Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

Background: Opioid analgesics and psychotropic drugs (medical narcotics) are essential for treating pain and psychiatric disorders. Unlike tiered classification systems used globally, Korea uniformly classifies these medications with illicit drugs under a single narcotics category. This creates misunderstandings among patients and physicians. This study investigates perceptions of medical narcotics, assesses awareness of the Narcotics Information Management System (NIMS), and proposes strategies to prevent misuse and abuse. Methods: A cross-sectional survey from September 2021 to June 2025 enrolled 322 patients prescribed opioid analgesics or psychotropic drugs for ≥180 days per year and surveyed 300 physicians via email. Categorical variables were expressed as frequencies (percentages) and compared using a Chi-square test. Multivariable logistic regression adjusted for age and gender was performed and subgroup analyses were performed, including by patient education level (using ANOVA and Bonferroni-corrected post hoc comparisons) and treatment duration, alongside physician specialty and affiliation. Results: Significant perception differences emerged between patients and physicians. The largest perception discrepancy was in distinguishing medical narcotics from illicit drugs (48.8 percentage point difference; 9.9% vs. 58.7%; p < 0.001). The NIMS Data Service awareness was lowest in both groups (patients 14.6% vs. physicians 34.3%). In multivariable-adjusted analysis, perception differences were greater in those over 60 years old. In the subgroup analysis, patient-physician perception gaps, as reflected by odds ratios, were greater in patient-groups with shorter treatment duration (<36 months) compared to those with longer treatment duration (≥36 months). Conclusions: Perceptions of opioid analgesics and psychotropic drugs are significantly different between patients and physicians. Both groups showed limited awareness of medical narcotics and the narcotics control system. Targeted educational initiatives are crucial for both patients and physicians to bridge existing perceptual and knowledge gaps, especially for patients aged 60 years or older and patients with shorter medical narcotics treatment duration (less than 36 months).

Background: In zoster-associated pain (ZAP), earlier epidural steroid injection (ESI) has been associated with better outcomes, but optimal timing remains unclear, and prior studies have largely relied on pain reduction alone. Methods: In this multicenter retrospective cohort, 215 patients with ZAP who completed a three-session ESI course were classified into early (<30 days) and delayed (≥30–≤180 days) groups. The primary endpoint was complete remission at 12 weeks (≥50% visual analog scale [VAS] reduction, VAS ≤ 2, and sensory normalization); successful response (≥50% VAS reduction) served as the secondary endpoint. An ordered three-category framework and an exploratory generalized Youden index threshold analysis were applied. Results: Complete remission occurred in 82.1% versus 39.0% and successful response in 91.7% versus 67.8%. Each additional day of delay was associated with lower odds of complete remission (adjusted odds ratio [aOR], 0.957; p < 0.001) and higher odds of a worse outcome category (aOR, 1.030; p < 0.001). Exploratory candidate boundaries were 22 and 42 days. Conclusions: Earlier ESI initiation was associated with a higher likelihood of complete remission incorporating pain reduction, low residual pain intensity, and sensory normalization. These findings highlight the clinical relevance of treatment timing and recovery assessment beyond pain reduction alone in ZAP.

Background and Objectives: Off-label medical narcotic use may be classified as misuse and abuse, but this classification need not coincide with judgments about how broadly medical narcotic use should be permitted. We examined the association and discordance between these judgments, as well as how each was related to three dose reduction-related responses. Materials and Methods: We analyzed cross-sectional web-based survey data from 300 physicians specializing in neurology, psychiatry, or anesthesiology and pain medicine in South Korea. Strict classification of all off-label use as misuse and abuse and a restrictive view of how broadly medical narcotic use should be permitted were entered simultaneously into logistic regression models for prior recommendation of dose reduction or discontinuation, belief that dose reduction would be helpful, and future intention to attempt dose reduction. Models were adjusted for age, sex, practice type, and specialty, with false discovery rate (FDR) adjustment across six primary associations. Results: Strict classification was selected by 42 physicians (14.0%), and a restrictive view by 107 (35.7%). The two judgments were positively associated (adjusted odds ratio [aOR], 4.99; 95% confidence interval [CI], 2.38–10.46), but 92 of 297 physicians (31.0%) gave discordant responses. After FDR adjustment, strict classification was associated with prior recommendation (aOR, 3.06; 95% CI, 1.37–6.83) and belief that dose reduction would be helpful (aOR, 4.51; 95% CI, 1.91–10.67). A restrictive view was associated with the same belief (aOR, 3.59; 95% CI, 2.12–6.10) and future intention (aOR, 2.89; 95% CI, 1.55–5.40). Conclusions: These findings indicate that physicians’ broad judgments about off-label medical narcotic use and the permitted scope of medical narcotic use are related but distinct and show different patterns of association with three dose reduction-related responses. They support the view that tapering decisions should be guided by individualized clinical assessment rather than by legal and regulatory frameworks alone.

Background and Objectives: Off-label medical narcotic use may be classified as misuse and abuse, but this classification need not coincide with judgments about how broadly medical narcotic use should be permitted. We examined the association and discordance between these judgments, as well as how each was related to three dose-reduction-related responses. Materials and Methods: We analyzed cross-sectional web-based survey data from 300 physicians specializing in neurology, psychiatry, or anesthesiology and pain medicine in South Korea. Strict classification of all off-label use as misuse and abuse and a restrictive view of how broadly medical narcotic use should be permitted were entered simultaneously into logistic regression models for prior recommendation of dose reduction or discontinuation, belief that dose reduction would be helpful, and future intention to attempt dose reduction. Models were adjusted for age, sex, practice type, and specialty, with false-discovery rate (FDR) adjustment across six primary associations. Results: Strict classification was selected by 42 physicians (14.0%), and a restrictive view by 107 (35.7%). The two judgments were positively associated (adjusted odds ratio [aOR], 4.99; 95% confidence interval [CI], 2.38–10.46), but 92 of 297 physicians (31.0%) gave discordant responses. After FDR adjustment, strict classification was associated with prior recommendation (aOR, 3.06; 95% CI, 1.37–6.83) and the belief that dose reduction would be helpful (aOR, 4.51; 95% CI, 1.91–10.67). A restrictive view was associated with the same belief (aOR, 3.59; 95% CI, 2.12–6.10) and future intention (aOR, 2.89; 95% CI, 1.55–5.40). Conclusions: These findings indicate that physicians’ broad judgments about off-label medical narcotic use and the permitted scope of medical narcotic use are related but distinct and show different patterns of association with three dose-reduction-related responses. They support the view that tapering decisions should be guided by individualized clinical assessment rather than by legal and regulatory frameworks alone.