Predictive Factors Affecting Long-term Cure and Patient Satisfaction of the Tension-free Vaginal Tape Procedure for the Treatment of Female Stress Urinary Incontinence

PURPOSE: We evaluated predictive risk factors affecting the long-term efficacy of the tension-free vaginal tape(TVT) procedure for the treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: We included 138(mean age 52.4+/-9.3) women who underwent the TVT procedure and followed up for at least 5 years. We analyzed parameters including patient characteristics, history, physical examination, 1-hour pad test, and urodynamic studies using univariate and multivariate analyses with respect to the cure rates. The patients were regarded as cured in the absence of any episodes of involuntary urine leakage during stressful activities and stress cough test. RESULTS: The overall 5-year cure rate was 76.8%, with an 86.9% patient satisfaction rate. On univariate and multivariate analyses, there were no significant parameters affecting the cure rate. The urgency negatively impacted patients' satisfaction(p=0.017, OR=4.114). According to the subgroup analyses, cure rates were lower in patients with high body mass index(BMI=25 kg/m(2), 68.3% vs 83.3%, p=0.044), lower Valsalva leak point pressure(VLPP<60 cmH2O, 51.6% vs 82.8%, p=0.003), and high-grade incontinence(40.0% vs. 69.7%, 86.6%, p=0.012). CONCLUSION: the TVT procedure is an effective and safe surgery for SUI without any independent predictive factors affecting long-term cure execept urgency affecting satisfaction. However, higher BMI, low VLPP and high- grade incontinence may impair the efficacy of the TVT procedure.

Seasonal variation of snail population of Parafossarulus manchouricus and larval trematode infection in river Kumho, Kyungpook province, Korea

Studies were conducted to determine the ecology of the snail, Parafossarulus manchouricus, the seasonal variation of the snail population, and the infestation rates of these snails with the cercariae of digenetic trematodes, in the snail habitat of river Kumho, in Dongchon of Taegu city, in Kyungpook Province, Korea, from 1975 to 1979. The earliest time the snails were found was early in April every year. At that time the water temperature ranged from 13 to 14 degrees C. The population density of snails ranged from 2 to 8 per square meter. The highest population density of snails was encountered in late June and the water temperature was between 24 and 26 degrees C. The snails disappeared in early and mid-November, when the water temperature dropped to 10-13 degrees C. The average snail population in June was 115.9 per square meter in 1975 but in 1976 dropped abruptly to 30.5 and remained at approximately the same level in 1977. It then decreased at considerably lower rates, with the average of 18.7 in 1978 and 14.5 in 1979. The snails collected in the habitat were examined for the presence of cercariae of digenetic trematodes. Of these, four species, Clonorchis sinensis, Cyathocotyle orientalis, Exorchis oviformis, and Loxogenes liberum were found. The most frequently liberated cercaria was L. liberum 43.3 per cent, followed by E. oviformis 6.2 per cent and C. orientalis 1.5 per cent. The least frequently liberated was C. sinensis 0.1 per cent. In the monthly liberation rates for larval trematodes, the higher rates were observed in June, July and August every year, and the cercarial rates for Clonorchis sinensis, Cyathocotyle orientails and Exorchis oviformis demonstrate a fairly consistently fluctuating downward trend over the five-year period, except for Loxogenes liberum. Summarizing the results, this study indicated that the population density of snails in the habitat and the infection of the snail with the cercariae of digenetic trematodes has decreased over the five-year period from 1975 to 1979.

Clonorchis sinensis in Kyungpook Province, Korea 1. Distribution and demonstration of the cercaria of Clonorchis sinensis from snail, Parafossarulus manchouricus Bourgigant

Studies were conducted in rivers in Kyungpook Province, Korea from July 1970 to September 1974 to determine the stations where Parafossarulus manchouricus, the intermediate snail host of Clonorchis sinensis, are abundant, and the infection rates of these snails with the cercaria of Clonorchis sinensis. Snail collections were made during four consecutive summers(July to September in each year). Ten snail habitats were found. The population density of the snails per square meter of the river bottom ranged from 25 to 250. The highest population of snails was encountered at the Dong-chon station. Cercaria studies by means of the immersing and crushing technics indicated surprisingly low rate of Clonorchis sinensis infection among the snails examined. The proportion of infected snails in Kyungpook Province was 0.8 per thousand of all snails examined. Results indicated that the Parafossarulus manchouricus exists in limited areas within the rivers under study and the infection of the snail with the cercaria of Clonorchis sinensis is very low.