One-Year Outcomes of Mid-urethral Sling Procedures for Stress Urinary Incontinence According to Body Mass Index

PURPOSE: The purpose of our study was to investigate the safety and efficacy of the suprapubic arch (SPARC) sling operation and the transobturator tape (MONARC) sling operation according to body mass index (BMI). MATERIALS AND METHODS: Between January 1, 2004, and July 12, 2009, a retrospective clinical trial was performed with 284 patients treated by the SPARC sling procedure and 49 patients treated by the MONARC sling procedure. The women were classified into 3 groups by BMI according to the WHO Expert Consultation: normal weight (A, BMI 18.5 to 22.9 kg/m2), overweight (B, BMI 23 to 27.5 kg/m2), and obese (C, BMI>27.6 kg/m2). Patients' characteristics and clinical outcomes of the operation were analyzed according to BMI at 1 year after surgery via questionnaires and interviews with the patients about their voiding symptoms and medical records. RESULTS: There were 103 patients in group A, 186 in group B, and 34 in group C. The objective cure rates for groups A, B, and C after the SPARC procedure were 94.4%, 96.7%, and 96.8%, respectively (p=0.321), and the subjective cure rates were 94.4%, 96.1%, and 96.8%, respectively (p=0.222). The objective cure rates for groups A, B, and C after the MONARC procedure were 100.0%, 90.9%, and 66.7%, respectively (p=0.742), and the subjective cure rates were 92.3%, 93.9%, and 66.7%, respectively (p=0.779). The complication rates were similar among the three study groups. CONCLUSIONS: Mid-urethral sling procedures for urinary incontinence result in similar objective and subjective cure rates and postoperative complications irrespective of BMI.

Effect of Prostatitis on Lower Urinary Tract Symptoms: Retrospective Analysis of Prostate Biopsy Tissue

PURPOSE: Most patients, even some urologists, assume that prostate volume is the most important prognostic factor for lower urinary tract symptoms (LUTS). In some cases, however, prostatic inflammation is a more important factor in LUTS than is prostate volume. For this reason, comparison of the impact on LUTS of inflammation and prostate volume is an attractive issue. MATERIALS AND METHODS: From January 2000 to May 2009, 1,065 men aged between 47 and 91 years (who underwent transrectal ultrasound-guided prostate needle biopsy and transurethral prostatectomy) were retrospectively investigated. Components such as age, serum prostate-specific antigen (PSA) level, prostate volume, and the presence of prostatitis were investigated through independent-sample t-tests, chi-square tests, and univariate and multivariate analyses. RESULTS: Chi-square tests between prostatitis, prostate volume, serum PSA, and severe LUTS showed that prostate volume (R=0.173; p=0.041) and prostatitis (R=0.148; p<0.001) were related to LUTS. In particular, for a prostate volume under 50 ml, prostatitis was a stronger risk factor than was prostate volume. Among the multivariate predictors, prostatitis (odds ratio [OR]: 1.945; p<0.001) and prostate volume (OR, 1.029; p<0.001) were found to be aggravating factors of LUTS. CONCLUSIONS: For patients with prostate volume less than 50 ml, prostatitis was found to be a more vulnerable factor for LUTS. For those with prostate volume over 50 ml, on the other hand, the volume itself was a more significant risk factor than was prostatitis. In conclusion, the presence of prostatitis is one of the risk factors for LUTS with increased prostate volume.

Evaluation of Possible Predictive Variables for the Outcome of Shock Wave Lithotripsy of Renal Stones

PURPOSE: The aim of this study was to evaluate possible predictive variables for the outcome of shock wave lithotripsy (SWL) of renal stones in a single center. MATERIALS AND METHODS: Between March 2008 and March 2010, a retrospective review was performed of 115 patients who underwent SWL for solitary renal stones. The patients' characteristics and stone size, location, skin-to-stone distance (SSD), and Hounsfield units (HU) of stone were reviewed. The impact of the possible predictors on the disintegration of the stones was evaluated by logistic regression analysis. Receiver operator characteristic (ROC) curves were generated to compare the predictive powers of the variables. RESULTS: Seventy-nine patients (68.7%) had successful outcomes, whereas 36 patients (31.3%) had residual stones. Significant differences were found in the mean size and mean HU of the stones (size: 8.34+/-3.58 mm vs. 13.57+/-5.41 mm, p<0.001; HU: 675.29+/-254.34 vs. 1,075.00+/-290.41, p<0.001). In the unadjusted model, age, stone size, and stone density were significant predictors. In the reduced model, stone density and size were significant predictors for the outcome of SWL. The area under the ROC curve (AUC) was significantly higher for stone density and size than for the other parameters, but the AUC between stone density and size did not differ significantly (stone density: 0.874, stone size: 0.827, p=0.388). CONCLUSIONS: Stone density and size were significant predictors of the outcome of SWL for renal stones less than 2.0 cm in diameter. We should consider HU and stone size when making decisions on the treatment of renal stones.

Torsion of Appendix Testis: 14 Cases / 대한비뇨기과학회지

In spite of today's striking development of radiologic studies, the differential diagnosis of acute scrotal diseases is difficult. We studied 14 cases of appendix testis torsion that had visited our hospital from May 1991 to October 1994 in order to be diagnosed accurately and made appropriate treatment. The torsion of appendix testis occurred during prepubertal ages, and ages of our 14 cases were from 3 to 13, and average age was 9.6 years old. In all of our cases the chief complaint was scrotal pain. The localized pain and palpable tender mass of testicular upper pole were present in only 8 of 14 cases and 5 cases had blue dot sign. These were very helpful in diagnosis of torsion of appendix testis. Doppler ultrasonography was done in 9 cases and radionuclide scrotal imaging was done in 3 cases, but none of these studies were diagnosed as torsion of appendix testis definitely. But in 8 cases that had positive blue dot sign and/or localizing tender mass in upper pole of testis, we could diagnose torsion of appendix testis certainly. We operated 11 of l4 cases( scrotal exploration and excision of torsed appendix testis) and treated conservatively 3 of 14. Most 11 operated cases were revealed that scrotal pains were relieved within 24 hours of postoperative period and secondary complications did not occurred in 3 cases treated conservatively. In summary, the early surgical exploration is necessary to improve maximal testicular salvage when testis torsion cannot be ruled out completely in acute scrotal diseases. But if testis torsion can be ruled out completely, conservative treatment may be considered in torsion of appendix testis.