Three-year Outcomes of the Innovative Replacement of Incontinence Surgery Procedure for Treatment of Female Stress Urinary Incontinence: Comparison with Tension-free Vaginal Tape Procedure

Innovative replacement of incontinence surgery (IRIS) is a polypropylene tape that is placed beneath the midurethra to restore urinary continence. We evaluated the long-term efficacy and safety of the IRIS procedure and compared it with tensionfree vaginal tape (TVT) for the treatment of female stress urinary incontinence. We included all 66 consecutive women who underwent IRIS (n=34) or TVT (n=32) between February 2002 and April 2003 and followed them up for at least 3 yr postoperatively. The 3-yr success rate was 94.1% for the IRIS and 93.8% for the TVT, and the satisfaction rates were 91.2% and 90.6%, respectively. Intraoperative complications for the IRIS group included 3 cases of bladder perforation, and there were 3 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 2 patients with de novo urgency and one patient with mesh erosion. Three patients with TVT developed de novo urgency. One case of each group showed temporary voiding difficulty. On the basis of our results, the IRIS may be an effective and safe procedure as compared to TVT, with a high success rate and a low complication rate.

Transurethral Resection of the Prostate with a Bipolar Tissue Management System Compared to Conventional Monopolar Resectoscope: One-Year Outcome

The purpose of the present study was to evaluate the efficacy and safety of bipolar transurethral prostatectomy (TURP) using the GyrusTM PlasmaKinetic System compared with conventional monopolar TURP. This study included 102 patients with benign prostatic hyperplasia (BPH) who underwent TURP from January 2003 to March 2005. In all, 49 consecutive patients had bipolar and 53 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, change in serum sodium and hemoglobin, duration of catheter use, length of hospital stay, and complication rates. Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in serum sodium and hemoglobin, improvement of IPSS and peak flow rate (Qmax), or complication rates over the 12-month follow-up in both groups. There was, however, a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.28 days vs. 3.12 days) and hospital stay (3.52 days vs. 4.27 days) were shorter in the bipolar group (p = 0.012 vs. p = 0.034, respectively). Our results demonstrate that bipolar TURP using the Gyrus(TM) Plasma Kinetic System is as effective as conventional monopolar TURP with the additional advantage of reduced length of catheter use and hospital stay. Bipolar TURP is a promising new technique that may prove to be a good alternative to conventional TURP in the future.

Tamoxifen Only versus L-Carnitine and Tamoxifen in the Oral Therapy of Peyronie's Disease / 대한남성과학회지

PURPOSE: To evaluate the effects of oral Tamoxifen only versus L-Carnitine plus Tamoxifen in patients with Peyronie's disease. MATERIALS AND METHODS: All 45 patients with Peyronie's disease, diagnosed using accepted definitions, were randomized into two groups and treated for 3 months with Tamoxifen only(40 mg/day)(n=17) or a combination ofL-Carnitine(2 g/day) and Tamoxifen(40 mg/day)(n=28). A medical history was obtained, and a physical examination was performed. Plaque size, pain, erectile function(IIEF score), and penile curvature were assessed. Both before and after therapy, the differences between the 2 groups were compared using independent-sample t-test with p<0.05 considered significant. RESULTS: The mean age of the 45 patients was 52.1 years, and no severe adverse events occurred in either group. In the Tamoxifen only group, the mean decrease of plaque-length was 0.46+/-0.88 mm, and mean reduction in the pain rating scale was 0.44+/-0.53. In the L-Carnitine and Tamoxifen group, mean decrease of plaque-length was 1.57+/-0.92 mm, and mean reduction in the pain rating scale was 1.27+/-0.96. Based on IIEF scores, the improvement of erectile function was 0.88+/-0.64 in the Tamoxifen only group and 1.56+/-0.75 in the L-Carnitine and Tamoxifen group. The degree of penile curvature was also measured, and the reduction of curvature angle was 9.17+/-4.92 degrees in the Tamoxifen only group and 9.55+/-6.50 degrees in the L-Carnitine and Tamoxifen group. CONCLUSIONS: This study showed significantly greater improvements in plaque size, pain, erectile function, and curvature in patients with Peyronie's disease who were treated with L-Carnitine and Tamoxifen compared with those treated with Tamoxifen only.

Effect of Metformin on the Expression of Nitric Oxide Synthase in High Fat Fed Obese Rats / 대한남성과학회지

PURPOSE: Obesity is a well known risk factorfor erectile dysfunction, and metformin normalizes androgen levels in patients with polycystic ovary syndrome and decreases body fat and leptin concentration in normal weight men. Thus, we hypothesized that metformin may restore the neuroendocrine abnormalities associated with obesity and improve erectile dysfunction. MATERIALS AND METHODS: Obesity was induced by a high fat(HF) diet fed for 4 months, and then metformin(300 mg/kg/day) was administered for 4 weeks. Penile nitric oxide synthase(NOS) expression and luteinizing hormone (LH), follicle stimulating hormone(FSH), testosterone, leptin, corticotropin releasing factor(CRF), adrenocorticotropin (ACTH), and proopiomelanocortin(POMC) were evaluated in control and HF obese rats. RESULTS: Penile nNOS and eNOS were suppressed markedly, and serum leptin and FSH were increased in HF rats compared to controls. However, POMCexpression in the hypothalamus was decreased in HF rats compared to controls,despite slightly elevated cerebrospinal fluid(CSF) leptin concentration. Metformin treatment for 4 weeks restored penile nNOS and eNOS expression, decreased serum leptin, increased POMC expression in the hypothalamus, and decreased serum concentration of FSH and CRF in HF rats. Surprisingly, metformin increased CSF leptin concentration in both control and HF rats. CONCLUSIONS: These results suggested that NOS expression was suppressed by the HF diet, but restored by metformin treatment. The effect of metformin on NOS expression resulted from not only a leptin sensitizing effect but also through a normalizing effect on levels of endocrine factors.

Bipolar Transurethral Resection of the Prostate: A Comparative Study with Monopolar Transurethral Resection / 대한비뇨기과학회지

PURPOSE: Transurethral resection of the prostate (TURP) using bipolar electrocautery and 0.9% saline is a new technology in the field of surgery for benign prostatic hyperplasia (BPH). This randomized prospective study was conducted to compare the efficacy and safety of the Gyrus(TM) Plasmasect loop bipolar TURP and the conventional monopolar TURP for the treatment of BPH. MATERIALS AND METHODS: This study included 50 patients who were randomized 1:1 to undergo bipolar or monopolar TURP from August 2003 to October 2004. Preoperatively, the patients were assessed by the symptom score, uroflow and transrectal ultrasonography, and the two groups were comparable with regards to these measures and the mean group age. The perioperative and postoperative parameters we studied included the operative time, the resected prostate volume and the change in serum Na and Hb. Postoperatively, the patients were assessed for the symptom score and uroflow at both 1 and 6 months. RESULTS: Postoperative improvements in the symptom score and the Qmax were significant for both groups and the improvements were similar for the two groups. There was no difference in the operative time and resected prostate volume. The serum Na dropped by 4.2mEq/l in the monopolar group, whereas it fell only 1.1mEq/l in the bipolar group (p<0.001). Significant smaller reduction in serum Hb, a shorter postoperative catheterization time and a shorter hospital stay were noted for the bipolar group. CONCLUSIONS: Bipolar TURP using the Gyrus(TM) system is as effective as conventional monopolar TURP and it has additional advantages too. Thus, bipolar TURP may be a good alternative to conventional TURP. However, more follow-up is necessary to assess its long-term efficacy.

A Case of Bladder Stone and Vesicovaginal Fistula after McDonald Operation / 영남의대학술지

The frequency of a bladder foreign body in the female is lower than in the male, and bladder stones attached to foreign bodies such as non-absorbable suture material are not common. Moreover, vesicovaginal fistulas due to migration or puncture of suture materials into the bladder are rare. In this report, we present a case of bladder stone and vesicovaginal fistula formation in a 29-year-old female patient who had been treated with the McDonald operation for an incompetent internal os of the cervix (IIOC) during pregnancy. The patient was successfully treated by cystoscopic removal of the bladder stone with suture material and conservative treatment for the vesicovaginal fistula.

Six-year Outcome of the Tension-free Vaginal Tape Procedure for the Treatment of Female Stress Urinary Incontinence

PURPOSE: We evaluated the efficacy and safety of the tension-free vaginal tape(TVT) procedure for the treatment of female stress urinary incontinence over a 6-year period. MATERIALS AND METHODS: We reviewed retrospectively our experience with 63 patients who underwent a TVT procedure for stress urinary incontinence, between March 1999 and March 2000. The preoperative evaluations included a comprehensive medical history, physical examination, urinalysis, urine culture, one hour pad test, urodynamic study including valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). Long-term evaluations were performed by questionnaires on the durability of surgical outcome and the patients' satisfaction of the procedure. RESULTS: The TVT procedure remained successful in 95.2%(cured 81.0%, improved 14.3%) and 93.7%(cured 77.8%, improved 15.9%) at the 1 and 6-year follow-up, respectively. The satisfaction rates were 93.7% and 92.1%, at the 1 and 6-year follow-up, respectively. There were no serious or long-term complications related to the procedure. CONCLUSION: The TVT procedure seems to be a minimally invasive, safe and effective surgical procedure for the treatment of female stress urinary incontinence, with long-term durability of continence and minimal complications related to the surgery.

Two-year Follow Up of IRIS Procedure for Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: To assess the efficacy and safety of a IRIS(innovative replacement of incontinence surgery) procedure for surgical treatment of stress urinary incontinence in women during the follow-up of 2 years. MATERIALS AND METHODS: From March 2003 to March 2004, 48 women with stress urinary incontinence underwent a IRIS procedure under local, spinal or general anesthesia. Post-operative evaluation was carried out after 1 month, 12 months and 24 months. The mean age was 51.1+/-11.0 years and mean follow-up period was 32.1+/-3.8 months. Operation time, success rate and patient's satisfaction, perioperative and postoperative complications were evaluated. RESULTS: The mean operation time was 24.46+/-1.95 minutes and mean hospital stay was 1.77+/-0.75 days. The success rates were 95.8%(cured 79.2%, improved 16.7%) and 93.8%(cured 75.0%, improved 18.8%), at the 1 and 2-year follow-up, respectively. The satisfaction rates were 91.7% at 1-year follow-up and persisted at 2-year follow-up. There were no serious or long-term complications related to the procedure, and no significant changes in the postoperative outcome over time. CONCLUSION: Our results demonstrate that the IRIS procedure is as safe and effective as TVT procedure for the treatment of female stress urinary incontinence, although longer follow-up is necessary to determine long-term effect.

The Analysis of Preference for Three PDE-5 Inhibitors / 대한남성과학회지

PURPOSE: To evaluate the preference factors for the treatment of erectile dysfunction (ED) with three different kinds of PDE-5 inhibitors. MATERIALS AND METHODS: This prospective, open-label study recruited 140 patients from 5 medical centers and urological clinics in the Daegu and Gyeongbuk area of South Korea. All patients underwent sildenafil, tadalafil, and vardenafil therapy with at least four attempts at sexual intercourse for each medication. There was a 1-week drug washout period following each medication period. Patients were asked to state their preference among the three medications. RESULTS: The mean age of the 140 patients was 50.9 years. Most patients had mild-to-moderate ED(57 patients, 40.7%) and moderate ED(47 patients, 33.6%), the remaining patients had mild(23 patients, 16.4%) or severe ED (13 patients, 9.3%). Of 140 evaluated patients, 58(41.3%) patients preferred treatment with tadalafil, compared with 39(28.1%) with sildenafil and 37(26.6%) with vardenafil. When grouped by age, tadalafil was most preferred by men in their 30s and 40s(42.9%, 57.5%), sildenafil was preferred by those in their 50s(48.3%), and vardenafil was preferred by those in their 60s(51.6%). The reasons for specific preferences were prolonged erectile function (68.0%) and good erectile function(66.0%) for tadalafil, good erectile function (88.2%) for the sildenafil, and good rigidity of the erect penis(59.4%) for vardenafil. CONCLUSIONS: Tadalafil was most preferred among the phosphodiesterase inhibitors, but the preference rates varied for men of different ages. All the medications were well tolerated.

The Analysis of Preference for Three PDE-5 Inhibitors / 대한남성과학회지

PURPOSE: To evaluate the preference factors for the treatment of erectile dysfunction (ED) with three different kinds of PDE-5 inhibitors. MATERIALS AND METHODS: This prospective, open-label study recruited 140 patients from 5 medical centers and urological clinics in the Daegu and Gyeongbuk area of South Korea. All patients underwent sildenafil, tadalafil, and vardenafil therapy with at least four attempts at sexual intercourse for each medication. There was a 1-week drug washout period following each medication period. Patients were asked to state their preference among the three medications. RESULTS: The mean age of the 140 patients was 50.9 years. Most patients had mild-to-moderate ED(57 patients, 40.7%) and moderate ED(47 patients, 33.6%), the remaining patients had mild(23 patients, 16.4%) or severe ED (13 patients, 9.3%). Of 140 evaluated patients, 58(41.3%) patients preferred treatment with tadalafil, compared with 39(28.1%) with sildenafil and 37(26.6%) with vardenafil. When grouped by age, tadalafil was most preferred by men in their 30s and 40s(42.9%, 57.5%), sildenafil was preferred by those in their 50s(48.3%), and vardenafil was preferred by those in their 60s(51.6%). The reasons for specific preferences were prolonged erectile function (68.0%) and good erectile function(66.0%) for tadalafil, good erectile function (88.2%) for the sildenafil, and good rigidity of the erect penis(59.4%) for vardenafil. CONCLUSIONS: Tadalafil was most preferred among the phosphodiesterase inhibitors, but the preference rates varied for men of different ages. All the medications were well tolerated.

Association between Obesity and Prostate Cancer / 영남의대학술지

BACKGROUND: The role of obesity in prostate cancer etiology remains controversial. The aim of this study was to evaluate the relationship between obesity and prostate cancer risk. MATERIALS AND METHODS: Between January 2000 and June 2005, 286 patients suspected of having prostate cancer underwent prostate biopsy. The clinical records of the 286 study patients were retrospectively reviewed with regard to age, Body Mass Index (BMI), serum PSA, TRUS, and prostate biopsy results. They were stratified by BMI into three groups according to the cutoffs recommended for Asian populations: normal, BMI less than 23 kg/m2; overweight, BMI 23 to 25 kg/m2; and obese, BMI greater than 25 kg/m2. RESULTS: As for BMIs, 132 (46.2%) were normal, 95 (33.2%) overweight and 59 (20.6%) were obese. A total of 99 (34.6%) patients were diagnosed as having prostate cancer. In multivariate logistic regression analyses, no significant association was observed between BMI and prostate cancer detection. CONCLUSION: We initially hypothesized that obesity may be biologically associated with increased prostate cancer development. However, our study did not show a significant association between BMI and prostate cancer.

Multicenter Study on the Efficacy and Safety of Intracavernous 'TM' (Standro(R)) for the Treatment of Erectile Dysfunction in Korean / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of an intracavernous injection of lyophilized papaverine/phentolamine/alprostadil (Standro(R)) for the treatment of erectile dysfunction (ED) in Koreans. MATERIALS AND METHODS: 249 men (>20 years old), with ED (>6 month duration), were enrolled from 14 clinical centers. The intracavernous 'TMs' were titrated in a stepwise fashion at the clinic, from 0.05-0.25ml (17.64mg papaverine, 0.6mg phentolamine, and 6mug alprostadil per ml), with increment of 0.02-0.05ml, according to the etiology and severity of the ED and the patients' ages. RESULTS: Of the 249 men, 238 completed the dose titration, and progressed to home treatment of 3 months duration. Of these 238, 193 (psychogenic 13.0%, organic 75.5%, mixed 11.5%) completed the home treatment (4 or more self-injections), with the other 45 dropping out (lost to follow-up in 24, patient refusal in 9, no chance to have intercourse in 7 and omitted recording of patient diary in 2). The success rate per trial (a total number of sufficient erection for vaginal intromission/a total number of injections) and per patient (number of patients who had one or more sufficient erections for vaginal intromission/the enrolled patients at beginning or 193 patients), and the satisfaction rate per patient (number of patients who had both patient and partner satisfaction with erection/193 patients) were 74.1, or 91.2 and 75.1%, respectively. The adverse reactions were prolonged erections in 3, urethral pain in 1 and penile skin edema in 2. Three patients complained of penile pain during an erection, but there was no dropout due to the pain. No significant changes in laboratory tests were found after the home treatment. CONCLUSIONS: A 'TM' seems to be effective and safe for an intracavernous injection for the treatment of men with erectile dysfunction.

The Effects of Externally Administered Insulin-like Growth Factor-I on Glomerulosclerosis during Compensatory Renal Hypertrophy in Rats / 대한비뇨기과학회지

PURPOSE: Among renotropic agents, a growth hormone (GH) independent insulin-like growth factor-I (IGF-I) improves renal function without inducing glomerulosclerosis and its potential for treating renaldisease is increasing. With this in mind, this study was designed to find out the effects of externallyadministered IGF-I toward preventing glomerulosclerosis after renal volume loss in rats. MATERIALS AND METHODS: Sprague-Dawley rats (110-130gm) were divided into four groups in accordance with 3/4 nephrectomyand/or IGF-I administration. The 3/4 nephrectomy was performed at 30 days after birth, and recombinanthuman IGF-I was administered for 60 days after 3/4 nephrectomy. The change of body weight and wet weight of the remnant kidney were determined. The glomerular planar area and percentage of glomerulosclerosiswere measured. RESULTS: The body weight andthe wet weight of remnant kidney were significantly increased after administration of IGF-I in the3/4 nephrectomy group. The glomerular planar area was significantly increased after administration of IGF-I in the 3/4 nephrectomy group, and significant increase in glomerular planar area was observed in the 3/4 nephrectomy group regardless of IGF-I administration. And the percentage of glomerulosclerosis was significantly decreased. CONCLUSIONS: Thus it is concluded that this study proved that the externally administered IGF-I prevents lomerulosclerosis after severe renal volume loss in rats. It may have a potential to become a useful medical agent for suppressing glomerular sclerotic change and facilitating renal function in chronic renal failure patients.

A Case of Congenital Fibroepithelial Polyp of the Ureter in a Child / 대한비뇨기과학회지

The fibroepithelial polyp of the ureter is a rare, benign tumor. Its pathogenesis is unclear, but most investigators agree that it arises from elements of mesodermal origin within the ureteral wall. Symptoms include hematuria and intermittent flank pain secondary to partial ureteral obstruction. Correct radiologic assessment is crucial to direct surgical management. We report a case of a fibroepithelial polyp of the ureter in a child in whom correct preoperative diagnosis was made by correlating the results of excretory urography, sonography, CT and urine cytology.

A Case of Retroperitoneal Neuroenteric Cyst / 대한비뇨기과학회지

Neuroenteric cyst derives from endodermal tissue displaced dorsally into the spinal canal ventral to the neural plaque through the interposed mesodermal layer that forms the vertebral bodies, embryologically. It is located along the alimentary canal, or ventral to the spinal cord in the cervical, thoracic area, or at the cervicothoracic junction within the boundaries of C3 above and T7 below and lies in an intramedullary or intradural extramedullary location in most patients. To date, retroperitoneal neuroenteric cyst has been described in only few cases. We report a case of asymptomatic retroperitoneal neuroenteric cyst in a 28-year-old man with a brief review of literatures, which found incidentally on health care center.