학 The aim of the study was to evaluate spermatogenesis injury in rats exposed to finasteride for 56 days and the efficacy of the novel compound MOTILPERM in regulating infertility. Sixty Sprague-Dawley (SD) rats were divided into the following six groups: CTR (control), M 00 (MOTILIPERM 00 mg kg-), M 200 (MOTILIPERM 200 mg kg-), F (finasteride mg kg-), F + M 00 (finasteride mg kg- + MOTILIPERM 00 mg kg-) and F + M 200 (finasteride mg kg- + MOTILIPERM 200 mg kg-). The rats were treated orally with 00 and 200 mg kg- MOTILPERM alone or in combination with finasteride mg kg- once daily for 56 days. There were no significant effect on body weight, testis weight, epididymis weight, testicular or epididymal sperm counts and sperm motility. Johnsen score and spermatogenic cell density were significantly improved in MOTILIPERM treated group compared to finasteride group (p<0.05). Testicular MDA level was deceased in MOTILIPERM treated group compared to finasteride treated group. Serum testosterone and DHT level were increased significantly in MOTILIPERM treated group (p<0.05). Endoplasmic reticulum (ER) stress and apoptotic activity were not significant in finasteride group compared to control. However, improvement had been observed in MOTILIPERM treated group. These results showed that finasteride group displayed no significant effect in spermatogenesis. Moreover, the present finding support MOTILIPERM may improve hormonal imbalance and prevent ER stress in testis. Keywords: Finasteride, Infertility, MOTILIPERM 280

I-009 Analysis of gene expression characteristics of enzalutamide resistant castration-resistant prostate cancer cells by using RNA sequencing technology 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수 성균관대학교의과대학삼성서울병원 목적 : 차세대남성호르몬차단약제인엔잘루타마이드 (enzalutamide) 저항성거세저항성전립선암 (castration-resistant prostate cancer) 세포에서약제저항성의분자기전및치료표적유전자발굴을위하여차세대염기서열분석법을이용한유전자발현패턴분석및스크리닝을수행하고자하였다. 대상및방법 : Enzalutamide 저항성의 CRPC 세포주제작을위하여 LNCaP 세포주에서기원한 C4-2B 세포주를사용하였다. 세포생존및성장에대한분석을위하여 CCK-9 assay를이용한 cell viability 분석및 clonogenic assay를수행하였다. 유전자발현양에대한전사및번역수준에서의분석을위해 real-time quantitative PCR 및 western blot analysis를수행하였다. Enzalutamide 저항성 CRPC 세포주 (C4-2B EnzR) 의유전자발현패턴분석을위하여차세대염기서열분석법에기반한 QuantSeq 3 mrna sequencing 기법을이용하였다. 생물학적 3반복실험을수행하였고, 유전자발현의 fold change 값이 2배이상이면서 p-value가 0.05 미만인경우통계적으로유의한변화로정의하였다. 결과 : Enzalutamide 저항성 CRPC 세포 (C4-2B EnzR) 와대조군인 C4-2B 세포에 Enzalutamide를, 5, 0 µm의 Enzalutamide를처리하였고, C4-2B EnzR 세포가 C4-2B 세포에비해모든약제처리농도에서세포생존률이높은것으로나타났다. Clonogenic assay에서도 0, 20 µm 처리군에서 C4-2B EnzR 세포는군집이형성된반면, 대조군에서는군집형성이관찰되지않았다. AR 활성화유도체인 DHT을처리하였을때, 남성호르몬 (androgen receptor, AR) 의표적유전자인 KLK2, KLK3 및 TTMPRSS의발현양을비교한결과 Enzalutamide 처리여부와관계없이 C4-2B EnzR 세포에서 AR 표적유전자들이유의하게상승한것이관찰되었다. 또한, Enzalutamide 저항성세포에서 AR-V7의발현이상승한것을 real time-pcr 및 western blot 분석에서확인하였다. Enzalutamide 저항성 CRPC 세포주와대조군세포주에대해 QuantSeq 3 mrna sequencing을수행한결과, C4-2B EnzR 세포주에서총 590개의유전자가 DEG (differential expression gene) 으로추출되었고, 367개의유전자가발현이상승, 223개의유전자가발현이감소한것을확인하였다. DAVID에기반한분석결과발현이상승한군에서는 positive regulation of vascular endothelial growth factor production, 발현이저하된군에서는 cell division이가장순위가높은유전자온톨로지 (ontology) 로나타났다. 결론 : 본연구에서는 enzalutamide 저항성의 CRPC 세포주를안정적으로제작하였으며, 표현형및유전자수준에서 enzalutamide 저항성여부를확인하였다. RNA sequencing 기법을통해유전자발현특성을분석하였으며, 스크리닝을통해핵심표적유전자들을선별적으로가려낼수있었다. Keywords: Castration-resistant prostate cancer, Enzalutamide resistant, RNA sequencing 28

I-00 A novel nomogram for predicting high grade prostate cancer after initial negative results Gang Song Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center of China, Beijing, China Objectives: To develop and internally validate nomograms based on multi-parametric magnetic resonance imaging (mpmri) to predict prostate cancer (PCa) and high-grade prostate cancer (HGPCa) in patients with a previous negative prostate biopsy. Patients and Methods: The clinical and pathological data of 23 patients who underwent repeat prostate biopsy and mpmri were reviewed. Based on Prostate Imaging and Reporting Data System (PI-RADS) version 2 scoring, the mpmri results were assigned a PI-RADS grade from 0-2. Two logistic regression nomograms for predicting the probabilities of PCa and HGPCa were constructed. The performances of the nomograms were assessed using area under the receiver operating characteristic curves (AUCs), calibrations and decision curve analysis. Results: Of the total cohort of patients, on repeat biopsy PCa was detected in 75 (32.5%) and HGPCa was detected in 59 (25.5%). In multivariate logistic regression analysis, age, PSA, PV, DRE and mpmri results were significant independent predictors of the diagnosis of PCa and the diagnosis of HGPCa (all P<0.05). Two mpmri-based nomograms with super predictive accuracy were constructed (AUCs=0.878 and 0.927, both P<0.00), and both exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of probability thresholds. Conclusion: mpmri combined with age, PSA, PV and DRE can predict the probability of PCa and HGPCa in patients with negative initial biopsies. The two nomograms generated may aid the decision-making process in men with prior benign histology before the performance of repeat biopsy. 282

O-2 전립선암환자에서의림프절전이 : 골반림프절절제술결과와비교한술전자기공명영상을이용한탐지 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 오종진, 이상철, 정성진, 홍성규, 변석수, 이상은 분당서울대학교병원비뇨기과학교실 Aim: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). Methods: The data of 528 patients who underwent radical prostatectomy and PLND from 2003 to 207 in our institution were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI and pathologic lymph node metastasis. The prediction model for pathologic lymph node (LN) metastasis was assessed using univariate and multivariate logistic regression analyses and areas under receiver operating characteristic curves (AUCs). Results: The median age of our cohort was 66.4±6.7 years. Positive preoperative MRI finding was observed in 9.4% (45/528) of patients. 5.3% (8/528) patients had confirmed final pathologic lymph node metastases. Sensitivity and specificity of preoperative MRI were 30.8% and 9.7%, respectively. Multivariate analysis showed that preoperative MRI findings and biopsy Gleason score were independent significant predictors for pathologic LN metastasis. Prediction model using preoperative MRI findings and NCCN risk stratification showed fair accuracy using ROC analysis (AUC=0.758) (Fig. ). Conclusion: Preoperative MRI findings for pathologic LN metastasis showed limited prediction value. A large-scale, multicenter, prospective study is needed to fully evaluate the clinical significance of preoperative MRI. Keywords: Prostate, Cancer, MRI 283

O-22 전립선암의근치적전립선절제술후전립선특이항원 nadir 수치와전립선암생화학적재발의연관성 정재용, 전황균 2, 정병창 2, 서성일 2, 이현무 2, 최한용 2, 전성수 2 성균관대학교의과대학 강북삼성병원비뇨기과학교실, 2 삼성서울병원비뇨기과학교실 Objective: Examined the ability of PSA nadir to predict biochemical recurrence after radical prostatectomy (RP) of prostate cancer. Material and Method: From 994 to 202, 2434 men treated with RP were followed with PSA measurements at 3, 6 and 2 months, and every six months or every year thereafter. Excluding patients with adjuvant therapy or resection margin positive, 728 (7%) patients underwent analysis and stratification by PSA nadir. Biochemical recurrence was defined as 2 consecutive increasing post-nadir PSA measurements of 0.2 ng/ml or greater. Result: A 255 of 728 men (4.8%) experienced biochemical recurrence with a mean time to recurrence of 33.8 months. Mean time to PSA nadir was 6.4 months. Biochemical recurrence rates in men with a PSA nadir of 0.0-0.02 (n=438), 0.03-0.04 (n=73), 0.05-0.09 (n=80) and 0.-0.9 ng/ml (n=37) were 8.8%, 28.9%, 56.3% and 9.9%, respectively. Men with a nadir of 0.0-0.02 ng/ml had a statistically significantly lower biochemical recurrence rate than men with a nadir of 0.03-0.04 (p<0.0), 0.05-0.09 (p<0.0) or 0.0-0.9 ng/ml (p<0.0) on Kaplan-Meir survival analysis. Multivariate logistic regression analysis showed that a nadir of 0.03-0.04 (HR 4.49, p<0.0), 0.05-0.09 (HR.49, p<0.0) and 0.0-0.9 ng/ml (HR 45.26, p<0.0) independently predicted an increased risk of biochemical recurrence compared to a nadir of 0.0-0.02 ng/ml. Conclusion: PSA nadir group predicts the risk of biochemical recurrence following RP. Higher nadir points may identify candidates for early adjuvant or salvage therapies. Keywords: PSA nadir, Biochemical recurrence, Radical prostatectomy 284

O-23 전립선수술을시행한 positive surgical margin 환자들에서생화학적재발인자로서의 cribriform pattern 구자윤 부산대학교의과대학비뇨기과학교실 Objective: To investigate the relationship between cribriform pattern and biochemical recurrence of positive surgical margin patients. Methods: This study was based on 87 radical prostatectomy specimens (margin positive status; 65) collected at our center, from 2003 to 206. We compared and analyzed age, body mass index, preoperative prostate-specific antigen (PSA) and Gleason score (GS), OP methods, postoperative GS, pathology T stage, pathology tumor percentage, lymphatic invasion status and perineural invasion status, nadir PSA, positive margin area and length, cribriform pattern status, positive margin GS associated with biochemical recurrence (BCR). Results: Overall, 9% (3/46) of margin positive patients were identified as cribriform pattern (CP). In Cox regression model, preoperative PSA, postoperative GS, pathology tumor percentage, positive margin area and length, the presence of the CP were predictive factors of BCR, respectively (P=0.048, 0.022,<0.00, 0.009, 0.002, 0.037) (Table ). Moreover, We observed BCR two times more frequently in patients with the CP than in those without the CP (p=0.005) (Figure ). Conclusion: We suggest that the cribriform pattern has highly value in predicting BCR in positive surgical margin patients. Keywords: Cribriform, Oncology outcome, BCR 285

O-24 Adverse features and biochemical recurrence free survival in men with high-risk prostate cancer Jung Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital Objectives: To assess biochemical recurrence free survival (BCRFS) in prostate cancer (PCa) patients following radical prostatectomy (RP) through a combination of pathological adverse features (AF). Methods: Using a prospectively collected institutional registry, we identified patients with high-risk PCa who underwent RP between 2009 and 206. Patients treated with neoadjuvant therapy and those lacking clinical, pathologic, and follow up data were excluded. The final population consisted of 252 patients with at least one AF: preoperative PSA 20 ng/ml, pathologic Gleason score 8 and no organ-confined disease at final pathology (seminal vesicle involvement, and/or extracapsular extension, and/or lymph node invasion). Kaplan-Meier analyses were used to assess BCRFS rates by stratifying patients into 3 risk categories according to the number of AFs (namely,, 2, and 3 AFs). Multivariable competing risk Cox regression analyses were used to assess BCRFS. Results: Overall, 27 (50.4%) men had AF, 8 (32.%) had 2 AFs and 44 had 3 AFs (7.5%). The median follow up duration was 30 months (IQR 9, 45). Men with AF had higher BCRFS estimates compared to those with 2 and 3 AFs (7.0% vs. 32.3% vs. 3.4% at 3 years follow-up, p<0.00 - Figure). At multivariate competing risk Cox regression analyses, the presence of 3 AFs (HR 9.8, p<0.00), 2 AFs (HR 3., p<0.00), adjuvant radiation plus androgen deprivation therapy (HR 0.65, p=0.007) were independent predictors of BCRFS. Conclusions: The risk group stratification according to the number of AFs was fairly simple, however, it could help physicians to accurately predict oncologic outcomes. The patientst with high-risk PCa could have a relatively good prognosis if he had only one AF. Keywords: Prostate, Cancer, Survival 286

O-25 전립선암환자에서전립선절제술후늦게발생한생화학적재발의임상적의미 박사현, 임고산, 김명, 송채린, 안한종울산대학교서울아산병원 Purpose: We aimed to analyze the clinical characteristics of delayed biochemical recurrence (BCR) after RP. We examined radiographic progression and cancer-specific survival according to timing of the BCR. Materials and Methods: From March 998 to December 205, a total of 2398 patients who underwent RP were evaluated. BCR, radiographic progression, and cancer-specific deaths of all patients were investigated. Patients receiving adjuvant therapy were excluded from this study. Radiographic progression was assessed at regular intervals following RP including prostate-specific antigen test, radionuclide bone scan, abdominopelvic CT. Early, mid, and late BCR was defined as two consecutive rising PSA levels 0.2 ng/ml after RP at<2, 2-5, and 5 years, respectively. Results: Overall 5-year and 0-year BCR-free survival rates were 75.3% and 60.9%. Overall 5-year and 0-year radiographic progression-free survival rates were 95.8% and 85.5%. Of the 559 patients with BCR, early, mid, and late BCR occurred in 322 (57.6%), 6 (28.8%), and 76 (3.6%) patients. In patients with radiographic progression, distant metastasis was observed 84.9%, 64.3%, and 37.5% in early, mid, and late BCR group, while local recurrence was 5.%, 35.7%, and 62.5%, respectively. From the BCR, 5-year radiographic progression-free survival rates were 66.0% in early, 76.0% in mid, and 8.2% in late BCR group, respectively (p=0.020). From the BCR, 5-year distant metastasis-free survival rates were 70.7% in early, 84.2% in mid, and 96.3% in late BCR group, respectively (p<0.00). From the BCR, 0-year cancer-specific survival rates in early, mid, and late BCR group were 7.0%, 88.5%, and 00%, respectively (p<0.00). Conclusions: The later BCR occurs after RP, the lower the risk of radiographic progression and cancer-specific death. However, radiographic progression can occur in patients with BCR 5 years after RP. Careful clinical evaluation should be performed even in patients with late BCR. Keywords: Prostatic neoplasms, Prostatectomy, Recurrence 287

O-26 전립선적출술후보조방사선요법, 조기구제방사선요법, 지연구제방사선요법의종양학적성적비교 : 다기관연구 김명, 박사현, 임고산, 전황균 2, 전성수 2, 송완 2, 김태헌 2, 곽철 3, 정창욱 3, 변석수 4, 이상철 4, 김종욱 5, 박홍석 5, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 3 서울대학교병원비뇨기과학교실, 4 분당서울대학교병원비뇨기과학교실, 5 고려대학교구로병원비뇨기과학교실 Purpose: There has been a debate on the superiority of adjuvant radiotherapy over early salvage radiotherapy (RT) after radical prostatectomy (RP) for prostate cancer. We compared the oncologic outcomes among the adjuvant RT, early salvage RT and delayed salvage RT groups. Materials and Methods: Data from,93 patients who underwent RT after RP at five tertiary referral centers in 998-206 were collected. Early salvage RT was defined as administration of RT after biochemical recurrence (BCR; PSA range at commencement of RT; 0.2-0.5 ng/ml) without evidence metastatic disease. Delayed salvage RT was defined as commencement of RT when PSA was greater than 0.5 ng/ml. Results: After excluding 425 patients (35.6%) due to history of other malignancy, neoadjuvant hormone therapy, node positive diseases, persistent PSA following RP, incomplete data and lost to follow-up, 768 patients were included in this study. Adjuvant RT, early salvage RT and delayed salvage RT were given in 98 patients (2.8%), in 4 (53.5%) and 259 patients (33.7%), respectively. During median 83. months of follow-up after RP, 232 patients (30.2%) experienced the BCR, and 89 (.6%) had radiographic progression. Patients in adjuvant RT group tended to have greater preoperative PSA, higher pathologic T stage, and more frequent positive surgical margins, than those in early or delayed salvage RT groups. After controlling PSA, surgical Gleason score, pathologic T stage, percentage of tumor volume, positive surgical margin, and administration of concomitant ADT using propensity scored matching, three group showed similar 7-year BCR-free survivals (52.5 vs. 65.5 vs. 56.9, p=0.443) and 7-year radiographic progression-free survivals (83.6 vs. 83. vs. 86.8%, p=0.835) from the RP. Of the delay salvage RT group, patients who received RT when PSA was greater than.0 ng/ml demonstrated poorer BCR-free (7-year rates: 66.4 vs. 35.3%, p=0.052) and radiographic progression-free survivals (90.9 vs. 76.7%, p=0.88) than patient who started the RT when PSA was between 0.5 and.0 ng/ml without statistical significance. Conclusions: There was no significant difference in the survival outcomes from the date of prostatectomy, among the adjuvant, early salvage, and delayed salvage RT groups. However, we believe that the salvage RT should be commenced before the PSA level rises to.0 ng/ml. Keywords: Prostate cancer, Radiotherapy, Oncological outcome 288

O-27 전립선암희귀변이에대한연구 오종진, Manu Shivakumar 2, Jason Miller 2, Shefali Verma 2, 이학민, 홍성규, 이상은, 김도균 2,3, 변석수 서울대학교의과대학분당서울대병원비뇨기과학교실, 2 Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, Pennsylvania, USAB, 3 The Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA Introduction: We investigate prostate cancer related rare variants among 985 prostate cancer patients and 6,273 normal population. Material and Methods: We prospectively recruited 985 prostate cancer patients from single tertiary hospital and conducted a case-control study including 6,273 controls from the Korean Association Resource (KARE) study as part of the Korean Genome and Epidemiology study (KoGES). All included subjects were analyzed using using the HumanExome BeadChip 2v- system (Illumina, Inc.; San Diego, CA), which includes 23,099 probes focused on protein-altering variants (nonsynonymous,stop and splice) selected from exome and whole-genome sequences. The rare variants analysis using variants with low minor allele frequency (<5%) was conducted to find prostate cancer association. Results: The rare variants were fist collapsed into gene bins and intergenic region bins and applied a dispersion test using SKAT to identify rare variants on 34 genes associated with prostate cancer in the Korean population (Figure & Table ). Finally, in a separate analysis, rare variants were binned into their respective pathways. Many significant genes and marginally significant pathways were identified, some of which have been already implicated in Prostate cancer. Conclusions: Taken together, our findings suggest that identified rare variants may play a crucial role as prostate cancer susceptibility genes in the Korean population. Keywords: Prostate, Prostate cancer, Rare variants 289

O-28 근치적전립선적출술을시행받는환자의불안과우울에대한분석 : 다기관, 전향적연구 조희주, 김상진 2, 문경태, 조정만, 류재현 2, 김윤범 2, 정태영 2, 고우진 3, 유탁근, 김덕윤 4 을지병원, 2 중앙보훈병원, 3 국립암센터, 4 대구가톨릭대학교병원 목적 : 전립선암을진단받고근치적전립선적출술을시행받는환자가수술전후에느끼는불안, 우울함의정도를분석한다. 대상및방법 : 206년 월부터 207년 4월까지전립선암을진단받고근치적전립선적출술을시행한환자중수술전정신과적질환이없는환자를대상으로수술전, 수술 개월후디스트레스온도계 (DT), Hospital anxiety and depression scale (HADS), 심리증상평가지를이용하여불안과우울의정도를정량적으로분석하였다. 디스트레스온도계는환자의스트레스정도를 0에서 0까지표시하며 4이상인경우유의한스트레스로판단한다. HADS는불안과우울항목 (subscale) 으로구성되어각각의 subscale이 8점이상인경우의유의함으로판정한다. 심리증상평가지는불면, 불안, 우울의정도를정량화하며이러한증상에대해환자스스로 전문의료진의도움을원하는가? 라는질문을포함한다. 결과 : 총 3개의기관에서 48명의환자가연구에참여되었다. 수술전 DT의평균은 3.96±2.57 였으며임상적으로유의한환자 (DT 4) 는 27명 (56.3%) 이었다. HADS의평균값은.4±7.3였으며임상적으로유의한불안 (anxiety subscale 8) 혹은우울함 (depression subscale 8) 을호소하는환자는 20명 (4.7%) 였다. 수술후 DT, HADS의평균은각각 2.97±2.67, 8.0±7.로유의하게감소하였으며 (p<0.05) DT가 4 이상이거나유의한불안혹은우울함을호소하는환자의비율도각각 22명 (45.8%), 5명 (0.4%) 으로유의하게감소하였다 (p<0.05). 심리증상평가에서수술전불면, 불안, 우울증상으로나타낸사례는총 9명에서각각 7건, 9건, 7건이었으며전체환자중 7명의환자가불면, 불안, 우울에대해전문의료진의도움을원한다고답했다. 수술후유의하게이러한증상의호소가감소하였으나 (8명의환자, 불면 5건, 불안 4건, 우울 4 건 ) 2명의환자가여전히전문의료진의도움이필요하다고답했다. 결론 : 근치적전립선적출술시행전후많은환자들이임상적으로유의한수준의디스트레스, 불안, 우울, 불면등을호소하였으며전문의료진의도움을원하였다. 전립선암수술전후환자의심리상태에대한적극적인검사와지지치료가필요하다고생각된다. Keywords: 전립선암, 우울, 불안 290

O-29 Health-related quality of life (HRQoL), perceived social support, and depression in disease-free survivors of surgically treated prostate, kidney and bladder cancer 신현빈, 박현식, 신동욱 2, 이상협 3, 전승현 3, 조석 4, 강석호 4, 박승철 5, 박종혁 6, 박진성 을지대학병원, 2 성균관대학교의과대학삼성서울병원, 3 경희의료원, 4 고려대학교안암병원, 5 원광대학교부속병원, 6 충북대학교병원 Purpose: Although the number of urological cancer (UC) survivors has increased and their HRQoL became important issues, few studies adequately examined general QoL issues of UC survivors. We aimed to assess HRQoL of disease-free prostate cancer (PC), kidney cancer (KC) and bladder cancer (BC) survivors, and compare them with those from the general population. Materials and Methods: A total of 33 UC patients (PC 4, 08 KC, and 09 BC) 50 years who had undergone curative surgery and no evidence of recurrence for at least year after surgery were included. As a control,,77 subjects without a history of cancer were randomly selected from general Korean population. HRQoL was compared among 3 UC survivors and between each type of cancer and general population with the EORTC QLQ-C30, Patient Health Questionniare-9 and Duke-UNC Functional Social Support Questionnaire. Results: PC, KC, and BC survivors were not different with all domains of functioning and symptom scales, except for slight but significant difference in social functioning between KC and BC survivors (89.5 vs. 80.6, P=0.02). Three groups were neither different for depression nor functional social support. When compared to matched general population, PC and BC survivors showed lower social functioning and lower appetite problem than control, while KC survivors showed lower physical functioning as well as higher pain and dyspnea symptom. All three UC survivors reported higher financial difficulties, but also higher perceived social support than control. When examined by time elapsed from curative surgery, some different patterns were observed by cancer type (Figure ). Conclusion: While HRQoL issues were generally similar among disease-free UC survivors, different patterns were noted according to UC type, compared with general population. Our results will be valuable to both urologists and patients by providing HRQoL information following surgery, and planning future supportive care needs. Keywords: Urologic cancer, Quality of life, Disease-free survivors 29

O-220 Changes of health-related quality of life (HRQOL) in prostate cancer patients after radical prostatectomy: a longitudinal cohort study in Korea 박현식, 신현빈, 신동욱 2, 이상협 3, 전승현 3, 윤석중 4, 박승철 5, 남종길 6, 김태환 7, 정승일 8, 박진성 을지대학병원, 2 성균관대학교의과대학삼성서울병원, 3 경희의료원, 4 충북대학교병원, 5 원광대학교부속병원, 6 양산부산대학교병원, 7 경북대학교병원, 8 전남대학교병원 Purpose: We aimed to investigate HRQOL change after open, laparoscopic and robotic radical prostatectomy (RP), and compare HRQOL of surgically treated prostate cancer (PC) patients with that of age-matched general population. Materials and Methods: In this multicenter prospective longitudinal cohort study, patients who underwent RP for PC at 7 medical centers between October 204 and December 205 were enrolled. To measure HRQOL, the EORTC QLQ-C30 and PC-specific module (PR25) were administered at baseline, postoperative 3 and 2 months. Generalized estimating equation were used after adjusting baseline characteristics, and HRQOL was compared between PC patients and general population after : propensity score matching. Results: Among 258 screened PC patients, 209 (4 open, 63 laparoscopic, and 05 robotic) were included. Overall HRQOL change of PC patients following surgery are shown in Table. Comparison of general QOL by surgery type showed that emotional and social function at 2 months was significantly lower after laparoscopic RP compared to open RP, while fatigue, pain, insomnia and appetite loss symptoms at 2 months significantly improved after open RP, compared to laparoscopic or robotic RP. Comparison of PC-specific QOL showed that sexual activity at 3 months after laparoscopic and robotic RP were significantly better than open RP, but it became similar at 2 months. Meanwhile, physical, role, and social function of PC patients were significantly deteriorated at 3 months compared to general population, while physical and role function became similar between the two groups at 2 months. Notably, overall QOL of PC patients was better than general population at 2 months after surgery. Conclusion: While patients undergoing different type of surgery showed slightly different recovery pattern, HRQOL of PC patients generally recovered over 2 months, similar to general population except social function. Keywords: Prostate cancer, Quality of life, Radical prostatectomy 292

O-22 신장암병기결정을위해수술전흉부전산화단층촬영 (CT) 을어느경우시행하여야하는가? 강준구, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김태환, 유은상, 권태균, 정성광, 김현태 경북대학교의과대학비뇨기과학교실 Objectives: To provide objective criteria for preoperative staging chest computed tomography (CT) in patients diagnosed with renal cell carcinoma (RCC) because, in the absence of established indications, the decision for preoperative chest CT remains subjective. Patients and Methods: A total of 439 patients undergoing surgical treatment of RCC from Jan 20 to Dec 206 were collected, retrospectively. The outcome of the study was presence of pulmonary metastases at staging chest CT. A multivariable logistic regression model predicting positive chest CT was fitted. Predictors consisted of preoperative clinical tumor (ct) and nodal (cn) stage, presence of systemic symptoms and platelet count (PLT)/ hemoglobin (Hb) ratio. Results: The rate of positive chest CT was 0.3% (n=45). At multivariable logistic regression, ctb and systemic symptoms were associated with higher risk of positive chest CT (all P<0.05). Using ROC curve, optimal cutoff value was 40 mm (sensitivity 95.6% and specificity 56.9%). Conclusions: The findings of the present study support a recommendation for chest CT in patients with ctb, systemic symptoms. Keywords: Renal cell carcinoma, Clinical staging, Pulmonary metastases, Chest computed tomography 293

O-222 신장피질봉합을생략한로봇부분신절제술의실행가능성 : 예비연구 강성민, 성재우, 양종협, 조신제, Fahad Bashraheel, 정현철, 박용현, 배웅진, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교의과대학비뇨기과학교실 목적 : 부분신절제술시신장조직을봉합하는과정에서봉합사에끼이게된신장조직은혈류공급이감소하여허혈손상이발생하여신기능이감소할위험성이있다. 이에저자들은신기능을최대한보존하기위한방법으로, 로봇부분신절제술시종양절제후신장수질만봉합하고피질봉합을생략하는방법을시행하였다. 대상및방법 : 206년 2월부터 207년 5월까지본원에서신종양으로단일술자에의한신장피질봉합을생략한로봇부분신절제술을시행받은 0명을대상으로병리학적결과, 수술전 / 후신장의용적및기능의변화, 부작용등에대하여후향적으로조사하였다. 신장의용적은 CT를이용하여측정하였으며, 수술전 / 후로 DTPA renal scan을통하여신장의기능을측정하였다. 결과 : 술전 R.E.N.A.L. Nephrometry score는저위험군과중등도위험군이각각 2명 (20%) 및 8명 (80%) 이었다. 종양의크기는평균 3.76±.3 cm (2.0-6.0) 이었으며, 콘솔시간은평균 85.2±0.7분 (6-05) 이었다. 수술중허혈시간은 2.3±4.2 분 (3-27) 이었다. 수질봉합이후재관류시출혈을보여피질봉합을시행한것은 4례 (40%) 이었고, 수술후요누출은관찰되지않았으며출혈로인한수혈은 례 (0%) 로혈관색전술을시행하였다. 조직검사결과모든환자에서신장암으로진단되었으며, 절제면양성소견은보이지않았다. 수술전신장의용적에서절제용적을제외한용적은평균 60.4±28.3 cm 3 (96.-205.7) 이었으며, 수술후신장의용적은평균 43.0±6.8 cm 3 (28-79) 으로, 수술후회복과정에서평균 7.4 cm 3 의용적감소 (7.04%) 를보였다 (p=0.28). 수술시행한신장의수술전 / 후 GFR은평균 7.8 ml/min (33.3%) 감소하는양상을보였다. 결론 : 신장피질봉합을생략한로봇부분신절제술은시행이가능하였다. 향후봉합방법에따른수술전 / 후용적및신기능의변화에대한추가적인전향적연구가필요할것으로생각된다. Keywords: Renal cell carcinoma, Robot-assisted partial nephrectomy, Cortical renorrhaphy 294

O-223 Ta 신세포암에서복강경하고주파열치료의종양학적및신기능적장기추적관찰결과보고 이재근, 박종목, 나용길, 송기학, 임재성 충남대학교병원의과대학비뇨기과학교실 Purpose: Few studies report long-term outcomes of renal cell carcinoma treated by laparoscopic radiofrequency ablation (RFA). We reviewed our experience with Ta renal cell carcinoma treated with laparoscopic RFA. Materials and Methods: A total of 62 patients with Ta renal cell carcinoma treated between January 2005 and October 204 were identified from a retrospective review. Patients with biopsy confirmed Ta renal cell cancer and a follow up period >48 months were included in our analysis. Local recurrence, metastasis, survival rate and change in glomerular filtration rate (GFR) were analyzed. Results: The mean (range) follow-up for the laparoscopic RFA was 60 (30-04) months. The respective mean tumor size was 2.4 (±0.66). The laparoscopic RFA patients did not significantly differ in terms of the change in mean egfr (relative to preoperative values) at -2 weeks after surgery or at the last follow up. There were not local recurrences, metastasis and disease-specific deaths. The 5-year overall survival was 98%, cancer-specific survival was 00%, and recurrence-free survival was 00%. Conclusions: This data showed that laparoscopic RFA for Ta renal cell carcinoma has comparable oncological and functional outcomes. Keywords: Kidney neoplasms, Laparoscopy, Radiofrequency albation 295

O-224 근치적신장절제술을시행한신세포암환자에서수술전후예후영양지표변화양상의예후적가치 장춘태, 강민용, 성현환, 전황균, 정병창, 서성일, 전성수, 최한용, 이현무 성균관대학교의과대학삼성서울병원비뇨기과학교실 Purpose: To examine the prognostic role of prognostic nutritional index (PNI) dynamics in the pre- and postoperative periods in patients with renal cell carcinoma (RCC) who underwent radical nephrectomy (RN). Materials and Methods: We analyzed 324 patients with RCC who underwent RN. Overall population was classified into 4 groups according to 4 types of pre- to postoperative PNI dynamics as follows: Group (low low PNI), 2 (low high PNI), 3 (high low PNI) and 4 (high high PNI). The level of PNI was calculated using the following formula: 0 serum albumin level (g/dl)+0.005 absolute lymphocyte counts in blood (/mm 3 ). Primary and secondary endpoints were cancer-specific survival (CSS) and overall survival (OS), respectively. Results: Patients with higher pre- and postoperative PNI (>45) had better survival outcomes than those with lower pre- and postoperative PNI ( 45) (Fig -2). Notably, patients in Group 4 (high high PNI) showed the best CSS and OS rates, whereas patients in Group (low low PNI) had the worst survival outcomes. Furthermore, PNI dynamics was identified as an independent predictor for CSS and OS outcomes, in addition to pre- and postoperative PNI, tumor size, and pt stage. Patients with localized RCC ( pt2) showed significant differences in both CSS and OS estimates, while patients with advanced pt stage ( pt3) demonstrated a difference only in OS outcomes, according to PNI dynamics. Conclusions: Our study is the first that provides the independent prognostic importance of dynamics of nutritional status for patients with RCC. Keywords: Renal cell carcinoma, Radical nephrectomy, Prognostic nutritional index 296

O-225 단일 3 차대형병원에 년동안내원한신세포암환자 3076 례의보고 - (2) 병기및치료에따른예후및생존률 나준채, 윤민지, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 본연구는단일 3차대형병원에내원한신세포암환자들의예후를분석하고자하였다. 이에 년동안신세포암으로본원에내원한환자군의병기에따른치료후의생존률에대하여조사하였다. 대상및방법 : 2005년 월 일이후본원에내원한환자중신세포암을진단받은모든환자들의나이, 성별, 진단일, 치료방법및치료결과, 영상검사, 조직병리검사, 사망일등을조사하였다. 결과 : 신세포암환자의 5년-overall survival (OS) 는 I기 94.5%, II기 85.0%, III기 70.0%, IV기 2.2% 였으며, 0년 OS는 I 기 85.4%, II기 6.6%, III기 47.2%, IV기 6.0% 였다 (Fig. A). 5년-cancer specific survival (CSS) 는 I기 97.%, II기 87.0%, III기 73.7%, IV기 3.2% 였으며, 0년-CSS는 I기 88.5%, II기 63.0%, III기 50.2%, IV기 6.4% 였다 (Fig. B). I, II기에서의 cell type에따른생존률은 clear cell type이 non-clear cell type과비교하여유사하거나더낮았으나, Stage IV의 cell type 에따른 median OS는 clear cell type 9.2개월, papillary type 3.2개월, chromophobe type 0.8개월이었다. 항암치료를시작한이후의 median OS은 clear cell type 30개월, papillary type 5.6개월이었다. I기환자의부분신절제술과근치적신절제술후예후를비교한결과평균OS는 Ta에서각각.4년대 0.8년, Tb에서.7년대 0.9년으로 Ta의경우부분신절제술에서예후가더좋았으나 (p=0.00, Fig. C, D), 평균CSS는 Ta에서각각.6년대.5년, Tb에서각각.6년대.3년으로두군사이의유의한차이가없었다 (Fig. E, F). 결론 : 신세포암의저병기생존률은높으나, 다양한표적치료의개발에도불구하고전이성신세포암은예후가매우불량하였다. I기환자에서신절제법에따른예후를비교하였을때부분신절제술이근치적신절제술에비해 OS는일부좋았으나 CSS는차이가없었다. Keywords: Renal cell carcinoma, Survival, Prognosis 297

O-226 Effect of diverse histologic differentiation on the oncological outcomes of patients with upper urinary tract carcinoma after radical nephroureterectomy: the korean multi-institutional results 오주용, 오정훈, 손수민, 류지원, 박태주, 김태희, 은성종, 김명수, 정호석, 황의창, 정승일, 권동득, 김종범, 조양현, 오경진, 김선옥, 강택원, 박광성, 최석환 2, 권태균 2, 김준석 3, 노준화 3, 유재형 4, 김명기 4, 조원진 5, 강성구 6, 강석호 6, 전준 6, 오태훈 7, 서일영 7, 정홍 8, 김홍섭 8, 이찬호 9, 구자윤 9, 하홍구 9, 김병훈 0, 정창욱, 구자현, 곽철, 김현회 전남대학교의과대학비뇨기과학교실, 2 경북대학교의과대학비뇨기과학교실, 3 광주기독병원비뇨기과, 4 충북대학교의과대학비뇨기과학교실, 5 조선대학교의과대학비뇨기과학교실, 6 고려대학교의과대학비뇨기과학교실, 7 원광대학교의과대학비뇨기과학교실, 8 건국대학교의과대학비뇨기과학교실, 9 부산대학교의과대학비뇨기과학교실, 0 계명대학교의과대학비뇨기과학교실, 서울대학교의과대학비뇨기과학교실 Purpose: To determine the prognostic effect of upper tract urothelial carcinoma (UTUC) with diverse histologic differentiation after radical nephroureterectomy (RNU). Methods: A total of 73 patients who received RNU for UTUC without neoadjuvant chemotherapy in institutions between 2002 and 206 were retrospectively reviewed. Clinicopathological variables, recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) were compared between patients with pure UTUC and patients with UTUC with diverse histologic differentiation. Univariable and multivariable cox proportional regression model were used to determine independent variables associated with oncological outcomes. Results: The UTUC with diverse histologic differentiation was associated with aggressive clinicopathological features and shorter RFS, CSS, and OS (log rank, p=0.00) compared with pure UTUC. In addition, multivariable analysis demonstrated that diverse histologic differentiation was independently associated with poor RFS (hazard ratio [HR]=.59; 95 CI:.20-2.2; p=0.00), CSS (HR=2.60; 95 CI:.63-4.7; p=0.00) and OS (HR=2.04; 95 CI:.35-3.08; p=0.00). However, in patients who received adjuvant chemotherapy, the differences in RFS, CSS and OS was not significant by Kaplan Meier survival analysis. Conclusions: Our multi-institutional results suggested that UTUC with diverse histologic differentiation associated with poor oncological outcomes compared with pure UTUC. However, adjuvant chemotherapy would be helpful to increase survival in these patients. Keywords: Upper tract urothelial carcinoma (UTUC), Diverse histologic differentiation 298

O-227 Development of the clinical calculator for mortality of patients with metastatic renal cell carcinoma: an analysis of patients from Korean renal cancer study group database 박재영, 정창욱 2, 송채린 3, 서성일 4, 정진수 5, 홍성후 6, 황의창 7, 곽철 2, 서일영 8, 박수연 9 ; 한국신장암연구회 고려대학교안산병원, 2 서울대학교병원, 3 울산대학교서울아산병원, 4 성균관대학교의과대학삼성서울병원, 5 국립암센터, 6 가톨릭대학교서울성모병원, 7 화순전남대학교병원, 8 원광대학교부속병원, 9 순천향대학교의학통계학과 Purpose: To develop the clinical calculator for mortality of patients with metastatic renal cell carcinoma (mrcc) using Korean Renal Cancer Study Group (KRoCS) database. Materials and Methods: Data from 5 patients with mrcc treated in 4 hospitals joining KRoCS between 993 and 206 were pooled. Three-, and 5-year mortality rates were calculated using Kaplan-Meier curve. A calculator (nomogram) for 3- and 5-year mortality were developed and validated internally using multivariable logistic regression analysis. Results: Mortality rates were 56.9% at 3 years and 7.5% at 5 years. Among baseline factors, synchronous metastasis pattern, neutrophil-lymphocyte ratio, low albumin (<3.9 g/dl), high corrected Ca (>9.2 mg/dl), and number of metastasis ( 2) were the significant factors in 3-year mortality calculator. In 5-year mortality calculator, synchronous metastasis pattern, neutrophil-lymphocyte ratio, low albumin (<3.9 g/dl), and high corrected Ca (>9.2 mg/dl) were proven to be the significant factors. Good internal validity was demonstrated, with area under the curve estimates being 0.73 and 0.76 at 3- and 5-year mortality calculation, respectively (Fig ). Conclusion: A clinical nomogram has been developed to quantify the risk of death for individual patients after treatment of mrcc. This tool may be useful for patients or their guardians who want to know their prognosis and to identify patients requiring aggressive therapy and additional supportive measures during and after treatment. Keywords: Metastatic renal cell carcinoma, Mortality, Calculator 299

O-228 혈액투석중인환자와신이식을받은환자에서발생한신세포암의병리학적특징및종양학적결과비교 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 Introduction: We compared the clinical features, pathologic features, and oncologic outcomes of patients with renal cell carcinoma (RCC) which newly arose after hemodialysis (HD) and kidney transplantation (KT). Materials and Methods: We defined RCC-HD group as patients newly diagnosed with RCC on HD and RCC-KT group as those who underwent KT in our institution before. Of 4326 patients who underwent KT in our institution, 24 (0.6%) patients were newly diagnosed with RCC after surgery. After excluding patients with metastatic RCC and those who did not underwent surgery for RCC, 40 patients in the RCC-HD group and 22 patients in the RCC-KT group were finally included.in the analysis. We divided histologic types of RCC into clear cell RCC, acquired cystic disease-associated RCC, and other RCC. We compared clinical and pathologic features between two groups, and the impacts of those on survival were assessed using multivariate analysis. Mean follow-up duration was 5 months. Results: The mean duration of hemodialysis was 8 months in the RCC-HD group and 53 months in the RCC-KT group (p=0.079). The mean duration from kidney transplantation to nephrectomy in the RCC-KT group was 8 months. Sex predominance, age, body mass index, or follow-up duration were not significantly different between two groups. The RCC-HD group had higher incidences of acquired cystic disease-associated RCC compared to the RCC-KT group (2.% vs. 4.5%, p=0.002), but there were no significant differences in tumor size, Fuhrman grade, pathologic T stage, regional node metastasis, or lymphovascular invasion between two groups. 5-year overall survival (OS) rate was 72.9% and 82.5% (p=0.346), and 5-year cancer-specific survival (CSS) was 94.2% and 93.8% (p=0.99) in the RCC-HD and RCC-KT group, respectively. In multivariate analysis, diagnosis of acquired cystic disease-associated RCC in addition to kidney transplantation and hemodialysis were not predicting factors of OS and CSS. Conclusions: More patients were diagnosed with acquired cystic disease-associated RCC in RCC-HD group than RCC-KT group, but OS and CSS were not significantly different between RCC-HD and RCC-KT groups. Keywords: Kidney transplantation, Renal cell carcinoma, Hemodialysis 300

O-229 Efficacy of first line targeted therapy in real world Korean metastatic renal cell carcinoma patients: focused on sunitinib and pazopanib Ju Yong Oh, Jeong Hoon Oh, Taeju Park, Myung Soo Kim, Ho Seok Chung, Seung Il Jung, Dong Deuk Kwon, Jong Bum Kim, Yang Hyun Cho, Kyung Jin Oh, Sun-Ouck Kim, Taek Won Kang, Kwangsung Park, Jun Eul Hwang 2, Woo Kyun Bae 2, Jae Young Park 3, Chang Wook Jeong 4, Cheol Kwak 4, Cheryn Song 5, Hwang Gyun Jeon 6, Seong Il Seo 6, Seok-Soo Byun 7, Sung-Hoo Hong 8, Jin Soo Chung 9, Eu Chang Hwang 화순전남대학교병원 비뇨기과학교실, 2 혈액종양학교실, 3 안산고려대학교병원비뇨기과학교실, 4 서울대학교병원비뇨기과학교실, 5 서울아산병원비뇨기과학교실, 6 성균관대학교삼성병원비뇨기과학교실, 7 분당서울대학교병원비뇨기과학교실, 8 강남성모병원 비뇨기과학교실, 9 국립암센터비뇨기과학교실 Purpose: The aim of this study was to evaluated survival outcomes and prognostic factors for overall survival in patients with metastatic renal cell carcinoma who received sunitinib and pazopanib as first line therapy. Methods: A total of 2 patients who received sunitinib or pazopanib at 7 institutions from 2007 to 206 were retrospectively reviewed. The patients were grouped into sunitinib (n=827) or pazopanib (n=294) cohorts by the targeted therapy. Clinicopathological variables and survival rates were compared between the 2 groups. The multivariable-adjusted cox proportional harzard model was used to determine the prognostic factors for overall survival. Results: The median follow up was 20.2 months (interquartile range, IQR: 9.4-39.). The pazopanib group was more older and poor performance status ( 2). The dose reduction rate and grade 3 toxicity were high in sunitinib group. The objective response rates were comparable between two groups (sunitinib: 34.4% vs. pazopanib: 36.8%) Overall survival was significantly longer in pazopanib group (35.7 month vs. sunitinib: 24.8 month, log-rank, p=0.00). Body mass index, synchronous metastasis, Heng risk criteria (intermediate and poor), lung, liver, lymph node, bone metastases, sunitinib, dose reduction and drug interruption were associated with shorter overall survival. Conclusions: Our real world data from Korean metastatic renal cell carcinoma suggested that along with previous prognostic factors, sunitinib, dose reduction and drug interruption were associated shorter overall survival. This phenomenon was probably due to the high dose reduction and drug interruption rate in sunitinib group. Keywords: Metastatic renal cell carcinoma, Sunitinib, Pazopanib 30

O-230 차표적치료제를시행받은전이신장암환자에서조건부생존및관련예측인자에대한분석 : 국내다기관연구 나준필, 강민용, 성현환, 전황균, 정병창, 박세훈, 전성수, 이현무, 최한용, 정진수 2, 정창욱 3, 곽철 3, 송채린 4, 홍성후 5, 박재영 6, 황의창 7, 서성일 성균관대학교의과대학삼성서울병원, 2 국립암센터, 3 서울대학교병원, 4 울산대학교서울아산병원, 5 가톨릭대학교서울성모병원, 6 고려대학교안산병원, 7 화순전남대학교병원 Purpose: Conditional survival (CS) indicates the probability that patient would survive additional periods, given that the patients has previous survivorship after diagnosis or initial treatment. CS estimate can predict more accurately the prognosis of cancer patients compared to a conventional survival estimate. Although the clinical significance of CS have been investigated in several types of malignancy, there are few reports in metastatic renal cell carcinoma (mrcc). Here, we aim to evaluate the CS probabilities in mrcc patients who underwent targeted therapy with tyrosine kinase inhibitors (TKI) and to identify the significant prognostic factors of the CS over time. Methods: A total of,498 mrcc patients receiving st line TKI was finally analyzed from Korean multicenter database of mrcc. Kaplan-Meier survival estimates was used to calculate overall and cancer-specific CS rates as primary and secondary endpoints, respectively.the Cox regression analysis was used to determine the predictors of CS after adjusting various clinical factors. Results: Of note, mrcc patients who had already survived additional years after initial TKI treatment had a more favorable conditional OS and CSS probabilities in all given survivorships compared to those with shorter survival periods. As shown in Figure, 5 year conditional OS and CSS rates gradually increased over time, whereas actual survival rates were remarkably decreased over time after initial targeted therapy. More importantly, while all variables was significantly associated with conditional OS and CSS at baseline, these factors lost their prognostic significance for predicting CS in the multivariate analysis over time. Conclusions: In sum, CS improves over time after initial targeted therapy compared to baseline survival estimation in mrcc patients. Our study offers valuable information for practical survival estimation and relevant predictive factors for patients with mrcc receiving targeted therapy. Keywords: Metastatic renal cell carcinoma, Conditional survival, Prognosticator 302

V-0 임상적 T2 및 T3 전립선암환자에서근치적전립선적출술후요실금회복을위한술중중요 5 단계술식 : 로봇보조전립선적출술과순수복강경하전립선적출술의차이는존재하는가? 김태남, 이경, 남종길, 이정주, 정문기 부산대학교의과대학비뇨기과학교실 Purpose: We compared the results of laparoscopic radical prostatectomy (LRP) with robot assisted radical prostatectomy (RARP) against the perspective of the five surgical steps among the various techniques to improve postoperative urinary incontinence. Methods: We have routinely performed five surgical steps for preventing postoperative incontinence both in LRP (n=20) and RARP (n=20) group. The first step was the delicate dissection without thermal injury between the endopelvic and prostatic fascia which preserved the levator and periurethral muscle of the levator system. The second step was the bladder neck preservation through careful dissection of the prostatovesical junction. The third step was the posterior reconstruction to reapproximate the flap to the distal end of Denonvilliers fascia close to the urethral stump. The fourth step preserved the puboprostatic ligament complex which was refixed to the anterior aspect of the vesicourethral anastomosis. The fifth step anchored the bladder neck to the pubic bone. Results: The perioperative parameters of both groups didn t show the statistical difference (Table ). The pad free ratio in RARP group (30%) at postoperative 2 weeks was twice as high as that in LRP group (5%). However, pad free ratio of LRP group compared with RARP group at, 3, 6 and 2 months postoperatively was not significantly different (Table 2, p>0.05). Conclusions: The five surgical steps to prevent postoperative incontinence were easily and safely performed both in LRP and RARP. The five steps provided excellent results for the recovery of the recovery of the postoperative continence irrespective of surgical approach. Keywords: Incontinence, Prostate, Laparoscopy 303

V-02 로봇보조복강경전립선절제술에서성기능및요자제의최대보존을위한술식 최세영, 류제만, 이재훈, 이원철, 채한규, 김휘우, 유달산, 정인갑, 김청수울산대학교의과대학비뇨기과학교실 Introduction: Radical prostatectomy is a standard treatment for patients with localized prostate cancer. In men with low or intermediate risk, localized cancer and good erectile function, current guidelines recommend nerve sparing surgery. For past 20 years, different anatomical studies and surgical advances have been reported to improve nerve sparing procedure. Urinary continence and erectile function have a profound impact on patients quality of life after radical prostatectomy. The aim of radical prostatectomy is to eliminate cancer with maintaining sexual and urinary function. Case Report: In cases of robot-assisted laparoscopic prostatectomy, we try to preserve full thickness of neurovascular bundle (NVB). Intrafascial dissection is considered a dissection that follows a plane on the pseudocapsule, remaining internal to the prostatic fascia at the antero- and posterolateral aspect of the prostate and anterior to the prostatic fascia. The intrafascial approach allows a whole-thickness preservation of the NVB. This technique can be helpful to preserve sexual function. The shape of prostate apex may be different, influencing the length of the urethral sphincter after emerging from the apex because parts of the urethral sphincter can be found inside the prostate apex as a distinct structure surrounded by prostatic tissue. The apex may overlap the urethral sphincter circumferentially, symmetrically bilaterally, asymmetrically unilaterally, anteriorly only, or posteriorly only, or it can end bluntly above the sphincter. Significant overlap might render the preservation of the entire urethral sphincter difficult. A full-length preservation of the urethral sphincter can be helpful by identifying and dissecting the distinct striated and smooth muscle part of the sphincter inside the prostate apex. This technique allows preservation of the entire length of the urethral sphincter system and may result in better continence. In addition, we perform Rocco stitch (posterior pelvic reconstruction) and Kim s stitch (pubovesical complex reconstruction) that may lead to better postoperative continence. Keywords: Nerve sparing, Erectile function, Continence 304

V-03 로봇근치적전립선절제술시토글링을이용한역행성초기노출과표지동맥의확인 김승빈, 태종현, 윤성구, 김재윤, 심지성, 강석호, 이정구, 김제종, 천준, 강성구 고려대학교안암병원비뇨기과학교실 Purpose: 본 video의목적은로봇보조근치적전립선적출술중 toggling (30 degree down switching) 기법을이용한 retrograde early release시에 neurovascular bundle (NVB) 의박리용이성과 land mark artery를 demonstration 하는것이다. Materials and Methods: 205년부터 207년 5월까지로봇보조근치적전립선적출술을시행하고 bilateral NVB을 sparing한 70명의환자를대상으로하였으며자료는전향적으로기록되었다. Toggling을시행한 group (n=50) 과시행하지않은 group 2 (n=20) 로나누어각 group의 age, PSA, Gleason score 등을분석하였다. NVB penetration (prostate anterior 에서 Denonvillier s space와의관통여부 ) 에성공한비율에대해서좌, 우각각을조사하였으며술자가느끼는 subjective nerve sparing score도추가로비교분석하였다. Results: 환자들의평균연령은 63.36±6.9 였으며 group간차이는없었다 (p=0.74) (Table ). 각 group의 NVB penetration 비율은각각 76% (76/00), 60% (24/40) (p=0.058) 였으며 group 에서 bilateral penetration이성공한환자는 64% (32/50) 였다. Subjective surgeon s nerve sparing score 평균은 group 에서좌, 우모두유의하게높았으며 (p value:<0.00, 0.003, respectively), 5점으로 scoring 된비율도 group 에서유의하게높았다 (60% (60/00) vs 30% (2/40): p=0.00). Conclusion: Toggling을시행한 group에서 NVB penetration 비율, Surgeon s subjective nerve sparing score가유의하게높았으며술후 6개월내에대부분의환자에게서 potency가회복되었다. 또한정확한 NVB의 penetration을통하여 land mark artery가확인된경우는 50% 였으며이경우의 sparing score는모두 5점이었다. Keywords: Robot assisted radical prostatectomy, Toggling, Neurovascular bundle 305

V-04 방광요도문합술을함께시행한변형된복강경하단순전립선절제술 정현철, 성재우, 양종협, 조신제, 강성민, 문형우, 이규원, 배웅진, 박용현, 조혁진, 하유신, 이지열, 김세웅, 홍성후 가톨릭대학교서울성모병원비뇨기과학교실 Purpose: The treatment of BPH has been developed in various ways, and surgery using devices such as laser is widely used even in large sizes of 80 g or more. However, simple prostatectomy is still the standard therapy of large size BPH and is performed using various approaches. We present a case of a modification of laparoscopic simple prostatectomy with vesico-urethral anastomosis. Methods: 74-years old male presented with hematuria, voiding difficulty and high PSA. His total IPSS score was 20, QOL score was 4 and PSA was 4.82. The MRI showed severe BPH sized 58 g and no definite focal prostate cancer. He already had done prostate biopsy years ago and result was atypical small acinar proliferation. Qmax was 6.8 ml/s and residual urine was about 24 cc. So we planned laparoscopic simple prostatectomy. Five -mm trocar was inserted periumbilical and both McBurney s point and medial side of anterior superior iliac spine. To start with, the Retzius space was dissected bluntly, and the influential fatty tissues were swept gently. Without incision of endopelvic fascia and ligation of dorsal vein, the preprostatic fascia was incised transversally and the anterior wall of bladder neck was opened. A horizontal incision was made on the vesical mucosa overlying the prostatic lobes, at the level of the posterior bladder neck. Whole adenoma was freed from prostatic capsule with the aid of claw forceps and ultrasonic scalpel. After the specimens were placed outside the capsule, the vesicourethral anastomosis was performed with PDS #3-0. Suture was performed at 6 o clock direction toward 2 o clock clockwise and counter-clockwise. And then running sutures of 2-0 Vicryl were placed to close the prostatic capsule, securing the wall of the urethra. Results: The operative time was 20 minutes and estimated blood loss was 200 cc. Continuous bladder irrigation was stopped at POD#3 and urethral catheter was removed at POD#7. Blood transfusion was not needed. The pathology showed prostate adenocarcinoma with Gleason 6. Surgical margin was negative. month later on uroflowmetry, Qmax was 34.4 ml/s and residual urine was ml. Total IPSS score was 8 and QOL score was 2. Conclusions: A modified laparoscopic simple prostatectomy with vesico-urethral anastomosis is a safe and effective method for large size BPH with less post operative bleeding. Keywords: BPH, Vesico-urethral anastomosis, Prostatectomy 306

V-05 로봇하부요관절제술 윤영은, 정재훈, 조정기, 이형호 2, 나준채 3, 박성열, 김용태, 박해영, 한웅규 3 한양대학교비뇨기과학교실, 2 일산병원비뇨기과학교실, 3 연세대학교의과대학비뇨기과학교실 Introduction: The gold standard for the management of upper urinary tract transitional cell carcinoma is nephroureterectomy with bladder cuff excision. However, segmental ureterectomy or distal ureterectomy could be a treatment option in selected patients. Herein we report our initial experiences of distal ureterectomy using the Da Vinci Xi robotic system in the distal ureter cancer patients. Methods: Three patients underwent robotic distal ureterectomy and ureteral reimplantation from April through June 206. We included the patients who showed distal ureter mass and diagnosed as ureter cancer by previous diagnostic ureteroscopy. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted. Results: The mean operation time was 58 minutes and the mean console time was 22 minutes. The mean estimated blood loss was 70 ml. There s no intraoperative or postoperative complications. Two patients needed psoas hitch during the procedure to facilitate the ureteroneocystostomy. Length of hospital stay ranged between 4 and 8 days. After week, no patient showed leakage in anastomosis site in cystography, so the D-J catheter and the Foley catheter were removed. Pathologic reports revealed that 2 patients had pt2 and one had pt disease. All margin status was negative and postoperative image will be followed. Conclusions: Our initial experience with distal ureterectomy using the Da Vinci Xi robotic system shows that the procedure is feasible and safe. We believe that robotic distal ureterectomy may be considered as a treatment option for the minimally invasive excision and reconstruction of localized distal ureter tumor in selected patients. Keywords: Ureter cancer, Robot, Transitional cancer 307

O-23 소수전이가있는전립선암환자에서의로봇보조근치적전립선적출술 박재원, 장원식, 김명수, 정원식, 장기돈, 조강수, 함원식, 나군호, 홍성준, 최영득연세대학교의과대학비뇨기과학교실 Objective: To investigate perioperative and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in oligometastatic prostate cancer (PCa). Patients and Methods: We retrospectively reviewed the records of 79 oligometastatic PCa patients treated with RARP or ADT between 2005 and 205 at our institution. Of these 79 patients, 38 were treated with RARP and 4 were treated with ADT without local therapy. Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan. We evaluated perioperative outcomes, progression-free survival (PFS), and cancer-specific survival (CSS). We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models. Results: RARP-treated patients showed comparable postoperative complications to those previously reported in RP-treated patients, and fewer urinary complications than those of ADT-treated patients. PFS and CSS were improved in RARP-treated, compared with ADT-treated, patients (median PFS: 75 vs. 28 months, p=0.008; median CSS: not reached vs. 40 months, p=0.002). Multivariate analysis further identified RARP as a significant predictor of PFS and CSS (PFS: hazard ratio [HR]=0.388, p=0.003; CSS: HR=0.264, p=0.004). Conclusions: We demonstrated that RARP in the setting of oligometastatic PCa is a safe and feasible procedure and that it improves oncologic outcomes in terms of PFS and CSS. In addition, our data suggest that RARP effectively prevents urinary tract complications from PCa. However, our study highlights results from expert surgeons and highly selected patients that cannot be extrapolated to all patients with oligometastatic PCa. Therefore, to confirm our findings, large, prospective, multicenter studies are required. Keywords: Local treatment, Metastatic, Prostate cancer, Radical prostatectomy, Robot-assisted 308

O-232 전립선암환자에서호르몬치료중단이후남성호르몬수치의회복에영향을미치는인자 남욱, 최세영, 류재만, 한재현, 최원석, 신정현, 이재훈, 이원철, 채한규, 김휘우, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과교실 Objectives: We evaluated the factors associated with testosterone (TT) recovery after withdrawal of androgen deprivation therapy (ADT) in patients with prostate cancer Materials and Methods: Medical records of prostate cancer patients who underwent RP form 200 to 204 at Asan medical center were retrospectively reviewed and 745 patients who received ADT were selected. Among these, 22 patients with pre-adt and follow-up TT level at least 6 months after ADT withdrawal were included for the analysis. TT recovery was divided defined supra-castration as out of castration level (>50 ng/dl) and TT recovery as out-of-hypogonadism (>300 ng/dl) after ADT withdrawal. Standard Kaplan-Meier actuarial statistics and multivariate analysis were used to estimate the cumulative incidence of TT recovery and to determine the affecting factors for recovery of TT after ADT cessation. Results: The mean age at the time of ADT start was 64.7 years. The mean duration of ADT was 5.7 months and the mean follow-up duration after withdrawal of ADT was 22. months. After ADT, the mean duration had a supra-castration level was 7.9 months (92.8%), and had to the TT recovery level was 2. months(55.3%). The cumulative rates of TT recovery were 26 (6.7%), 54 (34.6%), 74 (47.4%), 86 (55.%), respectively, at 6 months, 2 months, 24 months and 36 months after ADT, respectively. Mean time for TT recovery was 6.8 months in patients treated with ADT for 8 months compared to 9.7 months in patients treated with ADT for 9 months(log-rank p=0.000), and recovery rate was 74.6%, 27.5%, respectively. In multivariate analysis younger at the time of ADT application, higher serum SHBG levels, higher initial TT levels, shorter duration of ADT were factors which is significantly associated with the TT recovery after ADT-withdrawal, and younger at the time of ADT application, higher serum SHBG levels and shorter duration of ADT were significantly associated with recovery to supra-castration level after ADT withdrawal. Conclusion: In patients treated with ADT for 8 months recovered TT more and faster after withdrawal of ADT. The AGE, SHBG level, initial TT level and duration of ADT were determined as a factor associated with TT recovery. Keywords: Testosterone recovery, Prostate cancer, Androgen deprivation therapy 309

O-233 복합운동이호르몬박탈치료를받는전립선암환자의신체활동량, 체력, 그리고삶의질에미치는영향 김규식, 임정준 2, 김연수 2, 최홍용, 문홍상 한양대학교의과대학비뇨기과학교실, 2 서울대학교대학원체육교육학교실 Introduction: The purpose of this study is to identify the effects of 2 weeks combined exercise on level of physical activity, physical fitness and quality of life in prostate cancer(pca) patients with androgen deprivation therapy. Method and Material: 29 Pca patients who receive at least more than three months ADT, in Hanyang University Hospital, were selected. Measurement was executed before and after the intervention, which included body composition, physical activity level, physical fitness, quality of life, and blood analysis. Supervised exercise program and home-based exercise were executed once a week in exercise group, whereas two muscle stretch sessions were executed in the control group for 2 weeks. 7 subjects in the exercise group were excluded due to insufficient participation for the exercise intervention due to personal concerns such as residence moving, trip, complications and occupational issue while the remaining subjects actively involved in the facility-based exercise program by achieving remarkable 90 percentage attendance rate. The final analysis was performed with 9 subjects (with subjects in the exercise group and 8 subjects in the control group) while excluding 4 subjects in the control group. Results: Positive changes in body composition from Inbody 370 were resulted in the exercise group than the control group, and a statistically significant improvement was found in thigh circumference in the exercise group. The results of physical fitness measures from Senior Fitness Test (SFT), Grip dynamometer, and MMT (manual muscle test) were statistically significant in all categories except for flexibility item in the exercise group. Also, improvements were found in the exercise group in daily steps. Moderate-vigorous intensity physical activity from using an accelerometer (Control vs. Exercise: from 36.3±27.49 to 24.0±25.54 vs. from 30.49±27.47 to 6.0±07.78, p=0.037). Quality of life was improved in the survey The reliability of exercise was demonstrated from no change in PSA serum level between pre- and post-exercise intervention. Conclusion: Taken together, the combined exercise in this research was resulted to be effective in body composition, physical fitness, level of physical activity, and quality of life in prostate cancer patients despite of low testosterone from ADT. Keywords: Combined exercise, Prostate cancer, ADT, Quality of life 30

O-234 전립선암환자에서남성호르몬박탈요법이심뇌혈관의발병에미치는위험요인에대한연구 : 국민건강보험표본코호트를이용한연구 문형우, 조신제, 양종협, 최세웅, 박용현, 배웅진, 조혁진, 홍성후, 이지열, 김세웅, 성종미 2, 하유신 가톨릭대학교서울성모병원비뇨기과, 2 이화여자대학교약학대학 Objective: 남성호르몬박탈요법이심뇌혈관계발병에미치는영향에관한연구의대부분은서구인들을대상으로진행되었다. 그러나남성호르몬박탈요법에의한체내변화는인종에따라다양하게나타날수있는반면에아시아권에서의연구는부족한실정이다. 이에남성호르몬박탈요법이심뇌혈관질환의발병에미치는영향에대해분석하였다. Methods: 2002년부터 203년까지의국민건강보험표본코호트에서 2003년부터 2008년까지전립선암으로진단된환자들중심뇌혈관질환의이전병력이없는 2,07명의자료를분석하였다. 전립선암은비약물치료군, 생식선자극호르몬분비호르몬작용제 (GnRH agonists) (년중 80일이상의처방기간을가지고있는경우로정의 ), 그리고항남성호르몬제제 (antiandrogen only) 단독사용군의 3군으로분류하여진단시점부터, 203년까지경과관찰기간중심뇌혈관질환의발생위험도를분석하였다. 질환정의는 ICD-0코드를이용하였으며, 나이, 당뇨, 고혈압, 지질이상증의동반병력을인자로함께분석하였다. Results: 대상환자들의관찰기간중위수는 7.6년이었으며, 심뇌혈관질환은허혈성심질환 (Ischemic heart disease, IHD) 와뇌혈관질환 (cerebrovascular disease, CVD) 로구분하여분석하였으며각각 32명과 58명에서 IHD와 CVD가발병하였다. IHD의경우비약물치료군에비해 GnRH agonists 투여군에서유병률과위험도가높지만통계적유의한차이를보이지않았다. CVD의경우에도 GnRH agonists 투여군에서위험도의증가를확인할수없었다. Conclusion: 본연구의코호트에선전립선암환자들에게 GnRH agonists 투여가심뇌혈관질환의위험도를높이지는않는것으로분석되었다. 확고한결론을위해선향후관찰기간및환자군이큰연구가필요할것으로사료된다. Keywords: Prostate cancer, Ischemic heart disease, Cerebrovascular disease 3

O-235 진단당시전이성전립선암으로진단받은환자들에게안드로겐차단요법을시행하였을때, 전이부담정도가거세저항성전립선암으로진행하는시간에미치는영향 이상민, 김성진, 박창후, 김한권, 박종연 울산대학교강릉아산병원 목적 : 진단당시전이성전립선암으로진단받은환자들에게 androgen deprivation therapy (ADT) 를시행하였을때, 전이부담 (metastatic burden) 정도가 CRPC로의진행에미치는영향을평가하고자한다. 대상및방법 : 998년 5월부터 206년 9월까지전이성전립선암으로 ADT를받은환자들중에서 ADT 이전전립선암에대하여다른치료를받거나 ECOG PS 3점이상, 기대수명 3개월미만, 심각한동반질환이나 5년이내의다른급성기암으로진단받은환자들을제외한총 85명을대상으로하였다. 전이부담을평가하기위하여림프절전이에대해서는 solitary vs diffuse여부및 true pelvis이내 vs pelvis까지 vs pelvic cavity이상침범유무를분석하였고, 골전이의정도를평가하기위해서는골전이의개수및 modified Soloway score (mss) 에따라전이의정도를정량화하여분석하였다. visceral organ의전이유무및 noncastrate metastatic prostate cancer의예후인자로알려진 Glass model의유효성을분석하였고추가적으로 CRPC에영향을미칠수있는다른인자들을함께분석하였다. Cox 회기분석을사용하여 CRPC에대한위험요인을분석하였다. 결과 : median 22.2개월 (3.8-86.5) 의추적조사결과, CRPC가 48명 (56.5%) 의환자에서나타났다. Median time to CRPC 는 5.0개월 (95% CI.07-20.960) 이었다. 단변량분석에서는 ECOG PS 점이상, albumin 4 g/dl 미만, Gleason score 0 점, clinical T stage 4, diffuse type 또는 true pelvis이상으로의림프절전이가유의한위험인자였으며, 골전이에대해서는다른장기전이유무와상관없이골전이가있는경우, 골전이가 곳이상및 mss 2점이상에서유의한위험인자였다. 또한 Glass risk group, nadir PSA 0.2 ng/dl 이상도유의하였다. 다변량분석에서는 clinical T stage 4, mss 2점이상, nadir PSA 0.2 ng/dl 이상만이유의한위험인자였다 (P<0.05). 결론 : Clinical T stage 4, mss 2점이상, nadir PSA 0.2 ng/dl 이상은 CRPC로의진행에독립적인위험요인으로작용한다. 특히골전이는골전이유무, 골전이의숫자및전이 volume 모두에서 CRPC 로의진행에위험요인으로판단된다. 향후 CRPC 예측을위하여전이부담의정량화및특히, 골전이의정도와 CRPC와의연관성및이를정량화하는방법에대한추가적인연구가필요할것으로판단된다. Keywords: 전이성전립선암, CRPC, Androgen deprivation therapy 32

O-236 호르몬박탈요법을받은한국인환자에서거세저항성전립선암의위험도평가 : KCS-prostate scoring model 최세영, 류제만, 경윤수, 남욱, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We investigated the progression to castration-resistant prostate cancer (CRPC) after primary androgen deprivation therapy (ADT) and aimed to build a risk prediction model in primary ADT patients. Materials and Methods: A total of 555 patients who received primary ADT were enrolled in Korean Cancer Study of the Prostate (KCS-prostate) database. Multivariate Cox models were used to determine the effect of prognostic factors. In each patient the weight of all factors was summed to KCS-prostate score and the patients were divided into 3 risk groups according to the scores. The Kaplan-Meier method was used to estimate the probability of CRPC, cancer-specific survival (CSS) and overall survival (OS). Results: During a median follow-up 49.8 months, 82 patients (32.8%) progressed to CRPC. On multivariate analysis for CRPC, the significant variables were initial PSA, biopsy Gleason score, clinical N and M stage. KCS-prostate scoring model was calculated with a score of 0 to 7 for CRPC. Patients were categorized into 3 groups by score. The risk groups stratified CRPC (p<0.000), CSS (p<0.000), and OS (p<0.000) on Kaplan-Meier graph. KCS-prostate model predicted CRPC with a c-index of 0.7876, CSS with a c-index of 0.754, and OS with a c-index of 0.66. Five-year CRPC rates were 4.9% of low, 32.6% of intermediate, and 66.5% of high risk. Conclusion: The KCS-prostate scoring model can help to predict CRPC, CSS, and OS in patients with primary ADT. Large cohort studies should be performed to construct an ideal prognostic model for Korean patients with primary ADT. Keywords: Risk classification, Androgen deprivation therapy, Castration-resistant prostate cancer 33

O-237 전이성전립선암에서도세탁셀항암요법방법에따른효과와독성의비교 육형동, 윤민영, 구자현, 곽철, 김현회, 정창욱서울대학교병원비뇨기과 Introduction: To compare weekly, every 2 weeks (2 weekly), every 3 weeks (3 weekly) regimens of docetaxel in metastatic castration-resistant prostate cancer (CRPC) patients. Methods: We retrospectively analyzed 62 CRPC patients who underwent docetaxel chemotherapy between 2004 and 206. The subjects were divided into three groups according to the chemotherapy regimen. The dose of docetaxel was 30 ml/m 2 for weekly, 50 ml/m 2 for 2 weekly, and 60 ml/m 2 for 3 weekly. Results: 38, 4 and 83 patients were in the weekly, 2weekly and 3weekly arms, respectively. The basic characteristics of patients except easteran cooperative oncology group performance score (ECOG-PS) were similar. In the case of ECOG-PS, grade was higher in weekly. There was no significant difference in overall survival, cancer specific survival, and progression free survival among the three groups. There was no difference in toxicity such as hematologic, neurological, respiratory, gastrointerstitial, fatigue among three groups. In cox multivariate regression analysis, age, ECOG-PS, duration of hormone therapy, PSA level at the onset of chemotherapy, response to chemotherapy, and chemotherapy cycle affected survival. And the ECOG-PS, response to chemotherapy, and chemotherapy cycle also affected progression. Conclusion: There was no significant difference in toxicity and efficacy according to the docetaxel chemotherapy regimen. Clinical outcomes are influenced by chemotherapy cycle, response, and patient performance status rather than by regimen. Keywords: Docetaxel, CRPC, Chemotheraphy 34

O-238 도세탁셀로치료한전이성거세저항성전립선암환자의치료반응에대한예측인자 김정권, 김성한, 정재영, 서호경, 정진수, 이강현 국립암센터전립선암센터비뇨기과 목적 : 도세탁셀로치료한전이성거세저항성전립선암환자에서도세탁셀에대한치료반응을예측할수있는인자를알아보고자하였다. 대상및방법 : 2005년부터 206년까지본기관에서전이성거세저항성전립선암으로진단받고도세탁셀로최초치료를시행받은 9명의환자를대상으로분석을시행하였다. 도세탁셀요법은 75 mg/m 2, 3주간격이었으며, 부작용발생및환자의 performance status 에따라용량및간격을조절하였다. 매주기마다 PSA 수치를측정하여치료반응을관찰하였으며, 3개월마다영상의학검사를통해측정가능한전이병소의반응을 RECIST 지침에따라평가하였다. 도세탁셀의지속여부는치료반응 (response) 및환자의내약성 (tolerability) 을모두만족할때를기준으로하였다. 본연구에서는총 0주기이상의도세탁셀치료를받은환자군을좋은반응군 (good responder group) 으로정의하였다. 반응군에따라주요임상인자들을비교분석하였으며, 로지스틱회귀분석을통해치료반응의예측인자를조사하였다. 결과 : 35명 (8.3%) 의환자가 good responder으로보고되었으며, Kaplan-Meier 분석을시행하였을때질병무진행생존율및전체생존률에서그렇지않은군에비해서유의하게우월한것으로보고되었다 (all, p<0.00). 치료반응여부에따라두군으로나누어분석하였을때, PSA nadir( 0 vs. >0) 와 PSA nadir까지의기간 (Time To PSA nadir, TTPN, 3 months vs. >3 months) 이유의한차이를보였다. 로지스틱회귀분석을시행하였을때, 단변량분석에서는전이병소 (p=0.039), TTPN (p<0.00), metastatic volume (p=0.04), ALP (P=0.030) 및 3등급이상의 neutropenia 발생 (p=0.035) 이좋은치료반응의유의한독립적인예측인자였으나, 다변량분석에서는 TTPN만이유의한예측인자로나타났다 (OR, 5.906; 95% CI,.622-2.499; p=0.007) (Table ). 결론 : 도세탁셀로치료한전이성거세저항성전립선암환자에서 3개월이상의 TTPN은도세탁셀에대한치료반응을예측할수있는유의한독립적인예측인자였다. Keywords: Docetaxel, CRPC, Response 35

O-239 전립선암과거력과 25(OH)D2 수치와의상관관계 : 미국국가보건영양실태조사 (NHANES) 2007-2008 데이터 박지수, 김종찬, 이형호 2, 허지은, 최영득, 나군호, 이주용, 함원식 연세대학교의과대학신촌세브란스병원비뇨기과학교실, 비뇨기과의과학연구소, 2 국민건강보험공단일산병원 Purpose: Many studies have revealed that there is an association between vitamin D levels and prostate cancer risk, but whether the association is positive or negative remains unclear. This study is the first to report an association between prostate cancer history and vitamin D levels among different races in a single population in the United States. Materials and Methods: We investigated whether there was an association between vitamin D level and prostate cancer history in different races in the United States. We used data collected from,363 men during the National Health and Nutrition Examination Survey 2007-2008. Multivariate logistic regression analysis was used to evaluate the independent associations between vitamin D levels (not only 25-hydroxyvitamin D (25(OH)D), but also 25(OH) D2 and D3) and prostate cancer history. Association between vitamin D levels and prostate specific antigen level was also analyzed in non-hispanic white males without prostate cancer. Results: Older age was significantly associated with a history of prostate cancer in all races (p<0.05), whereas vitamin D (p=0.024), especially 25(OH)D2 (p=0.027) was significantly higher only in non-hispanic white males. There was no difference in vitamin D between non-hispanic white males with a prostate specific antigen concentration >3 ng/ml and 3 ng/ml. Conclusions: This study revealed a positive association between vitamin D, especially 25(OH)D2, and prostate cancer only in non-hispanic white males. And vitamin D was not associated with prostate specific antigen level causing detection bias. Keywords: Prostate cancer, Vitamin D, 25-hydroxyvitamin D 36

O-240 엔잘루타마이드를사용한항암치료받지않은거세저항전립선암환자에서생존예측인자 최세영, 류제만, 경윤수, 채한규, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We evaluated the prognostic factors of survival in chemotherapy-naïve castration-resistant prostate cancer (CRPC) with enzalutamide. Materials and Methods: We retrospectively reviewed patients with prostate cancer who did not treated with enzalutamide before chemotherapy. We collected serum labs including PSA, testosterone, hemoglobin, platelet, neutrophil, lymphocyte, protein, albumin, liver and lipid profiles from pre-enzalutamide to 6 months. The Kaplan-Meier method was used for overall survival. Cox regression analysis was used to identify the factors associated with overall survival. Results: A total of 94 patients enrolled. Among them, 7 patients (7.6%) were ECOG performance status 2, 56 patients (65.9%) had Gleason score 9, 23 patients (24.5%) received prior radical prostatectomy, and 24 patients (25.5%) underwent prior radiation therapy. The mean period from diagnosis to enzalutamide was 3.7±3.4 years. At the initiation of enzalutamide, there were 86 patients (9.5%) of bone metastasis, 43 patients (45.7%) of lymph node metastasis, and 23 (24.5%) of visceral metastasis. PSA, neutrophil-to-lymphocyte ratio (NLR), and alkaline phosphatase (ALP) levels decreased from 43.4 ng/ml to 3.0 ng/ml (p<0.00), from 2.3 to.5 (p=0.002), and from 25 IU/L to 96 IU/L (p=0.006), respectively. On multivariate analysis, the predictors of overall survival were ECOG performance status (2 vs ; hazard ratio [HR] 3.655, p=0.0269), visceral metastasis (HR 3.30, p=0.008), PSA (HR.00, p=0.0360), NLR (>3 vs 3; HR 4.493 p=0.0002) and ALP (HR.002, p=0.0076). On Kaplan-Meier curve, NLR >3 (p<0.000) and visceral metastasis (p=0.0003) showed poor overall survival. Conclusion: In chemotherapy-naïve CRPC patients who treated with enzalutamide, ECOG ( 2), visceral metastasis, NLR (>3), high PSA and high ALP were associated with poor overall survival. Keywords: Enzalutamide, Chemotherapy-naïve castration-resistant prostate cancer, Neutrophil-to-lymphocyte ratio 37

O-24 신이식환자에서발생하는요로상피암 유지웅, 강민용, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수성균관대학교의과대학삼성서울병원비뇨기과학교실목적 : 신이식환자에서발생하는요로상피암의발생률, 위험인자그리고치료에대한본원에서의경험에대해보고하고자하였다. 대상및방법 : 997년 7월부터 206년 2월까지본원에서신이식을받은 286명중요로상피암이발생한 9명의환자와외부병원에서신이식후요로상피암에대해본원에서치료를받은환자 5명을후향적으로분석하였다. 신이식후발생하는요로상피암의발생양상, 위험인자, 치료에대해분석하였고, 국내암통계자료를이용하여일반인군과비교하였다. 특히상부요로상피암에대해수술을시행한신이식환자 9명을본원에서상부요로상피암에대해수술을시행한일반인 585명중유사한특성을갖는 27명과짝을지어비교하였다. 결과 : 신이식환자에서요로상피암의 0만명당연령표준화발생률은각각 22.2명, 4.0명으로일반인군에비해각각 25.5 배, 29.5배높았다 ( 각각, p<0.00). 또한일반인군에서방광암이상부요로상피암보다 5.5배많이발생한것에비해신이식환자군에서는상부요로상피암이방광암에비해 2.0배더많이발생하였다 (p<0.00). 일반인군에비하여신이식환자군에서여성이요로상피암의발병위험이높았다 (OR.29; p=0.023). 신이식후방광암이발생한 5명의환자중방광암치료전사망한 명을제외한 4명에서경요도방광종양절제술을시행하였다. 재발하는표재성방광암에대해방광내항암제주입술을시행하였으나, 방광내 BCG 주입술을시행한경우는없었다. 침윤성방광암에대해근치적방광적출술이시행된경우는없었다. 신이식후상부요로상피암이발생한 9명의환자는각각근치적신장-요관절제술 (8명) 및신장절제술 (명) 을시행받았다. 상부요로상피암에대한치료이후에일반인군과신이식환자군에서 0만인년당암재발및진행수 (9. vs. 77.2; p=0.770) 및암특이사망자수 (22.4 vs. 4.9; p=0.709) 에는차이가없었다. 결론 : 신이식환자에서는일반인군에비해요로상피암의발생이높아서이에대한각별한주의가요구되며, 특히상부요로상피암및여성환자에대하여더욱그러하다. 신이식후발생하는요로상피암에대해일반인과유사한치료적접근이가능하며, 특히상부요로상피암에대해근치적신장-요관절제술을시행할시일반인군에서와대등한치료성적을기대할수있다. Keywords: Urothelial carcinoma, Kidney transplantation 38

O-242 신체질량지수 (BMI) 에따른방광암발생위험예측 성재우 4, 양종협 4, 조신제 4, 문형우 4, 최진봉, 이은주 2, 한경도 3, 홍성후 4,5, 하유신 4,5 가톨릭대학교부천성모병원비뇨기과학교실, 2 국민건강보험공단 Department of Big Data Steering, 가톨릭대학교서울성모병원 3 생물통계학교실, 4 비뇨기과학교실, 5 The Cancer Research Institute We examined the association between obesity and bladder cancer using nationally representative data on the Korean population from the National Health Insurance System (NHIS). We estimated the impact of obesity on bladder cancer and stratified by smoking status. Of the 45,850,458 people who underwent at last one health examination from 2009-202, 23,378,895 without bladder cancer were followed from the January 2009 to the December 205. Multivariate adjusted Cox regression analysis was conducted to examine hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between bladder cancer and obesity. In total, 4,43 (0.089%) were diagnosed with bladder cancer in the non-obesity group and 7,76 (0.04%) were diagnosed with bladder cancer in the obesity group. The HR for bladder cancer development significantly increased as body mass index (BMI) increased beyond the reference BMI in a model adjusted for age and multiple variables. Smoking was associated with significant high risk for bladder cancer development in regression analysis. An analysis of HR for bladder cancer stratified by obesity across smoking status strata showed, significant trend of increasing HR for bladder cancer across obesity and smoking status in age-adjusted and multivariate-adjusted models (p for interaction=0.33 for age and 0.35 for multivariate). For a population with the same smoking status, those with obesity were more likely to have bladder cancer than those without obesity. Especially in ex and current smokers, obesity increased the impact of smoking on development of bladder cancer. This population-based study showed that increasing BMI was a risk factor for develop bladder cancer independent of confounding variables. Obesity increased the impact of smoking on development of bladder cancer. Keywords: Bladder cancer, Body mass index, Smoking 39

O-243 Identification of red/green/blue values from white-light imaging and narrow-band imaging for the discrimination of bladder cancer features 이광석, 구교철, 정병하 연세대학교의과대학강남세브란스병원 Background: White-light cystoscopy (WLC) has been the standard method for detecting urothelial carcinoma and narrow-band imaging (NBI) has recently been reported to provide improved detection rates for bladder cancer. Objective: To investigate the relationship of numerical information (using red/green/blue values) of lesions suspected as bladder cancer with detection, stage, and tumor grade. Design, Setting, and Participants: This prospective double-blind controlled study was performed in 02 patients with suspected bladder cancer. The patients were assessed by 2 urologists. We analyzed the mean red/green/blue values from WLC and NBI for 72 lesions. Outcome measurements and statistical analysis: Using functions in the Picture Archiving and Communication System, lesion characteristics were measured as a red/green/blue scoring method (RGB) (average values from three consecutive slices). Pairwise comparison of ROC curves was applied to compare the predictive performance of various parameters and their combination. Results and Limitations: The rates of malignancy and carcinoma in situ at the sites identified only by NBI were 63.0% and 53.3%, respectively. The R value from WLC ( 209 vs. >209) was a significant predictor of bladder cancer detection in multivariate analysis. The area under the curve of using the red/green/blue values along with conventional factors was significantly higher than that of conventional factors (0.790 vs. 0.740, p=0.0053). The B value from WLC ( 25 vs. >25), G value from narrow-band imaging ( 49 vs. >49), and B value from NBI ( 4 vs. >4) were significant predictors of muscle invasion. Moreover, the R value from WLC ( 76 vs. >76) and G value from NBI ( 38 vs. >38) were significant predictors of high-grade bladder cancer. Conclusions: Red/green/blue values from WLC and NBI for suspicious lesions might help in the prediction of bladder cancer features. Additionally, NBI is an effective method for identifying bladder cancer and carcinoma in situ. Keywords: Bladder cancer, Narrow band imaging, RGB, White light imaging 320

O-244 BCG 치료를받은비근육침윤성방광암환자의예후예측을위한 NLR 의효용성과 CUETO scoring model 과의관계 김진우, 민경찬, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 유은상, 권태균, 정성광, 김태환 경북대학교의과대학비뇨기과학교실 목적 : Neutrophil-to-lymphocyte ratio (NLR) 는전신염증반응의 marker로서여러종양의재발과진행과관계가있는것으로알려져있다. 본연구자들은 CUETO scoring model과함께 NLR이 BCG 치료를받은비근육침윤성방광암환자의예후예측능력을가지는지확인해보고자하였다. 방법 : 2005년 8월부터 206년 5월까지경요도방광암절제술을시행받고, BCG instillation therapy가행해진 28명의환자를대상으로하였다. NLR와각임상병리항목과전체 CUETO 총점의예후예측능력의확인은다변량 Cox regression 분석및 Kaplan-Meir curve를이용하였다. 결과 : 평균추적관찰기간은 46개월 (Range, -29개월 ; median, 46개월 ) 이었으며, 84명 (29.9%) 의환자에서재발이 4환자 (5.0%) 에서진행이관찰되었다. 재발에대한 NLR의 cut-off value는 2.29이며, 전체환자 28명중 73명 (6.6%) 이높은 NLR을보였다. Kaplan-Meir curve에서높은 NLR은재발 (Log rank test, P<0.00) 과진행 (Log rank test, P<0.00) 모두유의한연관성을보였으며, CUETO 총점을 4개계층으로범주화하여분석한 Kaplan-Meir curve에서 CUETO 총점은재발과는유의한연관성을보였으나 (Log rank test, P<0.00), 진행 (Log rank test, P=0.423) 의발생과는유의한관계를보이지않았다. NLR의고저와 CUETO 총점 4계층의조합을 4그룹으로나누어시행한 Kaplan-Meir curve에서재발 (Log rank test, P<0.00) 과진행 (Log rank test, P=0.002) 모두유의한연관성을보였다. 다변량분석에서높은 NLR(HR 2.45, P<0.00), 성별 (HR 2.565; P=0.0), 재발성 tumor (HR, 2.320; P=0.006), tumor 개수 (HR,.874; P=0.0) 그리고 CIS 동반여부 (HR, 2.007; P=0.033) 가재발과유의한연관성이확인되었으며, 높은 NLR (HR 5.9, P=0.08) 과재발성 tumor (HR, 3.997; P=0.027), 동반된 CIS 여부 (HR, 4.903; P=0.008) 가진행의유의한예측인자로밝혀졌다. 결론 : 비근육침윤성방광암환자에서 NLR은재발및진행을예측하는유의한예측인자로확인되었다. 예측인자로서술전 NLR의포함은예후를예측하기위한 CUETO 모델의정확성을증가시키며, 높은 NLR을갖는환자는보다적극적인관리를권고할수있을것이다. 추후확대된연구를통해 biomarker가포함된방광암예후예측 scoring system의개발이필요하다. Keywords: Neutrophil-to-lymphocyte ratio, BCG instillation therapy, Spanish urological club for oncological treatment scoring model 32

O-245 비근침습방광암에서 BCG 유지요법시행후 BCG failure 에대한예측인자 백승룡, 강병진, 박지훈, 김경환, 이경, 이찬호, 구자윤, 이정주, 하홍구부산대학교의과대학비뇨기과학교실 Introduction: To determine the predictive factors to BCG failure in patients with non-muscle invasive bladder cancer (NMIBC) after BCG maintenance treatment Materials & Methods: We retrospectively reviewed the medical records of 8 intermediate/high-risk NMIBC patients who underwent BCG maintenance treatment after TUR-BT from 20 to 206. Tumor size, number, CIS lesion, 973/2004 WHO grading, re TUR-BT, neutrophil-lymphocyte ratio(nlr) were analyzed by logistic regression analysis Results: During a median follow-up of 30.9 months (IQR, 8.75-47.0). patients (0.2%) were intermediate-risk group, 07 patients (89.8%) were high-risk group. Mean age was 67 years. BCG failure was observed in patient (9.%) of intermediate-risk group and 30 patients (26.3%) of high-risk group. Among the 3 patients, NMIBC with high grade is present within 3month in 9 patients (7.6%). The number of high grade tumor appeared after 3 months of BCG therapy was 2 patients (.7%). High grade tumor recurrence after completion of BCG maintenance in 9 patients (7.6%). MIBC is detected during follow-up in patients (9.3%). On logistic regression analysis, Tumor size (OR=2.299, p=0.027), 204 WHO grading (OR=5.452, p=0.00) were independently associated with BCR failure (Table ). Conclusions: Tumor size larger than 3 cm and higher grade may be related with BCG failure in patients with non-muscle invasive bladder cancer (NMIBC) after BCG maintenance treatment Keywords: BCG failure, Bladder cancer, Predictive factor 322

O-246 상부요로상피암에서진단적요관경검사의정확성 정재동, 나준필, 성현환, 전황균, 정병창, 서성일, 이현무, 최한용, 전성수성균관대학교의과대학삼성서울병원비뇨기과학교실 Objectives: Diagnostic ureterorenoscopy (URS) is currently recommended before endoscopic management of upper tract urothelial cancer (UTUC) as it shows different characteristics from bladder cancer. The aim of this study was to evaluate the diagnostic value of the URS. Materials & Methods: Between 994 and 205, a total of 785 patients had undergone radical nephroureterectomy (RNU) in our center. Diagnostic URS was performed in 389 patients among them. After excluding ) non-diagnostic case (n=34), 2) patients who did not undergone biopsy (n=4), 3) patients with unknown cancer stage (n=2), 93 patients were finally enrolled and analyzed retrospectively. Their URS biopsy result were evaluated in comparison with final pathology. T stages above T2 were defined as invasive tumors. Results: Table summarizes baseline charateristics. There was statistical difference between URS biopsy and final histology grade and stage (P<0.00). 78.3% of the grade tumors in URS biopsy were non-invasive tumors and 77.% of grade 3 tumors in URS biopsy were invasive tumors. Grade 2 tumors in URS biopsy were non-diagnostic outcome as a predicting factor for invasive tumor at final pathology. Ta tumors in URS biopsy were non-diagnostic and only 33.3% were invasive tumors. Stage above T tumors in URS biopsy were invasive tumors and upgraded final stage in 83.3%. Grade 3 in URS biopsy as a predicting factor for invasive tumor had an accuracy of 0.67, sensitivity of 0.58, specificity of 0.78, positive predictive value of 0.73, and negative predictive value of 0.75; corresponding values for stage above T tumors in URS biopsy as a predicting factor for invasive tumor were 0.75, 0.73, 0.78, 0.82, and 0.67, respectively. Conclusions: URS biopsy is necessary to rule out invasive tumor. If the biopsy shows above T or grade 3, endoscopic management should not be recommended. It is more likely to be invasive tumor which shows above T tumors in URS biopsy. Especially, the accuracy of the ex Keywords: Upper tract urothelial carcinoma, Ureterorenoscopy, Grade and stage 323

O-247 상부요로상피종양에대한근치적신요관절제술이후신기능감소의예측인자 : 술전 99mTc-DTPA 결과와의연관성 류제만, 남욱, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 Introduction: We investigated the predictors of renal function decline after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and the correlation between preoperative 99mTc-diethylenetriamine pentaacetic acid (DTPA) renal scan and postoperative renal function. Materials and Methods: Among 38 patients who underwent RNU for UTUC in our institution between 2005 and 202, 203 patients underwent DTPA renal scan before surgery. Estimated glomerular filtration rate (egfr) was calculated using the Modification of Diet in Renal Disease (MDRD) Study equation before and 3 months after RNU. We analyzed preoperative and postoperative egfrs based on the preoperative DTPA renal scan and identified the predictors of egfr decline after RNU using multivariable analysis. Results: Median age was 64 years. Hydronephrosis in computed tomography was found in 45 (7.4%) of patients. Median tumor size was 3 cm and tumor was located in renal pelvis (45.3%), ureter (40.9%), or both (3.8%). The median egfr declined by 22.7% 3 months after RNU. In preoperative DTPA renal scan, median GFR of the operated and remained kidney was 26.2 and 40.0 ml/min, respectively. The GFR of the resected kidney in DTPA renal scan was significantly correlated with egfr decline after RNU (R 2 =0.334, p<0.00). On multivariable analysis except the factor of preoperative DTPA results, absence of hydronephrosis and smaller tumor size were significant predictors of more decline of egfr after RNU, while on multivariable analysis including DTPA results, the GFR of the resected kidney in DTPA renal scan was only significant predicting factor of more decrease of egfr. The equation of renal function 3 months after RNU was estimated as follows: Decreased egfr ratio=0.72 * (GFR of resected kidney on preoperative DTPA renal scan)-6.209. Conclusions: The GFR of the operated kidney in DTPA renal scan was a significant predicting factor of egfr decline and we established predictive equation of renal function based on the results of DTPA renal scan. Keywords: Transitional cell carcinoma, Glomerular filtration rate, 99mTc-diethylenetriamine pentaacetic acid 324

O-248 근치적전립선절제술을시행받은환자에서수술전배뇨근과활동이수술후저장증세에미치는영향 양종협, 성재우, 조신제, 이규원, 정현철, 최진봉, 최세웅, 박용현, 배웅진, 조혁진, 하유신, 홍성후, 김세웅, 이지열 가톨릭대학교서울성모병원 Purpose: To investigate the significance of detrusor overactivity (DO) as a predictor of storage symptoms after radical prostatectomy. Materials and Methods: This study included a total of 53 patients with clinically localized prostate cancer who underwent LRP and RARP between January 20 and April 206. The patients was devided into 2 groups, according to the detrusor overactivity detected by uronamic study preoperatively (Group I: DO-, N=9; Group II: DO+, N=34). The subjective symptom was assessed by international prostate symptom score (IPSS). We analyzed the factors affecting the aggravation of storage symptoms after surgery using logistic regression analysis. Results: There was no significant difference in demographic, perioperative parameters and oncologic outcomes between the two groups. Total IPSS score (P=0.00) and voiding symptom score (P<0.00) significantly improved, but storage symptoms were aggravated at 2 months after surgery (P=0.043). Except the total IPSS score and voiding symptom score, DO appeared to be the only independent factor associated with the deterioration of the storage symptoms after surgery on multivariate analysis. Conclusion: Preoperatively detected DO was closely associated with aggravation of storage symptoms after radical prostatectomy. Keywords: Radical prostatectomy, Storage symptom, Detrusor overactivity 325

O-249 한국인전립선암환자에서의근치적전립선절제술후건강관련삶의질변화 : 어떤요인이수술후만족도에영향을주는가? 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 Purpose: Health-related quality of life (HRQOL) outcomes after radical prostatectomy (RP) are one of major concerns for men with localized prostate cancer. HRQOL changes after RP are not yet fully investigated in Korean prostate cancer patients. We aimed to identify HRQOL changes after RP using EPIC questionnaires. Materials and Methods: EPIC questionnaires were prospectively obtained from 2 men with localized prostate cancer who underwent radical prostatectomy. Patients were routinely scheduled to visit the clinic at baseline,, 3, 6 and 2-months postoperatively and asked to complete EPIC. Patients who underwent adjuvant or salvage therapy in postoperative year were excluded. Four summary domains and each subscale components were evaluated. Each scores were calculated by the 0-00 scales, with higher scores representing better HRQOL. Results: Mean age of patients was 64.7 years. 8.2% of patients underwent robotic prostatectomy. Urinary function and bother scores worsen after RP, and returned stable from 6 months after RP. Mean urinary domain scores did not return to baseline at 2 months after RP. Sexual function and bother scores declined after surgery. Both began to improve since 6 months after surgery. Minimal changes were identified in the bowel and hormonal domains. Overall patient satisfaction rates on treatment were 64.9%, 64.3%, and 66.2% at 3, 6, and 2 months postoperatively. In multivariate analysis, urinary function (P=0.003) and urinary bother (P=0.03) changes were the independent factors influencing patient satisfaction at 2 months after RP. Conclusions: Mean urinary function and bother return to nearly close to preoperative baseline at 6 months after RP. However, mean sexual function and bother declined greatly after RP, and did not reach a new baseline until 2 months after RP. Sexual function assessment should be performed carefully even after year post-surgery. The urinary function and urinary bother changes were the independent influencing factor for patient satisfaction after RP. Keywords: Prostatectomy, Quality of life, Surveys and questionnaires 326

O-250 2 주간체계적인골반저근운동이근치적전립선절제술후요실금회복에미치는영향 박주현, 유상준, 조성용, 조민철, 손환철, 한가영 2, 송욱 2, 정현 서울특별시보라매병원, 서울대학교의과대학비뇨기과학교실, 2 서울대학교의과대학체육교육과 목적 : 근치전립선절제술을받은환자들을대상으로 2주간체계적인골반저근운동프로그램을시행하고, 요실금회복에미치는영향에대해알아보고자하였다. 대상및방법 : 본원에서전립선암으로진단받아근치전립선절제술을시행받은 60세이상의환자를대상으로하였으며, 과거골반내수술병력및배뇨기능에영향을술수있는질환을가진자는제외하였다. 총 2주간전문적인운동치료사가주 회직접교육을시행하며, 교육받은내용을환자가스스로주 6회자택에서시행하고, 시행여부를기록하도록하였다. 운동요법참여전후근력평가를포함하여, 환자의임상정보를수술전, 수술직후, 운동치료 6주후, 운동치료 2주후로나누어평가하였으며, 운동치료 2주후 hr 패드테스트를통한요실금량의감소율을 차연구종점으로삼았으며, 그외생화학적지표및근력향상등을 2차연구종점으로정하였다. 결과 : 총 57명의환자가 2주간의골반저근운동프로그램에동의하였으며, 이중 6명의환자는동의철회및수술후합병증등으로연구에서중도탈락되었다. 총 4명의데이터를분석하였으며, 운동프로그램참여율 50% 를기준으로적극운동참여군 (20명) 과비적극운동참여군 (2명) 으로구분하였다. 2주간의골반저근운동프로그램후적극운동참여군이비적극운동참여군에비해 Adductor 근력이유의하게향상되는것으로확인되었으며 (P=0.022), 다른근육의경우에는군간유의한차이를확인할수없었다. 다변량분석에서는 Extensor (P=0.036) 및 Adductor (P=0.048) 의근력이요실금량의변화에유의한영향을미치는것으로확인되었다. 결론 : 2주간의체계적인골반저근운동프로그램은 Adductor 근력향상을통해요실금의조기회복에도움이되는것으로나타났다. 또한 Extensor 근력또한요실금회복에도움이되는것으로분석되었으므로, 추후 Extensor도함께향상시킬수있는운동프로그램이필요하겠다. Keywords: Incontinence, Pelvic floor muscle exercise, Prostatectomy 327

NP-00 신세포암세포주 (Caki-) 에서 clear cell induction 및 metformin 에의한 mitochondria 활성이 mtor inhibitor 에의한세포고사효과를증대시킨다 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 신세포암세포주에서 clear cell induction (CCI) 및 AMPK를활성화유도물질로잘알려진 Metformin을투여했을때기존의신세포암치료제인 mtor inhibitor의효과에대한변화를알아보고자한다. 대상및방법 : Caki- 세포에 metformin을농도별로투여하여독성정도를 CCK-8 assay로시행했다. CCI시에나타나는특징인 mitochondria의증가가 metformin 투여시에도나타나는지보기위해 mitochondrial protein인 Voltage-dependent anion channel (VDAC) 의발현을 Western blotting으로확인하였다. Metformin이약물감수성에영향을줄수있는지보기위해 mtor inhibitor인 Temsilolimus와병행투여한후독성정도를 CCK-8 assay로시행했다. 결과 : Caki- 세포는 CCI 유도시에 Temsilolimus 농도별약 20% 이상독성이증가됨을확인하였다 (Fig-A). Caki- 세포내의 mitochondrial protein인 VDAC과 COX-IV의증가가관찰되었으며, mitochondria의중요 regulator인 PGC-a 의증가및이의 up-stream인 phospho-ampk의증가를관찰할수있었다 (Fig-B). 세포주에 Metformin을농도별 (, 0 mm, Fig-2) 로투여했을때에적정농도를찾는실험을진행하였다. 이후에같은농도로 5일동안 metformin 을처리하였을때 CCI와같이 mitochondrial protein 인 VDAC이농도의존적으로증가됨을확인하였다 (Fig-3A). 이러한변화는 Temsilolimus와 metformin을동시투여했을때, CCI처럼약물감수성을증가시켰다 (Fig-3B). 결론 : 본연구는 CCI 및 Metformin에의한 mitochondria 활성을증가시키는기전을제시하였고이에따른약제의감수성을증대시키는효과를입증하였다. Keywords: Renal cell carcinoma, Metformin, Mitochondria 328

NP-002 hsv2-mir-h9 and hsv-mir-h8 in formalin-fixed paraffin-embedded (FFPE) are valuable diagnostic biomarkers for prostate cancer 변영준, 박현미, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 Background: Previously, we investigated the expression of two viral mirnas (hsv2-mir-h9 and hsv-mir-h8) in prostate cancer (PCa) from fresh tissues and urine. In this study, we reconfirmed two viral mirnas as field-effect related biomarkers for PCa in FFPE (Formalin-Fixed Paraffin-Embedded) and could generate hypothesis with these results. Materials and Methods: In total, FFPE tissue samples from 67 PCa patients, 00 noncancerous surrounding tissues, 00 benign prostate hyperplasia (BPH) were analyzed by real-time polymerase chain reaction (RT-PCR) in this study. Results: The expression levels of two viral mirnas were significantly higher in FFPE of PCa than in BPH (P<0.00). Remarkably, the expression levels of two viral mirnas in noncancerous surrounding tissues also were higher than in BPH controls (P<0.005). In case of PSA levels below 0 ng/ml, hsv-mir-h8 could discriminate PCa, noncancerous surrounding and BPH from each other (P<0.00). Conclusion: Our finding suggests that hsv2-mir-h9 and hsv-mir-h8 may help for decreasing unnecessary biopsy with increasing positive detection for PCa as valuable diagnostic biomarkers. Keywords: Viral mirna, mirna, Formalin-fixed paraffin-embedded, Prostate cancer 329

NP-003 새로운비침습적방광암진단마커로서소변 cell-free nucleic acid IQGAP3 의진단적가치 변영준, 김예환, 정필두, 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 Background: There is growing interest in developing new non-invasive diagnostic tools for bladder cancer (BC) that have better sensitivity and specificity than cystoscopy and cytology. This study examined the value of urinary cell-free nucleic acid (NA) as a diagnostic marker for BC. Material and Methods: A total of 8 patients (74 BC and 7 normal controls) were used for a tissue set, and 22 patients (92 BC and 20 normal controls) were used as a urine set. Expression of tissue mrna and urinary cell-free NAs was then examined. Results: Four candidate genes were top-ranked in the tissue microarray. Expression levels of two of these (IQGAP3 and TOP2A) in BC tissue and urine samples from BC patients were significantly higher than those in samples from the control groups. Binary logistic regression analysis of cell-free NA levels in urine samples revealed that IQGAP3 was significantly associated with BC: PicoGreen-adjusted odds ratio (OR), 3.434; confidence interval (CI), 2.999-4.80; P<0.00; RiboGreen-adjusted OR, 2.242; CI,.793-2.840; P<0.00. Further analysis of IQGAP3 urinary cell-free NAs with respect to tumor invasiveness and grade also yielded a high AUC, suggesting that IQGAP3 can discriminate between BC patients and non-cancer patients with hematuria. Conclusions: Levels of IQGAP3 urinary cell-free NA in BC patients were significantly higher than those in normal controls or patients with hematuria. High levels of IQGAP3 urinary cell-free NA also reflected high expression in BC tissues. Therefore, IQGAP3 urinary cell-free NA may be a complementary diagnostic biomarker for BC. Keywords: Biomarkers, Nucleic acids, Urinary bladder neoplasms, Urine 330

NP-004 방광암에서 UroVysion TM FISH 를이용한혈중순환종양세포의염색체이상검출 하유신, 성재우, 조신제, 양종협, 문형우, 홍성후, 김태정 2 가톨릭대학교의과대학 서울성모병원비뇨기과학교실, 2 여의도성모병원병리학교실 Objective: 혈중순환종양세포 (circulationg turmor cells) 는종양에서흘러나와혈중을순환하며, 본종양의분자학적특 성을잘반영하는것으로알려져있다. 본연구에서는방광암환자의혈액과소변에서혈중순환종양세포및방광암세포를 fluorescence in situ hybridization (FISH) 를통해비교해보고, 이세포들의활성도 (viability) 및염색체이상과의관련성을확인하고자하였다. Methods: 방광암환자 8명의혈액 5 cc 및소변 50 ml을채취하여각각종양세포를분리후단기간배양하였다. High Density Microporous (HDM) chip을이용하여검출한 circulationg turmor cells (CTCs) 에서 fluorescence in situ hybridization (FISH) 를시행하여염색체 3, 7, 7 또는 9p2의결실에대해확인하였고, Bioview TM automated Imaging System 을이용하여혈액내의 CTC와소변내의종양세포사이에분자학적차이및세포활성도에대해조사하였다. CTC를배양하여종양세포의활성도는 DAPI 염색을이용하여간접적으로측정하였다. Results: 방광암환자 8명의혈중순환종양세포 (CTCs) 8례와 0명의소변에서확인된 0개의 CTC를비교분석하였다. 혈중종양세포와소변내종양세포사이에서세포활성도는서로일치하지않는결과를보였다. 염색체이상은세포활성도가높은종양세포, 전체종양세포, 방광암병기사이에상관관계를보이지않았으나, 이러한종양학적변수와상관없이비정상염색체가많은군과낮은군으로나눌수있었다. Conclusions: 혈중순환종양세포와소변에서확인된방광암세포사이의연관성및방광암병기와의연관성, 세포활성도에영향을끼치는인자에대한추가연구가더필요할것이다. Keywords: Circulating tumor cells, Bladder cancer 33

NP-005 인간방광암세포주에서 MutT homolog (MTH) inhibitors 의항암효과 이정우, 호진녕 2, 이상철 2, 변석수 2, 이은식 3 동국대학교의과대학비뇨기과학교실, 2 서울대학교의과대학비뇨기과학교실분당서울대학교병원, 3 서울대학교병원 Purpose: We investigated the antitumor effects and its possible molecular mechanisms of MutT homolog (MTH) inhibitors in cisplatin-sensitive (T24) and resistant (T24R2) human bladder cancer cell lines. Materials and Methods: T24 and T24R2 cells were exposed to MTH inhibitors (TH588 or TH287). Tumor cell proliferation was assessed using Cell Counting Kit-8 and clonogenic assays. Flow cytometry was performed to estimate the change in cell cycle and apoptosis. Protein expression related to apoptosis and cell cycle was determined by Western blot. Results: The Cell Counting Kit-8 and clonogenic assays demonstrated the antitumor effects of TH588 alone or TH287 alone on T24 and T24R2 cells in a dose dependent manner. A flow cytometric analysis showed cell cycle arrest at the G2/M phase after the treatment of TH588 or TH287 for 24 hours in T24 and T24R2 cells. TH588 or TH287 induced apoptosis via increased expression of PARP, caspase-3, 8, and 9, and cytochrome c. Cell cycle arrest induced by TH588 or TH287 was accompanied by increased expression of cyclin B. Conclusions: Results reveal that MTH inhibitors have potent antitumor effects in cisplatin-sensitive and resistant bladder cancer cells. These findings suggest MTH inhibitor as an attractive novel class of chemotherapeutic agents in patients not only with advanced bladder cancer but also who are refractory or recur to first-line cisplatin-based chemotherapy. Keywords: Bladder cancer, MutT homolog, Antitumor effect 332

NP-006 Association of FOXP3 expression and related signaling pathway with prognosis in human prostate cancer 최승권, 최태수 2, 이상협 2, 유구한 2, 이동기 2, 민경은 2, 전승현 2, 이선주 2, 이형래 2, 장성구 2 서울의료원비뇨기과, 2 경희대학교의과대학비뇨기과학교실 Purpose: FOXP3 is a transcription factor and well-known hallmark of immune suppressive T regulatory cells (Tregs). Recent studies reported that FOXP3 plays an important role in tumor development. Thus, we investigated tumoral FOXP3, infiltrated Tregs count, NF-κB, Lats2, and YAP expression in prostate cancer, and the relationships between expression of these proteins and clinicopathological variables. Materials and Methods: We evaluated 46 prostate cancer patients who underwent radical prostatectomy at our institute from 2006 to 203. We analyzed immunohistochemistry of tissues, in relation to survival and other clinicopathological factors. Results: Positive tumoral FOXP3 expression was significantly related with worse pathologic stage and Gleason score (GS), positive surgical margin, and higher tumor volume (positive vs. negative; pt3 52.2% vs. 5%; pgs 8-0 26.% vs. 5%; positive margin 39.% vs. 5%; tumor volume 70.% vs. 67.7%). Patients with NF-κB expression were showed similar trend to FOXP3 expression gourp (high vs. low expression; pt3 60% vs. 27.3%; pgs 8-0 50% vs. 2.%; tumor volume 42% vs. 20%). Furthermore, patients with positive FOXP3, and NF-κB experienced biochemical recurrence compared to those with negative groups. Conclusions: These findings suggested that FOXP3 and NF-κB expression is associated with unfavorable clinicopathological variables in prostate cancer. In conclusion, the high expression of FOXP3 in prostate cancer cells is thought to contribute to tumorigenesis and progression of prostate cancer. Keywords: FOXP3, Prostate cancer, Prognosis 333

NP-007 전기임피던스스펙트로스코피니들을이용한정상신조직및악성신종양조직의구분 김현우, 윤조호 2, 김경환, 강병진, 이경, 백승룡, 박지훈, 신동길, 이종현 2, 이정주 부산대학교의학전문대학원비뇨기과학교실, 2 광주과학기술원의생명공학과 Objective: Electrical impedance spectroscopy (EIS) added on a hypodermic needle can analyze the impedance (consist of magnitude and phase angle) of tissues in the frequency domain. In this study, an EIS-on-a-Needle (EoN) was proposed for real-time discrimination between normal and cancerous renal tissues. Materials and Methods: EoN was fabricated by adding an electrical sensor at the tip of a 22-guage hypodermic needle using photolithography technology in a semiconductor process. To evaluate the efficacy of EoN in discriminating between normal and cancerous renal tissues, three nephrectomy kidney specimens with clear cell carcinoma was prepared. EoN was inserted 2 mm deep into the normal and tumor tissue of each specimen and the electrical impedance of the tissues were measured over the frequency range from 00 Hz to MHz at an operating voltage of 200 mvrms. The mean of magnitude and phase angle from the three specimens at each frequency were compared between the normal and tumor tissues to evaluate the effectiveness of EoN. Results: The normal and tumor tissues were apparently discriminated by the mean magnitude and phase angle at the frequency range from 200 khz to MHz. The largest difference was observed at 630 khz and 200 khz for mean magnitude and phase angle, respectively. The mean impedance values of the normal tissues were tended to be larger than those of the tumor tissues at the frequency range from 200 khz to MHz. Conclusion: EoN could apparently discriminate between normal and cancerous renal tissues at the frequency range from 200 khz to MHz. Further studies using a larger number of specimens are essential for a precise evaluation of EoN in tissue discrimination. Keywords: Impedance, Kidney, Cancer 334

NP-008 투명신세포암환자에서 AKT 발현과의상관관계및임상적유효성 최태수, 유구한, 신용호, 김영빈, 최정혁, 이상협 2, 이동기, 민경은, 전승현 2, 이형래, 이선주 2, 이충현 2, 장성구 2 강동경희대학교병원, 2 경희의료원 DNA methylation is a crucial epigenetic mechanism for determining the destiny of a cell. Its upward or downward dysregulation may induce malignant changes in cells. AKT, one of RAC-alpha serine/threonine-protein kinases, affects cell proliferation and apoptosis. And its altered overexpression may induce the development and progression of various malignancies. Tissue samples from 60 clear cell renal cell carcinoma cases were used for immunohistochemical staining, and patients with low AKT expression were compared with those with high AKT expression. The Fuhrman grade of patients in the low expression group was significantly lower than that of patients in the high expression group (p=0.02). While the tumor (T), node (N) and metastasis (M) stages of the AKT low expression group appeared to be lower compared with those of the AKT high expression group; this difference was not statistically significant (T stage, p=0.33; N stage, p=0.526; M stage, p=0.526). Additionally, patients in the low expression group had lower risk of postoperative tumor recurrence compared with those in the high expression group (p=0.020). The results indicate that the high expression of AKT is associated with cancer tissue to a greater extent than normal tissue. Although the biological function of AKT in clear cell renal cell carcinoma needs to be identified, high AKT expression is associated with high Fuhrman grade and worse recurrence free survival in patients with clear cell renal cell carcinoma. Keywords: AKT, Clear cell renal cell carcinoma, Immunohistochemical staining 335

NP-009 음경해면체평활근에서 Kv7 채널의특성및기능적역할 정재동, 채미리, 강수정, 이종훈, 성현환, 이성원성균관대학교의과대학삼성서울병원비뇨기과학교실 Objectives: KCNQ-encoded voltage-gated potassium channels (Kv7) have recently been identified as key regulator of vascular and non-vascular smooth muscle tone. Kv7 channel subtypes (Kv7.-Kv7.5) have a specific tissue distribution and pathophysiological role. Loss of function mutations in four of the five KV7 genes lead to distinct inherited diseases. such as cardiac arrhythmias, epilepsy and sensorineuronal deafness. However, their physiological role in corporal smooth muscle (CSM) remains to be fully elucidated. In this study, we examined the molecular expression and functional role of Kv7 channels in corporal smooth muscle. Materials & Methods: Expression of KCNQ isoforms in corporal smooth muscle (CSM) cells was examined using RT-PCR. Functional responses to Kv7 channel modulators were evaluated in normal and diabetic (DM) rabbit corporal smooth muscle (CSM) tissue. Isolated CSM strips were mounted in an organ-bath system, and the relaxation effects of the following Kv7 channel subtype selective activators: ML23 (Kv7.2/Kv7.4channels), ML277 (Kv7.) and ICA 069673 (Kv7.2/7.3), Flupirtine (Kv7.2-7.5 channels) were evaluated by cumulative addition to strips pre-contracted with0-5 M phenylephrine (PE). Results: Of the five KCNQ subtypes, the transcripts for KCNQ, KCNQ3-KCNQ5 were detected in human corpus cavernosum smooth muscle cells. In functional studies, Flupirtine, ML277 and ML23 produced a concentration-dependent relaxation of PE-induced contractions, with potencies of ML23>Flupirtine>ML277 (at 30 µm, ML23: 00.9±7.7%, Flupirtine: 59.4±4.3%, ML277: 29.±.8%, n=8, p<0.05). Whereas ICA 069673 was effective at 00 µm (42.3±8.2% at 00 µm, n=8, p<0.05). The effects of ML23 was attenuated by pre-incubation with µm XE99 (Kv7.-7.5 channel blocker) (n=8, p<0.05), which in turn confirmed Kv7 channels selectivity. Moreover, ML23 also induced concentration-dependent relaxation in CSM strips from diabetic rabbit, with similar potency in normal rabbit. Conclusions: These data suggest that Kv7channels, most probably Kv7.4 channels play a role in erectile function and might be a novel therapeutic target for treatment of erectile dysfunction. Keywords: Kv7channel, KCNQ, Corpus cavernosum, ED 336

NP-00 당뇨성발기부전마우스에서배아줄기세포및혈관주위세포유래엑소좀의발기능개선효과 송강문, 권미혜, 칼얀가탁, 응웬낫민, 최민지, 강동혁, 윤국남, 류지간, 서준규 인하대학교의과대학비뇨기과학교실, 성의학특성화센터 목적 : 엑소좀은 40-00 nm 크기의생체나노입자로서세포간소통에중요한역할을하는다양한종류의단백질, mrna, mirna 등을함유하고있다. 최근여러연구에서엑소좀이심혈관질환, 신경질환, 당뇨합병증등에서치료제로서의가능성이제시되고있으나발기부전분야에서는연구된바가없다. 이에본연구에서는당뇨성발기부전마우스모델에서배아줄기세포또는음경혈관주위세포 (pericyte)-유래엑소좀의발기력개선효과를평가하였다. 대상및방법 : 생후 8주된수컷마우스 (C57BL/6J) 를대상으로하였고, 당뇨는 streptozotocin (50 mg/kg) 을 5일연속복강내투여함으로써유발하였다. 당뇨유발 8주후 4개의군으로나누어실험을진행하였다 ( 대조군 ; 당뇨 +HBS 투여군 ; 당뇨 + 배아줄기세포-유래엑소좀 [ μg/20 μl] 투여군 ; 당뇨 + 음경혈관주위세포-유래엑소좀 [ μg/20 μl] 투여군 ). 음경해면체내엑소좀투여후 2주째음경신경자극후발기력을측정하였고, 음경해면체조직에서 PECAM-, smooth muscle α-actin, NG2, βiii-tubulin에대한면역조직화학염색을시행하였다. 음경해면체조직에서분리한혈관내피세포및대동맥절편을고농도 glucose 조건하에노출후엑소좀이튜브형성및미세혈관생성에미치는영향을평가하였다. 결과 : 당뇨마우스에서배아줄기세포또는혈관주위세포-유래엑소좀은정상대조군의 90% 수준으로발기력을개선시켰고, 음경해면체내혈관내피세포, 평활근세포, 혈관주위세포, 신경세포의발현을현저하게회복시켰다. 또한이들엑소좀은고농도 glucose 조건하에서억제된음경혈관내피세포의튜브형성및대동맥절편에서의미세혈관생성을정상 glucose 조건에서배양한수준으로회복시켰다. 결론 : 배아줄기세포및혈관주위세포-유래엑소좀은음경혈관내피세포및신경세포의회복을통해서당뇨로인한발기력저하를현저하게개선시켰다. 향후엑소좀이발기력개선을유발하는구체적인기전에대한추가연구가필요하다. Keywords: Erectile dysfunction, Diabetes, Exosome 337

NP-0 정상신세포의새로운 3 차원세포배양법제시 김숙영, 나준채, 허준혁,2, 홍성준,2, 이형호 3, 윤영은 4, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실목적 : Oragnoid 배양법은 adult-organ-derived ex vivo 배양법으로 stem cell 혹은 progenitor cell을성장시켜서 self-renew 뿐아니라 differentiation 까지도가능한 3차원적인배양법이다. 본연구자는 adult 정상신장조직을이용하여 organoid 배양법에성공하여보고하는바이다. 대상및방법 : 정상신장의조직을얻어조직을분리하고이를 3D 배양법및 3D on-top 배양법을사용하였다. 대조군으로는상용화된 primary normal tubule cell (ATCC) 과비교하였다. Gentamycin이나 cisplatin로인한 acute injury를통해 Kidney Injury Molecule- (KIM-) 이나 Neutrophil gelatinase-associated lipocalin (NGAL) 의발현정도를 confocal microscopy을이용하여비교하였다. 결과 : 정상신장의조직세포중 tubule cell이주요하게배양됨을 ATCC primary normal tubule cell과비교하여알수있다 (Fig. A). 3D 배양으로 2주이상배양했을때, dome-like 한입체구조를이룸을확인할수있으며, 이러한현상은 ATCC 세포나본연구실에서분리한세포모두동일하게관찰되었다 (Fig. B). 그러나, ATCC보다 dome-like 한구조를만드는능력이 3배정도잘유지됨을 colony count 로확인하였다 (Fig. 2). Dome-like 한구조가 tubule cell의구조임을확인하기위해, Tamm-Horsfall glycoprotein염색을시행한결과, 기존 2D 보다 3D 배양에서더강한발현을보여줌을확인하였다 (Fig. 3). 다른보고에서와같이, tubule organoid 임을알아보기위해 acute injury를가했을때, NGAL과 KIM-의양이 organoid 전체혹은각 tubule 세포에서발현하고있음을알수있다 (Fig. 4). 결론 : 본연구에서는성인의정상신장조직을이용하여 Kidney organoid 배양을통해, 신장세포혹은 tubule 세포의특징이잘보존되고, injury model 에서도정상적으로 injury marker들을발현할수있음을제시하였다. Keywords: Kidney organoid, 3D culture 338

NP-02 백서요도에서요자제기전에관한베타 3 수용체의역할 권준범,2, 스즈키타카히사 2, 타카오카에이이치로 2, 시미즈노부타카 2, 타카이 2, 요시무라나오키 2 대구파티마병원비뇨기과, 2 피츠버그대학교의과대학비뇨기과학교실 Purpose: To investigate the effect of mirabegron and selective β3-adrenoceptor antagonists on the urethral contractile function using female rats. Material and Methods: Female SD rats were divided into 3 groups. In group A, 2 mg/kg and 0 mg/kg mirabegron were administered intravenously (IV). In group B, 50 µg/kg L-748,337, a selective β3-receptor antagonist, was injected IV prior to 0 mg/kg mirabegron. In group C, 3 mg/kg propranolol and 50 µg/kg L-748,337 were injected IV prior to mirabegron. LPP (leak point pressure), UBP (urethral baseline pressure) and dup (differential values of urethral pressure during intravesical pressure elevation) were measured before and after drug administration. Results: In group A, LPP, UBP, and dup were not changes after 2 mg/kg mirabegron, but showed significant decreases in these 3 parameters after 0 mg/kg mirabegron. In group B, L-748,337 made significant increase only in UBP. However, subsequent 0 mg/kg mirabegron reduced all the parameters significantly. In group C, any of 3 parameters were not changed by the combined administration of propranolol and L-748,337. But mirabegron following these combination still reduced LPP, UBP, and dup. Conclusions: β3-adrenoceptors play a minor role in the control of urethral baseline tone and reflex contractions of the urethral sphincter muscles. Mirabegron can induce urethral sphincter relaxation through β3-receptor-independent mechanisms at a high dose, possibly through interactions with other receptor types such as α-adrenoceptors. Keywords: Mirabegron, Adrenoceptor, Urethra 339

NP-03 홀뮴레이저를이용한전립선절제술후회수한일반전립선비대증조직과비치볼사이의전기임피던스차이 김현우, 윤조호 2, 김경환, 강병진, 이경, 백승룡, 박지훈, 신동길, 이종현 2, 이정주 부산대학교의학전문대학원비뇨기과학교실, 2 광주과학기술원의생명공학과 Objectives: To investigate the impedance difference between typical benign prostatic hyperplasia (BPH) tissues and beach balls by using a needle device with electrical impedance spectroscopy (EIS) sensor on the tip. Methods: A total of 0 respective pieces of typical BPH tissues and beach balls were prepared from 0 patients who presented beach balls during morcellation after Holmium Laser Enucleation of the Prostate were collected. The impedance of the samples was measured at the frequency range from 00 Hz to MHz by using the needle device with EIS sensor (Fig. a-c) followed by a pathological investigation of the samples. The impedance data obtained from the experiment were statistically compared and analyzed between the two tissue types. Results: The mean magnitude of the beach balls were tended to be larger than that of the typical BPH tissues at all frequencies from 00 Hz to MHz (Fig d). Notably, significantly larger mean magnitudes were measured in the beach balls compared to the typical BPH tissues at the frequencies higher than 5.9 khz (p 0.02). Also, a significant negative correlation was presented between the measured magnitudes and frequencies in beach balls (r=-0.28; p<0.00) and typical BPH tissues (r=-0.29; p<0.00). When the magnitude of the tissues was log-transformed, the variation of mean log-transformed magnitudes according to the frequency was significantly different between the two types of prostatic tissues (p<0.00). The pathologic features of the beach balls presented pure stromal nodule of nodular hyperplasia while the typical BPH tissues presented mixed epithelial-stromal nodule of nodular hyperplasia. Conclusion: The needle device with EIS sensor could effectively discriminate between the typical BPH tissues and the beach balls by measuring their electrical impedance. Also, the difference of impedance between the two types of prostatic tissues is assumed to be attributed to the amount of stromal content in the tissues. Keywords: Impedance, Prostate, Stroma 340

NP-04 Overexpression of transient receptor potential vanilloid-4 (TRPV4) in urothelium of rat urinary bladder following bladder outlet obstruction 오주용, 오정훈, 손수민, 류지원, 박태주, 김태희, 은성종, 김종범, 조양현, 김명수, 정호석, 황의창, 오경진, 김선옥, 정승일, 강택원, 권동득, 박광성 전남대학교의과대학비뇨기과학교실 Purpose: The purposes of this study were to investigate the effect of detrusor overactivity induced by partial bladder outlet obstruction (BOO) on the expression of transient receptor potential vanilloid-4 (TRPV4) in rat urinary bladder, and to determine the role of these molecules in the detrusor overactivity. Methods: Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. The BOO group underwent partial BOO. The control group underwent a sham operation. After 4 weeks, a urodynamic study was performed 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 BOO group (3.±.2) than in the control group (6.9±0.9) (p<0.05). Conversely, the average contraction pressure (mmhg) was significantly higher in the BOO group (20.±3.5) than in the control group (2.±2.) (p<0.05). TRPV4 was expressed mainly in the cytoplasm of the urothelium. The TRPV4 protein expressions were significantly increased in the BOO rats (p<0.05). Conclusions: Detrusor overactivity induced by BOO causes a significant increase in the expression of TRPV4. This finding may imply that TRPV4 might be closely related to the bladder signal activity and may have a functional role in detrusor overactivity that occurs in association with BOO. Keywords: TRPV4, Bladder outlet obstruction, Rats 34

NP-05 로봇이용근치적방광절제술 : 로봇 naïve 술자의학습곡선분석 윤성구, 태종현, 김승빈, 김재윤, 심지성, 강성구, 천준, 이정구, 김제종, 강석호고려대학교의과대학비뇨기과학교실 Purpose: To estimate the learning curve on perioperative and oncologic outcomes of the robot assisted radical cystectomies (RARC) in bladder cancer patients by a robot naïve surgeon. Materials and Methods: Utilizing a prospectively maintained, single institution robotic cystectomy database, we identified 0 consecutive patients (including 70 intracorporeal urinary diversion) who underwent RARC between November 2007 and May 207. The surgeon has prior experience with open radical cystectomy (RC), but does not have any robotic surgery experiences as a ` surgeon. The learning curve was assessed using chronological subgroups and by trends across the cohort. Results: The overall total operation times, mean estimated blood loss and complication rate showed a decreasing tendency. Minor and Major complication rate within 30 days were 28% and 6%, between 30 and 90 days were % and 4%, respectively. In the process of RC and LN dissection, the number needed to reach proficiency level in the learning curve was 24 cases. 2 cases were needed to be proficient in total intracorporeal urinary diversion procedure. When the groups of the first 0 patients and the last 0 patients were compared, LN yields were significantly higher in the last group. Conclusion: RARC is a complex and challenging procedure, but it can be performed safely without compromising perioperative outcomes during the learning curve in a robot naïve surgeon. Especially, the each proficiency level of RARC with LN dissection and total intracorporeal urinary diversion process was achieved after 24 and 2 cases respectively. Keywords: Bladder cancer, Robot cystectomy, Learning curve 342

NP-06 골반계측치가근치적방광절제술및신방광조형술후요역동학패턴에미치는영향 김광현, 윤현석, 송완, 추희정 2, 윤하나, 정우식, 심봉석, 이동현 이화여자대학교의과대학비뇨기과학교실, 2 이화여자대학교부속목동병원비뇨기과 목적 : 근치적방광조형술후신방광조형술을시행하는경우다양한배뇨형태를나타낸다. 본연구에서는신방광조형술후나타나는배뇨형태를요역동학검사에따라군집화하고, 이런배뇨형태에골반계측 (pelvimetry) 이영향을미치는지확인해보고자하였다. 대상및방법 : 202년 월부터 205년 월까지본원에서방광암으로근치적방광절제술및신방광조형술을시행받은 42명중술후요역동학검사와배뇨에관한자료가있는 03명의환자가본연구에포함되었다. 요역동학검사항목 (maximal cystometric capacity, residual volume, maximal flow rate, compliance, and abdominal pressure at maximum flow rate) 으로 K-mean 군집화분석을하여세그룹을확인하였으며, 세그룹은각각 well voider ( 그룹 ), small capacity with low compliance ( 그룹 2), large residual urine volume ( 그룹 3) 의특징을가졌다. 술전시행한 MRI를통하여 anteroposterior diameter of pelvic inlet (API), anteroposterior diameter of pelvic outlet (APO), pelvic depth (PD), interspinous distance (ISD), bony femoral width (BFW) 를측정하였고, 이러한계측치가배뇨형태에독립적인인자로작용하는지확인하였다. 결과 : API, APO, PD, BFW, ISD중 API, APO, PD 3가지항목이적어도 개이상의요역동학검사항목과상관성을나타내었다. API, APO, PD중 API, PD는서로상관성이관찰되어 (Pearson계수 0.877, P<0.00), APO와 PD 두가지항목을분석항목으로선택하였으며, APO, PD는남녀성별간유의한차이가관찰되지않았다. 나이, 성별 (female vs. male), 체질량지수, 고혈압과당뇨의유무, APO, PD를다변량분석하였을때, 그룹 (well voider) 를예측하는인자는나이 (HR 0.95, P=0.043), 성별 (HR 0.09, P=0.00), PD (HR.05, P=0.047) 이었고, 그룹 2 (small capacity with low compliance) 를예측하는인자는성별 (HR 3.34, P=0.023), PD (HR 0.92, P=0.002) 였다. 그룹 3 (large residual urine volume) 은골반계측치와연관없었으나, 성별 (HR 2.97, P=0.06) 과체질량지수 (HR.7, P=0.072) 가가장큰연관성을보였다. 결론 : 근치적방광절제술및신방광조형술을시행하였을때, 골반계측치중 PD 계측치는성별, 나이등과함께요역동학검사에기초한배뇨형태에독립적으로영향을미친다. 하지만, 수술후발생하는요정체등에는무관한것으로보인다. Keywords: Neobladder, Urodynamics, Pelvimetry 343

NP-07 초기방광암및진행성방광암환자의전치적방광절제술후생존률의비교분석 김태진, 이인재, 이상철, 홍성규, 변석수, 오종진분당서울대학교병원비뇨기과학교실 Introduction: To compare survival outcomes between radical cystectomy patients diagnosed as T or above after initial transurethral resection of the bladder tumor (TUR-BT) and patients who had tumor progression during follow up at the time of tumor recurrence. Methods: The study population comprised of 92 patients who underwent radical cystectomy. The initial group consisted of 0 patients with a diagnosis of T or higher after initial TUR-BT (initial group) and 82 patients who progressed to T2 during follow up after TUR-BT at the time of tumor recurrence (progressed group). Progression was defined as recurrence to a higher grade and/or stage than the previous result, while MIBC progression was defined as progression to stage T2 or higher and/or N+, and/or M. Results: The mean age for the initial group was 65.05±.24 years and 66.90±0.55 for the progression group. The mean survival duration for both groups was 26.72±5.03 and 20.36±5.32 months, respectively. Kaplan-Meier curve analysis showed significantly decreased 5-year OS (83.5% vs. 67.3%) (Fig ), CSS (82.4 vs. 66.7%) (Fig 2), and the median recurrence-free survival duration was 8.79±6.9 months for the initial group and 85.2±4.72 months for the progressed bladder cancer group. Conclusions: The progressed bladder group showed slightly poorer survival outcomes compared with the initial group. In conclusion, with progressive bladder cancer patients who underwent radical cystectomy, intensive surveillance and treatment strategies should be considered. Keywords: Bladder cancer, Survival 344

NP-08 방광암으로근치적방광절제술을받은여성환자에서생식기관침범의예측인자 최세영, 류제만, 경윤수, 한재현, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We evaluated predictors of organ involvement and oncological outcomes after radical cystectomy with anterior exenteration in female patients. Methods: Among,98 patients who underwent radical cystectomy for the bladder tumor between 990 and 205, 78 (4.9%) patients were female. They were divided into two groups according to pelvic involvement in pathology. Their medical records and pathology and image findings were reviewed retrospectively. Non-urothelial cell carcinoma and no genital organ pathology were excluded. Multivariate logistic regression was performed to predict factors associated with female organ involvement. Results: Out of 2 eligible female patients with urothelial cell carcinoma, (9.8%) had female genital organ involvement. Female genital organ involvement occurred primarily in the uterus (63.6%) mostly. The 5-year overall survival rates were 67.3% in the non-involvement group and 8.9% in the involvement group. On multivariate analysis, tumor location of trigone or bladder neck at transurethral resection of bladder tumor (TUR-B) (odds ratio [OR] 9.84, 95% confidence interval [CI] 2.89-230.68, p=0.0056), maximum tumor size at computed tomography (CT) (OR 2.7, 95% CI.29-4.34, p=0.0095), and hydronephrosis at CT (OR 7.6, 95% CI 2.28-296.26, p=0.058) were associated with female organ involvement. Conclusions: Female genital organ involvement showed poor prognosis. Tumor location of trigone or bladder neck at TUR-B, maximum tumor size at CT or hydronephrosis at CT were significant factors to predict female genital organ involvement. Preoperative recognition of female genital organ involvement need to consider radical cystectomy and multimodal treatment. Keywords: Bladder cancer, Radical cystectomy, Female genital organ 345

NP-09 원위부요관의요로상피암에대한개복및최소침습신우요관절제술의종양학적결과비교 류제만, 남욱, 홍준혁, 김청수, 안한종, 홍범식 울산대학교서울아산병원비뇨기과학교실 Introduction: We investigated the differences of oncological outcomes between open and minimally invasive nephroureterectomy for urothelial carcinoma involving distal ureter. Material and Methods: Among 55 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) from 997 to 202, patients with pathologic T4 disease, nodal metastasis, previous history of bladder tumor or UTUC not involving distal ureter were excluded. 3 patients with UTUC involving distal ureter were finally included for the study. Patients were divided into the 2 groups according to surgical methods (open vs. minimally invasive surgery [MIS]). We evaluated the impacts of surgical methods on oncological outcomes, including intravesical recurrence and survival using multivariate analysis. Mean follow-up duration was 62 and 56 months in open and MIS group, respectively. Results: Of the 3 patients, 60 (53.%) and 53 (46.9%) patients underwent open and minimally invasive nephroureterectomy, respectively. There was no difference in clinical characteristics, including age, gender, body mass index, and tumor laterality between the two groups. In addition, pathologic T stage, tumor grade, and incidence of lymphovascular invasion or surgical margin were not different between the two groups, while carcinoma in situ was more frequent in MIS group than open group (32.% vs. 0.0%, p=0.004)..7% and 8.9% of patients in open and MIS group underwent adjuvant chemotherapy, respectively, but there was no statistical difference. The estimated 5-year intravesical recurrence-free survival (RFS) (36.7 vs. 38.9%, p=0.339), extravesical RFS (62. vs. 65.%, p=0.803), and overall survival (OS) (64.5 vs. 67.8%, p=0.300) rates were not different between open and MIS groups. On multivariate analysis, surgical method was not significant predictor of RFS and OS, although lymphovascular invasion (HR: 2.075, p=0.020), carcinoma in situ (HR: 2.609, p=0.004), pathologic T stage (T3 vs. T2; HR:.955, p=0.050), and tumor grade (3 vs. 2; HR: 2.698, p=0.030) were significantly associated with OS. Conclusions: In patients with UTUC involving distal ureter, minimally invasive nephroureterectomy showed equivalent oncological outcomes compared to open nephroureterectomy after adjusting tumor characteristics. Keywords: Transitional cell carcinoma, Ureter, Minimally invasive surgery 346

NP-020 로봇보조근치적방광전절제술의학습곡선 : 단일술자의초기경험 황진호, 서영은, 유영동, 이영주, 김정준, 이학민, 이상철, 정성진, 홍성규, 변석수, 이상은, 오종진분당서울대학교병원비뇨기과학교실목적 : 단일술자의최초 30례의경험을바탕으로하여수술적, 종양학적, 임상적결과를토대로로봇보조근치적방광전절제술 (RARC) 의학습곡선을파악하기위함. 방법 : 204년 5월부터 207년 4월까지 RARC와요로전환술을시행받은단일술자의최초경험인 30명의환자를대상으로후향적분석을하였다. 이술기의학습곡선을파악하기위해계산실혈량 (EBL), 총수술시간 (OR), 로봇수술시간 (CO), 종양학적병리결과, 그리고합병증발생률등을조사하였다. 우리는전체환자를수술순서에따라 5분위군으로나누어분석하고 (quintiles), 또전, 후의 2개군으로나누어분석해보았다. 결과 : EBL은마지막 5번째군 (25-30) 으로들어서며크게감소하였다 (p=0.04). OR 및 CO는지속적인감소추세를보였으며, 5례부근부터는안정화되는양상을보였다. OR과 CO모두전 / 후반 5례에서통계적으로의미있는차이를확인하였다 (p=0.07, p<0.00). 절제임파선수역시후반 5례에서유의미하게증가하였으며 (4.5 vs 20.5, p=0.027), 마지막 5분위군까지증가추세가지속되었다. 술후병리결과에서경계면양성을보인경우는없었다. 재원기간및퇴원후합병증발생률은큰차이를보이지않았다. 결론 : RARC의최초 30례의분석을통해, 총수술시간, 로봇수술시간, 계산실혈량의감소와절제임파선수의증가를확인하였고, 이를통한학습곡선의극복과정을파악할수있었다. 종양학적병리결과및합병증발생률은학습곡선과관련이없었다. 좀더정확한파악을위해복수의술자와많은수의사례에대한분석을요한다. Keywords: Bladder, Cancer, RARC 347

NP-02 수술받은상부요로암환자에서방광내무재발생존률, 질병무진행생존률, 암특이생존률에대한유의한예후인자분석 김정권, 김성한, 송미경 2, 주정남 2, 정재영, 정진수, 이강현, 서호경 국립암센터전립선암센터비뇨기과, 2 국립암센터암역학예방연구과바이오메트릭스연구과 Objective: This study aimed to identify prognostic factors for bladder recurrence, disease progression, and cancer-specific survival after radical nephroureterectomy among patients with upper urinary tract urothelial carcinoma (UTUC). Methods: We retrospectively reviewed 84 non-metastatic cases of UTUC after radical nephroureterectomy, bladder cuffing, and/or partial cystectomy (2004-206). Bladder recurrence-free survival (BRFS), disease progression-free survival (DPFS), and cancer-specific survival (CSS) were estimated. The prognostic values of clinicopathological parameters were evaluated using Cox logistic regression analysis. Results: During a median follow-up of 36.5 months, we identified bladder recurrence (64 cases, 34.8%), disease progression (54 cases, 29.4%), and cancer-specific death (24 cases, 3.0%). The median BRFS, DPFS, and CSS values were 9.0 months, 38.5 months, and 67.0 months, respectively. BRFS was independently associated with former smoker status (hazard ratio [HR]: 2.34), previous bladder tumor (HRL 0.56), previous intravesical instillation (HR: 29.544), and lymphovascular invasion (HR: 0.445). DPFS was independently associated with active smoker (HR: 0.345). CSS was independently associated with alkaline phosphatase levels (HR: 0.962), tumor location (HR: 5.420), and pathological N stage (HR: 7.433). Conclusion: This study identified factors that predicted BRFS, DPFS, and CSS after surgery for UTUC. Patients with these factors should receive adjuvant intravesical/systemic chemotherapy and intensive surveillance Keywords: Nephroureterectomy, Ureter cancer, Bladder, Prognosis, Risk factor 348

NP-022 기생식세포종환자에서혈중종양표지자의임상영역에서의실용적평가 채한규, 최세영, 유달산, 정인갑, 홍범식, 홍준혁, 김건석, 안한종, 김청수울산대학교의과대학서울아산병원비뇨기과 Introduction: We assessed postoperative changes of serum tumor marker in stage I germ cell tumor. In addition, we evaluated the oncological outcomes of patients with stage I germ cell tumor. Methods: Among 237 patients who underwent radical orchiectomy from 99 to 207, germ cell tumor was identified on pathological examination in 99 patients, including 68 patients with non-seminomatous germ cell tumor (NSGCT), 33 patients with stage I and 35 patients with stage II or III. 3 patients were diagnosed of seminoma, 22 patients with stage I and 9 patients with stage II or III. Postoperative change of serum tumor markers was assessed. In addition, half-life of each tumor marker was calculated. We also evaluated oncological outcomes in stage I germ cell tumor. Median follow-up duration was 95 months. Results: Median age was 23 years. Stage was as follows; stage IA in 27(49.0%) patients, stage IB in 23 (4.8%) patients and stage IS in 5 (9.%) patients. In patients with stage I seminoma, there shows no definite elevation of serum tumor marker. Among stage I NSGCT patients, median AFP at diagnosis was 2648 ng/ml (0.8 to 628). After one month of orchiectomy, AFP in stage I NSCGT decreased into 44.7 ng/ml ( to 289). Estimated serum half-life of AFP was 5.09 days in stage I NSGCT. Median beta human chorionic gonadotropin (hcg) at diagnosis was 232.5 miu/ml ( to 440), decreased into 2.04 miu/ml ( to 3.2) after one month of orchiectomy. Serum half-life of beta hcg was 4.3 days in NSGCT. There was one patient with recurrence. He was in stage IS NSGCT. Beta hcg increased after 2 months of orchiectomy, so he started chemotherapy 4 months after orchiectomy. Eight years later, tumor recurred in aortocaval lymph node and retroperitoneal lymph node dissection (RPLND) was done and pathology showed cystic teratoma. Recurrence free survival was 97.6 months, 5-year overall survival rate was 00%. Conclusions: Real half-life of beta hcg was longer than that of reference in stage I NSGCT. This result of hcg half-life will be helpful in clinical field for follow-up of patients with stage I NSGCT. Keywords: Germ cell tumor, Testicular cancer, Serum tumor marker 349

NP-023 근치적방광절제술환자에서림프관침윤의예후적가치 육형동, 윤민영, 정창욱, 곽철, 김현회, 구자현서울대학교병원비뇨기과 Introduction: To evaluate determine the prognostic value of lymphovascular invasion (LVI) in patients with bladder cancer who underwent Radical cystectomy.. Methods: 747 patients underwent radical cystectomy. The number of patients who did not undergo LND was 64. Patients were divided into 4 groups (N0, N, non-lnd with LVI, non-lnd without LVI). Results: Median follow up was 4.5 (0-3) months. The N and LVI groups showed significantly higher T stage and Grade than the N0 and without LVI groups. And the recurrence rate and mortality rate were.5 to 2 times higher than the N0 and without LVI groups. Overall survival (OS) was significantly higher in the N group than in the N0, without LVI groups (p=0.00, p=0.02). And OS of LVI group was significantly higher than the LVI group was significantly higher than the N0, without LVI group (P=0.000, p=0.000). Recurrence free survival (RFS) was significantly higher in the N group than in the N0, without LVI groups (p=0.000, p=0.000). And RFS of LVI group was significantly higher than the LVI group was significantly higher than the N0, without LVI group (P=0.000, p=0.000). Conclusion: Clinical results according to LVI were similar to those predicted by lymph node involvement in patients undergoing radical cystectomy. For LVI in patients who underwent Radical cystectomy, treatment is required according to the node positive patients. Keywords: Lymphovascular invasion, Radical cystectomy, Bladder cancer 350

NP-024 요관에위치한 pt3b 상부요관종양에서의수술후보조적치료 김종근 2, 박사현, 김명, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 김청수, 안한종 울산대학교서울아산병원, 2 한림대학교동탄성심병원 Purpose: We reported the tumor that invades peripelvic fat or periureteral fat (pt3b) had worse prognosis than the tumor that invades renal parenchyma (pt3a). We evaluated the disease recurrence and cancer-specific survival of patients with pt3b urothelial carcinoma of the upper urinary tract who received adjuvant treatment. Materials and Methods: The data from a total of 28 pt3b patients after radical nephroureterectomy were analyzed. The patients were divided into 4 groups; 6 without adjuvant therapy (Group ), 2 with adjuvant radiotherapy (Group 2), 26 with adjuvant chemotherapy (Group 3), and 20 with adjuvant radiotherapy plus adjuvant chemotherapy (Group 4). Recurrence-free survival and cancer-specific survival rates were compared among these groups. Results: The mean follow-up duration was 39.8 months. The patients who received adjuvant radiotherapy (Group 2 and 4) were more likely to have a high pathologic grade (p=0.036) and a more-frequent positive surgical margin (p=0.007). Five-year recurrence-free survival rates of group, group 2, group 3 and group 4 were 25.5%, 6.2%, 27.2% and 54.5%. Five-year cancer-specific survival rates in group, group 2, group 3 and group 4 were 52.3%, 48.%, 48.7% and 6.9%. In the patient with tumor that invades periureteral fat, adjuvant radiotherapy significant reduced the risk of disease recurrence (HR=0.425, p=0.004) and adjuvant chemotherapy significant reduced the risk of distant metastasis (HR=0.500, p=0.033). Higher cancer-specific survival was noted in group 4, but did not reach statistical significance (p=0.273). Conclusion: Adjuvant radiotherapy in the pt3b patients significantly reduced the risk of disease recurrence. Adjuvant chemotherapy increased the distant metastasis-free survival in patient with ureteral tumor. Adjuvant radiotherapy with adjuvant chemotherapy should be considered in patients with pt3b and ureteral tumor. Reference:. Park, J., et al., Peripelvic/periureteral fat invasion is independently associated with worse prognosis in pt3 upper tract urothelial carcinoma. World J Urol 204;32():57-63. Keywords: Urothelial neoplasm, Adjuvant treatment, Cancer-specific survival, Recurrence-free survival 35

NP-025 Identifying carcinoma in situ lesions in the bladder using red/green/blue numerical values from white-light imaging 이광석, 구교철, 김장환 2, 홍성준 2, 정병하 연세대학교의과대학 강남세브란스병원, 2 신촌세브란스병원 Purpose: Carcinoma in situ (CIS) of the bladder is difficult to visually distinguish from normal mucosa and inflammatory tissue. We investigated whether the numerical values of the red-green-blue (RGB) spectra can diagnose malignancies. Materials and Methods: Patients who underwent white-light cystoscopy (WLC) and diagnosed with CIS on pathology after bladder resection were reviewed. Patients with interstitial cystitis (IC), cystitis, and normal bladders were also analyzed. WLC images were analyzed using the picture archiving and communication system for R/G/B values and compared among normal or abnormal bladder walls. Univariate and multivariate analyses using Cox proportional hazards regression models were performed for predicting Bacillus Calmette-Guérin (BCG) failure. The RGB values of pixels from 3 randomized points on abnormal and normal bladder walls were compared. Results: The R value for CIS was significantly higher than that of IC and lower than that of cystitis. WLC G value >97 (odds ratio [OR]=0.46, p<0.00) and B value >73 (OR=2.94, p=0.008) were significant predictors of CIS in abnormal lesions. On multivariate analysis, previous bladder cancer diagnosis (Odd ratio [OR]=7.90, p<0.00) and a WLC R value 75 (OR=3.28, p<0.00) were significant predictive factors for recurrence. Previous bladder cancer diagnosis (Hazard ratio [HR]=3.40; p=0.005) and a WLC G value 45 (HR=2.30, p=0.04) were significant predictors of bladder contraction frequency failure after BCG therapy. Conclusions: RGB analysis, which is simple and efficient, is useful for identifying CIS without the need for dyes. RGB bladder wall analysis can be helpful for predicting bladder cancer recurrence and BCG failure. Keywords: Bladder cancer, Carcinoma in situ, Color analysis, White-light cystoscopy 352

NP-026 OPD based biopsy and fulguration during follow-up period in NMIBC 김문성, 노주현, 김종녕, 임건우, 정재호, 이태호, 최경화, 이승렬, 홍영권, 박동수 CHA의과학대학교분당차병원 Objective: To evaluate the differences in pathologic diagnosis according to cystoscopic morphological findings in patients who underwent OPD based biopsy and fulguration for NMIBC follow-up. Methods: We retrospectively analyzed the medical records of 36 patients who underwent OPD based biopsy and fulguration for NMIBC follow up enrolled in this study. The cystoscopic morphological findings of NMIBC were classified into three types and those were categorized by one resident and two urologists as consensus (Fig. ). ANOVA analysis and Chi-square or fisher's exact test were used (p<0.05). Results: There were significant differences in the tumor size of less than 3 centimeters in each group at the initial diagnosis (p=0.026, Table ). The cancer diagnosis rates of each type when biopsy had done were relatively low in Type and 2 but statistically insignificant (p=0.50). Also, the proportion of patients who were diagnosed as non-cancer at time of biopsy, but were diagnosed with cancer later was relatively higher in type and type2, but was not statistically significant (p=0.260). The final recurrence rates of the cancers after biopsy and fulguration were relatively lower in type 3, although there were no statistical significances (p=0.87). Conclusions: The pathologic diagnosis according to cystoscopic findings was not different from each other. In type and 2, the total recurrence rate was relatively higher, maybe due to lower cancer diagnosis and absence of BCG instillation at the time of biopsy and fulguration. Therefore, advertent follow-up is required for type and 2 Keywords: Non-muscle-invasive bladder cancer, Cystoscopic morphological type 353

NP-027 The impact of waist circumference on the risk of bladder cancer development according to body mass index: complete enumeration results of the Koreans 양종협, 강성민, 문형우 2, 이규원, 정현철, 최진봉 3, 김정호 2, 홍성후, 하유신 가톨릭대학교서울성모병원, 2 동남권원자력의학원, 3 가톨릭대학교부천성모병원 Purpose: We examined the association between obesity and bladder cancer using nationally representative data on the Korean population from the National Health Insurance System (NHIS). We estimated the impact of waist circumference (WC) on the risk of bladder cancer development according to body mass index (BMI) Materials and Methods: Of the 45,850,458 people who underwent at last one health examination from 2009-202, 23,308,825 without bladder cancer were followed from the January 2009 to the December 205. Multivariate adjusted Cox regression analysis was conducted to examine hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between bladder cancer and obesity. Results: Increasing WC and BMI were risk factors of bladder cancer development. A significant increasing trend in risk of bladder cancer was seen with increasing BMI in a stepwise method model. A significant increasing trend in risk of bladder cancer was seen with increasing WC in a stepwise method model of male. A significant increasing trend in risk of bladder cancer was seen with increasing WC in female. However, Different associations between BMI and bladder cancer development were observed between the group WC 90 and WC<90 in male. In the group WC<90, the HRs for bladder cancer rather decreased as BMI increased beyond the reference BMI in a model adjusted for age and multiple variables. In the group WC 90, the HRs for bladder cancer increased more steeply than in the overall male as BMI increased in the contrary. Similar associations between BMI and bladder cancer development were observed between the group WC 85 and WC<85 in female. Conclusion: This population-based study showed that increasing BMI and WC were risk factors for develop bladder cancer independent of confounding variables. However, Different associations between BMI and bladder cancer development were observed according to WC categories. Keywords: Bladder cancer, Body mass index, Waist circumference 354

NP-028 신경보존근치방광절제술 : 발기능및장기종양학적결과 권세윤, 하윤석 2, 최석환 2, 김현태 3, 김태환 3, 권태균 3 동국대학교경주병원, 동국대학교의과대학비뇨기과학교실, 2 경북대학교병원, 경북대학교의과대학비뇨기과학교실, 3 칠곡경북대학교병원, 경북대학교의과대학비뇨기과학교실 Purpose: Radical cystectomy (RC) is currently regarded as the gold standard for the management of muscle-invasive bladder cancer, extensive uncontrollable non-muscle-invasive cancer, and refractory carcinoma in situ (CIS). Despite outstanding oncologic outcome of RC, erectile dysfunction (ED) remains a health related quality of life domain that is commonly impaired after RC. We performed nerve sparing RC (NSRC) to overcome this problem and compared operative outcomes between the non NSRC (NNSRC) and NSRC groups. Material and Methods: We retrospectively analyzed the data from 7 patients who underwent NNSRC and 2 patients who underwent NSRC in our institution from July 2009 to May 204. Data were collected on patients demographics, pathologic staging, perioperative outcomes and long term oncologic outcomes as well as erectile function. Results: The median follow-up periods were 42.0 months and 59.0 months in NSRC and NNSRC, respectively. There were no statistically significant differences between two groups in patients demographics, pathologic staging, perioperative outcomes. There were no significant differences in the 5-year overall survival rate (88.2% vs 85.7%), the cancer-specific survival rate (88.2% vs 90.0%). Overall postoperative potency rate was higher significantly in NSRC than in NNSRC (4.2% vs 9.5%, p=0.022). Conclusions: Our clinical experiences indicate that NSRC in selected patients is a feasible procedure in terms of oncologic outcome and able to preserve erectile function relatively effectively. Keywords: Radical cystectomy, Erectile function, Oncologic outcome 355

NP-029 Tb 신세포암에서수술전 CKD 2 등급인환자가수술후 CKD 3 등급이하로진행할위험이부분신절제술과근치적신절제술사이에유의한차이가없다 나준채, 윤민지, 김진우, 박지수, 안현규, 강숭구, 이형호 3, 윤영은 4, 홍성준,2, 한웅규,2 연세대학교의과대학비뇨기과학교실, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 목적 : 신장종양수술에서신기능보존은중요한고려대상이다. 부분신절제술은신기능보존에유리하며종양학적예후에영향을주지않는다고생각되어최근표준수술법으로자리매김하고있다. 하지만크기가 4 cm보다큰 Tb 종양은기술적인제한으로인해부분신절제술과근치적신절제술사이에서선택이어려운경우가있다. 본연구는 Tb 종양환자에서수술전신기능이정상범위일때부분신절제술혹은근치적신절제술이수술후신기능에미치는영향분석하였다. 방법 : 200년 월 일부터 20년 2월 3일사이에신절제술을받은환자들중수술전 egfr (MDRD) 60 ml/min/.73 m 2 이상인환자들을대상으로하였다. 이들의나이, 성별, BMI, 고혈압 당뇨과거력, 술전과술후혈중 creatinine 및 egfr (MDRD), 술전 cholesterol, proteinuria, 신절제술방법을조사하였으며, 수술전 CKD 등급과 2등급인환자에서각각부분신절제술과근치적신절제술을받은환자들을비교하였다. 결과 : 총 03명의환자가포함되었으며, 수술전 CKD 등급인 7명과 26명이, 수술전 CKD 2등급인 7명과 53명이각각부분및근치적신절제술을받았다. 수술후 CKD 3등급이하로진행하는비율은 CKD 등급과 2등급인경우모두신절제술방법에따라다르지않았다 (p=0.555, p=.000). 수술전 CKD 2등급인환자가수술후 CKD 3등급이하로진행하는경우는부분신절제술후 40.0%, 근치적신절제술후 40.8% 였으며, 부분신절제술을받은환자군의 BMI가더낮았고고혈압과거력이있는경우가더많았다. 수술전 egfr은두군사이에유의한차이가없었으며수술후 median egfr은근치적신절제술군이지속적으로낮았으나수술후 3년부터두군사이에유의한차이가없었다 (Mann-Whitney 검정, 표, 그림 ). 결론 : 본연구에서 CKD 2등급인 Tb 신장종양환자에대해부분신절제술을시행한경우 CKD 3등급이하로진행할가능성이근치적신절제술에비해낮지않았다. 대상환자군이적고신종양의위치등에대한분석이포함되어있지않아해석에유의해야하나, 신종양의크기가큰경우 CKD 2등급인환자들에게부분신절제술이신기능보존측면에서환자들에게실제적인이득이있는지연구할필요성을느끼게한다. Keywords: Partial nephrectomy, CKD, Tb renal tumor 356

NP-030 Clinical considerations for achieving the trifecta of laparoscopic partial nephrectomy 이경, 김태남, 남종길 2, 이완 3, 이정주, 정문기 2 부산대학교의과대학비뇨기과학교실, 2 양산부산대학교의과대학비뇨기과학교실, 3 동남권원자력의학원 Objective: We analyzed the trifecta outcomes of laparoscopic partial nephrectomy (LPN). Trifecta was defined as a combination of negative surgical margin, short warm ischemic time less (WIT) than 25 min and no surgical complication more than grade 3 according to Clavien-Dindo classification Methods: Patients who underwent laparoscopic partial nephrectomy for clinical T renal masses by two surgeons between May 2006 and January 207 were included. The medical records of 00 patients were retrospectively collected and divided into 2 groups (trifecta and non-trifecta group). Multiple logistic regression models were used to predict the clinical factors of trifecta outcomes. Results: Of the 00 patients, 44 (44%) achieved trifecta. The most common reason for fail to achieving trifecta was the long ischemic time more than 25 min (00%, 56/56), but The WIT in majority of the patient (78%) was less than 30 min. Three patients had positive surgical margins and more than grade 3 surgical complication, respectively. Maximal tumor diameter (p<0.022), exophytic rate of nephrometry score (R.E.N.A.L., PADUA) (p<0.027) and incomplete clamping of the renal hilar vasculature (p<0.009) were significantly different between the trifecta and non-trifecta group. Multivariate analysis showed maximal tumor diameter and exophytic rate (score 2) to be independent predictors of trifecta outcomes. Conclusion: Maximal tumor diameter and exophytic rate (score 2) seems to be strong predictors of trifecta outcomes after laparoscopic partial nephrecetomy in T renal mass. Keywords: Laparoscopy, Partial nephrectomy, Trifecta 357

NP-03 25 개의면역염색조직인자를이용한 multilocular cystic RCC 와 multilocular cystic clear cell RCC with low malignant potential 의신장조직의발현비교연구 김성한, 박원서 2, 정진수 국립암센터전립선암센터 비뇨기과, 2 병리과 Background and Objective: Multilocular cystic clear cell RCC with low malignant potential (MccRCCLMP) is a tumor composed entirely of numerous cysts, the septa of which contain individual or groups of clear cells without expansile growth. This disease is morphological indistinguishable from low-grade multicystic clear cell RCC (MccRCC), but recurrence or metastasis have not been reported. This study was aimed to find out any significant differential pathological characteristics in resected specimens using immunohistochemistry of 25 tissue makers. Methods: A total of 3 (23.6%) MccRCCLMP and 7 (76.4%) MccRCC patients specimens staged either with Ta,Tb, or T2 were evaluated immunohistochemically using 25 tissue markers (AMARC, BAP, CD0,3, 34, CK7tubule, CK- PAN, HIFa, HIF2a, Ki67,pS6, PAX8, PBRM, PDGFRa,b, PDL, PSMA, PTEN, RCC, SMA, TGase2, VEGFR,2,3, and Vimentin). The MccRCC was pathologically selected by senior uropathologist with a criteria of more than 0 cysts in the gross specimens.. The 25 tissue biomarkers were immunohistochemically stained on tissue microarrays of RCC, and the semi-quantitative H-score (0-300), including intensity score, was used to grade the sample. Only CD3, CD34, CK7tubule, CK-PAN, and Ki67 marker were expressed in intensity score (0,, 2, and 3). The comparison between two disease were statistically evaluated using Fisher exact, student t-test, Wincoxan sum tests with a significance of p-value<0.05. Results: During a median follow-up of 62.9 (2-4.0) months, 27 male and 3 female patients experienced only one recurrence among 7 MccRCC patients. A median 3.8 cm tumor was resected by 9 (63.7%) radical and (36.7%) partial nephrectomy. The pathologic stage showed 3 (0.0%) pt2, 8 (26.7%) ptb, 9 (63.3%) pta. The clinicopathological differences between each groups showed only necrosis rate (MccRCCLMP, 7.7% vs MccRCC, 52.9%, p=0.07) was significant and other parameters were not (p>0.05). The 25 tissue markers showed that only HIFa, PDGFR, PSMA, SMA, VEGFR,2,3, CD3, cd34, CK7tubule, and Ki67 were significantly different between two groups (p>0.05). Conclusion: Significant tissue markers showed differential expressions between two disease, which might give a clue to understand the differential pathophysiologic characteristics from each disease. Keywords: Renal cell carcinoma, Cyst, Immunohistochemistry, Comparison 358

NP-032 신장암환자의부분신절제술후만성신장질환위험예측모델 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실목적 : 만성신장질환은그자체로상당한합병증과사망률을갖고있는단독질환이다. 신장암환자의부분신절제술후추적관찰중만성신장질환으로진단받는경우가있으나그위험을예측하고예방하고있지는않은상황이다. 방법, 대상 : 본연구진은본원에서신장암을진단받고부분신절제술을시행받은환자들중수술전만성신장질환을진단받지않고 년동안추적관찰을한총 628명을대상으로하였다. 상기환자의임상병리학적특성이후향적으로조사되었으며환자의개인정보를제거하고익명으로저장된자료를이용하여분석하였다. 결과 : 628명중 208명이 년후만성신장질환이발생하였고그들은수술전나이가많고크레아티닌수치가통계적으로유의하게많았다. 또한고혈압및당뇨환자인경우가통계적으로유의하게많았으나고혈압의경우다변량분석에서는의미가없었다. 다변량분석에서의미가있는 3개의변수를이용하여신부전위험예측모델을설계하였다. Model Y=Exp (0.066 ( 나이 )+0.775 ( 당뇨병유무 )+4.40 ( 수술전크레아티닌수치 )-8.553) (Y=0~, Cut-off value: 0.290, 당뇨병유무 ( 유 :, 무 :0)) 모델의곡선화면적 (AUC, area under the curve) 은 0.775, 정확도 69.%, 민감도 76,4%, 특이도 65.5% 였다. 결론 : 본연구진이만든모델을이용하여 년후만성신장질환의위험이높은환자군을대상으로면밀한관리를통해만성신장질환으로진행할확률을낮출수있을것이다. 뿐만아니라만성신장질환위험이높은그룹을수술할경우술자의주의가더필요하겠다. 추후연구로신장암의위치및크기를포함하여보다더정확하고객관적인모델개발이필요하겠다. Keywords: Partial nephrectomy, Chronic kidney disease, Prediction model 359

NP-033 Is intraoperative sonography really useful in patients with open partial nephrectomy? 노주현, 김종녕, 최경화, 이승렬, 홍영권, 박동수 CHA 의과학대학교분당차병원비뇨기과학교실 Objective: The intraoperative sonography is expensive, and the real time angle changes making it difficult to determine the correct margin. Therefore we aim to evaluate the correlation between actual postoperative resection margin and measured marking margin using intraoperative sonography in open partial nephrectomy patients. Methods: We performed a retrospective analysis of 0 patients who underwent open partial nephrectomy by single surgeon between 2000 and 203. The distance between tumor and marking margin on the kidney surface using intraoperative sono was compared with the distance measured on the actual specimen section (Figure ). Results: Of the total case, endophytic (n=), mesophytic (n=40), exophytic (n=50) mass features were observed. In all case of endophytic mass, intraoperative sonography was used to define the location of mass. There was no difference in distance between intraoperative sono-non-use group and use group. In endophytic mass, the distance between tumor and marking margin on the kidney surface using intraoperative sono was not different with the distance measured on the actual specimen section, however in 3 cases showed 0.7 cm or more difference between sonography and specimen. Conclusions: In open partial nephrectomy, intraoperative sonography would not be necessary to decide the surgical margin except some endophytic cases. Keywords: Introperative sonography, Renal mass 360

NP-034 4 cm 이상의단일신장종양에대한개복신부분절제술과로봇신부분절제술의비교 : 후향적연구 정연수, 이동환, 이상철, 홍성규, 변석수, 이상은 분당서울대학교병원 Object: We compared the surgical outcomes and complications between open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RPN) for 4 cm single renal mass (SRM). Materials and Methods: We retrospectively reviewed the data of 220 patients who underwent partial nephrectomy for 4 cm SRM between June 2003 and April 207. Various clinicopathologic factors including renal function and surgical complications were analyzed. The cancer specific survival (CSS) and recurrence free survival (RFS) were evaluated using Kaplan-Meier analysis. Results: There were no significant differences in mean age, gender, body mass index, preoperative tumor size, tumor laterality, tumor location, and clinical T stage between OPN and RPN groups. For perioperative outcomes, the operative time, radical conversion, and postoperative transfusion rate were not significantly different between two groups. RPN group showed significantly less estimated blood loss (32.4 ml vs 206. ml, P=0.003), less intraoperative transfusion rate (7.7% vs 0.8%, P=0.007), less postoperative day VAS pain score (4.49 vs 4.2, P=0.028), less postoperative Clavien grade III, IV complication (9.8% vs 2.3%, P=0.07) and the shorter length of hospitalization (8.33 vs 6.0 day, P<0.00). Although the ischemic time was longer in the RPN group (P<0.00), there was no significant difference between OPN and RPN groups in terms of change of serum creatinine and estimated glomerular filtration rate. Two groups showed significantly similar rate of pathologic T stage and resection margin rate except Fuhrman nuclear grade (P=0.035). There was no significant differences for CSS and RFS between two groups. Conclusion: RPN should be considered to be safe and favorable surgical procedure for 4 cm SRM in terms of perioperative outcomes and postoperative complications. Keywords: Single renal mass, Open partial nephrectomy, Robot-assisted partial nephrectomy 36

NP-035 Epithelioid Angiomyolipoma 는 Classical Angiomyolipoma 와비교하여더불량한예후를가지는가 이원철, 최세영, 이찬우, 유상준, 유달산, 정인갑, 송채린, 김건석, 홍범식, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: Classical angiomyolipoma (AML) is the most common benign tumor of kidney and has benign clinical course. On the other hand, epithelioid AML (EAML) has poorer clinical course compared with classical AML. We aimed to assess characteristics and prognosis of EAML, including a comparison with classical AML. Material and Methods: Medical record of 23 patients who diagnosed with epithelioid AML (27 patients) or classical AML (204 patients) were reviewed retrospectively. Before operation or needle biopsy (3 patients), all patient performed computed tomography (CT) scan and specimens were reviewed by pathologists. For analysis, we checked recurrence or metastasis, age, sex, size of the tumor, BMI, comorbidities, and Hounsfield unit according to each CT phase. We defined unfavorable group as patients with metastasis, recurrence and patients who expired due to tumor. The variables were compared with univariate analysis and multiple logistic regression analysis. Results: Epithelioid AML patients were younger (4.2 years vs. 49. years, p=0.00) and male dominant (56% vs. 29%, p=0.005). Tumor size of epithelioid AML is larger (7.5 cm vs. 4.2 cm, p<0.00). Epithelioid AML group showed lower enhancement at CT scan, thus difference of Hounsfiled unit between pre-contrast and arterial phase was significant lower in epithelioid AML group (46.6 HU vs. 65.9 HU, p=0.022). In multivariable logistic regression analysis, younger age (p=0.024) and male gender (p=0.024) had significantly greater odds of epithelioid AML. Of the 27 EAML patients, 5 patients were categorized as unfavorable group. Two patients in the unfavorable group had lymph node metastasis in para-aortic or aortic area with no metastasis in other sites. Three of them had lung metastasis. Enhancement at CT scan showed no difference between 2 groups (30.6 HU vs. 52.9 HU, p=0.5). Conclusions: EAML has malignancy potential and has poorer prognosis compared with classical AML. Younger age, male sex and larger size of the mass give more possibility of the diagnosis of EAML. Higher Hounsfield Unit of the mass on the precontrast CT scan showed a tendency to be diagnosed as EAML but showed no statistical significance. EAML has malignant potential and requires careful follow up. Patient characteristics and and tumor size can be helpful determining the type of AML preoperatively. Keywords: Epithelioid angiomyolipoma, Poorer prognosis 362

NP-036 병리학적 T3a 신세포암환자에서신주위지방침범과신동지방침범의종양학적결과비교 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 Introduction: We investigated the influence of perinephric fat invasion (PFI) and sinus fat invasion (SFI) on the oncologic outcomes after radical nephrectomy (RN) or partial nephrectomy (PN) for pathologic T3a renal cell carcinoma (RCC). Materials and Methods: Among 392 patients who underwent RN or PN in our institution between 998 and 202, 390 patients were diagnosed with pathologic T3a RCC. Of this cohort, we excluded nodal or distant metastatic RCC, RCC with renal vein thrombosis, and RCC with perinephric and sinus fat invasion. Finally, 07 patients of PFI group and 58 patients of SFI group were included in this study. All patients underwent RN or PN. We compared the clinico-pathological characteristics and oncological outcomes between two groups, and factors predicting disease progression or survival were assessed. Results: There were no significant differences in age, gender, the American Society of Anesthesiologists (ASA) status classification, and preoperative estimated glomerular filtration rate (GFR) between two groups. The proportion of patients who underwent RN was significantly higher in the SFI group than PFI group (9.4% vs. 72.9%, p=0.005). Mean maximal tumor diameter in the patients of SFI group was also longer than PFI group (6.5 cm vs. 5.9 cm, p=0.03). Tumor laterality, Fuhrman grade, histology, and presence of lymphovascular invasion were not significantly different between two groups. In Kaplan-Meier analysis, there was no significantly difference in 3-year disease progression-free survival (PFS; 83.0% vs. 75.3%, p=0.643), 3-year cancer-specific survival (CSS; 85.6% vs. 93.%, p=0.373), and 3-year overall survival (OS; 82.7% vs. 89.9%, p=0.658) between PFI and SFI group. In multivariate analysis, longer maximal tumor diameter was an independent predicting factor of shorter PFS (HR:.7, p=0.006) and CSS (HR:.9, p=0.033). The predictors of shorter OS were older age (HR:.03, p=0.022) and longer maximal tumor diameter (HR:.3, p=0.02). Conclusions: Sinus fat invasion compared to perinephric fat invasion was not associated with an increased risk of disease recurrence, cancer-specific death, or overall death. Keywords: Renal cell carcinoma, Nephrectomy, Pathology 363

NP-037 Prognostic factors for recurrence in patients with pathologic stage T3a renal cell carcinoma 신택준, 변혜진, 정원호, 하지용, 김병훈, 박철희, 하윤석 2, 권태균 2, 권세윤 3, 이경섭 3, 김천일 계명대학교의과대학비뇨기과학교실, 2 경북대학교의과대학비뇨기과학교실, 3 동국대학교경주병원비뇨기과학교실 Introduction: In 7th edition of the AJCC (American Joint Committee on Cancer) TNM system, renal cell carcinoma (RCC) grossly extended perinephric fat invasion (PFI) or sinus fat invasion (SFI) or renal vein invasion (RVI) defines pathologic T3a (pt3a). This study was conducted to analyze the prognostic values of PFI, SFI and RVI in patients with pt3a RCC. Materials and Methods: 02 patients who were diagnosed pt3an0m0 RCC after radical nephrectomy from Keimyung University Dongsan medical center, Kyungpook University medical center and Dongguk University Gyeongju medical center were included in this retrospective study from January 200 to June 206. In these patients, the prognostic values of PFI, SFI, RVI, age, tumor size, histology and grade to predict recurrence-free survival were analyzed by Cox proportional hazards models. Results: There were 50 patients with PFI, 60 patients with SFI, 37 patients with RVI. Total 26 (25.5%) recurrences were observed over a median follow up of 27.7 months (IQR=7.0-46.5). Median time to recurrence was 7.4 months (IQR=8.2-26.2). In multivariable analysis, patients with SFI were significantly associated with poor recurrence-free survival (HR=3.69, 95% confidence interval.36-9.99, p=0.00). However, there was no statistical significance in other factors. Conclusions: In pt3an0m0 RCC, patients with SFI had worse recurrence. However, we think that multi-center studies with a larger size is needed because our study includes a small number of patients. Keywords: pt3a renal cell carcinma, Recurrence-free survival 364

NP-038 Retrospective comparative study between robot-assisted partial nephrectomy and open partial nephrectomy for the treatment of cystic tumors 김정준, 국하림, 김광모, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 Background: To evaluate and compare the outcomes of robot-assisted partial nephrectomy (RAPN) in cystic tumors with open partial nephrectomy (OPN) in single-institutional series of RAPN, as limited data are available about the efficacy and safety of RAPN in cystic tumors. Material and Methods: We evaluated patients who received RAPN or OPN for either cystic tumors from 2004 to 206 and included in the single-institutional, retrospective database. Cystic renal masses were diagnosed on cross-sectional imaging (computed tomography or magnetic resonance imaging). Results: Among 233 cases of partial nephrectomy, 37 patient underwent RAPN (n=37) and 4 patients underwent OPN (n=4) for the treatment of a cystic tumor. There was no difference between the groups in terms of the patient's age, comorbidity scores (ECOG, ASA), the size, laterality and Bosniak classification of cystic tumors and preoperative clinical stage and RENAL nephrometry score (Table). In terms of surgical outcome, the operation time, ischemic time, estimated blood loss and pathologic profile was not different between two surgical approaches (Table). The safety profiles including the length of surgical margin and rate of positive surgical margin and complication rate classified by Clavien-Dindo were also not different between groups. The pain visual analog scale at postoperative first day demonstrated no difference between groups (Table). Conclusion: RAPN demonstrated comparable surgical outcome with OPN, the classic gold-standard surgical method for the treatment of cystic renal tumors in terms of efficacy and safety profile. Keywords: Robot assisted surgery, Cystic renal mass, Partial nephrectomy 365

NP-039 Retrospective comparative study between robot-assisted partial nephrectomy and open partial nephrectomy for the treatment of highly complex renal tumors with RENAL nephrometry score 8 김정준, 오종진, 이상철, 홍성규, 이상은, 변석수 분당서울대학교병원비뇨기과 Background: To evaluate and compare the outcomes of robot-assisted partial nephrectomy (RAPN) in highly complex tumors with open partial nephrectomy (OPN) in single-institutional series of RAPN, as limited data are available about the efficacy and safety of RAPN in highly complex renal tumors. Material and Methods: We evaluated patients who received RAPN or OPN for either highly complex renal tumors from 2004 to 205 and included in the single-institutional, retrospective database. Highly complex renal tumors were defined as the RENAL nephrometry score 8. Results: Of cases, the 43 patient underwent RAPN and 3 patients underwent OPN for the treatment of the highly complex tumor. There was no difference between the groups in terms of the patients' age, comorbidity scores (ECOG, ASA), the size, laterality and preoperative clinical stage and RENAL nephrometry score. In terms of surgical outcome, the operation time, ischemic time, estimated blood loss and the pathologic profile was not different between two surgical approaches. The safety profiles including the length of surgical margin and rate of positive surgical margin and complication rate classified by Clavien-Dindo were also not different between groups. Conclusion: RAPN demonstrated comparable surgical outcome with OPN, the classic gold-standard surgical method for the treatment of highly complex renal tumors in terms of efficacy and safety profile. Keywords: Robot assisted surgery, Highly complex renal mass, Partial nephrectomy 366

NP-040 복강경하부분신절제술시행 년후신기능손상발생의위험인자 김상원, 하헌, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김현태, 김태환, 유은상, 정성광, 권태균경북대학교의과대학비뇨기과학교실 Purpose: Recent studies proved that partial nephrectomy as a treatment method for early stage kidney cancer shows excellent results in oncologic outcomes and preservation of renal function. However, morphological characteristics of the tumor should be considered to determine surgery method due to delicate surgical technics and higher complication rate in partial nephrectomy compared to radical nephrectomy. In this study, we evaluate the patient demographics and perioperative characteristics as risk factors for progression of chronic kidney disease after laparoscopic partial nephrectomy. Material and Methods: From March 20 to May 206, total 74 patients who underwent laparoscopic partial nephrectomy. We retrospectively reviewed the medical records of patients. Patients were classified into two groups according to CKD progression (post-operative egfr decreased more than 20% at a year after surgery). Age, sex, body mass index (BMI), underlying disease, centrality index, RENAL nephrometry score, warm ischemic time (WIT), estimated blood loss (EBL), pathology were analyzed using binary logistic regression analysis. Results: Of 74 patients, 26 patients progress CKD (4.9%)..Univariate analysis revealed that progression group was associated with age, centrality index and RENAL nephrometry score (P=0.045, P<0.00, P<0.00, respectively). Also patient s sex, BMI, hypertension, diabetes mellitus, WIT, EBL and pathology were not statistically significant. Multivariate analysis revealed that centrality index (Odds ratio, 0.273; 95% CI, 0.42-0.525; P<0.00) was a significant risk factor for progression of CKD at year after surgery(table). The cut-off value of centrality index was 2.68 (Sensitivity, 73.6%; specificity, 73.%; AUC 0.803). Conclusions: This study demonstrated that lower centrality index may be a risk factor of progression of CKD at year after laparoscopic partial nephrectomy. Keywords: Partial nephrectomy, CKD, Centrality index 367

NP-04 T 병기투명신세포암환자에서부분신절제후절제변연양성이암재발에미치는영향 서성필, 강호원, 김원태, 김용준, 윤석중, 이상철, 김원재 충북대학교의과대학비뇨기과학교실 Purpose: To assess the risk factors of positive surgical margins (PSM) and the influence of margin status on recurrence in pt clear cell renal cell carcinoma (RCC) following partial nephrectomy (PN). Materials and Methods: Patients (83) with pathologically confirmed stage T clear cell RCC were retrospectively analyzed following PN at eight institutions in Korea between 999 and 20. Demographics, operative data, pathological margin status, and site of recurrence were analyzed. Results: Resection margins were positive in 3 patients (.7% of the cohort) on final pathology. None of the clinicopathological parameters were significantly related to the marginal status (all P>0.05). During a median follow-up of 32.5 months, local recurrences were observed in 0.4% of negative surgical margins. There was no local recurrence in any of the cases with PSM. Distant recurrences developed in.7% of negative surgical margins and 3.2% of PSM. There were no significant differences in recurrence-free survival by margin status (P=0.566). Conclusions: Our multi-institutional data suggest that marginal status does not influence tumor recurrence risk in pt clear cell RCC after PN. Careful surveillance seems to be a sufficient strategy in this clinical scenario. Keywords: Partial nephrectomy, Recurrence, Margin 368

NP-042 제 형및제 2 형유두상신장암, 그리고투명세포신장암의비교 : T 병기에있어조직학적타입과종양학적예후간의상관관계 이재훈, 채한규, 이원철, 최세영, 류제만, 유달산, 정인갑, 송채린, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 Objectives: We compared histological subtype of papillary renal cell carcinoma (type and type2 prcc), and clear cell renal cell carcinoma (ccrcc) in patients with T stage RCC to analyze the prognostic impact of papillary histology on oncological outcomes. Materials and Methods: From998 to 202, 93 patients with prcc and 252 patients with ccrcc of clinical T stage were reviewed. All patients underwent radical nephrectomy or nephron sparing surgery. We assessed the impact of histologic subtypes on oncologic outcomes after surgery in patients with T stage RCC. Results: There was no difference in patient and tumor characteristics between prcc and ccrcc except age (p=0.003) and Fuhrman grade (p<0.00). And there was no difference in patient and tumor characteristics between type prcc and type2 prcc, but Fuhrman grade was higher in type 2 prcc (p=0.00). In comparison with recurrence free survival and overall survival of prcc and ccrcc, prcc is inferior to ccrcc regarding recurrence free survival (P=0.0077), but there is no difference in overall survival between prcc and ccrcc. Kaplan-Meier analysis identified there was no significant difference between type prcc and type2 prcc with recurrence free survival and overall survival. 5-year recurrence free survivals of prcc and ccrcc were 93.7% and 97.5% respectively. 5-year overall survivals of prcc and ccrcc were 95.7% and 94.5% respectively. At multivariate analysis predictors for overall survival were only age (HR.069, p<0.000) and recurrence(hr 4.93, p<0.0007). Conclusion: In patients with T stage RCC recurrence after surgery occurred more commonly in prcc compared with ccrcc. The histological subtype of prcc (type and type2) had no impact on recurrence free survival and overall survival in Kaplan-Meier analysis. Close observation and long term follow up is recommended in patients diagnosed as prcc for recurrence. Keywords: Renal cell carcinoma, RCC subtypes, Recurrence 369

NP-043 신장에서발견된 2 cm 이하의고형종물의병리결과를예측하는데 MRI 가 CT 보다정확한가? 이동훈, 이정우, 남종길, 박성우, 정문기 부산대학교의과대학양산부산대학교병원비뇨기과학교실 Introduction: We compared the pathologic outcomes of solid renal mass less than 2.0 cm after the diagnosis of suspicious malignancy according to computed tomography (CT) and/or magnetic resonance imaging (MRI) to evaluate the diagnostic accuracy of each image modalities. Material and Methods: We reviewed 28 patients who underwent partial nephrectomy between 2009 and 207, retrospectively. Among them, we found 93 patient who had solid renal mass less than 2.0 cm in the preoperative evaluation using CT and/or MRI. To evaluate solid renal mass, 48 patients underwent CT only, 25 patients underwent MRI only and 20 patients underwent an additional MRI after CT. We performed the partial nephrectomy for these patients and compared the pathologic outcomes to identify the accuracy of each imaging modalities. Results: Among 93 patients who underwent partial nephrectomy, 78 patients had renal cell carcinoma (67 clear cell type, eight papillary type, three chromophobe type), two other malignancy and 3 benign tumor (nine angiomyolipoma, two oncocytoma, one juxtaglomerular tumor and one hemorrhagic cyst). The patients who underwent CT showed 4 malignancy and 7 benign tumors, the patients who underwent MRI showed 2 malignancy and 4 benign tumors and the patients who underwent CT + MRI showed 8 malignancy and 2 benign tumors. There was no statistical difference between three imaging modalities (p=0.834). Also, the sensitivity was not statistically different (p=0.899). Conclusion: To evaluate the solid renal mass less than 2.0 cm, CT and MRI showed the similar diagnostic accuracy and an additional MRI after CT also seemed to have the similar diagnostic accuracy. Especially, we thought that an additional MRI has a limited role for the evaluation of solid renal mass less than 2.0 cm if the solid renal mass have radiologic characteristics of malignancy in the CT. Keywords: Small renal mass, CT, MRI 370

NP-044 불량한예부를보이는전이투명세포신장암에서 차치료효과 김정호, 정진수 2, 곽철 3, 정창욱 3, 서성일 4, 송채린 5, 서일영 6, 강성구 7, 박재영 7, 황의창 8, 홍성후 9 동남권원자력의학원암센터, 2 국립암센터전립선암센터, 3 서울대학교의과대학비뇨기과학교실, 4 성균관대학교의과대학비뇨기과학교실, 5 울산대학교의과대학비뇨기과학교실, 6 원광대학교의과대학비뇨기과학교실, 7 고려대학교의과대학비뇨기과학교실, 8 전남대학교의과대학비뇨기과학교실, 9 가톨릭대학교의과대학비뇨기과학교실 Purpose: The aim of this study was to investigate the outcomes of first-line targeted therapy in patients with poor-risk metastatic renal cell carcinoma (mrcc). Material and Methods: Data of patients who had mrcc between 200 and 206 at multiple institutions were collected retrospectively. Inclusion criteria were as follows: age 8 years; clear cell type RCC; poor-risk group; received first-line targeted therapy with sunitinib, pazopanib or temsirolimus. We compared the efficacy and safety of sunitinib, pazopanib and temsirolimus in this group. Result: A total of 48 patients were enrolled for the analysis. There was no significant differences in the mean follow-up period between the three groups (p=0.222). The median PFS was 4 months (95% confidence interval [CI], 2.4-5.6 months) after treatment with sunitinib, 8 months (95% CI, 3.5-2.5 months) with pazopanib and months (95% CI, 0.-.9 months) with temsirolimus. The median CSS was 7 months (95% CI, 5.-8.9 months) after treatment with sunitinib, 0 months (95% CI, 7-3 months) with pazopanib and 4 months (95% CI, 2.6-5.4 months) with temsirolimus. There was no significant difference in the best response between the three groups. Multivariate analysis revealed that nephrectomy (p=0.03), brain metastasis (p=0.024), symptoms at diagnosis (p=0.037) were independently associated with CSS. There were no differences in the rate of AEs between the three groups (p=0.99). Conclusion: Pazopanib shows better survival outcomes in metastatic clear cell RCC with poor-risk features. Keywords: Renal cell carcinoma, Poor-risk, Targeted therapy 37

NP-045 로봇전전립선절제술시행후전립선특이항원수치가최저점까지도달한고위험군전립선암환자에서질병진행까지의시간이전이와사망을예측할수있는가? 김도경, 구교철, 이광석, 하윤수, 나군호, 홍성준, 양승철, 정병하 연세대학교의과대학비뇨기과학교실 Introduction: Robot-assisted radical prostatectomy (RARP) is a feasible treatment option for high-risk prostate cancer (PCa) and patients may postoperatively achieve undetectable PSA levels. Nevertheless, risk of disease progression is relatively high. We investigated metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) outcomes and prognosticators of these survival endpoints in this subset of patients. Materials and Methods: Using a single institutional cohort of 342 patients treated with RARP and pelvic lymph node dissection between August 2005 and June 20, we identified 25 (73.4%) patients with high-risk PCa (clinical stage T3 and/or biopsy Gleason score 8 and/or PSA 20 ng/ml) who postoperatively achieved undetectable PSA, defined as<0.0 ng/ml. Biochemical recurrence (BCR) was defined as two consecutive rises of PSA 0.2 ng/ ml. Results: Median patient age was 66.5 years (IQR 63.0-7.0). During the median follow-up of 75.9 months (IQR 59.4-85.8), metastasis occurred in 38 (5.%) patients; mostly often to bone, followed by LNs, lung, and liver. The 5-year metastasis-free survival, CSS, and OS rates were 87.%, 94.8%, and 94.3%, respectively. Multivariate Cox-regression analysis revealed time to BCR as an independent predictor for metastasis (p<0.00). Time to metastasis was an independent predictor for overall survival (p=0.003). Patients who exhibited BCR in less than 60 months showed significantly lower metastasis-free survival and OS compared to the counterparts (log-rank p<0.00) Conclusions: RARP confers acceptable oncological outcomes for high-risk PCa. Close monitoring beyond 5 years is be warranted for early detection of disease progression and for timely adjuvant therapy. Keywords: Prostate cancer, Prostatectomy, Recurrence 372

NP-046 진행된전립선암환자에서고식적경요도전립선절제술이종양학적결과에미치는영향 : 성향점수분석 최세영, 류제만, 경윤수, 신정현, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We investigated the oncologic effect of palliative transurethral resection of the prostate (TURP) in prostate cancer comparing primary androgen deprivation therapy (ADT). Materials and Methods: A total of 64 patients who received primary ADT was analyzed retrospectively. Patients with incidental prostate cancer (Ta or Tb) were excluded. Patients were divided into TURP group (83 patients) and non-turp group (53 patients). A propensity score matching was carried out between TURP and non-turp groups. The Kaplan-Meier method was used to confirm castration-resistant prostate cancer (CRPC), cancer-specific survival (CSS), and overall survival (OS). Cox regression was performed to confirm factors affecting CSS. Results: Before matching, TURP group had worse TNM stage (p<0.0), biopsy Gleason score (p=0.028), and larger prostate volume (50. cc vs 39.0, p=0.005) than ADT group. Most common reason for TURP was acute urinary retention. After matching by comorbidity, initial PSA, TNM stage, and Gleason score, the characteristics were similar between TURP and non-turp groups. On Kaplan-Meier curve, TURP group showed poor outcomes in CRPC (p=0.003), CCS (p=0.003) and OS (p=0.026) than non-turp group. On multivariate analysis, factors to predict CSS were Gleason score (9 vs 8; HR 2.274, p=0.0237, 0 vs 8; HR 4.809, p=0.0002) and TURP within 3 months after biopsy (HR 2.585, p=0.022). Conclusion: Although TURP group showed poor CRPC-free survival, CCS, and OS, TURP was needed to care symptoms. TURP within 3 months after biopsy should be performed observed carefully and managed properly. Keywords: Prostate cancer, Palliative transurethral resection of the prostate, Oncologic outcome 373

NP-047 근치적방광절제술로우연히발견된전립선암의임상양상및예후 신정현, 류제만, 최세영, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수울산대학교서울아산병원비뇨기과학교실 Objectives: We investigated the clinical features and prognosis of prostate cancer incidentally detected after radical cystoprostatectomy for bladder cancer. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent radical cystoprostatectomy from 997 to March 207 with synchronous prostate cancer and bladder cancer at the specimen. Patients with previous prostate cancer diagnosis were excluded and total number of 97 patients was finally included. We analyzed the baseline characteristics of patients including perioperative PSA, Gleason score and T stage of prostate cancer. We also investigated the presence of biochemical recurrence (BCR) and the association between prostate cancer and bladder cancer survival by multivariate Cox regression. Results: Mean age was 67.8±8. years old with mean follow-up of 35.3 months. 45 patients had hypertension and 6 patients had diabetes. Urinary diversion performed was 34 ileal conduits and 63 orthotopic neobladder. 4 patients underwent neoadjuvant chemotherapy and 30 patients had adjuvant chemotherapy. Final pathologies of bladder cancer were transitional cell carcinoma in 9 patients and other histologies in 6 patients. One patient had pathologic T0 bladder cancer but Gleason 9 (4+5) prostate cancer with bladder invasion (pt4). 7.8% of patients had serum PSA<3.0 ng/ml.. 66 patients (68.0%) had Gleason 6 prostate cancer and only four patients had high Gleason score ( 8). Majority of patients (93.8%) had pathologic T2 stage prostate cancer. None of the patients showed BCR. On multivariate analysis, presence of lymph node metastasis was associated with worse clinical outcome (HR 2.429, p=0.032). Gleason score, pathologic T stage of prostate cancer and preoperative PSA were not associated with bladder cancer survival. Conclusion: Prostate cancers accidentally detected after radical cystoprostatectomy have high Gleason score ( 8) in 4.% and pathologic stage pt3 in 6.2%. None of them showed BCR with indolent clinical course. Keywords: Prostate cancer, Radical cystoprostatectomy, Bladder cancer 374

NP-048 비전이성전립선암에대한안드로겐차단요법및근치적전립선절제술간의생존율비교 하유신,, 최진봉 2, 최인영 3, 곽철 4, 김청수 5, 변석수 6, 서성일 7, 이승주 8, 이승환 9, 강민주 0, 강신희 0, 박주연 0, 심정임 0, 양장미 0, 최인순 0, 박은정 0, 이지열, 가톨릭대학교서울성모병원비뇨기과학교실, 2 가톨릭대학교부천성모병원비뇨기과학교실, 3 가톨릭대학교서울성모병원 Department of Medical Informatics, 4 서울대학교병원비뇨기과학교실, 5 울산대학교서울아산병원비뇨기과학교실, 6 분당서울대학교병원비뇨기과학교실, 7 성균관대학교의과대학삼성서울병원비뇨기과학교실, 8 가톨릭대학교성빈센트병원비뇨기과학교실, 9 연세대학교의과대학 Department of Urology, Urological Science Institute, 0 National Evidence-based Healthcare Collaborating Agency, Seoul, 가톨릭대학교서울성모병원 The Cancer Research Institute Introduction: We conducted a comparative survival analysis between primary androgen deprivation therapy (PADT) and radical prostatectomy (RP) based on nationwide Korean population data including all patients with prostate cancer. Methods: A total of 4,538 prostate cancer patients from the National Health Insurance Service (NHIS) database linked with Korean Central Cancer Registry data (KCCR) who were treated with primary PADT or RP between January 2007 and December 3 204 were enrolled. Kaplan-Meier (KM) and multivariate survival analyses stratified by stage (localized and locally advanced) and age (<75 and 75) were performed using a Cox proportional-hazards model to evaluate the treatment effect. Results: Of 8,403 patients from the NHIS database diagnosed with prostate cancer during the study period, 4,538 who met the inclusion criteria were included in the analysis. Of these, 3,36 underwent RP and,402 received PADT. There was a significantly increased risk of death in patients who received PADT compared with those who underwent RP in the propensity score matched (PSM) cohort. In subgroup analysis stratified by stage and age, patients who received PADT had a significantly increased risk of death compared with patients who underwent RP in every subgroup. Especially, a much greater risk was observed in those with locally advanced prostate cancer. Conclusion: In a nationwide survival comparative analysis between RP and ADT in non-metastatic prostate cancer, patients who underwent RP had longer survival than those who received ADT. Especially, even in the group of older patients with advanced prostate cancer, RP provided a survival benefit when compared ADT. Keywords: Prostate cancer, Androgen deprivation therapy, Prostatectomy 375

NP-049 전립선암의배부정맥침범은로봇보조복강경전립선적출술후생화학적재발의예측인자이다 최세영, 류제만, 경윤수, 신정현, 이재훈, 이원철, 유달산, 정인갑, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We investigated the role of dorsal vein involvement (DVI) in predicting biochemical recurrence (BCR) during robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: A total of 27 patients who underwent RALP for prostate cancer with dorsal vein frozen section to confirm DVI between October 2008 and April 206 were analyzed, retrospectively. We investigated the association between pathologic parameters with DVI and BCR using Kaplan-Meier analysis and multivariate Cox regression. Results: Positive DVI was found in 7 patients (6.3%) who had higher tumor volume (3.5 cc vs 3.6 cc, p=0.006), more pathologic T3 stage (70.6% vs 32.3%, p=0.003), more extracapsular extension (70.6% vs 32.7%, p=0.004) and more positive surgical margin (88.2% vs 36.6%, p<0.00) than 254 patients of negative DVI. After a median follow-up 23.8 months, BCR occurred in 40 patients (4.8%). BCR free rates at 2 years were 47.% in positive DVI and 92.5% in negative DVI group. On Kaplan-Meier curve with log-rank test, the presence of DVI increased the probability of BCR (p<0.00). On multivariate analysis, initial PSA (hazard ratio [HR].097, p<0.000), positive surgical margin (HR 2.535, p=0.08), seminal vesicle invasion (HR 4.003, p=0.0005), lymph node involvement (HR 6.366, p=0.0230), and DVI (HR 6.84, p=0.000) were significant factors for BCR. Conclusion: DVI was a prognostic factor associated with BCR after RALP. This finding supports routine evaluation of DVI and suggests that patients with DVI should be more carefully followed after RALP. Keywords: Prostate cancer, Dorsal vein, Robot-assisted laparoscopic prostatectomy 376

NP-050 SNUPCRC 전립선암위험도계산기의임상적유용성 육형동, 윤민영, 구자현, 김현회, 곽철, 정창욱서울대학교병원비뇨기과 Introduction: To evaluate the usefulness of the calculator to reduce unnecessary prostate biopsy and to increase the detection rate of high risk cancer. Methods: We retrospectively analyzed 489 patients who underwent prostate biopsy between 204 and 206. The subjects were divided into two groups according to the use of SNUPCRC (conventional and SNUPCRC group) In the SNUPCRC group, Prostate biopsy was performed when the probability of SNUPCRC was more than 30%. Results: The SNUPCRC group had significantly smaller prostate volume (p=0.00) and significantly more DRE and TRUS abnormalities (p=0.0 and p=0.00). Overall detection (7.9% vs. 32.%) and high risk cancer detection rates (40.6% vs 9.3%) were significantly higher in the gray zone (PSA 4-0) (p=0.000 and p=0.006). In SNUPCRC 30% group compared to<30% group, overall detection rate of 72.3% vs 30.2% and high risk detection rate of 60.6% vs 8.3% were significantly different (p=0.000 and p=0.000). Applying the SNUPCRC to the conventional group could avoid unnecessary prostate biopsy in 77.4% and avoid 84.5% if it included low risk prostate cancer. Conclusion: SNUPCRC is clinically useful to reduce unnecessary prostate biopsy and increase overall detection rate and high risk cancer detection rate. Keywords: Prostate cancer, Prostate biopsy, Prostate cancer risk 377

NP-05 전립선적출술후요자제능회복에영향을미치는해부학적, 기능적, 수술적인자에대한고찰 김명, 박명찬 2, 박사현, 임고산, 최승권, 심명선, 송채린, 정인갑, 유달산, 홍준혁, 김청수, 안한종 울산대학교서울아산병원비뇨기과학교실, 2 인제대학교해운대백병원비뇨기과학교실 Purpose: To identify the preoperative anatomical and functional features of sphincter complex, and degree of neurovascular bundle (NVB) preservation affecting the return of continence after radical prostatectomy. Materials and Methods: Four-hundred and seven patients with radical prostatectomy were prospectively enrolled. Anatomical factors including pelvic diaphragm length (PDL) and membranous urethral length (MUL) on sagittal view of preoperative magnetic resonance image (MRI) were assessed. Functional parameters on urethral pressure profiles (UPPs) such as maximum urethral closure pressure (MUCP), functional urethral length (FUL), or area of continence zone (ACZ) were also preoperatively measured. Degree of NVB preservation was stratified as bilateral interfascial, unilateral interfascial, and none. Continence, defined as being pad-free, was assessed according to their anatomical, functional, and surgical factors. Binary logistic regression was performed to identify predictive factors for continence return at 2 months after prostatectomy. Results: The rates of continence return at postoperative, 3, 6, and 2 months were 47.2. 72.5, 78.4, and 92.4%, respectively. Patients with long PDL ( 0 mm;.2 vs. 3. months), high MUCP ( 67 cmh 2 O;.9 vs. 3. months), and bilateral NVB preservation (.9 vs. 3.0 vs. 3. months) demonstrated significantly earlier continence returns than others. On multivariate analysis, preoperative PDL (Odds ratio [OR]=.764 per mm), MUCP (OR=.04 per cmh₂o), and bilateral NVB preservation (OR=3.805) were independently associated with continence return at 2 months after prostatectomy, along with age (OR=0.95 per year) and body mass index (OR=0.778 per kg/m 2 ). Conclusions: Preoperative anatomical, functional features of sphincter complex and degree of NVB preservation independently affected the long-term continence status after prostatectomy. Preoperative MRI and UPPs were valuable evaluations to predict the persistent continence status after the surgery. Moreover, bilateral NVB preservation should be achieved for better functional outcomes. Keywords: Magnetic resonance imaging, Incontinence, Prostatectomy 378

NP-052 Predictors of biochemical recurrence in margin positive prostate cancer after radical prostatectomy without adjuvant radiotherapy 고동훈, 장원식, 박재원, 조강수, 함원식, 나군호, 홍성준, 최영득 연세대학교의과대학신촌세브란스병원 Background & Purpose: Men with positive surgical margin (PSM) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR). The role of adjuvant radiotherapy (ART) for patients with PSM after radical prostatectomy (RP) has been shown to prevent BCR, but overtreatment remains a significant concern. The present study, therefore, sought to identify men with PSM at higher risk for BCR after RP in the absence of ART. Materials & Methods: We retrospectively reviewed 230 men who underwent RP for prostate cancer at our institution between 200 and 200. The patients who received neoadjuvant or adjuvant therapy and patients without adequate medical records were excluded. Among these patients, 977 patients with positive surgical margins were analyzed. The Kaplan-Meier method was used to estimate and compare BCR-free survival (BCRFS). Cox regression models were used to investigate predictors of BCR. Results: The median age was 66.0 (interquartile range [IQR]: 62-70), the median time of follow-up was 78.0 months (IQR: 64-95). In the univariate and multivariate analyses, preoperative prostate specific antigen (hazard ratio [HR].37, p=0.003), pathologic T stage T3 (HR.322, p=0.032), RP Gleason score (GS=7: HR.954, p<0.00; GS 8:HR 4.23, p<0.00), and tumor volume 5 cc (HR.808, p<0.00) were significant predictors for BCR after RP. Conclusion: Our study demonstrated the heterogeneity of oncologic outcomes in patients with PSM. Stratifying men with PSM by prognostic factors such as preoperative PSA, pathological T stage, RP GS, and tumor volume will improve identification of those at higher risk for BCR that should be strongly considered for ART. Keywords: Radical prostatectomy, Biochemical recurrence, Positive surgical margins 379

NP-053 혈중지질농도와전립선암의관련성에관한연구 정재윤, 김명, 김종근, 이찬우, 유달산, 정인갑, 송채린, 홍준혁, 김청수, 안한종울산대학교의과대학서울아산병원비뇨기과학교실목적 : There have been some controversies on correlation of lipid profile and prostate cancer risk. This study aimed to assess the association among lipid profiles and prostate cancer using the large prostate biopsy cohorts. 대상및방법 : Total of 4776 patients who received prostate biopsy between January 2005 and December 205 were analyzed. These patients routinely performed the lipid profile laboratory study including serum total cholesterol, low density lipoprotein (LDL), HDL, and TG level. Correlation of lipid profile and prostate cancer was evaluated. 결과 : Among the 4776 patients, 54 patients (32.2%) were diagnosed the prostate cancer. Univariate analysis showed age, PSA, glucose, total cholesterol, LDL to be related with prostate cancer. However, in multivariate analysis, prostate cancer was only associated with age (OR=.060; p<0.00), PSA (OR=.07; p<0.00) and triglyceride level higher than 200 mg/dl (OR=.28; p=0.04). High TG/HDL ratio also increased the risk of prostate cancer (OR=.039; p=0.006), and the risk was more increased when TG/HDL was adjusted with age (OR=.055; p<0.00). Subgroup analysis of prostate cancer patients was done. Borderline high LDL (00-89 mg/dl) showed negative relationship with metastatic prostate cancer (OR=0.282; p=0.04) while borderline high triglyceride (50-99 mg/dl) increased the risk of pathologic T3 or high grade (Gleason score 8) disease (OR=.75; p=0.02). 결론 : TG is associated with prostate cancer and TG/HDL ratio showing stronger relationship. Further studies are needed to confirm the mechanism linking TG/HDL ratio and prostate cancer. Keywords: Prostate cancer, Lipid profile 380

NP-054 근치적전립선절제술후발생한탈장의위험인자와발병률 구자윤, 이찬호, 이경, 김경환, 백승룡, 박지훈, 하홍구부산대학교의과대학비뇨기과학교실 Objective: To investigate risk factor and the occurrence rate of postoperative inguinal hernia (PIH) in patient undergone radical prostatectomy. Methods: This study was based on 460 patients undergone radical prostatectomy specimens, from 20 to 206. We first compared the occurrence rate of PIH in the radical prostatectomy group [460; (LRP :34) and (RARP:9)] and control group (664; transurethral resection of bladder tumor;), and then we analyzed the risk factors (age, operative methods, previous abdominal operative history, the thickness and width of external oblique muscle and rectus muscle, the thickness of abdominal subcutaneous fat layer at Hesselbach s triangle level, BMI, PSA, operative time, specimen weight and Gleason score) of PIH in radical prostatectomy group. Results: In Kaplan-Meier curve analysis, the occurrence rate of PIH was 5.3% (8/34), 4.2% (5/4), and 0.5% (3/664) for the LRP, the RARP, and the control group, respectively (p<0.00) (Figure ). Multiple logistic regressions showed that previous abdominal operative history, the thickness and length of external oblique muscle and rectus muscle, the thickness of abdominal subcutaneous fat layer at Hesselbach s triangle level was significant risk factors (p=0.048, <0.00, =0.005, =0.00), respectively (Table ). Among them, the thickness of external oblique muscle was strongly risk factor. Conclusion: We suggest that if the thickness of the muscle is less than 7 mm, careful surgery is needed for radical prostatectomy and care should be taken to determine if the hernia occurs during the follow-up. Keywords: Inguinal hernia, Prostate cancer, Robotics assisted laparoscopic prostatectomy 38

NP-055 원격전이를동반하지않은림프절전이전립선암환자에서첫치료에따른종양학적결과의차이 : 근치적전립선절제술 vs. 남성호르몬박탈요법 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 Introduction: We investigated the differences of oncologic outcomes in patients with prostate cancer with nodal metastasis without distant metastasis who underwent radical prostatectomy (RP) or androgen deprivation therapy (ADT) as an initial treatment. Materials and Methods: After excluding patients with clinical T4 or metastatic prostate cancer, total 0 patients with prostate cancer with nodal metastasis who underwent RP or ADT in our institution were included for the analysis. We defined nodal metastasis as pathologic N in the RP group and clinical N in the ADT group. The estimated castration-resistant prostate cancer (CRPC) free survival, cancer-specific survival (CSS) and overall survival (OS) were calculated by Kaplan-Meier analysis. Multivariate Cox regression analysis was performed to assess the prognostic factors. Results: 46 patients in RP group and 55 patients in ADT group were included in this study. Although there were no significant differences in age, body mass index, and presence of diabetes mellitus or hypertension between the two groups, the ADT group had higher Charlson comorbidity index than RP group (p<0.00). Clinical T stage was also higher in the ADT group, but initial prostate-specific antigen (PSA) level and Gleason score at prostate biopsy were not significantly different between two groups. ADT was performed for mean duration of 4. months in ADT group and 26 (56.5%) of patients in RP group underwent adjuvant androgen deprivation therapy according to postoperative PSA levels. In Kaplan-Meier analysis, 2-year CRPC free survival was 95.% and 76.9% (p<0.00), 2-year CSS was 94.4% and 83.0% (p=0.0), and 2-year OS was 86.0% and 7.6% (p=0.003) in RP and ADT group, respectively. In multivariate analysis, higher initial PSA level (HR:.0, p=0.029) and ADT (vs. RP, HR: 3.85, p=0.004) were independent predictors of shorter CSS and OS, respectively. Conclusions: ADT as an initial treatment for non-metastatic node positive prostate cancer was a significant predicting factor of shorter OS comparing RP after adjusting the other clinical features. Keywords: Prostate cancer, Androgen deprivation therapy, Prostatectomy 382

NP-056 도세탁셀항암화학요법치료를받는거세저항성전립선암환자에서남성호르몬박탈요법의기간이종양학적결과에미치는영향 류제만, 최세영, 경윤수 2, 유달산, 정인갑, 홍범식, 홍준혁, 안한종, 김청수 울산대학교서울아산병원 비뇨기과학교실, 2 건강의학과 Introduction: We investigated whether the duration of first androgen deprivation therapy (ADT) influences oncologic outcomes in patients with castration-resistant prostate cancer (CRPC) treated with docetaxel. Materials and Methods: 0 patients who were diagnosed with CRPC after ADT and treated with docetaxel were included for the analysis. We estimated the optimal threshold of the effective duration of ADT before diagnosis of CRPC, and the impacts of the duration of ADT on oncologic outcomes were assessed using multivariate analysis. Mean follow-up duration was 44 months. Results: Total 74 patients (73.3%) of cohorts died during follow-up duration. Mean initial PSA was 59.3 ng/ml and Gleason scores was as follows: 6 in 2 (2.0%), 7 in 6 (5.9%), 8 in 27 (26.7%), 9 in 50 (49.5%), and 0 in 6 patients (5.8%). Median duration of ADT was 37.3 months. We considered 30 months as the proper cut-off value of the effective duration of ADT, because 30 months had the highest sensitivity and specificity (53.4% and 28.6%, respectively) to cancer progression in ROC curve. All patients were treated with docetaxel median 9 months after CRPC onset. In Kaplan-Meier analysis, 2-year progression-free survival was 44.8% in patients with ADT for below 30 months and 72.4% in patients with ADT for more than 30 months (p<0.00). In addition, 2-year overall survival was 48.0% and 68.8% in patients with ADT for below 30 months and the others, respectively (p<0.00). Multivariate analysis indicated that duration of ADT ( 30 months) was the independent prognostic factor for progression-free survival (PFS) and overall survival (OS), respectively (p<0.00), but not for cancer-specific survival (CSS) (p=0.082). Charson comorbidity index, visceral metastasis at the time of diagnosis, initial PSA >90 ng/ml, Gleason score 9 were not shown as independent prognostic factors for PFS, CSS, and OS in multivariate analysis. Conclusions: The effective duration of first ADT was considered significant prognostic factor for survival. CRPC patients who had poor response on first ADT are associated with poor prognosis. Keywords: Castration-resistant prostate cancer, Androgen deprivation therapy, Docetaxel 383

NP-057 The prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy in a contemporary grading system for prostate cancer 장원식, 함원식, 김명수, 정원식, 조강수, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실 Purpose: Recently, a new prostate cancer (PC) grading system has been introduced, where Gleason score (GS) 7(3+4) and GS 7(4+3) are categorized into grade group (GG) 2 and 3, respectively. However, whether downgrading and upgrading from needle biopsy (NB) to radical prostatectomy (RP) affects oncologic outcomes is currently unknown. Here, we investigated the prognostic impact of downgrading and upgrading from biopsy to radical prostatectomy in the new classification. Materials and Methods: We retrospectively reviewed the medical records of 3253 patients with localized (pt2-3n0m0) PC who underwent RP at our institution between 995 and 204. We identified 739 patients with GS 7 PC on both NB and RP specimens. After exclusion of patients who had received neoadjuvant or adjuvant treatment (i.e., radiation, androgen deprivation therapy, or both) and those with incomplete pathological or follow-up data, 692 men were included in the final analysis. We analyzed data using Kaplan-Meier methods with log-rank tests and multivariate Cox regression models. Results: Of the 692 patients enrolled in this study, 264 (38.%), 25 (8.%), 42 (20.5%), and 6 (23.3%) patients were classified as group (NB and RP GG2), group 2 (NB GG3 downgraded to RP GG 2), group 3 (NB GG2 upgraded to RP GG3), and group 4 (NB and RP GG3), respectively. Kaplan-Meier curves showed significant differences in biochemical recurrence (BCR)-free survival across the groups (Log-rank test, p<0.00). In multivariate Cox regression analyses, these groups were significantly associated with BCR (group 2: HR.675, p=0.026; group 3: HR.908, p=0.002; and group 4: HR 2.699, p<0.00). Conclusions: Downgrading and upgrading from NB to RP was an independent predictor of BCR, and could be due to the amount of Gleason pattern 4. Keywords: Prostate cancer, Biochemical recurrence, Gleason grade 384

NP-058 A propensity score matched analysis comparing retzius-sparing versus anterior robot-assisted radical prostatectomy Ali Abdel Raheem, Ki Don Chang, Mohamed Alenzi, Ahmed Al-ghiaty, Trung Van, Won Sik Ham, Young Deuk Choi, Koon Ho Rha Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine Purpose: Data regarding retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is lacking. In this study, our main objective was to compare urinary continence function of RS-RARP and conventional (C-RARP). Methods: All patients with low and intermediate risk PCa who underwent RARP in our urology department between 2005 and 207 were analyzed. We included patients with minimum follow-up of year, patients with incomplete data and those who receive early adjuvant and/or salvage therapy were excluded. Patients were classified into 2 groups according to the surgical approach (RS-RARP, n=08) and (C-RARP, n=624). Urinary continence was defined as (no pad or safety pad usage). RS-RARP was matched to C-RARP in a to fashion according to the following variables: pelvic lymph node dissection (PLND) and nerve sparing technique. The primary endpoint was to compare the urinary continence function at year between groups, while the secondary end point was to evaluate early oncological outcomes as well as, predictors of persistent urinary incontinence at year. Results: There was no significant in clinical and pathological variables between matched groups (p>0.05). While, patients who didn t had nerve-sparing surgery in C-RARP were 8% versus 5.4% of RS-RARP (p=0.038). Regarding oncological outcomes, there was no difference in BCR (p=0.797), and -yr BCR free-survival (p=948). At year, the rate of recovery of urinary continence was significantly higher in RS-RARP compared to C-RARP in both the non-matched groups (93.5% vs 84.%, p<0.00) and the matched groups (8.6% vs 94.4%, p<0.00). Predictors of urinary incontinence were age (OR:.084, 95%CI:.07-.08, p=0.003), prostate volume (OR:.02, 95%CI:.003-.022, p=0.03), and RS-RARP (OR: 0.38, 95%CI: 0.70-0.854, p=0.09). Conclusions: In low and intermediate risk PCa, RS-RARP appears to have better urinary continence rate, while maintaining the same oncological safety of C-RARP. In elderly patients and those with larger prostate volume, RS-RARP may be more advantageous and may ameliorate these risk factors of urinary incontinence. Further large studies are warranted to confirm our results. Keywords: Robotic, Radical prostatectomy, Urinary incontinence 385

NP-059 전립선암발견에있어 multiparametric MRI 의정확성 : whole-mount radical prostatectomy 병리시료와의직접비교 이찬호, 구자윤, 강병진, 이경, 김경환, 백승룡, 박지훈, 박원영, 이남경, 하홍구 부산대학교병원비뇨기과 Objective: To assess the accuracy of multiparametric magnetic resonance imaging (mpmri) in prostate cancer (PCa) detection, and determine the PCa detection volume by mpmri. Materials and Methods: A total of 07 patients who underwent mpmri before radical prostatectomy at a single institution were retrospectively analyzed. The pre-radical prostatectomy (RP) mpmri that originally did not have PI-RADS score reported were reassessed using PI-RADS V2 classification. The mpmri results and histological findings from whole mount RP specimens were directly compared by uropathologist and genitourinary radiologist. Results: Of the 07 patients, 39 (36.5%) had solitary and 68 (63.5%) had multifocal tumors. The overall mpmri sensitivity for PCa detection was 46.4% (0/237). The sensitivity and specificity of mpmri were 75.4% and 77% for clinically significant cancer, and 89.6% and 80.6% for pathologic index tumor. We observed a moderate and significant correlation of increasing PI-RADS score with increasing pathological grade, tumor volume, index tumor status, and clinically significant cancer status (all, P<0.00, respectively). On multivariate analysis, pathologic tumor volume was a significant predictor for PCa detection by mpmri. With a cutoff value of 0.89 cc, the sensitivity and specificity of mpmri for any PCa detection were 0.87 and 0.65. Conclusions: mpmri was a useful tool for clinically significant cancer and pathologic index tumor detection. The pathologic tumor volume was a significant predictor for PCa detection by mpmri. However, since the PCa detection under 0.8 cc by mpmri is still imperfect, it cannot replace the diagnostic role of conventional tests for PCa detection. Keywords: Multiparametric magnetic resonance imaging, Prostate cancer detection, PI-RADS 386

NP-060 전립선암고위험군환자에서 ISUP grade group IV 에대한저용량방사선동위원소영구삽입술단독치료의성적 임건우, 김종녕, 노주현, 이승렬, 최경화, 이태호, 정재호, 김문성, 박동수 CHA 의과학대학교분당차병원비뇨기과 Purpose: To investigate the clinical outcome of low dose rate (LDR) brachytherapy (BT) alone in the International Society of Urological Pathology (ISUP) grade group IV high-risk prostate cancer (PCa) compared to that with supplemental EBRT. Materials and Methods: Among 85 high-risk PCa patients with a follow-up period >3 years those who had undergone 25I LDR BT +/- EBRT and ADT since April 2007, 50 were classified into ISUP grade group IV, in which 27 were treated with LDR BT alone (BT group) and the rest had combination therapy (C group) as recommended in the NCCN guideline. Biochemical recurrence-free survival rates were compared between the patients with BT alone and those with BT in combination with EBRT. Results: The mean initial PSA was 26.2 ng/ml in BT group, and 27.8 ng/ml in C group. The mean D90 was 235.8 Gy in BT group, 75.2 Gy for C group. During a median follow-up of 37.2 months, biochemical control was obtained in 86% (43/50) of the total patients; the estimated 3-year BCR-free survival was 92% for BT group, while 88% for C group. Late grade 3 toxicities were observed in 5% (4/27) for BT group and 30% (8/23) patients in C group, respectively. Conclusion: Our previous study demonstrated that 25I LDR brachytherapy-based multimodal therapy in highrisk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score 8. Although the present NCCN guideline specifies that one of the initial treatments for grade group IV marks BT+EBRT +/- ADT, this study may bring up the feasibility of LDR BT monotherapy for dealing with grade IV group effectively. Keywords: ISUP IV, Low dose rate brachytherapy, Prostate cancer 387

NP-06 TRUS biopsy 후발생하는직장출혈에대한위험요인 노주현, 김문성, 김종녕, 임건우, 이태호, 정재호, 최경화, 이승렬, 홍영권, 박동수 CHA의과학대학교분당차병원 Purpose: As the incidence of prostate cancer increases, the number of prostate biopsies and the incidence of complications are also increasing. Of the various complications, rectal bleeding is usually minimal and does not require additional treatment. However, at very low rates, the amount of bleeding can be very high and can be fatal. As a risk factor for such bleeding, the presence of the use of aspirin and cardiovascular disease are usually assumed. Thus, the authors evaluated the association between this history and rectal bleeding, as well as the other potential risk factors. Materials and Methods: From June 204 to May 207, we performed retrospective case-control study of patients who underwent TRUS biopsy in the urology outpatient department of Bundang CHA Hospital. The confirmed cases were matched to the control group at a ratio of : 5. Results: Of the total 786 patients, 0 patients (.27%) had bleeding. As a control group, 50 patients were randomly selected and compared. The prevalence rates of hypertension and diabetes were 70% and 0% in the bleeding group, respectively, which were not significantly different from the control group (48%, p=0.302, 30%, p=0.263). Also, none of the 0 patients with bleeding group had stroke, cardiovascular disease, or aspirin use, and this was also irrelevant to the occurrence of bleeding. In addition, PSA values, prostate size, hemorrhoids, and the timing of the test were also checked to identify risk factors for bleeding, but the results were not statistically significant either. Conclusions: As a result, it was confirmed that there was no relationship between bleeding and easily predictable aspirin use, and no other factors were found clearly. There is the possibility that the unnecessary damage of the rectal tissue has increased due to the aging of the biopsy gun. There may be other factors that can be clearly prevented, but the incidence is low and there is a procedural, economical limit, so further research is needed in the future. Keywords: Prostate, Biopsy, Rectal bleeding 388

NP-062 조직검사 Gleason 7 전립선암에서 upgrading 이근치적전립선암적출술후생화학재발에미치는영향 안치현, 유상준, 박주현, 조성용, 조민철, 손환철, 정현 서울특별시립보라매병원비뇨기과 Purpose:To investigate the impact of pathologic upgrading of Gleason score (GS) 7 prostate cancer on the risk of the biochemical recurrence after radical prostatectomy Materials and Methods: The prospectively collected prostate cancer records of 678 patients with postoperative GS 7 prostate cancer without lymph node metastasis were reviewed retrospectively via two databases. The patients were categorized into four groups depending on pathologic upgrading; upgraded GS 3+4, non-upgraded GS 3+4, upgraded GS 4+3, and non-upgraded GS 4+3. Kaplan-Meier multivariate model were employed to examine the influence of pathologic upgrading of GS 7 prostate cancer on the risk of biochemical recurrence. Results: The mean age of the patients was significantly higher in the non-upgraded GS 4+3 group than other groups, whereas the mean prostate-specific antigen (PSA) level was lower in the upgraded GS 3+4 group than other groups. Pathologic findings, such as extracapsular extension, seminal vesical invasion, and the surgical margin rate were different from each other group. Five-year biochemical recurrence-free survival rate was 85%, 73%, 69%, and 60% in upgraded GS 3+4 group, non-upgraded GS 3+4 group, upgraded GS 4+3 group and non-upgraded GS 4+3, respectively. There was no significant difference in the two middle patient groups; i.e., the non-upgraded GS 3+4 group and the upgraded GS 4+3 group (Log-rank test, p-value=0.259). Conclusion: The information on pathologic upgrading in the biopsy reports of patients could help to provide more-detailed analysis for the biochemical recurrence of GS 7 prostate cancer. Keywords: Biochemical recurrence, Pathologic upgrading, Prostate cancer 389

NP-063 국소전립선암의근치적전립선절제술후원격전이가발생한환자군에서호르몬요법개시시점이생존율에미치는영향 안현규, 구교철, 이광석, 김도경, 나군호, 홍성준, 정병하 연세대학교의과대학비뇨기과학교실 Objective: The clinical benefit for early androgen-deprivation therapy (ADT) in PSA-only recurrent prostate cancer (PCa) patients following radical prostatectomy (RP) is controversial, and the M0 castrate-resistant PCa (CRPC) population may be a result of early off-label ADT. We investigated the impact of early versus delayed ADT on survival outcome in patients with localized or locally advanced PCa who received RP and later developed metastasis. Methods: We evaluated data of 3,920 patients treated with RP for localized and locally advanced PCa at a single institution between January 2006 and December 202, and identified 923 (23.5%) patients who received ADT with radiotherapy as adjuvant therapy at biochemical recurrence (BCR). Prognosticators for progression to CRPC and cancer-specific mortality (CSM) were evaluated for 74 patients who later developed distant metastasis. The parameters evaluated were: age, body mass index, Charlson Comorbidity Index, prostate-specific antigen (PSA), pathological Gleason score and stage, BCR period, PSA nadir following RP, PSA level at ADT initiation, time to PSA nadir, and use of ADT use prior to metastasis. Results: The median period from RP to BCR and metastasis were 9.0 (IQR 7.0-5.0) and 40.5 (IQR 23.8-77.8) months. Median follow-up was 85.0 (IQR 55.3-7.8) months. Patients who received early ADT (PSA<2 ng/ml) showed significantly delayed period to metastasis (p=0.05) and cancer-specific death (p=0.045) compared to those who received delayed ADT (PSA 2 ng/ml). Delayed ADT was associated with increased risks of CRPC (HR=3.84, 95% CI:.04-9.79; p=0.05) and CSM (HR=6.495, 95% CI.432-29.47; p=0.047). Conclusions: Delayed ADT following PSA elevation beyond 2 ng/ml was associated with early onset of metastasis and increased risks of CRPC progression and CSM. Keywords: Androgen-deprivation therapy, Biochemical recurrence, Prostatectomy 390

NP-064 로봇보조전립선적출술와근치적전립선적출술의초기임상결과의전향적코호트비교 윤민영, 정창욱 서울대학교병원비뇨기과학교실 목적 : 전립선암환자에서수술 ( 로봇보조전립선적출술 (RALP) vs 근치적전립선적출술 (RRP)) 에따른초기임상결과를전향적코호트를이용하여비교하였다. 대상및방법 : 206년 3월부터 206년 2월까지서울대학교병원에서수술한전형적인전립선암환자 344명 (RALP 253명, RRP 9명 ) 의 SUPER-PC-RP 코호트에서수술후 6개월이상외래추적진료한 242명의환자들을대상으로분석하였다. 결과 : 전체환자의평균나이는 68.3±6.3세 (SD) 였고체질량지수는 24.6±2.9 (SD) kg/m 2, 초기전립선특이항원은 4.6±49.9이었다. 환자나이는 RRP의경우유의하게많았으며 (RALP 67.4세, RRP 7.0세, p<0.00), 체질량지수는 RALP의경우가유의하게높았다 (RALP 25.0, RRP 23.7, p=0.004). 재원기간 (RALP 4.25일, RRP 4.20일 ) 과수술시간 (RALP의경우 console time. RALP 2.분, RRP 05.8분 ) 는유의한차이가없었다. 하지만추정출혈량은 RRP가 RALP 보다유의하게많았으며 (RALP 33 cc, RRP 585 cc, p<0.00) 수술후 일째통증 VAS는 RALP (2.99/0점) 가 RRP (2.96/0점) 보다유의하게높은것으로나타났으나 (p=0.00) 이는진통제사용과관련있을것으로생각된다. 수술후 3일째통증 VAS는유의한차이가없었다 (RALP 2.82/0점, RRP 2.82/0점, p=0.484). 혈색소수치는수술전유의한차이가없었으나수술후 RALP의경우 2.6로 RRP의경우 (.53) 보다유의하게높았다 (p<0.00). 수술후요실금비율은 RRP 가조금더높았으나 (Fig ) 유의한차이는아니었다 (Log Rank X2=.055, p=0.304). 수술합병증도 RALP (3.3%), RRP (9.7%) 로 RRP가조금더많았으나유의한차이는없었다 (p=0.08). 결론 : 로봇보조전립선적출술 (RALP) 과근치적전립선적출술 (RRP) 은추정출혈량, 수술후 일째통증 VAS, 수술후혈색소수치는유의한차이로 RALP가우수한초기임상결과를보여주었으나그외재원기간, 수술시간, 수술후 3일째통증 VAS, 수술후요실금비율, 수술합병증에있어서는유의한차이가없었다. 이후더많은환자들을대상으로하는추가연구가필요하다. Keywords: Prostate cancer, RALP (Robot-assisted laparoscopic prostatectomy), Early outcome 39

NP-065 근치적전립선절제술후기능적회복평가시인터뷰와설문지방법의비교 : 차이를발생시키는요인은무엇인가? 박사현, 임고산, 김명, 송채린, 안한종 울산대학교서울아산병원 Purpose: The typically lengthy survival after radical prostatectomy (RP) has brought attention to the health-related quality of life (HRQOL) and functional outcomes after surgery. We evaluated patient-reported EPIC to assess urinary and sexual functional changes after RP. We compared longitudinal urologist-based interviews and self-reports in the assessment of functional outcome after radical prostatectomy in prostate cancer patients. Materials and Methods: We evaluated 2 men with localized prostate cancer who underwent radical prostatectomy by a single surgeon. Patients were routinely scheduled to visit the clinic at baseline,, 3, 6 and 2-months postoperatively and asked to complete EPIC. Medical interviews were performed by a urologist without the information on self-reports. The agreement between EPIC and interview methods was examined using simple proportions and κ coefficient. Results: We reviewed a total of 055 patient-reported questionnaires and medical records. On questionnaires, daily pad usage was.5, 0.8, 0.4, and 0.3 at, 3, 6, 2 months postoperatively. On medical records,., 0.6, 0.3, and 0.2, respectively. The κ coefficient showed moderate agreement at 3 months (κ=0.568), substantial agreement at 6 and 2 months (κ=0.664 and 0.66). Functional erection rates on questionnaires were 3.5%, 8.5%, and 4.6% at 3, 6, and 2 months postoperatively. On medical records, 3.9%, 5.6%, and 26.7%, respectively. The κ coefficient showed fair agreement at 3 (κ=0.377) months, moderate agreement at 6 and 2 months (κ=0.485 and 0.420). In patients without functional erection preoperatively, questionnaires and medical records showed substantial agreement at 6 (κ=0.74) and 2 (κ=0.756) months postoperatively. In patients with preoperative functional erection, questionnaires and medical records showed fair agreement at 6 (κ=0.306) months and 2 (κ=0.290) months. Conclusions: In our study, the agreement between medical records and questionnaires for post-prostatectomy incontinence was substantial. However, for erectile dysfunction, the agreement was relatively poor, especially in patients who had preoperative functional erection. In these patients, modified questionnaires are needed to identify the more accurate sexual function and HRQOL after RP. Keywords: Prostatectomy, Erectile dysfunction, Surveys and questionnaires 392

NP-066 Predicting tumor volume using a novel biopsy-related parameter derived from location and relationship of positive cores on standard 2-core trans-rectal ultrasound-guided prostate biopsy 유상준, 안치현, 박주현, 조성용, 조민철, 손환철, 정현 서울특별시립보라매병원 Introduction: To develop a novel biopsy-related parameter, named overlapping line, defined as the overlapping line between the locations of positive cores on 2-core trans-rectal ultrasound-guided prostate biopsy, and evaluated the value of overlapping line for predicting tumor volume in the final pathologic examination. Materials and Methods: Among patients with prostate cancer who underwent radical prostatectomy at Boramae Medical Center, 470 patients who underwent standard 2-core trans-rectal ultrasound-guided prostate biopsy were selected. The number of overlapping line was determined in each patient, and its effects on tumor volume were evaluated after adjusting for other variables. Results: Median prostate specific antigen level was 9. ng/ml, and the maximum % cancer in positive cores was 42.8%. Median numbers of positive cores and overlapping lines were 3 and 2, respectively. The pathologic stage was T2 or less, T3a, and T3b or greater in 297 (63.5%), 04 (22.2%), and 67 patients (4.3%), respectively. Median tumor volume in prostatectomy specimen was 3.4 ml. In multivariate analysis, the number of overlapping lines (B: 0.750, p<0.00) was a significant predictor for tumor volume, in addition to prostate specific antigen level and maximum % cancer in positive cores. In addition, the model with overlapping line showed superior accuracy compared to the model without overlapping line. based on the 0-folds cross-validation using bootstrap with replacement (R-squared: 0.443 vs. 0.426). Conclusions: The number of overlapping lines, a novel prostate biopsy-related variable, was thought to be a reliable predictor for tumor volume and could be easily applied to routine daily practice. Keywords: Biopsy, Prostatic neoplasms, Tumor burden 393

NP-067 수술절제면양성 pt3an0/nx 전립선암환자에서글리슨점수가생화학적재발에미치는영상 : 전립선암연구회내다기관연구 송완, 전황균 2, 정병창 2, 서성일 2, 이현무 2, 최한용 2, 김종욱 3, 이상철 4, 변석수 4, 정창욱 5, 곽철 5, 조진선 6, 안한종 7, 전성수 2 이화여자대학교의과대학비뇨기과학교실, 2 성균관대학교의과대학삼성서울병원비뇨기과학교실, 3 고려대학교의과대학구로병원비뇨기과학교실, 4 서울대학교의과대학분당서울대병원비뇨기과학교실, 5 서울대학교의과대학서울대병원비뇨기과학교실, 6 한림대학교의과대학비뇨기과학교실, 7 울산대학교의과대학서울아산병원비뇨기과학교실 Background and Purpose: Oncologic outcomes of patients with pt3an0/nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients. Materials and Methods: A retrospective, multicenter study was performed on 795 patients with pt3an0/nx PCa with PSM after RP between January 2006 and December 204. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan-Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR. Results: During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pt3an0/nx PCa with PSM (GS 6 vs. GS 7 (3+4), P=0.047; vs. GS 7 (4+3), P=0.007, and vs. GS 8-0, P<0.00). When patients were stratified according to GS, 5-year BFS was 78.6% in GS 6, 66.2% in GS 7 (3+4), 5.% in GS 7 (4+3) and 35.5% in GS 8-0. Conclusions: In patients with pt3an0/nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis. Keywords: Biochemical recurrence, Gleason score, Positive surgical margin 394

NP-068 아스피린을복용에따른로봇보조근치적전립선절제술의수술직후결과비교 변경현, 박경민, 이유진, 정재욱, 하윤석, 최석환, 이준녕, 김범수, 김태환, 유은상, 권태균, 정성광, 김현태 경북대학교의과대학비뇨기과학교실 Aspirin is the most widely used anti-platelet drug and has been taken regularly for the prevention of cardiovascular disease. Stopping aspirin confers a significant threat to the patient because of increased rates of significant perioperative ischemic events in patients undergoing non-cardiac surgery. We compared perioperative outcomes of men who underwent RALP on aspirin with patients who operated RALP without aspirin. From 200 to March 206, we retrospectively reviewed prostate cancer patients who underwent RALP in out institution. We obtained preoperative characteristics such as demographic, prostate cancer diagnostic details, D Amico risk group and perioperative outcomes including operating time, hematocrit change, transfusion, hospital stay, Clavien complications. The patients were split into 3 groups of perioperative continuation of aspirin medication (group), aspirin stopped preoperatively (group2) and no chronic aspirin medication (group3). Group, 2 and 3 were identified as 5, 49 and 266, respectively. Gleason score and D'Amico risk were statistically significant in the operative characteristics (p=0.025 and p=0.029). Age, Clinical T stage and PSA were statistically not significant, but high PSA, high T stage was observed in the group who continued taking aspirin. We found Operative time, postoperative transfusion, duration of hospital stay, rate of Clavien complication and HCT change were no statistically difference in perioperative outcomes. The use of aspirin perioperatively was not found to have significant effects on postoperative outcome in RALP. Keywords: RALP, Aspirin, Prostatectomy 395

NP-069 로봇보조근치적전립선적출술중골반자율신경모니터링의안전성과효용성 : MMEN (monitoring and mapping of erectile nerve during RALP) study 초기분석 정창욱, 윤민영, 태범식 2, 박주현 3, 김기원 4, 서정화 5, 구자현, 곽철, 김현회 서울대학교병원비뇨기과, 2 고려대학교안산병원비뇨기과, 3 서울특별시립보라매병원비뇨기과, 4 서울대학교병원재활의학과, 5 서울대학교병원마취통증의학과 목적 : 현재까지골반자율신경을근치적전립선적출술중음경해면체신경을직접모니터링하거나매핑하는방법은확립되지않았다. 이에본연구자들은로봇보조근치적전립선적출술 (RALP) 중발기신경보전을위한골반자율신경모니터링의방법론을확립하고그안전성과효용성을전향적으로평가하였다. 방법 : 전향적, 제 상, 안전성및타당성평가임상연구로진행되었다 (NCT02507427). 205년 7월부터 207년 3월까지임상적국소전립선암으로 RALP를시행받는 30명의환자들을대상으로하였다. 전신마취시 propofol과 remifentanil을 Bispectral index 40-60이유지되는범위로정주하였고, rocuronium은 Train-of-Four count가 이하가되도록간헐적또는지속투여하여근이완을필요한최소한으로일정하게유지하였다. NIM-Eclipse (Medtronic, Minneapolis, USA) 을이용하여, 구부해면체반사, 회음부감각유발전위을비롯하여해면체신경의활동전압을측정하였다. 해면체신경활동전압의측정은다양한크기와기간의자극을주고, 다양한방법으로반복측정하였다. 주요측정은수술시작시, 방광과전립선을절단하여신경혈관다발이노출되었을때, 전립선을적출한직후, 수술종료시시행하였다. 안전성이일차결과변수로합병증을측정하였다. 이차결과변수는본신경모니터링의성공가능성으로타당성을보았으며, 신경보존을정량화할수있는지, 또이와발기력의회복의상관관계가있는지였다. 결과 : 모든환자에서수술중별다른합병증없이모니터링이가능하였으며, 한명의환자에서수술후심부정맥혈전증과방광요도문합부요유출이있었으나본검사와의관련성은없는것으로판단되었다. 완전한근이완을하지않고수술을진행하는것은문제가되지않았다. 그러나근이완정도에따라신경모니터링에는큰차이가없는것으로판단되었다. 음경해면체의임피던스변화는자극을주지않았을때도드물게관찰되었지만, 직접신경혈관다발을자극하였을때더자주, 더큰전압의변화로짧은저주파파형으로관찰되었다. 여러자극중가장효과적인자극은 30 ma, 5. Hz single pulse 로약 5-0초자극과 30초추가관찰로측정이가능하였다. 반응의정도는좌우각각 0,, 2점으로어느정도정량화가가능하였으나, 매핑이가능할정도로공간분해능을보이지는않았다. 결론 : 본연구진은세계최초로인간의음경해면체신경의활동전압을직접관측에성공하였다. RALP시골반자율신경모니터링의방법론을확립하였고안전하게적용가능하였다. 정량화가가능하였으나향후공간분해능을높이는기술적극복이필요해보인다. 추후음경해면체신경활성도정량화결과와발기력회복과의상관관계를확인할예정이다. Keywords: Prostatectomy, Caverosal nerve, Monitoring 396

NP-070 술전초고위험전립선암에대해근치적전립선절제술시행시예후인자로써 charlson comorbidity index 의적용가능성 박재원, 장원식, 함원식, 이주용, 김명수 2, 정원식 3, 조강수, 나군호, 홍성준, 최영득 연세대학교의과대학비뇨기과학교실, 2 전남대학교의과대학비뇨기과학교실, 3 광주기독병원비뇨기과 Purpose: National comprehensive cancer network (NCCN) guideline recommended radical prostatectomy (RP) for very high risk prostate cancer with younger, healthier patients without tumor fixation to the pelvic side-wall. So in this study, we investigated feasibility of Charlson comorbidity index (CCI) as a prognostic factor when consider RP for preoperative very high risk prostate cancer. Materials and Methods: we retrospectively investigated the medical records of prostate cancer patients who underwent RP at our institution from 992 to 200. Very high risk prostate cancer was defined according to NCCN guideline. Patients without adequate medical records and who received neoadjuvant therapy were excluded. Preoperative comorbidity was evaluated by CCI. We used univariate and multivariate Cox regression test for analysis. Results: As a result, 228 men were included for final analysis. Median age was 66 (Interquartile rage (IQR) 62-7). And median PSA was 0.7 (IQR 7.0-7.4). Patients with CCI 4 were 4 (8%). 88 patients (38.6%) was reported Gleason score 9 by biopsy. 59 patients (69.7%) were non organ confined tumor ( T3) with preoperative evaluation. 5 year prostate cancer specific survival (PCSS) rate and overall survival (OS) rate was 96.4% and 93.9%. In univariate and multivariate Cox regression analysis, CCI was significantly associated with PCSS and OS (p<0.05). Conclusions: CCI was feasible as a prognostic factor for PCSS and OS in very high risk prostate cancer. RP should be considered carefully if CCI of patient was over 4. Keywords: Very high risk prostate cancer, Radical prostatectomy, Charlson comorbididy index 397

NP-07 The oncological outcomes following radical prostatectomy in men with Gleason grade 3+5, 4+5, and 5+5 on prostate biopsy Jeong Woo Lee, Dong Hoon Lee, Jong Kil Nam, Moon Kee Chung, Sung Woo Park Department of Urology, Pusan National University Yangsan Hospital Objectives: We evaluated the oncological outcome for patients with secondary Gleason score (bsgs) 5 prostate cancer (PC) on biopsy according to accompanying primary Gleason score (bpgs), following radical prostatectomy (RP). Materials and Methods: Using a prospectively collected institutional registry, we identified patients with bsgs 5 PC on biopsy who underwent RP with pelvic lymphadenectomy between 2009 and 206. Twelve patients were excluded because of neo-/adjuvant androgen deprivation or adjuvant radiation. Biochemical free survival (BCRFS) rates were compared according to bpgs using Kaplan-Meier estimation. Results: We included 50 patients with median age of 69 years (IQR 65, 73). The median follow up duration was 30 months (IQR 9, 45). Fourteen patients (28%) were diagnosed lymph node metastasis. However, there was no lymph node metastasis in men diagnosed with Gleason 3+5 on biopsy. In the case of biopsy Gleason grade 3+5, 4+5, 5+5, downgrade in pathological Gleason sum was 57%, 53% and 67%, respectively. The cases diagnosed with single positive core including bsgs 5 were 3 (43%), 0 (29%) and 2 (22%) in 3+5, 4+5 and 5+5, respectively (p<0.00). And, the median value of longest core length including bsgs 5 was 8, 0, and mm in each group (p=0.457). The 3-year BCRFS rates were 00%, 62%, and 56% in men with bpgs 3, 4, and 5, respectively (Figure). The patients with Gleason 3+5 on biopsy showed different BCRFS comparing with that of Gleason 4+5 or 5+5 (p=0.04, p=0.048, respectively). Conclusions: The Gleason grade 5 pattern PC is most important predictive factors of BCRFS following RP. However, the patients with small volume of bsgs 5 had relatively good BCRFS. In particular, patients diagnosed with only a few cores as Gleason 3+5 on biopsy do not need to take pelvic lymph node dissection if he had no other risk factor. Keywords: Prostate, Cancer, Gleason 398

NP-072 경직장초음파유도전립선생검후출혈에대한옥시셀룰로오스국소지혈제의효과 박지운, 정준세, 배상락, 박봉희, 이용석, 강성학, 한창희 가톨릭대학교의과대학비뇨기과학교실 Purpose: To investigate whether oxidized regenerated cellulose patch used immediately after transrectal ultrasound (TRUS)-guided prostate biopsy decreases complication rates. Materials and Methods: We prospectively evaluated a total of 37 consecutive patients who underwent TRUS-guided prostate biopsy between January 206 and May 207. Systematic 2-core prostate biopsy was performed in all patients. Of these, 00 patients were assigned to one of two groups: the oxidized regenerated cellulose patch group (n=50) received oxidized regenerated cellulose patch on biopsy tracts immediately after prostate biopsy, while the control group (n=50) underwent TRUS-guided prostate biopsy alone. The incidence rate and duration of hematuria, hematospermia, and rectal bleeding were compared between the two groups. Results: The incidence rates of hematuria and hematospermia were not significantly different between the two groups (60 vs. 64%, p=0.68; 22 vs. 30%, p=0.362, respectively, for oxidized regenerated cellulose patch vs. control group). The rectal bleeding incidence was significantly lower in the oxidized regenerated cellulose patch group as compared to the control group (25 vs. 44%, p=0.03). However, there were no significant differences in the median duration of hematuria, hematospermia, or rectal bleeding between the two groups (2, 8, and 2 days vs. 2, 0, and days, p>0.05, respectively, for oxidized regenerated cellulose patch vs. control group). Oxidized regenerated cellulose patch was significantly protective against the occurrence of rectal bleeding after prostate biopsy in multivariable analysis (p=0.0, odds ratio (OR) 0.45). Conclusions: Although it has no impact on other complications, oxidized regenerated cellulose patch on biopsy tract used immediately after TRUS-guided prostate biopsy is an effective and practical method to decrease or prevent rectal bleeding. Keywords: Biopsy, Prostate, Bleeding, Hemostatic agent 399

NP-073 호르몬박탈요법은고위험또는초고위험국소전립선암환자에서단독으로사용돼서는안된다 최세영, 류제만, 경윤수, 김휘우, 유달산, 정인갑, 홍준혁, 안한종, 김청수 울산대학교의과대학비뇨기과학교실 Objectives: We investigated the oncologic outcomes between androgen deprivation therapy (ADT) and radical prostatectomy (RP) in high or very high risk prostate cancer. Materials and Methods: This study included 47 ADT patients and 356 RP patients who were diagnosed with high or very high risk of National Comprehensive Cancer Network-defined guideline. Patients who underwent radiation therapy or N or M stage were excluded. The Kaplan-Meier and Cox regression analysis were used to evaluate cancer specific survival (CSS) and overall survival (OS). Results: High risk included 276 patients and very high risk included 227 patients. ADT patients had worse characteristics of age (74.6 vs 70.8, p<0.00), comorbidity index ( 2; 3.3% vs 4.8%, p<0.00), PSA (42. vs 9.5, p<0.00), T stage ( T3; 56.5% vs 42.7%, p<0.00), and Gleason score ( 8; 78.9% vs 66.0%, p<0.00). During median follow-up of 66.0 months, 5-year CSS were 90.7% of ADT and 99.7% of RP, and 5-year OS were 68.2% of ADT and 95.5% of RP. On Kaplan-Meier curve, ADT showed worse CSS (p<0.00) and OS (p<0.00) than RP in both high and very high risk patients. On multivariate analysis, Gleason score ( 9 vs 8; hazard ratio [HR] 2.927, p=0.049) and treatment (RP vs ADT; HR 0.080, p=0.000) were significant factors for CSS. Conclusion: RP was superior therapy than ADT in high and very high risk patients. If surgery is possible, RP can help to obtain survival gain than ADT monotherapy. Keywords: High risk prostate cancer, Radical prostatectomy, Androgen deprivation therapy 400

NP-074 요산결석의예측인자분석 : mean stone density, stone heterogeneity index, and variation coefficient of stone density on single-energy NCCT, and urine ph 김종찬, 정해도, 이종수, 강동혁 2, 조강수, 함원식, 최영득, 이주용 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 인하대학교의과대학비뇨기과학교실 목적 : 결석성분중요산결석은화학적제거및예방이가능한결석으로치료전예측이가능하다면다른결석보다높은결석제거율을기록할수있다. 저자들은 single-energy 비조영전산단층촬영 (NCCT) 에서여러인자및요폐하와의관계를통하여요산결석을예측할수있는인자들을분석하였다. 대상및방법 : 204년 2월에서 206년 4월까지수술및결석이자연배출된환자 50명을대상으로의무기록을분석하였다. 그중 420명의환자에서수술전 NCCT 및결석성분분석이진행되었다. 결석의최대길이 (MSL), HU를이용한 MSD 및 SHI 그리고 variation coefficient of stone density (VCSD; SHI/MSD 00) 를수술전 NCCT를통하여측정하고요검사에서요폐하를기록하였다. 결석성분에따른세가지그룹 (Calcium oxalate compounds, infection stones 및요산결석 ) 으로나누어분석하였다. 결과 : 환자들의평균나이는 55.55±5.46세이었다. 수술전 NCCT로분석한요산결석의 MSD (454.68±77.80 HU) 및 SHI (5.82±96.3) 는다른결석이비하여낮은경향을보였다. 결석을세군으로나누어분석하였을때, 요산결석의 MSD (448.59±73.2) 는다른결석들에비하여의미있게낮은수치를보였으며 (vs. CaOx: P<0.00; vs. infection stones: P<0.00), SHI (00.8±77.37) 및 VCSD (22.59±0.55) 역시낮은수치를보였다 (vs. CaOx: P<0.00; vs. infection stones: P<0.00). 요폐하역시요산결석 (5.33±0.56) 이다른결석들에비하여의미있게낮은수치를기록하였다 (vs. CaOx: P<0.00; vs. infection stones: P<0.00). ROC 곡선을이용한요산결석을예측도는 MSD를이용하였을때, AUC 0.806 (95% CI 0.76-0.850) 및절단치 572.3 HU이었으며, SHI를이용하였을때, AUC 0.893 (95% CI 0.855-0.93) 및절단치 40.4 HU이었다. VCSD와요폐하의 AUC 는각각 0.782 (95% CI 0.726-0.839), 0.797 (95% CI 0.749-0.846) 이었으며, 절단치는각각 25.79와 6.0이었다 (Fig. ). 네 ROC 곡선의차이를 DeLong s test로분석하였을때 SHI가가장효과적으로예측할수있는 AUC를보였다 (P<0.00). 결론 : SHI는요산결석을예측하는데있어 MSD, VCSD 및요폐하보다더효과적인예측도를보였으며, 그절단치는 40.4 HU이었다. 향후 SHI를이용한수술전요산결석예측에도움을줄수있을것으로생각한다. Keywords: Stone composition, Uric acid stone, Stone heterogeneity index 40

NP-075 로봇을이용한산과적수술과복강경을이용한산과적수술이후발생한요관 - 질누공에대한보존적치료로서요관경하요관부목시술 김경환, 강병진, 박지훈, 백승룡, 이경, 김현우, 이정주, 신동길 부산대학교의과대학비뇨기과학교실 Aims of Study: Iatrogenic ureteral injuries are among the most serious complications in gynecologic surgery. With the increasing popularity of laparoscopic and robotic gynecologic surgery, the incidence of ureteral injuries is on the rise. This study was aimed to evaluate the minimally invasive approach and endourological techniques in female patients with iatrogenic ureterovaginal fistula. Materials and Methods: The present retrospective study included 2 patients (mean age: 60.9 years, range: 48-69) who were managed with retrograde stenting using ureteroscopy for ureterovaginal fistula. The diagnosis was based on clinical presentation, double dye test, cystoscopy, and excretory urography. The preoperative characteristics and the intra- and postoperative data were assessed by reviewing the operative notes, medical records, and office notes. Results: Between July 202 and October 204, twelve women underwent ureteroscopic ureteral stenting. The mean (range) interval between surgery and the diagnosis of the presence of incontinence was 2.4 (0-65) days. Retrograde stenting was successfully performed in all patients, using an 8Fr semi-rigid ureteroscope. Eleven patients became continent the day after surgery. One had urinary incontinence 2 weeks after surgery, which the injured site was at the ureterovesical junction. Three patients showed ureteral stricture in urography which was performed at 4 weeks after the stent removal. These patients were all cured after transurethral balloon dilation of the stricture site. Conclusions: Ureteroscopic stenting can be an effective method to manage ureterovaginal fistula which is a complication from robotic and laparoscopic gynecological operations. Thus, an attempt of ureteroscopic stenting should be considered in patients with ureterovaginal fistula before subjecting them to other modalities. Keywords: Ureteral stenting, Ureterovaginal fistula, Gynecological operation 402

NP-076 경피적신절석술후출혈에영향을끼치는위험인자들 장재윤, 장준보, 고영휘, 송필현, 문기학, 정희창, 최재영영남대학교의과대학비뇨기과학교실 Introduction: Percutaneous nephrolithotomy (PCNL) is the surgical procedure in renal stone management. Even though it is performed quite often, the complication rates are also high. Hemorrhage is a major complication after PCNL. In the current study, we analyzed risk factors that effect the bleeding after PCNL. Materials and Methods: Retrospective study of medical record from January 204 to June 206 was performed. We analyzed 0 consecutive patients undergoing PCNL. Patients were divided into 2 groups by loss of hemoglobin (Hb) after operation; Group A (Hb loss<3), B (3<Hb loss). We reviewed the types of renal stone, puncture sites, operation time and hounsfield unit(hu) of stones, respectively. All analyses were performed using SPSS 9.0. The Pearson s chi-square test was used to evaluate the association between categorical variables. One-way analysis of variance ant t-test were used to compare the means of continuous variable. Result: Of all 0 patients, 84 males (76.4%) and 26 females (23.6%) were included. The mean age (±SD) was 53.05±.03 years. A total of 00 (90.9%) and 0 (9.%) were included in group A and B, respectively. 6 patients of group B underwent renal angiography and embolization due to hemodynamic unstability. 4 patients in remaining underwent transfusion of blood pack cell. The puncture site was the inferior calyx in 90, the middle calyx in 7, the upper calyx in and multiple in 2. Group B included 9 cases with inferior calyx access and case with multiple access. In comparison between both groups by the puncture site, there was statistical significance (p=0.007). Conclusion: In conclusion, severe postoperative bleeding after PCNL is associated with renal puncture via the inferior calyx. Additional prospective and larger-scale studies are required to support the conclusion of our study. Keywords: Percutaneous nephrolithotomy, Bleeding, Nephrolithiasis 403

NP-077 2-3 cm 크기의신결석환자에서역행성신장내결석수술의시행시 ureteral access sheath 의직경이수술결과에영향을미치는가? 장재윤, 장준보, 고영휘, 송필현, 문기학, 정희창, 최재영 영남대학교의과대학비뇨기과학교실 Introduction: During retrograde intrarenal surgery (RIRS), ureteral access sheath (UAS) offers many advantages, especially for the treatment of large sized kidney stones. However, comparisons of each diameter of UAS have not been conducted. We aimed to investigate the surgical outcomes of 2-3 cm sized renal stones according to the diameter of UAS. Materials & Methods: We retrospectively evaluated 25 patients who underwent RIRS for 2-3 cm sized renal stone. All operations were performed by a single experienced surgeon. Patients were divided into three groups by UAS diameter (Group ; 2 Fr, Group 2; 3 Fr, Group 3; 4 Fr). We compared patient characteristics and surgical outcomes including success rates, ureteral injury, complications among three groups. Results: There were no significant differences in patient sex, age, stone size and laterality among three groups (Table ). The mean operation time was not significantly different among three groups (p=0.563). Success rates were similar among three groups (Group ; 86.%, Group 2; 88.2%, Group 86.8%, p=0.6). However, in group 3, ureter wall injury over grade II was significantly more frequent than other groups (p=0.03). Complication including fever, postoperative bleeding was not significantly different among three groups (Table 2). Conclusion: In our study, regardless of UAS diameter, RIRS can be performed effectively in 2-3 cm sized renal stones. However, more than the diameter of UAS 4 Fr, precautions should be taken as it may occur more often, high grade ureter wall damage Keywords: Renal stone, Ureteroscopy 404

NP-078 하대정맥후요관 (retrocaval ureter) 의치료를위한복강경하신우성형술의유용성 : 단일술자경험및문헌고찰 오태훈, 이재환, 박승철, 정희종, 서일영 원광대학교의과대학비뇨기과학교실 Purpose: We present surgical techniques and operative results of laparoscopic pyeloplasty for patients with retrocaval ureter (RCU) in a single surgeon s experience, and review similar papers. Materials and Methods: Seven patients with RCU were enrolled in this study from April 2005 to October 206. The mean age of 5 males and 2 females was 36.3 years old. The chief complaint was flank pain in 5 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Three patients showed obstructed patterns on the renal scans. A single surgeon performed laparoscopic pyeloplasties with transperitoneal approaches including double-j ureteral stent insertions. The operative and follow-up results were checked and compared with published papers. Results: All laparoscopic pyeloplasties were successfully completed without conversion to open surgery. The mean operative time was 7.8 minutes (range, 97-240 minutes). The estimated blood loss was 84.3 ml (range, 50-332 ml). No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 6.3 months (range, 6-30 months). We found 7 papers from PUBMED, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters. Conclusions: Our results show that transperitoneal laparoscopic pyeloplasty is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it. Keywords: Retrocaval ureter, Hydronephrosis, Laparoscopic pyeloplasty 405

NP-079 누적합법을이용한영상보조최소절개술 (video-assisted minilaparotomy surgery) 을이용한부분신장절제술의학습곡선 (learning curve) 분석 박지수, 안현규, 김진우, 강숭구, 오경택, 김종원, 나준채, 이형호 3, 윤영은 4, 윤민지, 한웅규,2 연세대학교의과대학비뇨기과학교실, 비뇨의과학연구소, 2 Brain Korea 2 PLUS Project for Medical Science, Yonsei University, 3 국립건강보험공단일산병원비뇨기과, 4 한양대학교의과대학비뇨기과학교실 영상보조최소절개술 (Video-Assisted Minilaparotomy Surgery) 은개복수술의특징을살리면서도복강경의장점을활용한수술법으로기복 (pneumoperitoneum) 을사용하지않고보조자가없이수술이가능하고후복막접근을통해장손상위험이적은등여러가지장점이있는술식이다. 누적합법 (cumulative sum analysis, CUSUM analysis) 은산업화문제모니터링에적합화된분석법이나이전연구에서의학술기의학습곡선분석에이용되었다. 본연구는표준화된영상보조최소절개술을이용한부분신장절제의학습곡선을누적합법을통해최초로분석하였다. 신촌세브란스병원에서단일술자에게영상보조최소절개술을이용한부분신장절제술을시행받은총 20명의환자를대상으로하였다. 상기환자의시술시간, 임상병리학적특성등이후향적으로조사되었고, 환자의개인정보를제거하고익명으로저장된자료를이용하여분석하였다. 학습곡선분석을위해누적합법을이용하였다. 전체환자평균나이는 55세였다. 총시술시간에따른누적합법의결과는그림 에서보듯이, 첫번째증례에서 7번째증례까지급격한경사를보이는누적합곡선 ( 구간 ) 을보이고 8번째증례에서 2번째증례까지는비교적완만하고편평한모양 ( 구간 2), 3번째증례부터는기울기가급격히하락 ( 구간 3) 하였다. 본연구에서누적합법을통해서술자가학습곡선에도달하기위해서는 7예정도의수술경험이필요하고 3예정도의경험이있다면술자가능숙하게짧은시간내에수술을진행할수있음을보여주었다. 본연구에대해서는다양한선행경험을가진술자에대한추가적인전향적인연구가더필요하겠으나기존에학습곡선분석에쓰이는누적합법에의한본단일술자에대한연구를통해서여러가지장점을가진영상보조최소절개술학습이비교적많지않은수술을통해습득할수있다는결과를보였다. Keywords: Partial nephrectomy, Learning curve, Cumulative sum analysis 406

NP-080 역행성요관경하접근법을이용한매복요관결석 (impacted ureteral stone) 의수술적치료에대한고찰 민경찬, 김상원, 권순오, 김범수 경북대학교의과대학비뇨기과학교실 목적 : 매복요관결석은요관의완전폐색을동반하고요관내점막에단단하게고정되어있는경우가많아요관경하절석술 (URS) 시요관의손상및결석의이동등의합병증발생률이높고, 수술성공률이낮은것으로보고되고있다. 그러나최근홀뮴레이저및 stone basket 등과같은결석의이동을방지할수있는장비의발달로매복요관결석에서도안전하고효과적으로 URS를시행할수있을것으로기대되고있다. 이에본연구기관에서매복요관결석으로 URS를시행받은환자를대상으로그안전성및효용성에대하여분석하고자하였다. 대상및방법 : 20년 월부터 206년 2월까지요관결석으로본원에서 URS를시행받은환자들중신결석이동반되어동시에수술을진행한경우, 술전요관스텐트또는신루를삽입한경우, 술전요로감염이동반된경우를제외한 245례를대상으로하였다. 매복요관결석은결석이요관의완전폐색을초래하여술중유도철사가결석상방으로통과되지않는경우로정의하였고, 매복요관결석유무에따라두군으로나누어술전환자및결석의특징, 수술과관련된인자, 수술성공률, 합병증발생률등에대하여후향적으로비교하였다. 결과 : 전체 245례중 55례 (22.5%) 에서매복요관결석이확인되었고, 환자의나이, 성별, 체질량지수등에서는두군간에유의한차이가없었다. 술전결석의크기 (8.4 vs.9 mm, p<0.00) 및하운스필드단위 (86.7 vs 052.0U, p<0.00) 는매복결석군에서유의하게높았고, 수술시간 (50.9 vs 68.0분, p<0.00) 도매복결석군에서유의하게길었다. 술중홀뮴레이저사용률 (40.0 vs 63.6%, p=0.002) 또한매복결석군에서유의하게높았으나, stone basket과같은결석이동을방지하기위한기구의사용률 (90.5 vs 94.5%, p=0.348), 합병증발생률 (4.2 vs 8.2%, p=0.469) 및수술성공률 (9.6 vs 89.%, p=0.570) 은두군간에유의한차이가없었다. 결론 : 요관경하절석술시매복요관결석은상대적으로결석의크기가크고경도가높아수술시간이많이소요되는단점은있으나, 홀뮴레이저와 stone basket 등과같은결석의이동을방지할수있는장비를적절히사용한다면안전하고효과적으로시행될수있을것으로생각한다. Keywords: Ureteroscopic stone removal, Impacted ureteral stone, Stone free rate 407

NP-08 방사선투과성신장및요관결석의 potassium citrate/sodium bicarbonate 를이용한용해요법의성공에미치는인자 이승수, 이정우, 이동훈, 남종길, 박성우, 한지연, 정문기, 정재민, 이상돈 부산대학교의과대학양산부산대학교병원비뇨기과학교실 목적 : 방사선투과성신장및요관결석의일차치료로약물을이용한용해요법을사용할경우성공을예측할수있는인자를알아보고자하였다. 대상및방법 : 방사선투과성신장및요관결석으로진단되어 Potassium citrate 또는 Sodium bicarbonate를이용한용해요법을일차치료로선택한 24명의환자를대상으로후향적분석을시행하였다. 각환자에서나이, 성별, 체질량지수, 동반질환 ( 당뇨, 고혈압, 만성신장병, 통풍, 심장질환및기타등 ), 치료전혈청크레아티닌및요산수치, 요 ph 및사용한약제 (Potassium citrate 및 Sodium bicarbonate) 의종류및용량을조사하였다. 컴퓨터단층촬영 (Computed tomography, CT) 으로결석에대해위치 ( 신장및요관 ), 크기, Hounsfield unit 및치료후 CT로결석제거성공여부를확인하였다. 결과 : 24명의환자중용해요법이성공한환자는 9명 (79.2%) 이었고, 실패한환자는 5명 (20.8%) 이었다. 각환자군에서환자의나이, 성별, 체질량지수및동반질환은차이가없었다. 치료전혈청크레아티닌및요 ph는두군에서차이가없었으나혈청요산수치는성공한군에서높았다 (p=0.046). 결석인자로서결석위치및크기는양군에서차이가없었으나 Hounsfield unit은성공한군에서낮게측정되었다 (p=0.032). Potassium citrate는성공한군에서 3례, 실패한군에서 5례, Sodium bicarbonate는성공한군에서 6례, 실패한군에서 0례사용되었으나통계적인차이는없었다 (Table ). 결론 : 방사선투과성신장및요관결석의일차치료로 Potassium citrate나 Sodium bicarbonate를이용한용해요법을적용할경우결석의 Hounsfield unit이낮은경우, 혈청요산수치가높은경우성공확률을더높게예측할수있다. Keywords: Kidney stone, Potassium citrate, Sodium bicarbonate 408

NP-082 The efficacy of OPD based-pudendal nerve block in the treatment of chronic pelvic pain 김문성, 노주현, 김종녕, 임건우, 홍재엽, 최경화 CHA 의과학대학교분당차병원비뇨기과학교실 Objective: To determine the effect of OPD based-pudendal nerve block in patients with chronic pelvic pain. Methods: We performed a retrospective analysis of 3 patients with refractory chronic pelvic pain. Pudendal nerve block was performed in chronic pelvic pain patients that subjective pain scale did not decrease by more than 30% despite of various medications for more than 2 months (NSAIDs, TCA, opioids, antibiotics including quinolone, α-blocker and pentosane polysulphate). Patients with anatomical abnormality, gynecological problems, or infections were excluded. An OPD-based transvaginal pudendal nerve block targets the pudendal trunk as it enters the lesser sciatic foramen, about cm inferior and medial to the attachment of the sacrospinous ligament to the ischial spine. Using a 5 cm/25 gauge spinal needle with a plastic guard, total 0 cc of % lidocaine (n=8) or 5 cc of 2% lidocaine with 5 cc of 7.5% ropivacaine (n=3) was injected in bilateral pudendal nerve. Vital sign was checked pre and post treatment status and hr after treatment. The change of subjective pain scale, reduction of medication, improvement of other symptoms were analysed at post-block 3 months. The chi-square test and paired t-test were used. All analyses performed with SPSS v23.0. Results: Mean age of patients was 42.3 years (3-62). Before the nerve block, the mean duration of medication was 4. months. 25/3 (80.6%) patients were accompanied by peri-pudendal tenderness and surrounding trigger points. 23 (74.2%) patients received nerve block once, 8 (25.8%) patients received twice, with an interval of 2 weeks (n=5), -.5 month (n=3). 26 patients (83.9%) that received pudendal block reported improvement in pelvic pain including dysuria and dyspareunia post procedure (p<0.03). Among them, 6/26 (6.5%) patients showed improvement of frequency and urgency. In total, 20/3 (64.5%) patients could reduce (n=6) or stop (n=4) the medication. Mild dizziness developed immediate after procedure and resolved within 30 minutes were reported in 8/3 patients (58.%), and 2 case of UTI (6.5%) were reported. Conclusions: The use of OPD based-pudendal nerve block is feasible and safe and also associated with an overall improvement in chronic pelvic pain. Keywords: Chronic pelvic pain, OPD-based pudendal nerve block, Efficacy 409

NP-083 여성요실금치료에서새로운회음질압측정기 (KegelQ) 를이용한바이오피드백의임상적유용성에대한연구 : 다기관전향적무작위배정대조연구 이영주, 이정근, 이순미, 천성희 2, 이유경 3, 김성화 3, 조성용 2, 오승준 3, 정성진 분당서울대학교병원비뇨기과, 2 서울특별시립보라매병원비뇨기과, 3 서울대학교병원비뇨기과 목적 : 여성복압성요실금에서골반저근운동 (PFME) 은치료효과를향상시키기위해다양한방법이시도되었고, 특히운동중에직접시청각적반응을주어골반저근의인식과수축을더적절히할수있게하는여러바이오피드백방법이소개되었다. 그러나, 바이오피드백을병용했을때더치료효과가향상되는지에대해서는아직논란이있고이는연구마다대상환자군과측정지표등이다양하고사용된 device가다양했다는점도일정부분작용했을것이다. 본연구는새로운바이오피드백 device인 KegelQ의임상적유효성을 PFME 단독치료와비교하고자시행하였다. 대상및방법 : KegelQ device는기존과다른몇가지특징이있는데, 질삽입프로브가타원형이아닌수평형으로팽창이가능하여질내의어느위치에있어도효과적으로운동이가능하고, 피드백하는방식이그래프형태가아닌수치로표시되고적정수축이가해지면화면의색깔로환자가인지할수있게해준다. 3개의병원에서 3개월이상복압성요실금증상, SANDVIK 설문에서 번문항에 yes인경우, 시간패드테스트에서 2 g 이상의요누출이있는 20-80세여성 90명을대상으로 3개월간무작위배정연구를실시하였다. PFME 단독군과 KegelQ 바이오피드백병용군으로구분하였으며환자는 physiotherapist와 4회의접촉을하였고운동의순응도를모니터링하였다. 3개월째 시간패드테스트에서 2 g 미만의요누출을보이는경우를 cure로판정하였다. 결과 : 3개월간 75명 ( 단독군 39명, 병용군 36명 ) 이추적관찰을받았으며, 평균나이는 57.7, 55.3세, 요실금기간은 5.5, 48.개월, 패드무게는 0.0, 2.6 g, 질수축압은 3.3, 3.6 mmh 2 O로, 양군 baseline characteristics에차이는없었다. 3개월째 cure rate는 48.7%, 63.9% 로차이가없었으나, 2차평가지표에서, 3개월째 SANDVIK 설문에서주회이상요실금을보이는경우가 64., 36.% (p=0.030), 중간이상의요실금 25.6, 5.6% (p=0.033), 질수축압 개월 5.9, 22.6 (p=0.006), 3개월 8.3, 25.2 mmh 2 O (p=0.0), 3개월째 PPBC 3.3, 2.5 (p=0.07) 로, 일부지표에서 KegelQ 병용군에서이득을보였다. 치료전과비교하여패드무게의감소정도는 개월 3.7, 6.4 g, 3개월 5., 9.5 g (p=0.048) 로병용군에서감소폭이더컸다. KegelQ 병용군에서 device 사용불편감에대한 VAS는 2.점으로, 대부분의환자에서경미하였다. 결론 : KegelQ device를이용한 PFME는 3개월치료에서 63.9% 완치율을보였고 PFME 단독치료와비교하여통계적차이가없었다. 그러나, SANDVIK index, PPBC, 패드무게감소에서단독치료보다유의한호전을나타냈고이는골반저근의수축강도를향상시킴으로써이루어지는것으로생각된다. KegelQ device는 PFME 시에유용한보조치료로생각되고안전하게일상사용이가능할것으로생각된다. Keywords: Stress urinary incontinence, Pelvic floor muscle exercise, Biofeedback 40

NP-084 단일기관에서시행한방광질루교정술의장기추적결과 정현우, 고광진, 이규성성균관대학교의과대학비뇨기과학교실목적 : 단일기관에서시행한방광질루 (vesicovaginal fistula) 교정술의장기추적결과에대해알아보고자하였다. 대상및방법 : 200년부터 206년까지본원에서방광질루교정술을받은환자의자료를후향적으로분석하였다. 수술전환자의특성과발병원인, 이전수술여부와방사선치료여부, 방광경검사를통한환자의위치, 크기, 개수등을확인하였고수술후에는수술방법에따른수술의성공률, 재발률을확인하였다. 수술은복벽경유 (transabdominal) 혹은질경유 (transvaginal) 접근방법으로시행되었다. 수술성공은수술후도뇨관제거전누수검사 (indigocarmine test, cystography) 에서음성으로나온것으로정의하였다. 결과 : 대상환자는 65명으로 44명환자는방광질루교정술을처음받은환자였고 2명은타병원에서수술을받은후재발한환자였다. 평균추적관찰기간은 20.개월이었다. 첫번째수술성공률은 84.6% (55/65) 이었고, 이중 5명은추척중누공이재발하였다. 복벽경유방법의성공율은 85.4%, 질경유방법은 82.4% 였다. 첫수술에서실패하거나재발한 5명의환자중 2명의환자는 ileal conduit을권유했으나거부하였으며 5명의환자는다른원인으로추가수술을받지않았다. 최종적으로 8명의환자가재수술을받았고이중 명의환자는누공의크기가크고방광용적이적어 ileal patch를사용하였으며 명은 ileal conduit을시행하였다. 이후 2명의환자에서재발소견이보여 3차수술을시행하였다. 이차수술의성공율은 62.5%, 3차수술의성공율은 00% 였다. 최종적으로 93.8% (6/65) 의성공률을보였다. 방사선치료를받았던 0명환자의수술성공률은 54.6% 이었다. 결론 : 수술후 20개월추적한결과방광질루교정술의성공률은 차수술후 84.6% 이었고, 최종적으로 93.8% 이었다. Keywords: Vesicovaginal fistula, Surgical outcomes, Recurrence rate 4

NP-085 복압성요실금정도평가척도들의비교분석 : 전향적연구 윤민영, 김병수, 조성용 2, 오승준 서울대학교병원비뇨기과학교실, 2 서울특별시립보라매병원비뇨기과목적 : 복압성요실금환자들에서요실금의정도를계량화하기위한다양한방법들이제시되어여러가지지표들이임상진료에서활용되고있으나이러한지표들에대한상관관계의적절한평가가필요한실정이다. 이에이지표들의상관관계를전향적으로알아보려고하였다. 대상및방법 : 여성복압성요실금환자들을대상으로 ICIQ-UI, PPBC, KHQ 설문지결과와 -hour pad test, Q-tip test, 요역동학검사 (ALPP) 를시행하여분석하였다. 결과 : 총3명환자들의평균나이는 57.7±0.2세 (SD) 이었고요실금은복압성 26명, 복합성 80명이었다. 설문지들은 ICIQ- UI와 PPBC (r=0.580, P<0.00), ICIQ-UI와 KHQ (0.85<r<0.473, P<0.00), KHQ와 PPBC (0.304<r<0.656, P<0.00) 사이에강한상관관계를보여주었다. Q-tip test는설문지, pad test, urodynamic result와상관관계가없었다 (Fig ). () pad test는 KQH 설문지의하위항목인 role limitations (r=0.306, P=0.004), physical limitations (r=0.29, P=0.044), social limitations (r=0.302, P=0.004), emotions (r=0.336, P=0.00), sleep/energy (r=0.430, P<0.00), severity measures (r=0.29, P=0.005) 들과유의한상관관계를보여주었다. 그러나 personal relationships와는유의한상관관계가없었다. (2) pad test는 VLPP (r=-0.254, P=0.02) 와 CLPP (r=-0.266, P=0.02) 에음의상관관계를보여주었다. (3) PPBC는 pad test (r=0.305, P=0.003), VLPP (r=-0.24, P=0.025), CLPP (r=-0.206, P=0.046) 와중등도 고도의상관관계를보여주었다. (4) VLPP는모든 KHQ 항목들과중등도 고도의음의상관관계를보였다. CLPP는 social limitations, emotions, sleep/energy, severity measures과중등도 고도의음의상관관계를보였다. (5) ICIQ-UI는 pad test와유의한상관관계가없었다. (6) ICIQ-UI는 VLPP (r=-0.324, P=0.003) 와강한음의상관관계를보였다. (7) MUCP 는 VLPP (r=0.326, P=0.002), CLPP (r=0.337, P=0.00) 와강한양의상관관계를보여주었다. 결론 : 요실금환자의 pad test와 urodynamic results는각종설문들과유의한상관관계를보여주었다. Q-tip test는요실금상태를평가하는데도움이되지않았다. Keywords: Urinary incontinence, ICIQ-UI, Urodynamics 42

NP-086 뇌졸중환자에서과민성방광증상이삶의질및기능수행척도에미치는영향 홍정희, 표혜나 2, 김은주 2 단국대학교의과대학비뇨기과학교실, 2 국립재활병원재활의학과 Objective: Overactive bladder (OAB) symptoms are common in stroke patients, but their effects on stroke rehabilitation over time are unclear. We aimed to identify the effects of OAB symptoms on health related quality of life (HRQOL) of stroke patients. Materials and Methods: Thirty post-acute stroke patients who were admitted for rehabilitation treatments were included. All participants completed questionnaire survey to evaluate urinary symptoms with overactive bladder symptom score (OABSS) and general HRQOL with Short Form 36 health survey. To assess their performance status, we also assessed function ambulation category, modified Rankin scale (MRS), modified Barthel index, and mini-mental state examination (MMSE). All assessments were carried out at baseline and 3 months. We divided patients into OAB and non-oab group with OABSS. Correlation analysis and multivariate regression were performed. Results: All performance scales showed improvement over 3 months in the non-oab group (n=8; p<0.02), but in the OAB group (n=2), MRS and MMSE scores did not improve significantly (p=0.57 and 0.20, respectively). In the OAB group, vitality and mental health scores significantly decreased over 3 months (p=0.02 and 0.04, respectively) and the mental component summary (MCS) score showed a marginal decrease over 3 months (p=0.050). Multivariate regression analysis revealed that OAB symptoms were negatively correlated with 3 months MCS score (B=-8.5, p=0.034). Conclusion: OAB symptoms can have negative effects on HRQOL and performance status in stroke patients Keywords: Stroke, Overactive bladder, Quality of life 43

NP-087 The effect of observing the degree and pattern of urine leakage during the provocative test before applying and adjustment of the mesh during trans-obturator tape (TOT) procedure in mixed incontinence 김종원, 이형호, 박상언, 이석영, 고우진, 김영식 국민건강보험공단일산병원비뇨기과 Objectives: Our study evaluates external manual compression during adjustment trans-obturator tape sling procedure in mixed type urinary incontinence. Methods: The study was conducted on patients selected randomly, who visited the hospital between Jan 204 and Jan 206. A total of 48 patients were included. 8 patients underwent trans-obturator tape procedure without external manual compression, and 67 patients underwent trans-obturator tape procedure with external manual compression. Trans-obturator tape was performed by three surgeons. Surgeon was performed external manual compression during adjustment trans-obturator tape. We classified the degree of leakage by the three groups (Grade I/II/III) (Fig ), intra-operative test, the degree of tape adjustment was varied in the group with urgency and urge incontinence. After the observation of degree and pattern of urine leakage, applied and adjusted the mesh. We compared the results of postoperative outcomes with surgeon and the others. Results: In the group not applied provocation test the cure rate was 50.6%, the improved rate was 38.3%. In the group applied provocation to test the cure rate was 86.6%, improved rate was.9%. The group applied provocation test had a significantly higher success rate compared to the group not applied provocation test (p=0.000). Stamey grade was compared in mixed type incontinence by provocation test. In the group not applied provocation test, Stamey grade 0 was 43.5% and in the group applied provocation test was 8.4% (p=0.007). Conclusion: To identify leakage grade by provocation test during the operation showed good results after sling operation. It is mixed type incontinence that intraoperative provocation test effective. Keywords: External manual compression, Transobturator tape, Mixed incontinence 44

NP-088 영유아에서포피의 HPV 유병률 : 문헌고찰및메타분석 이현영, 김재헌, 두승환, 양원재, 송윤섭순천향대학교서울병원비뇨기과학교실배경 : 영유아포피의실제 HPV 유병률은거의보고되지않았다. 영유아의 HPV 유병률보고는무증상남아에서의치료기준을정하는데에매우중요하다. 방법 : 960년부터 200년까지의 HPV 포피유병률의전향적연구데이터베이스를연구하였다. 메타분석을시행하였으며영유아포피 HPV 유병률을모으기위해확률효과모형을사용하였다. 결과 : 총 8개연구가메타분석에적용되었다. 일반적 HPV, 고위험 HPV, 저위험 HPV, HPV 6/8, HPV 6, HPV 8의전체유병률은각각 7.3 (95% CI; 0.8, 46.3), 2. (95% CI; 0.9, 3.5), 2.4 (95% CI; 0.0,.2), 4.8 (95% CI; 0.0, 6.8),.7 (95% CI; 0.0, 5.) and 0 (95% CI; 0, 0.5) 로나왔다. 메타회귀분석에서유병률은장소, 평균나이, 연구연도와는관련없는것으로나타났다. 해석 : 영유아에서포피의 HPV 유병률은 0% 가아니며이것은성적접촉이아닌다른경로로 HPV가전파된것을의미한다. 영유아에서고위험 HPV가확인된다는것은포경수술이나백신접종을통한예방치료가권장된다. Keywords: Papillomavirus, Foreskin, Meta-analysis 45

NP-089 단일일차의료기관을방문한여성급성단순방광염환자의원인균및항생제감수성검사결과 두진경, 어홍선 PSI 어비뇨기과의원 목적 : 급성단순방광염은여성에게가장흔한요로감염으로일차의료기관에서치료하는경우가대부분이지만, 지금까지발표된국내결과들은병원급이상의의료기관조사이다. 본연구는일차의료기관을방문한여성의급성단순방광염의임상결과를알아보고자하였다. 대상및방법 : 202년 월부터 207년 6월까지급성단순방광염으로본원내원하여치료받은 5세이상의여성 ( 총 4969명, 평균나이 : 5.6±8.06세 ) 을후향적으로분석하였다. 요로카테터삽입, 신경인성방광, 요로결석, 요도협착등해부학적이상소견이있는경우는제외하였다. 환자를재발유무와검사기간에따라균주와항생제감수성결과를분석하였다. 결과 : 가장많은원인균은 E. coli (8.0%) 였다. 나이가증가할수록, 재발이있는경우 E. coli 발생빈도는줄어드는경향을보였으며, 나머지균주는증가되는경향을보였다 (Table, p<0.05). 검사일을 204년이전, 204-205년, 206년이후로나누었을때 E. coli는각각 83.0%, 80.5%, 79.8% 로발생빈도가점점줄어들었다. E. coli 균주를대상으로재발유무와검사기간에따라항생제감수성결과를확인했을때, 재발이있는경우와검사일이최근일수록항생제내성률이더증가되었다 (Table2, p<0.05). 결론 : 일차의료기관에서치료하는급성단순방광염의원인균은재발, 고령이거나검사기간이최근일수록 E. coli 발생빈도가줄어들었으며, ampicillin, TMP/SMX, Ciprofloxacin순으로항생제의내성이증가하였다. Keywords: Cystitis, Microorganism, Susceptibility 46

NP-090 ESBL 생성균에의한요로감염으로 ertapenem 치료후재발한 ESBL 양성환자의임상양상과재치료패턴 : 다기관연구, 예비조사 강정윤, 김정훈 2, 최재덕 2, 안승현 2, 문경태, 조희주, 조정만, 유탁근 을지대학교의과대학비뇨기과학교실, 2 한일병원비뇨기과 목적 : Extended spectrum beta-lactamase (ESBL) 생성균주에의한요로감염의일차치료제인 carbapenem 중하루한번투여가가능한 ertapenem이많이사용되고있다. 본연구에서는 ertapenem 주사치료후소변배양검사에서다시 ESBL 양성균이재발한환자들의임상양상을분석하고이런환자들의재치료의패턴을살펴보고자한다. 대상및방법 : 202년 4월부터 207년 4월까지 5년동안서울동북지역 2개의종합병원비뇨기과에내원하여소변배양검사에서 ESBL 양성균이확인되어 ertapenem 정맥주사로치료한환자중, 치료후 ESBL 양성균이다시재발한환자들을대상으로하였다. 이들의요감염의과거력, ertapenem 주사기간, 재발시기, 재발의위험인자, 재치료방법및치료후상태등에대하여의무기록을후향적으로조사하였다. 결과 : Ertapenem으로치료한환자는총 264 명이었고, 이중추적소변배양검사에서다시 ESBL 양성균이나온환자는총 34명 (2.9%) 였다. 환자들의평균나이는 70.9±9.세, 여자가 2명 (6.8%) 으로더많았다. 처음 ertapenem 주사기간은 주이내가 5명 (44.%), 8-3일이 6명 (47.%) 이었다. 치료후다시 ESBL 양성균이배양된기간은치료후 6개월이후가 3명 (38.3%) 으로가장많았다. 재치료는 ertapenem으로한환자가 6명 (47.%) 이었다. 재치료후추적관찰기간동안재발하지않은경우는 4명 (4.2%) 이었다. 환자들의임상양상에대한결과는 Table 과같다. 결론 : ESBL 양성균에의한요로감염환자에서 ertapenem 주사기간이 주이내로짧았고, 재치료에도다시재발하는양상이관찰되었다. 이에대하여현재서울동북지역 5개병원의다기관연구를진행하고있기에, 더많은환자들의분석이필요할것으로생각한다. Keywords: ESBL, Ertapenem, Re-treatment 47

NP-09 Advanced paternal age does not affect to sperm DNA fragmentation 이효석, 박용석 2, 최진호, 이중식, 서주태 단국대학교제일병원 비뇨기과학교실, 2 생식의학연구실 Objective: This study was performed to evaluate and compare the impact of age on sperm DNA damage in male infertility patient. Materials and Methods: A retrospective study was performed. Paternal patients were divided by 5 years age group. SDF test was performed and compared with sperm parameters according to paternal age. For the analysis of the paternal age factor, patients were divided into the following age categories; 30 years (n=2 cycles), 3-35 years (n=07 cycles), 36-40 years (n=73 cycles), and >40 years (n=23 cycles). Sperm parameters were assessed by the WHO guideline. SDF test was assessed using the Halosperm kit according to the manufacturer s instructions. A minimum of 500 spermatozoa per sample was scored. The fragmentation rate was calculated by the SDF (%)=(fragmented spermatozoa/total 500 spermatozoa counted) 00. SDF value that exceeds a threshold value of 30% considered DNA fragmented sperm. Results: In concern to age factor, the mean paternal age was 35.0±4.3 years. The overall results of sperm count was 67.2±63.5x06/mL, motility was 39.7±2.3%, viability was 60.7±6.9%, morphology was 3.4±2.8%, and SDF rate was 26.4±6.3%. The results of sperm parameters were not statistically different among age groups. In each age groups, SDF rate showed as follow; 30 years (24.7±6.0%), 3-35 years (26.0±7.5%), 36-40 years (25.9±2.8%), and >40 years (3.3±20.7%). Among of them, >40 years age group showed SDF rate was higher than other groups, however, statistically significant difference was not observed. Conclusions: Advanced age does not affect to the SDF rates. Our finding indicate that although SDF does not correlated with advancing age, the probabilities of poor assisted reproduction results should be explained to the over 40 years old paternal patients. Keywords: Paternal age, Sperm DNA fragmentation 48

NP-092 정관복원술후정액검사결과와임신성공과의연관성 정영환, 장춘태, 정승찬, 류동수성균관대학교의과대학삼성창원병원비뇨기과학교실 Purpose: Despite a thorough understanding of the factors and predictors influencing vasal patency after vasectomy reversal (VR), little is known about the patients semen parameters and pregnancy outcome. We analyzed semen analysis values and pregnancy after VR in order to assess its association. Materials and Methods: A total of 9 modified two-layer vasal reconstruction were performed at the Samsung Changwon Hospital by a single surgeon between 2006 and 206, and identified 87 cases with clinical pregnancy rates and semen analysis data. Data regarding patient and spouse ages, obstructive interval, intraoperative findings, postoperative semen results, and spontaneous pregnancy outcome were collected. Pearson chi-square test and independent t-test were used to analyze categorical and numeric variables, respectively. Results: The overall patency rate was 93.% (8/87) and pregnancy was achieved by 40.2% of patients (35/87). Of 8 patients who confirmed postoperative vasal patency, successful pregnancy was directly related to younger ages of patient (42.2 vs. 47.0 years; p=0.00) and spouse (38. vs. 40.9 years; p=0.00) while obstructive interval (mean 6.76±0.67 years) did not significantly differ between the two groups (6.3 vs. 7. years; p=0.553). Intraoperative microscopic findings of no sperm are inversely related to pregnancy rates (p=0.009). Sperm motility and morphology showed statistical significance as a factor affects pregnancy rates (Table). However, regardless of pregnancy success, semen parameters except sperm motility are better than the WHO reference values for human semen characteristics. Conclusions: Ages of patient and spouse, and microscopic findings of no sperm are inversely related to pregnancy rate. Post-VR sperm motility and morphology are statistically higher in patients who successfully conceived, however semen parameters except sperm motility are above the WHO reference values regardless of pregnancy success. These data will help counsel couples after VR and reinforce the importance of patient and female partner age. Keywords: Vasectomy reversal, Pregnancy, Semen analysis 49

NP-093 하부요로증상을가진한국남성을대상으로한타다라필 5 mg 매일복용법의시판후조사 : 다기관연구 Ji-Eon Won, Ji Yeon Chu, Hyunah Caroline Choi, Yun Chen 2, Hyun-Jun Park 3, Héctor José Dueñas 4 Lilly Korea, Seoul, Korea, 2 Lilly Suzhou Pharmaceutical Company, Shanghai, China, 3 Department of Urology, Pusan National University School of Medicine, Busan, Korea, 4 Eli Lilly de Mexico, Mexico City, Mexico Purpose: The aim of this study was to investigate the safety and effectiveness of tadalafil 5 mg once daily (QD) among Korean men with benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in a real-world clinical setting. Materials and Methods: This was a single country, prospective, observational cohort study in which patients newly prescribed tadalafil 5 mg QD for the treatment of BPH/LUTS were followed up for 2±2 or 24±2 weeks or to last treatment during post-marketing surveillance. Safety was evaluated by frequency of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). Effectiveness was assessed by changes in the International Prostate Symptom Score (IPSS) from baseline to each endpoint. Results: All patients receiving dose of tadalafil 5 mg QD (N=637) were included in the safety population. Two percent of patients (n=3) experienced 5 TEAEs of mild (n=0; 66.7%) or moderate (n=5; 33.3%) severity. No severe TEAEs and no SAEs were reported. Effectiveness evaluations included all patients receiving tadalafil who had both baseline and endpoint observations (2-week, N=265; 24-week, N=44). Compared with baseline, mean IPSS total score (±SE) significantly improved by 4.7±0.3 and 6.4±0.7 points at the 2- and 24-week endpoints, respectively (p<0.000), with significant improvements also on storage, voiding, and quality of life subscores. In total, 69.% patients had a clinically meaningful 3-point improvement in IPSS total score. Conclusions: Tadalafil 5 mg QD is well tolerated and effective in Korean men with BPH/LUTS in a real-world clinical setting. Keywords: Benign prostatic hyperplasia, Lower urinary tract symptoms, Tadalafil 420

NP-094 잠복정자증, 감소정자증환자에대한시험관아기시술전정자냉동의임상적의의 김대근, 강기예 2, 김동석 3, 송승훈 3 CHA 의과학대학교서울역센터비뇨기과학교실, 2 차병원여성의학연구소서울역센터배아생식연구실, 3 CHA 의과학대학교 강남차병원비뇨기과학교실 Objectives: To investigate the clinical implication of sperm freezing for oligozoospermia and cryptozoospermia patients who underwent in vitro fertilization-intracytoplasmic injection (IVF-ICSI). Methods: This retrospective cohort study included 63 oliogozoospermia (33) and cryptozoospermia (30) patients who underwent IVF-ICSI by fresh or frozen sperm between 206 and 207. Oligozoospermia was defined as spermatozoa under 5 0 6 /cc, and cryptozoospermia was defined as spermatozoa observed only in the pellet with sperm concentration under 04 after centrifugation. Semen analysis was performed according to WHO 200 recommendation. All sealed straws were placed at a distance of 3 cm above the level of liquid nitrogen (-80~-90 o C) for 30 min, and then samples are stored in liquid nitrogen vapor at -96.5 o C. Rate of using frozen sperm during IVF-ICSI was investigated, and cases in which no motile sperm to be found post-thaw at the time of a IVF cycle were analyzed. Pregnancy rate after IVF-ICSI using either fresh or frozen sperm was analyzed, respectively. Results: Frozen sperm was used in 36.5% of cases (23/63). Mean number of freezed straws per patient was 2.44 straws. Mean number of thawing straws were 2.4 per the patients who used freezed-thawed sperm. Complete immotile sperm after thawing of freezed sperm was identified in only for cryptozoospermia group 7.84% (4/5 cases). Clinical pregnancy rate were 32.5% (3/40) in fresh sperm group and 34.8% (8/23) in freezed-thawed sperm group (p=0.853). Conclusion: Failure to retrieve any motile sperm after thawing of cryopreserved sperm was identified only in cryptozoospermia group. Although infrequent event, for prevention of IVF-ICSI cancellation, sperm freezing up to 3 straws is requisite for prevention of lack of motile spermatozoa on the day of IVF-ICSI in cryptozoospermia patient with similar pregnancy rate using fresh sperm. Keywords: Sperm freezing, IVF-ICSI, Cryptozoospermia 42

NP-095 남성호르몬보충요법의치료유지영향인자비교 김진욱, 지병훈, 장인호, 명순철, 문영태, 김경도, 김태형중앙대학교병원비뇨기과학교실 Introduction: Despite Testosterone replacement therapy (TRT) gaining widespread use, it remains controversial in its indications, principally because the diagnosis of Late onset hypogonadism (LOH) remains ill defined, as what constitutes low serum testosterone and the unreliability of symptom scores in predicting testosterone levels. The current study reexamines the definition of LOH by assessing which definition helps maintain patient persistence of TRT. Materials and Methods: A cohort of patients with LOH were prospectively recruited and give the choice of TRT. Inclusion required serum testosterone levels below 5 ng/ml and ADAM questionnaire positive. Serum free Testosterone, DHEA, DHEAS and AMS scores were also assessed on entry. Patients received Testosterone Enanthate IM injection 250 mg (TE) once a month. Observation period was determined over when patients requested termination of testosterone medication, and drop outs were queried by phone calls to assess whether TRT improved their ADAM, 7 answers. Patient s were divided into tertiles of serum measurements and AMS questionnaire scores and submitted for survival analysis. Results: Initially, 28 patients were started. Overall median duration of treatment was 98 days. Patients who maintained treatment at year was over all 4.8% (56/34 patients). No serum parameters were significant for persistence of treatment by Cox analysis, with serum Testosterone, while not significant, showing that patients with higher levels (>4 ng/ml) maintained longer treatment. However, maintenance was significantly related to initial low AMS scores (p=0.0) On termination of treatment patients reported that they terminated treatment primarily due to failure to improve erectile function than their libido. Conclusion: Overall 4.8% of patients receiving TRT maintained their treatment at year, with median dosing duration at 98 days. Patients who maintained treatment tended to have low AMS, while patients who quit treatment reported disappointment in failure to improve sexual functions. Keywords: Testosterone replacement therapy, Late onset hypogonadism 422

NP-096 고환통증동반유무에따른정계정맥류환자의특성차이 백승룡, 박현준, 이경민, 박민정, 박남철부산대학교병원배경및목적 : 고환통증은정계정맥류의주요증상중하나이지만일부환자에서만통증을호소한다. 정계정맥류에의한고환통증은약물치료가잘되지않고, 수술을해도일부에서잔존하는경우가있어임상의들에게어려움을안겨주는증상중하나이다. 그러나고환통증을느낀환자는그렇지않은환자에비해일찍진단을받게되어수술을받을수있어향후불임의가능성을줄일수있는여지도있다. 본연구에서는통증을동반한정계정맥류환자와무증상정계정맥류환자의특징을비교하고자한다. 대상및방법 : 이번연구는 997년부터 206년까지연구자의병원에서정계정맥류절제술을시행받았던환자 954명을대상으로병력조사를통한후향적으로진행되었다. 고환통증의유무와각정계정맥류의관련지표와의관련성을조사하였으며, 내원시나이, 체질량지수, 양측고환용적차이, 정액지표, 혈중총테스토스테론, 정계정맥류의 grade 및위치, 증상기간등의관련지표가포함되었다. 결과 : 조사가이루어졌던총 954명의환자중통증및무통증인경우는각각 404례 (42.3%) 및 550례 (57.3%) 였다. 통증유무에따른각지표의결과는다음과같았다. 통증및무통증군에서나이 (24.29±9.72 vs 27.76±9.66세 ), BMI (2.96±2.80 vs 22.96±3.5 kg/m 2 ), 양측고환차이 (2.4±2.6 vs 2.32±2.25 cc), 정자농도 (8.84±7.57 vs 4.4±3.86 mil/ml), 정자운동성 (50.8±22.6 vs 47.66±29.53%) 및혈중총테스토스테론 (469.90±63.24 vs 426.55±63.40 ng/dl) 로나이, BMI, 정자농도에서유의한차이가있었다. 통증군에서정계정맥류의 grade가높았으며유병기간이짧았다. 결론 : 통증성정계정맥류환자는통증으로인해일찍자각을하게되어병원을찾았으며 grade가높은경향을보였다. 또한연령이더낮고, BMI가낮고정자의농도감소가덜한것으로나타나, 통증이있는경우조기에정계정맥류가진단되어치료를받게되는경향을확인할수있었다. 비록정계정맥류로인한고환통증이완치가어려운증상이나환자가조기진단과치료를받을수있은기회를제공하는증상으로생각된다. Keywords: Varicocele, Pain 423

NP-097 무증상남성갱년기증후군환자 : 남성호르몬보충요법이필요한가? 박현준, 이경민, 박민정, 박남철부산대학교병원 Objectives: Testosterone replacement therapy (TRT) is effective for treating the symptoms and ameliorating the metabolic consequences of hypogonadism. TRT improves muscle mass, bone mineral density, mood, and sexual performance. However, a significant number of patients have low serum levels of testosterone without any subjective symptoms or complaints. We evaluated the suitability of TRT for patients with non-symptomatic late-onset hypogonadism. Materials and Methods: Seventy patients whose initial serum levels of testosterone were<300 ng/dl without any symptoms or complaints were consecutively enrolled and followed for 30 weeks. All patients received,000 mg parenteral testosterone undecanoate on day, followed by additional injections on weeks 6, 8, and 30. Serological tests (for total testosterone, lipid profile, glucose, and prostate-specific antigen [PSA]) were performed and Body Mass Index (BMI), International Index of Erectile Function (IIEF) score, International Prostate Symptom Score (IPSS), the Aging Males Symptoms (AMS) questionnaire, and the Global Assessment Questionnaire (GAQ) were performed at baseline and at the end of the study. Results: Mean patient age was 56.2±0.5 years. The total IIEF score increased from 44.9±2.9 at baseline to 54.8±3.0 on week 30 (p<0.00). The AMS score improved from 37.9±.5 at baseline to 24.6±3.2 on week 30 (p<0.00). Baseline and 30-week total testosterone levels were 272.2±48.2 and 598.2±52.5 ng/dl, respectively (p<0.000). No significant changes were detected in the IPSS, lipid profiles, glucose, BMI, or PSA level. The percentage of patients reporting improvement in the GAQ was 58.6%. Improvements in the sexual desire domain of the IIEF, sexual subscale of the AMS, and change in total testosterone (>300 ng/dl) were significantly correlated with a positive GAQ response. The majority of adverse events were mild, reversible, and of short duration. Conclusions: Although a patient may not complain of any subjective symptoms at the initial visit, TRT can be considered in patients with low testosterone levels and decreased sexual desire and function. It is postulated that patients with low testosterone levels may not recognize their symptoms. Thus, more specific screening is needed for such patients. Keywords: Testosterone replacement therapy, Hypogonadism 424

NP-098 무자녀상태에서시행된정관복원술 20 례의임상적특성 박지훈, 김경환, 이경, 백승룡, 임미영, 류장현, 박민정, 박현준, 박남철부산대학교병원비뇨기과학교실, 한국공공정자은행연구원 Introduction: 난임치료를위해내원하는환자들이증가되는현실에서미혼이거나자녀가없는상태에서영구피임술인정관절제술을시행받는경우도꾸준히증가되고있는실정이다. 적절한수술및피임상담과정자은행시스템의부재속에서, 정관절제술의무계획적인시술은한국사회의심각한저출산문제를심화시키는의료적요인이되고있다. 본연구는미혼이거나무자녀인상태에서정관절제술을시행한증례분석을통해정관절제술의시술현황과인식도를조사하고자한다. Material & Methods: 2006년에서 207년까지부산대학교병원비뇨기과에서정관복원술을시술을위해내원한 396례중미혼혹은무자녀상태에서정관절제술을받은 39례 (9.8%) 에서설문조사에응답한 20례 ( 응답률 5.3%) 를대상으로하였다. 설문조사는외래, 입원및퇴원후대면조사혹은전화인터뷰로시행하였다. Results: 정관절제술시술당시평균나이는 30.2세 (IQR 27.0-35.0세 ) 였고, 미혼및기혼상태가각각 26례 (67%) 및 3례 (33%) 였다. 정관복원술받을당시평균나이 38.3세 (IQR 34.0-43.0세 ) 였고, 정관절제술후정관복원술시행까지기간은 7.2년 (95% CI: 5.7-8.8년 ) 이었다. 설문조사가수행된 20례에서정관절제술에대해알게된계기는인터넷과신문 (55%) 이가장많았고, 상식 (20%), 지인 (5%), 보건소 (5%), 군대 (5%) 순이었다. 정관절제술을결정하게된이유로독신주의 (70%) 가가장많았고, 배우자피임거부 (20%), 결혼전안전한성관계 (5%), 심리적스트레스 (5%) 순이었다. 피임을위해정관절제술을다시받겠느냐는질문에받지않겠다는대답이약 3/4을차지하였고, 정관절제술결정시문제점으로는의료진과의상담이부족했다는답변 (85%) 이가장많았다. Conclusions: 정관절제술및복원술그리고가임력보존방법에대하여일반인을위한대국민홍보와의료진에대한생애학술교육의지속적수행과함께무자녀임에도정관절제술을원하는환자에게는시술에앞서심층적평가가요구된다. 특히저출산이심화되고있는실정에서가임력보존을위한공공정자은행의설립과운영이시급한것으로판단된다. Keywords: Vasovasostomy, Childless, Vasectomy 425

NP-099 당뇨를동반한전립선비대증환자에게있어서경요도전립선절제술의임상적의의 강태욱, 이창민, 정현철, 김광진, 정재흥, 송재만 연세대학교원주의과대학비뇨기과학교실 Purpose: Benign prostatic hyperplasia (BPH) is a common diseas that requires treatment in in elderly. For many years, Transurethral Resection of Prostate (TURP) has been the definitive treatment of BPH. Many studies report an association between diabetes mellitus, (DM) and the BPH. Therefore, we evaluate the treatment outcomes of TURP according to the presence of DM Material & Methods: From January 20 and March 205 23 patients with BPH were analyzed, retrospectively. Baseline characteristics were collected. Patients with DM were assigned to Group and patients without DM were in Group 2. After TURP, we followed up the patients at three months. And we analyzed the treatment outcomes at that time. Results: Table showed baseline characteristics of patients. We identified BPH in 23 patients and confirmed BPH with DM in 48 patients. There were no significant differences in baseline characteristics, statistically. The IPSS values before and after TURP in group were 6.86±7.49 and 2.79±8.65 and the values in group 2 were 5.58±6.84 and.87±6.82 (P=0.069, 0.0). Postoperative Qmax were determined as 0.77±3.67 and.82±6.22 for the two groups, respectively (P<0.05). Conclusions: We suggest that TURP shows a tendency for improvement of storage symptoms & Qmax in BPH patients with DM as an underlying disease. Further well-designed prospective, randomized studies with larger cohorts are needed to confirm the findings of this study. Keywords: Alpha blocker, Benign prostatic hyperplasia, Metabolic syndrome, Transurethral resection of prostate, Diabetes mellitus 426

NP-00 HoLEP 시전립선암우연종의발견률및술전위험인자에대한고찰 김명, 안태영울산대학교서울아산병원비뇨기과학교실 Objectives: To identify incidence and its predictors of incidental prostate cancer following Holmium laser enucleation of the prostate (HoLEP). Methods: We retrospectively analyzed 37 consecutive patients who underwent HoLEP. Patients with preoperative prostate specific antigen (PSA) >3 ng/dl or palpable lesion on digit rectal exam (DRE) were routinely underwent systemic prostate biopsy. Incidence of incidentaloma during HoLEP was assessed. Logistic regression analysis was performed to determine the predictive factors. Results: Mean age was 7.8 (±6.9) years. Mean preoperative PSA and total prostate volume were 4.9 (±5.5) ng/ ml and 65.7 (±27.6) ml. Of all patients 04 patients received preoperative systemic prostate biopsy. A total of 2 patients (3.8%) were incidentally diagnosed with prostate cancer. The incidence of prostate cancer was not significantly different between the two groups (biopsy group vs. non-biopsy group: 3.8% vs 3.8%, p=0.968). Using multivariate analysis, any of preoperative parameters such as age, body mass index, prostate size, PSA, PSA density, previous history of negative biopsy, DRE findings and TRUS findings could not independently predict the incidental prostate cancer after HoLEP (p range: 0.05-0.999). Conclusions: Prior negative prostate biopsy does not rule out the possibility of prostate cancer after HoLEP, but no preoperative parameter independently predicted the incidental cancer. Patients should be warned about their potential risks for incidentaloma, preoperatively. Keywords: Prostate cancer, Benign prostatic hyperplasia, HoLEP 427

NP-0 전립선침생검시만성염증양성코어수의임상적의의 강수환, 서원태, 강필문, 최성, 류현열, 김택상고신대학교의과대학비뇨기과학교실 Objectives: For investigation of the clinical significance of the number of positive cores of chronic inflammation in prostate needle biopsy specimen, we look into several clinical characteristics and the number of positive cores of chronic inflammation in twelve core prostate biopsy specimen. Materials and Methods: Between March 205 to Feburary 207, total 256 patients underwent transrectal ultrasound guided twelve core prostate needle biopsy. Except the patients with prostate carcinoma, we reviewed medical records of 42 patients including prostate specific antigen (PSA), prostate volume, total IPSS score, QoL score, IPSS question to 7, IPSS voiding subscore, IPSS storage subscore and the numbers of cores with chronic inflammation. For evaluation of the clinical effect of the chronic inflammation in prostate biopsy, simple and multiple regression analyses were done. We excluded the patients who underwent prostate surgery, diagnosed symptomatic chronic prostatitis, and had alpha blockers, antiinflammatory drugs, antibiotics, diuretics, antimuscarinic agents, and 5 alpha reductase inhibitors within 4 weeks. Results: The patients with complete medical records and not relevent with exclusion criteria were 97 patients. The mean age, PSA, prostate volume was 66.5±9.5, 8.38±4.2, 53.3±9.8, respectively. The mean total IPSS score, QoL score, IPSS voiding subscore, IPSS storage subscore was.9, 3.3, 6.6, 5.2 respectively. The mean each IPSS question to 7 was.9,.9,.4,.6, 2.,.2,.9, respectively and the mean numbers of cores with chronic inflammation was 5.0. By simple regression analysis, the numbers of cores with chronic inflammation had a positively related trend with PSA (p=0.072), IPSS question 2 - frequency (p=0.072), and IPSS question 3 - intermittency (p=0.069). After multiple regression analysis (R2=0.46), PSA (p=0.028, B=0.7) and IPSS question 2 - frequency (p=0.046, B=.575) were statistically significant. Conclusion: PSA and urinary frequency were increased with the number of cores with chronic inflammation in the prostate biopsy. However, total IPSS score, voiding and storage IPSS subscore were not related. Keywords: Prostate biopsy, Chronic inflammation, Postive core number 428

NP-02 홀뮴레이저전립선적출술후전립선이행대에서우연히발견된전립선암의특성 김상훈, 이규원 2, 조수연, 김현우 가톨릭대학교 성바오로병원, 2 서울성모병원 목적 : 홀뮴레이저전립선적출술 (HoLEP) 은절제된조직을세절제거술을통해적출하여조직검사를시행함으로써, 전립선암이우연히발견되는경우가있다. 저자들은 HoLEP 후발견된전립선암의특징을분석하였다. 대상및방법 : 20년 2월부터 207년 4월까지 HoLEP을시행받은 834명의환자중전립선암이발견된 34명의환자를대상으로하였다. 이들에서술전전립선비대증지표및술후조직검사결과를분석하였고, 전립선암진단후치료유형및조직검사결과를살펴보았다. 결과 : 총 834명의환자중 34명에서전립선암이발견되어 4.% 의발견률을보였다. HoLEP만시행한환자는 4명이었고, HoLEP과초음파유도경직장전립선조직검사를동시에시행후전립선이행대에서만전립선암이발견된환자는 20 명이었다. 평균나이는 72.3±6.6세였으며, 평균전립선크기는 45.2±22.4 ml, 평균 PSA는 4.0±2.6 ng/ml였다 (Table ). Gleason 점수는 4점 (2+2) 2명 (6%), 6점 (3+3) 22명 (65%), 7점 (3+4) 0명 (29%) 이었고, 임상적병기상 cta (65%) 가 ctb (35%) 보다많았다 (Table ). 34명의환자중 5명에서근치적전립선절제술을시행하였고, 이들중 2명의환자에서 Gleason 점수가 6(3+3) 에서 7점 (3+4) 으로상승되었으며 3명은잔여종양이발견되지않았다. 근치적수술후조직검사에서 perineural invasion 소견이 2명에서관찰되었다. 수술을시행하지않은 9명중 3명은 active surveillance를시행하였으며, 2명은남성호르몬박탈요법을시행하였다. 결론 : HoLEP 후비교적높은빈도로전립선이행대에서우연히전립선암이발견되었다. 이들전립선암은낮은 Gleason 점수를보였으며, 근치적수술이후에도낮은병기로관찰되었다. 그러나드물지만병기가상승되는경우도있어추가치료를결정함에있어좀더신중하게접근해야할것으로사료된다. Keywords: Benign prostatic hyperplasia, HoLEP, Prostate cancer 429

NP-03 홀뮴레이저전립선적출술 (HoLEP) 후초기에나타나는발기능변화 김상훈, 이규원 2, 조수연, 김현우 가톨릭대학교 성바오로병원, 2 서울성모병원목적 : 홀뮴레이저를이용한전립선종절제술 (Holmium laser Enucleation of the Prostate; HoLEP) 은현재전립선비대증의치료에널리사용되는레이저술식이다. 저자들은 HoLEP 직후단기간동안의발기능의변화를알아보고자하였다. 대상및방법 : 202년 5월부터 206년 2월까지 HoLEP을시행받은환자중 3개월시점에서 IIEF-5 기록이완성된 4명을대상으로하였다. 술전 IIEF-5 점수에따라 I군 (7점이하, n=90), II군 (8-6점, n=36), III군 (7점이상, n=5) 으로분류하였다. 각군에서술전, 술후 3개월의 IIEF-5 점수를평가하였고, 모든환자의나이, 전립선크기, PSA, 수술전 IPSS, 요속검사, 잔뇨량, 적출시간, 세절시간, 사용된에너지양을비교분석하였다. 결과 : 각군의평균나이는 I군 70.6±6.5세, II군 68.9±5.0세, III군 67.3±6.3세로차이를보이지않았으며, 수술전전립선비대증지표에서도차이가없었다 (Table ). 수술중의사용된레이저에너지량및적출시간, 세절시간에서도세군간의유의한차이는관찰되지않았다 (Table ) 술후 3개월시점에서의 IIEF-5 점수는 I군에서는유의하게증가하였고, II군에서는유의하게감소하였으며, III군에서는차이를보이지않았다 (Table 2). 결론 : 발기능이정상인경우, HoLEP 이후초기시점에서발기능의변화는없었으나, 중등도의발기부전이있는경우에는술후초기에발기능의감소가나타날수있으므로술전에이에대한고려가필요하다고생각된다. Keywords: Erectile dysfunction, Benign prostatic hyperplasia, HoLEP 430

NP-04 하부요로증상 / 전립선비대증환자에서 urethral pressure profile 의유용성에대한재조명 박송철, 김병수 2, 윤민영 2, 오승준 2 Department of Urology, YanBian University Hospital, China, 2 서울대학교병원 목적 : LUTS/BPH 환자에서의 UPP와다른임상척도들을비교하여 UPP가 BOO를진단하는데도움이되는지를알아보고자하였다. 대상및방법 : 20년 5월부터 204년 5월까지요역동학검사를시행한 45세이상 LUTS/BPH 환자들을대상으로연구하였다. UPP parameter는 maximum urethral pressure (MUP), maximum urethral closure pressure (MUCP) 그리고 functional urethral length (FUL) 를포함하였다. 연속형자료와 rank자료에대해서는 Pearson과 Spearman 상관관계를이용하여분석하였다. BOO를진단하는 UPP parameter의실제적인가치를연구하기위해서 ROC 곡선을사용하였다. 결과 : 총,34명환자들의평균나이는 67.6세 (±7.5,SD) 이었고, TPV와 PSA는각각 57. (±34.0) ml와 3. (±3.9) ng/ml 이었다. IPSS-total, IPSS-storage, IPSS-emptying, IPSS-QoL은각각 7.9 (±8.), 7.2 (±3.6), 0.7 (±5.6), 4.0 (±.2) 이었다. 평균 BOO index는 40. (±26.8) 이었고 468명 (42.8%) 의환자가 BOO로분류되었다. TPV, TZV, PSA, Qmax, PVR, bladder contractility index (BCI) 모두 BOO군에서유의하게높았다 (p<0.05). Pearson 상관분석결과각각의 UPP parameter들은나이, PSA, PdetQmax와유의한관계가있었으나 total IPSS, Qmax, voided volume과는유의한관계가없었다. 또한 FUL은 TZV, PVR, BOOI와명백한유의관계를보였다 ( 각각 p<0.0, p=0.00, p<0.0). UPP parameter 들과 total IPSS 사이에는유의한관계가없었다. BOO 진단에있어 UPP지표들의 ROC 곡선에서 FUL만이 BPH환자의 BOO진단과상관관계가있었다 (p<0.0). FUL 74.5 mm가 BOO standard로가장의미있는기준값이었다 (sensitivity 53.2%, specificity 63.2%) (Figure). 결론 : LUTS/BPH 환자들에서 UPP상의 FUL은 BOO 정도를평가하는데상관관계가있었으나그유용성은낮았다. 전반적으로 LUTS/BPH 환자들에있어서 UPP의의의는크지않다고판단된다. Keywords: Prostatic hyperplasia, Urethral pressure profile, Urodynamics 43

NP-05 A novel vaporization-enucleation technique for benign prostate hyperplasia by using 20-W HPS GreenLight TM laser: seoul technique II 유상준, 강순호, 박주현, 조성용, 조민철, 정현, 손환철 서울특별시립보라매병원 Introduction: We developed a novel vaporization-enucleation technique (Seoul II), which consists of vaporization-enucleation of the prostate using 20-W HPS GreenLight laser, and enucleated prostate resection using bipolar devices for tissue removal. We compared the outcomes of the Seoul II with vaporization and a previously reported modified vaporization-resection technique (Seoul I). Materials and Methods: Among patients with benign prostate hyperplasia who underwent transurethral surgery using GreenLight laser at our institute, 347 patients with prostate volume 40 ml were included. The impact of surgical techniques on efficacy and postoperative functional outcomes were compared. Results: No difference was found in baseline characteristics, although the prostate volume was marginally greater in Seoul II (p=0.05). Prostate volume reduction per operation time (p<0.00) and lasing time (p=0.06) were greater in Seoul II. At postoperative 2-months, the International Prostate Symptom Score (I-PSS) was lower (p=0.0), and the decrement in I-PSS was greater in Seoul II (p=0.00) than other techniques. In multivariate analysis, postoperative 2-month I-PSS for Seoul II was significantly superior to vaporization (p<0.00), although it was similar to Seoul I. The maintenance of immediate postoperative I-PSS decrement, until postoperative 2-months was superior in Seoul II compared with vaporization (p=0.04) and Seoul I (p=0.048). Conclusions: Seoul II showed improved efficacy and voiding functional maintenance over postoperative 2-months in patients with prostate volume 40 ml compared with vaporization and Seoul I. This technique could be easily accepted by clinicians who are familiar with GreenLight lasers and add flexibility to surgery without additional equipment. Keywords: Lasers, Prostatic hyperplasia, Transurethral resection of prostate 432

NP-06 증상평가만으로저활동성방광과방광출구폐색남성환자의구별진단이가능한지에대한연구 김아람, 박영진, 최우석, 박형근, 백성현, 김형곤 건국대학교병원비뇨기과, 건국대학교의학전문대학원 Purpose: To perform differential diagnosis between DUA and BOO based on symptom assessment without invasive pressure flow study. Material and Methods: Signs and symptoms of the men with DUA were analyzed and compared with those of men with BOO according to 8 questions. The questions were selected based on large scale study about distinctive symptoms of DUA []. Patients with DUA should have bladder contractility index (BCI) lesser than 00 and patients with BOO should have BOO index (BOOI) more than 40 in urodynamic study (UDS). One urologist reviewed the patients medical records and responded the 8 questions without information of UDS. Results: A total of 57 men who underwent UDS were included in this analysis. Signs and symptoms were compared in patients classified as having DUA without BOO (n=98), BOO without DUA (n=59). The characteristics of the 2 groups were listed in Table. The mean age of the men with DUA was significantly older than that in the BOO groups (69.5 vs. 67.5, p=0.002) and mean prostatic volume in the BOO group was significantly larger than DUA groups (40.6 cc vs. 78.4 cc, p=0.008). Variables in UDS were also significantly different from DUA and BOO groups (BCI 73. vs. 34.2, pp=0.002; BOOI 6. vs. 77.4, p<0.00). Mean scores of No., 2, 4, 5, 6 and 7 questions were significantly different from 2 groups, moreover sum of mean scores except No. 3 and 8 were also significantly different. Conclusions: Male patients with DUA and BOO might be distinguished based on assessment of signs and symptoms before invasive evaluation. Keywords: Detrusor underactivity, Bladder outlet obstruction, Symptom 433

NP-07 The predictive factor for favorable outcome after surgical treatment of benign prostate hyperplasia performed by beginner urologist - is surgical modality important in young urologists? 김기홍, 양희조, 김두상, 전윤수 순천향대학교천안병원비뇨기과학교실 Introduction and Objective: To identify predictor for favorable outcome at 3 months after surgical treatment which were performed by beginner urologists in benign prostate hyperplasia (BPH), we retrospectively evaluated outcomes after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of prostate (TURP) which were undergone by two young urologists, respectively. Methods: Of 80 patients who were treated with HoLEP or TURP, 3 (HoLEP) and 36 (TURP) patients who were followed up to 3 months were enrolled in this study. Preoperative and perioperative variables were evaluated to identify predictive factors for favorable outcome after surgical treatment for BPH. Result: At postoperative 3 months of HoLEP or TURP, median decreased AUA-SI value were 3.0 (range: 6.0-9.0). Patients that AUA-SI values were decreased over 3 were defined as favorable response group after HoLEP or TURP. Univariate and multivariate logistic regression analysis were performed for identifying predictor of favorable outcome at 3 months after HoLEP or TURP, and preoperative AUA-SI score was identified as an independent predictor for favorable outcome (OR=.307, P<0.00). Conclusion: When young urologists plan to perform surgical treatment for BPH, they should consider that the severity of symptom is the most important factor for favorable outcome. The type of surgical modality for managing BPH is less important. Keywords: Benign prostatic hyperplasia, Holmium laser enucleation of the prostate, Transurethral resection of prostate 434

NP-08 갑상선호르몬과하부요로증상 / 전립선비대증과의상관관계 이준호, 최기복, 박연원국립경찰병원비뇨기과목적 : Thyroid hormones play an important role in cell differentiation, growth, and metabolism. Several investigators have documented the role of thyroid hormones in the development of prostate cancer. However, to date there are only limited data available regarding thyroid hormone levels in benign prostatic hyperplasia (BPH). 대상및방법 : A total of 5708 men were included. Lower urinary tract symptoms (LUTS)/BPH were assessed by international prostate symptom score (IPSS), prostate volume, maximal flow rate (Qmax), and a full metabolic workup. Serum levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured using chemiluminescence immunoassay by commercial kits. We divided participants into quartiles based on their TSH and FT4 levels: first quartile, Q; second quartile, Q2; third quartile, Q3; and fourth quartile, Q4. We then investigated their relationship using the chi-squared test, the Cochran-Armitage trend test and, logistic regression analyses. 결과 : The mean age of the study group was 5.±5.2 years, and the mean FT4 and median TSH were.05±0.4 and.44 (0.96-2.3) ng/ml, respectively. TSH was not significantly related to IPSS, Qmax, and total prostate volume in univariate and multivariate analyses. However, there was a significant increase in the percentage of men with IPSS>7, Qmax<0 ml/sec, and prostate volume 30 ml, with increase of FT4 quartile (IPSS>7(%): Q:57.2, Q2:56.7, Q3:60.3, Q4:62.5, P=.00; Qmax<0 ml/sec(%): Q:3.5, Q2:3.2, Q3:4., Q4:4.8, P=.038; total prostate volume 30 ml (%): Q:5.2, Q2:6.4, Q3:8.0, Q4:9.3, P=.002). After adjusting for age, body mass index, testosterone, and metabolic syndrome, the odds ratio for prostate volume 30 ml of FT4 Q3 and FT4 Q4 were significantly higher than FT4 Q [odds ratio; 5-95 percentile interval), P value; Q:.000 (references); Q2:.40 (.9-.36), P=.29; Q3:.260 (.030-.54), P=.025; Q4:.367 (.22-.665), P=.002]. After adjusting for age, body mass index, testosterone, metabolic syndrome, and prostate volume, the odds ratio for IPSS>7 of FT4 Q4 were significantly higher than that of FT4 Q (odds ratio(5-95 percentile interval), P value; Q:.000 (references); Q2:.969 (.836-.23), P=.677; Q3:.23 (.965-.308), P=.33; Q4:.22 (.049-.420), P=.00). 결론 : We found a potential role of thyroid hormone in developing LUTS/BPH. Keywords: Thyroid hormone, Benign prostatic hyperplasia 435

NP-09 로봇보조복강경하단순전립선절제술의초기경험 문경태, 조희주, 조정만, 강정윤, 유탁근을지병원목적 : 거대전립선비대증의치료로시행한로봇보조복강경하단순전립선절제술의초기경험및이의안정성과유효성에대해알아보고자한다. 대상및방법 : 200년 0월이후거대전립선비대증으로로봇복강경하단순전립선절제술을시행한환자중 3개월이상추적관찰이진행된 5명의환자를의무기록을통해조사하였다. 수술전환자상태및수술과관련된합병증여부, 수술전및수술후 3개월째국제전립선증상점수 (IPSS) 와요속검사결과를분석하였다. 결과 : 나이는 7.9±6.5세, 총전립선용적 (TPV) 은 3.7±22.5 cc 및이행대용적 (TZV) 68.5±2.6 cc였다. 4명의환자는수술전재발성요폐로카테터를유치상태였으며이중 명은요도손상으로인해치골상부카테터를유치하고있었다. 나머지 명의환자들은심한하부요로증상으로상기수술을시행하였고이중 2명의환자들은방광결석이동반되어있었다. 수술시간 (console time) 은평균 66.2±33.8분이소요되었으며절제된 adenoma의평균용적은 56.8±5.5 cc이었다. 로봇수술경험이적었던초기 2례에서수술중출혈로인한수혈을실시하였고다른수술중합병증은발생하지않았다. 수술후요도카테터의유치는평균 8.0±.6일이였으며수술후추적관찰기간에 명의환자에게방광경부협착이발생되어수술후 4개월째내시경하방광경부절개술을시행하였으며다른수술후합병증은발생하지않았다. 모든환자에서수술후 3개월째시행한요속검사및 IPSS의의미있는개선이관찰되었다 (Table ). 결론 : 내시경기구의발전으로전립선비대증에서침습적인전립선절제술의필요성은많이감소하였으나거대전립선비대증, 방광결석의동반, 요도손상및요도협착이있는환자의경우에는여전히침습적인전립선절제술이필요하다. 수술관련합병증, 술후결과및미용적인측면에서로봇전립선절제술은기존의개복전립선절제술을대체할수있을것으로생각한다. Keywords: Robotic prostatectomy, Huge BPH 436

NP-0 홀뮴레이저를이용한전립선광적출술을받은전립선비대증환자에서환자 - 중심목표를이용한성공적인수술적결과의평가 김경환, 강병진, 박지훈, 백승룡, 이경, 김현우, 신동길, 이정주 부산대학교의과대학비뇨기과학교실 Objectives: To evaluate the successful surgical outcome using the patient-centered goals in benign prostatic hyperplasia (BPH) patients who underwent Holmium Laser Enucleation of the Prostate (HoLEP). Methods: From April 2009 to June 200, 230 consecutive BPH patients scheduled for HoLEP were enrolled and listed their treatment goals for surgery outcomes. On the 3 postoperative months of follow-up, the patients reviewed their original goals and graded its achievement using 5-point goal attainment scale (GAS; -2 to +2; + and +2 was defined as goal achievement). They also completed postoperative satisfaction (0-00%), and quality of life (0-6 points) questionnaire. Results: Of the 82 (79.%) patients who completed this study, the most common goal was the loss of weak urinary stream (62.6%), followed by the loss of residual urine sense (6.5%). The goals were achieved in 40 patients (76.9%), mean postoperative satisfaction rate was 74.6±9.5%, and mean QoL scale was.8±. points. Postoperative satisfaction and QoL were correlated to the GAS significantly (r=0.775, p<0.00; and r=-0.725, p<0.00 respectively). Conclusions: The patients who underwent HoLEP presented successful surgical outcomes according to the patient-centered goal attainment scale which was significantly correlated to postoperative satisfaction and QoL. Keywords: Holmium lasers, Prostate, Goal 437

NP- Holmium laser enucleation of the prostate (HoLEP) can be one of the modality for treatment of benign prostatic hyperplasia (BPH) in young urologists 김기홍, 양희조, 김두상, 전윤수 순천향대학교천안병원비뇨기과학교실 Introduction and Objective: Most of beginners have been hesitant to embrace HoLEP because this technique has been known to require further endoscopic technique. The aim of this study is to identify that HoLEP as well as transurethral resection of prostate (TURP) can be considered as one of the modality for treatment of BPH in not only experts but also for beginner urologists. Methods: We retrospectively evaluated the efficacy and the safety of HoLEP (40 cases) and transurethral TURP (40 cases) that had been undergone by two young urologists who had never undergone surgical treatment for BPH before. Perioperative and postoperative data were compared by Mann-Whitney and chi-square tests. Results: HoLEP was significantly superior to TURP in resected volume (gm) (median 3.0 vs 6.0, p=0.02), resected ratio (%) (median 70.5 vs 53.0, p=0.036) and duration of catheterization (days) (median 2.0 vs 3.0, p=0.043). However, retrieval rate was no significant difference between two groups (p=0.43). Operative time (min) was significantly shorter in TURP (median 5.0 vs 70.0, p<0.00). At 3 months after operation, there was no significant difference between urodynamic results between two groups. However, anticholinergics were significantly more used in HoLEP group (52.3% vs 4.0%, p<0.00). Nevertheless, there was no uncontrolled urgency in both groups. There was no significant difference of complication rates between two groups. Conclusions: HoLEP can be considered as one of the modality for treatment of BPH in young urologists. Careful consideration should be focused on operative time and postoperative urgency in HoLEP. Keywords: Benign prostatic hyperplasia, Holmium laser enucleation of the prostate, Transurethral resection of prostate 438

NP-3 택시운전자에서야간운전이남성하부요로증상에미치는영향 박지운, 정준세, 배상락, 박봉희, 이용석, 강성학, 한창희가톨릭대학교의과대학의정부성모병원비뇨기과학교실 Objectives: Long-time driving and occupational driving is adverse effect to lower urinary tract symptom. We investigate the effect of night time driving and continuous driving without rest on lower urinary tract symptom on occupational taxi driver. Materials and Methods: The lower urinary tract heath examination was done in 07 occupational taxi drivers. All drivers were underwent IPSS, OABSS questionnaire and serum PSA and urinalysis was done and post-voiding residual urine volume was checked and all performed the transrectal ultrasonography. Medical interview and physical examination was done. All drivers was done a health-related questionnaire. Working years, night-time driving, the number of duty-on and duty-off time, average driving time during a day/week and average duration of night time driving was identified. Statistical analysis was done by SPSS ver 8.0. Results: Drivers mean age was 62.9 years old. Mean BMI was 25.39 and mean PSA was.40. Mean residual volume was 55.7 cc and mean prostate volume was 7.50 cc. Average career of taxi driving was 20 years. Mean 48.2 hours per daytime driving was performed and 2.25 days spent for duty-off. There were significant different in whether night-time driving was performed. In night-time driver, storage domain score in IPSS was higher than non-night-time driver (4.36 vs. 3.84, p=0.02). On OABSS questionnaire,, 4, total score was higher in night-time driver (0.28 vs. 0.39, p=0.022, 0.30 vs. 0.77, p=0.00, 2.96 vs. 4.07, p=0.004). NTD was longer career on taxi driving and longer day-time driving (9.46 vs. 20.94, p=0.049, 44.43 vs. 5.6, p=0.029). Conclusions: Night-time driving was negative effect to storage symptom. Duration of driving career was also had adverse effect on lower urinary tract symptom especially on storage symptom. Keywords: LUTS, Taxi driver, Night 439

NP-4 척수이형성증으로인한신경인성방광에서요로감염의발생과유발요인 박관진, 송원훈, 임영재서울대학교병원비뇨기과목적 : 척수이형성증으로인한신경인성방광에서청결간헐도뇨 (CIC) 를시행하는경우대부분에서요검사결과농뇨나세균뇨가보이고일부에서는요실금이나치골상부통증이발생하며그중일부는열성요로감염이발생한다. 이를예방하기위해도뇨횟수를증가시키고청결도뇨를강조하며예방항생제나 urinary antiseptics를처방하나그효과에대해서는알려져있지않다. 본연구는이들에서요로감염의빈도와가장효과적이었던치료방식을조사하였다. 대상및방법 : 99년부터 206년까지신경인성방광으로도뇨를시행하며사춘기가지날때까지추적결과가존재하는 58 명의자료를분석하였다. 요로감염은농뇨 (WBC>0/HPF), 치골상부통증또는요실금의증가를보이지만열이없었던하부요로감염과 38.5도이상의발열이관찰되었던상부요로감염으로구분하였다. 요로감염의연령별발생빈도를기술하고하부요로감염과상부요로감염에영향을미칠것으로예상되는임상적인자들의유의성을검정하였다. 결과 : 대상환자중하부요로감염을 회이상경험한경우는 89 (56%) 였고반복적인경우는 54 (34%) 였다. 반복적인하부요로감염을경험하는경우는초등학교시절을포함한사춘기이전에그이후보다더흔했다. 흥미롭게도사춘기이후도뇨횟수는유의하게감소하였다. 상부요로감염은 6명 (0%) 에서나타났으며전연령에서고르게분포하였다. 반복적인하부요로감염을보인경우그렇지않은경우에비해단순촬영에서 mean rectal stool length가길고변지림의빈도가더흔했다 (p<0.05). 다변량분석에서주요인자로조절안되는변지림의존재 (OR=3.6) 와, mean rectal stool length >7 cm (OR=6.8) 이주요인자로확인되었다. 상부요로감염의주요인자로는요역동학검사에서의악화소견 (OR=5.5) 와 mean rectal stool length >7 cm (OR=2.7) 이었다. 결론 : 신경인성방광에서도뇨를시행하는경우요로감염을예방하기위해대변의관리가중요하며갑작스러운상부요로감염의발생은비뇨기계의구조 / 기능적악화를의미하는신호일수있으므로이에대한검사가필요하다. Keywords: Urinary tract infection, Neurogenic bladder, Spinal dysraphism 440

NP-5 Tubularized incised plate 수술시사용한카테터크기에따른장기추적요속의비교 허지은, 이초녕 2, 김상운, 이용승, 한상원 연세대학교의과대학비뇨기과학교실, 2 연세대학교세브란스병원소아비뇨기과 목적 : 요도하열에대해 primary tubularized incised plate repair 시행한환자에서수술시사용한카테터크기에따른장기추적요속검사결과를비교하고자한다. 대상및방법 : 2006년 월부터 204년 2월까지본원에서요도하열에대해단일술자 (HSW) 에게 primary tubularized incised plate repair를시행받은환자를후향적으로조사하였다. 신경학적혹은요도하열외다른비뇨기과적질환이있는경우와요도누공, 게실, 협착의합병증이발생한경우를제외하였고, 수술당시의나이가 24개월미만인환자를대상으로하였다. 이중요속검사가아직시행되지않은환자들을제외한총 277명을대상으로하였다. 최종추적시요속검사결과와카테터크기에따른차이를분석하였다. 결과 : 카테터크기에따라 6 Fr (group I), 7.5 Fr (group II), 9 Fr (group III) 의세군으로나누었을때가장많이사용된카테터는 7.5 Fr로 205명 (74%) 이었으며다음으로는 6Fr 카테터의사용이많았다 (20.9%). 수술당시환자나이의중위값 (9 vs. 8 vs. 개월, p=0.564) 과최종요속검사시행당시나이의중위값 (59 vs. 54 vs. 54.5개월, p=0.248), follow up 기간의중위값 (48 vs. 45 vs. 40개월, p=0.459) 에는차이가없었다. 최종요속검사시배뇨량 (0. vs. 05.9 vs. 08.7), p=0.22) 과잔뇨량 (7.5 vs. vs. 7, p=0.692) 역시 3군간에차이는없었다. 최종검사시의전체환자에서최대요속중위값은 5.4 ml/sec였고최대요속을이용한 flow index 중위값은 0.28이었다. 최대요속은 group I과 group II에서통계적으로차이를보이지않았으며 (4.6 vs. 5.5, p=0.053), flow index 역시군간의차이를보이지않았다 (0.24 vs. 0.28, p=0.9). 세군간의비교에서는유일하게 group III가 group I에비하여최대요속 (4.6 vs. 7.9, p=0.036) 과 flow index가높았다 (0.24 vs. 0.4, p=0.045). 결론 : Primary TIP 시카테터로 6 Fr를사용한환자와 7.5 Fr를사용한환자에서장기추적시요속검사결과에서최대요속에차이는없었으며, 9 Fr 사용시에는 6 Fr와비교하여우위를확인할수있었다. Keywords: Hypospadias, TIP 44

NP-6 방광요관역류가동반된신우요관협착 : 치료순서결정인자와치료경과분석 한재현, 이상민, 이종필, 안동현, 김휘우, 송상훈, 김건석울산대학교서울아산병원비뇨기과학교실목적 : 심한방광요관역류 (VUR) 에서신우요관이행부폐색이동반이의심되는경우어느쪽을먼저치료할것인가를결정하는것이쉽지않다. 본원에서중등도이상의 VUR 및 UPJO가동반된경우의치료순서결정및경과에대해서분석하여보고자한다. 대상및방법 : 본원에서 2007년 월부터 207년 5월까지 20세미만의환아중 UPJO를진단받은환자를대상으로본원의환자연구시스템인 ABLE (Asan BiomedicaL Research Environment) 를이용하여분석하였다. 이중 VUR 3등급이상의중등도및이뇨신장스캔 (diuretic MAG3 renal scan) 으로의미있는 UPJO를진단받은환아 7명을대상으로의무기록을분석하였다. 결과 : 배뇨방광요도조영술로요관역류 (3등급이상 ) 및배설성신주사검사 (diuretic MAG3 renal scan) 에서동측의 UPJO를보이는환아는총 7명으로평균나이는 4세 (세-8세) 로 6명이남아였다. 모든환아가산전수신증을진단받았다. 대상환자는평균 VUR 4등급 (3등급-5등급) 을보였고 3명의환자에서양측성 VUR이확인되었다. 시행한배설성신주사검사에서환아의평균환측상대신기능은중위값 47.4% (24.2-48.2%) 이며신주사배설반감기는모두 20분이상이었다. 환아들의치료는첫째로신우성형술을먼저시행한후요관방광문합술을시행한환아가 3명이었으며수술후시행한배설성신주사검사에서배설반감기는 2명에서 8분, 2.5분으로경감되었다. 상대신기능은 40.6% 에서 40.3% 로큰차이가없었다. 심한 VUR은모든환자에서호전되었다. 신우성형술을먼저시행한후경과관찰중인 3명의환아는 VUR 3등급 (2명), 4등급 (명) 이었고배설성신주사검사에서 20분이상의신주사반감기를보였다. 명의환아에서신우성형술시행시 VUR 3등급의환측요관부에디플럭스주사를시행하였다. 일측성환아를제외한 2명의환아에서상대신기능은 47.6% 이었으며수술후 49.5% 로호전을보였다. 둘째, 방광요관문합술을먼저시행한환아는 명으로 5등급의심한방광요관역류및 24% 의낮은상대신기능을보이는신우요관폐색으로수술후방광요관역류는 4등급으로호전되었고, 수술후배설성신주사검사에서도반감기 4분, 상대신기능도 26.2% 로호전을보였다. 결론 : 중등도이상의 VUR에심하지않은 UPJO가동반된경우요관방광문합술만시행해도폐색을해결할수있으나폐색이심할때는신우성형술을시행한후요관방광문합술을시행하는것이필요하다. Keywords: Vesicoureteral reflux, UPJ obstruction, Pyeloplasty, Ureteroneocystostomy 442

NP-7 중복신장에서의동시요관재이식 : 단일기관경험 신정현, 안동현, 이상민, 이종필, 김휘우, 송상훈, 김건석울산대학교서울아산병원, 울산대학교의과대학비뇨기과학교실 Objectives: We aimed to investigate the clinical outcomes of patients who received common sheath reimplatation for duplicated kidney. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent common sheath reimplantation (CSR) for duplicated kidney from 200 to 206. We analyzed baseline characteristics and surgical outcomes of patients including postoperative urinary tract infection (UTI), dysfunctional voiding and persistent vesicoureteral reflux (VUR). Results: Total number of 37 patients was finally included. Mean age was 55.6 months with mean follow-up of 43.2 months. Duplication (either complete or incomplete) laterality was 29.7% right, 40.6% left and 29.7% bilateral. Mean episodes of febrile UTI before surgery was.8 times. Twenty-four patients (64.9%) were on prophylactic antibiotics but breakthrough UTI occurred in 4.7%. Combined anomalies were 3 ureteroceles (35.%) and 8 ectopic ureters (2.6%). Dilating VUR was found in 27 patients (8.8%). Ten patients (76.9%) had previous TUI for ureterocele and 2 patients underwent previous endoscopic injection. Hydronephrosis improved in 29 patients (78.4%) after CSR. Mean preoperative difference of renal function between affected kidney and contralateral kidney was -3.27±27.94% and mean postoperative renal function difference was -0.2±36.09%. Postoperative UTI occurred in four patients (0.8%) and percentage of prophylactic antibiotics was significantly higher (p=0.022) than in none UTI patients. Previous endoscopic surgery showed tendency to associated with postoperative UTI (p=0.054). Three patients (8.%) had voiding dysfunction (overactive bladder:, detrusor underactivity:, urinary incontinence: ) and they tended to have comorbidity than normal voiding group (p=0.050). Among the 24 patients with postoperative VCUG, persistent VUR was observed in two patients. However, both of them had no evidence of UTI and had improvement in hydronephrosis postoperatively. Conclusion: CSR showed low incidence of postoperative UTI and voiding dysfunction. In addition, patients had no significant deterioration in renal function and aggravation of hydronephrosis. CSR might be a good solution for duplicated kidney even after endoscopic ureterocele puncture. Keywords: Duplicated kidney, Common sheath reimplantation, Febrile UTI 443

NP-8 방광요관역류환아에서로봇보조방광근외봉수술법의초기경험 송상훈, 김휘우, 이종필, 이상민, 안동현, 김건석울산대학교의과대학비뇨기과학교실목적 : 방광요관역류환아에서다양한최소침습수술방법이폭넓게적용되고있으나아직까지국내에서로봇을이용한방광근외봉수술법의치료경험이알려진바없어본연구에서이를보고하고자한다. 대상및방법 : 203년 8월부터 207년 5월까지본원에서경복막로봇보조방광근외봉수술법을시행받은 20세이하환자 5명 (24 요관단위 ) 의의무기록을후향적으로분석하였다. 배꼽상부에 8 mm 또는 8.5 mm 카메라용투관침을삽입하여기복을형성한후 2개의 5 mm 또는 8 mm 로봇투관침을양측하복부에삽입하였다. Modified Lich-Gregoir 방식으로방광근외봉수술법을시행하였고수술시간, 진통제사용기간, 입원기간, 술후조기합병증, 술후배뇨기능, 신장기능, 수신증발생여부등의수술결과를조사하였다. 결과 : 대상자중여아가 9명 (60%), 양측성역류가 9명 (60%), 일측성역류가좌우측각각 3명 (20%) 씩이었고수술시중위연령은 50개월 (3-240) 이었다. 수술전예방적항생제복용은 6명 (40%), BBD는 2명 (3.3%), 과거항역류내시경수술경험은 2명 (3.3%), 수술전신반흔은 명 (73.3%) 에서확인되었다. 24개의신단위중역류단계는각각 5등급 5단위 (20.8%), 4등급 2단위 (50.0%), 3등급 3단뒤 (2.5%), 2등급 4단위 (6.7%) 였다. 대상자중 4명은 davinci Xi 시스템을이용하여수술하였고 명을 Si 시스템을이용하였으며 3명은 5 mm 로봇투과침을사용하였고초기 2명을제외한모든환자 (86.7%) 에서하복부로봇투과침을서혜부에설치하고보조투과침삽입을시행하지않아미용적효과를최대화하였다. 전체수술시간은평균 98.4±68.3분, 로봇사용수술시간은평균 3.6±47.5분이었다. 모든환자에서술후 일부터통증점수는 2 점이하로낮았고발열은없었으며술후 2일부터진통제투약이필요하지않았다. 양측성역류환자는술후 2일에도뇨관을제거한후잔뇨없이자가배뇨가가능하여퇴원하였으며, 평균퇴원일은술후 2.2일이었다. 평균 8.2개월간추적관찰기간동안 6명의환아에서배뇨중방광요도조영술을추적검사하였고 명의환아에서 2등급 ( 술전 4등급 ) 의역류가관찰되었으며 명 (6.6%) 의환아에서술후열성요로감염이발생하였다. 술후 개월에시행한신장초음파검사에서 등급수신증이 4단위 (6.7%), 2등급수신증이 5단위 (20.8%) 에서관찰되었으나술후 3, 6개월추적검사를시행한 7단위 (77.7%) 에서모두수신증이소실되었다. 결론 : 소아에서로봇을이용한방광근외봉수술법은양측성역류환자에서도배뇨장애발생없이방광요관역류의교정이가능한효과적이고안전한최소침습적인수술방법이다. 그러나, 현재까지추적관찰기간이짧고수술례가많지않으므로장기수술성공률과비용대비효과측면에대한후속연구가필요하겠다. Keywords: Veisoureteral reflux, Reimplantation, Robotic surgical procedures 444

NP-9 Pathologic analysis of the testicular remnant associated with the nonpalpable testes in children 정재민, 이승수, 이동훈, 한지연, 남종길, 박성우, 정문기, 이상돈 부산대학교의과대학비뇨기과학교실 Purposes: There is controversy using laparoscopy of the testicular remnant associated with the nonpalpable testis. To better understand the pathology associated with the testicular nubbin, we reviewed our experience regarding the pathologic analysis of the testicular remnant. Materials and Methods: A retrospective review was performed of all consecutive patients undergoing exploration for a nonpalpable testis at our hospital between 2009 and 207. Patients who were found no testis in all radiologic study were included in this analysis. Patients who have performed orchiectomy due to intraabdominal testis were excluded in this analysis. Results: Fourty eight patients underwent removal of the testicular remnant. Patient age ranged from 7 to 20 months. In 40 patients (83.3%) had left side testicular remnant. In 4 of the specimens (29.2%), we identified testicular tissues. In an additional 6 patients (2.5%), we identified seminiferous tubules. In 42 of the specimens (87.5%), we identified any kinds of paratesticular structures like as 9 epididymis, 20 spermatic cord, and 3 vas deference. However, in 6 of the specimens (2.5%), we could not find any testicular tissues or paratesticular structures. Conclusions: In our review, we identified that a more than 0% of testicular remnants have only fibrous tissue no testicular and paratestucuar structure. In this situation, diagnostic laparoscopy should be considered as the procedure of choice to confirm or exclude the presence of a paratesticular structure. Keywords: Testis, Nubbin, Pathology, Child 445

NP-20 Association between lipid profiles and CKD in Kidney donors 조신제, 성재우, 양종협, 문형우, 강성민, 이규원, 정현철, 최세웅, 배웅진, 조혁진가톨릭대학교서울성모병원 Objects: To evaluate the relationship between serum lipid profiles and residual renal function in live kidney donors year post donation. Methods: The patients evaluated between March 200 to May 206 that had living donor nephrectomy were retrospectively reviewed. 245 donors were studied, lipid parameters, systolic/diastolic blood pressure, kidney function(dtpa) were measured at baseline and year. And the relationship between postoperative renal function and lipid profiles was analyzed. Recursive partitioning was applied to identify optimal cut-off values for each parameters. Results: Preoperative mean serum total cholesterol, triglyceride, LDL and HDL levels were 93.±34. mg/dl, 20.4±92.6 mg/dl, 5.5±3.3 mg/dl, 54.2±2.0 mg/dl, respectively. And preoperative glomerular filtration decreased from 0.8±8.2 ml/min to 70.8±4.4 ml/min. The GFR at year follow-up was associated with age, preop GFR, total cholesterol and LDL. Roots node of preop GFR, age, total cholesterol in recursive partitioning was 97.7 ml/min, 50 years old, 24 mg/dl, respectively. On logistic regression analysis, preoperative total cholesterol(or.03, 95% CI.0-.07, p=0.036), age (OR.09, 95% CI.05-.3, p<0.00), preop GFR (OR 0.87, 95% CI 0.8-0.92, p<0.00) were predictors of development of CKD (GFR<60 ml/min). Conclusions: Age (>50 years), preop GFR (<97.7 ml/min), cholesterol (>24 mg/dl) is a prognostic factor in predicting CKD in kidney donors. Keywords: Donor nephrectmy, Lipid profiles 446

NP-2 증상의발현으로진단된성인의신우요관이행부협착에서신우성형술후이뇨성신주사의필요성 강준구, 하헌, 이유진, 정재욱, 하윤석, 최석환, 김범수, 김현태, 김태환, 유은상, 권태균, 정성광, 이준녕 경북대학교의과대학비뇨기과학교실 목적 : 성인에서신우요관이행부협착은대부분증상의발현을통해진단되고증상의관해를위해수술적치료인신우성형술이시행된다. 이뇨성신주사는소아의신우요관이행부협착에서수술의필요성을확인하고신우성형술후신기능과폐색의정도를추적하는데유용하게사용된다. 하지만, 증상으로발견된성인의신우요관이행부협착에서술후이뇨성신주사의통상적시행에는이견이있다. 본연구는성인기에증상의발현으로진단된신우요관이행부협착에서신우성형술후증상지속여부에따른이뇨성신주사의필요성에대해알아보았다. 대상및방법 : 2006년 월부터 206년 월까지증상의발현으로내원하여신우요관이행부협착으로진단받고신우성형술을시행받은 8세이상의환자를대상으로하였다. 양측성병변, 대측신장의이상, 그리고추적관찰이 2개월미만이거나술후이뇨성신주사를시행하지않은경우는분석에서제외하였다. 이들을대상으로술후 3개월의증상지속여부에따른이뇨성신주사의필요성을후향적으로분석하였다. 결과 : 총 45례의환자가연구에포함되었고신우성형술당시평균나이는 39.0세였으며추적관찰기간은 44.2개월이었다. 술후 3개월에증상이소실된경우는 40례였고, 이들중추적검사에서술후수신증의악화혹은분리신기능의감소가관찰된경우는없었다. 증상이소실된환자중 4례는술후이뇨성신주사에서폐색성배설양상이관찰되었으나이후시행한추적검사에서신기능의악화없이배설양상의호전이확인되었다. 증상이소실되지않은 5례중 례는경한통증이간헐적으로지속되었으나수신증의호전및신기능의유지로보존요법으로경과관찰중이고, 나머지 4례는각각증상의지속으로내시경적요관확장술 (2례), 신기능의감소로신우성형술의재시행 (례), 그리고무기능신으로신절제술 (례) 등의추가적인중재술이필요하였다. 결론 : 증상의발현으로진단된성인의신우요관이행부협착에서술후증상이소실된환자는양호한임상경과를나타내서통상적으로시행되는이뇨성신주사가필요치않을것으로생각한다. 또한, 술후증상이지속되는환자에서는추가적인중재술의필요성이높아조기에술후평가를시행하여야할것으로생각한다. Keywords: Pyeloplasty, Renogram, UPJO 447

NP-22 경직장초음파유도하전립선생검후발생한대량직장출혈의치료사례 서원익, 황진원 2, 김완석, 윤장호, 민권식, 정재일 인제대학교부산백병원 비뇨기과학교실, 2 소화기내과학교실목적 : 경직장초음파유도하전립선생검후발생하는직장출혈은자연지혈되거나경미한경우가대부분이다. 그러나대량의출혈이발생하는경우환자의생명에위협을줄수있다. 본연구는전립선생검후대량의직장출혈이발생하여내시경적치료를성공적으로시행한사례를보고하고자한다. 대상및방법 : 20년부터 206년까지경직장초음파유도하전립선생검을시행한 030명의대상자중직장출혈로내시경적치료를시행한 9례를후향적으로분석하였다. 전립선생검은환자를측와위자세로하여탐촉자를경직장으로삽입해횡단면기준으로 8-guage 침을장착한생검총 (TSK Laboratory, Japan) 을이용하였다. 모든대상자는경구용항생제를예방적으로복용하였으며항혈소판제, 항혈전제는시술 5-7일전중단하였다. 결과 : 총 9명의환자중 3명의환자는생검후출혈과함께수축기혈압이 90 mmhg 이하로측정되었으며 6명의환자는시술후 시간이상손가락을이용한압박에도지속적인출혈로 3회이상의혈변이있었다. 응급대장내시경은소화기내과전문의에의해시행되었으며용이한항문연직상방의전방부접근을위해가동성이좋은위내시경기구를사용하였다. 례에서동맥출혈, 8례에서지속적인정맥출혈이발견되었다. 내시경클립결찰을이용하여지혈하였고동맥출혈이확인된 례는점막하 Histoacryl 주입을추가로하였다. 평균혈색소감소는 4 g/dl였으며평균재원일수는 5.일이었다. 4 례에서전립선암이진단되었다. 3례에서수혈을시행하였으며모든환자가내시경지혈술후합병증없이퇴원하였다. 결론 : 경직장초음파유도하전립선생검후발생할수있는대량직장출혈은소화기전문의와의협진을통해응급대장내시경으로성공적인치료가가능하였다. 특히위내시경기구를이용하여접근이어려운직장내생검부위결찰이효과적이었다. Keywords: Needle biopsy, Bleeding, Colonoscopy 448