Impact of the Tension Adjustment of the mesh by using Babcock Clamp during Tension-Free Vaginal Tape Obturator Procedure on the Postoperative Voiding Pattern and Satisfaction

PURPOSE: To guarantee the proper tension of the tape, we have adopted standardized methods by using Babcock clamp. MATERIALS AND METHODS: Medical records of 118 women who underwent Tension-Free Vaginal Tape Obturator (TVTO) prucedure were retrospectively reviewed. Tension of the tape was controlled either by holding the 1 cm length of the mesh with Babcock clamp in 72 cases (Group I), or by placing Metzenbaum scissor between the tape and the urethra in 46 cases (Group II) before pulling on the tape. The preoperative evaluations included symptom questionnaire, history taking, physical examination, one hour pad test and complete multichannel urodynamic study. Postoperatively, uroflowmetry, postvoiding residual urine volume and symptom questionnaire were repeated. RESULTS: The success rates of the operation were not different between groups. However, postoperative complication rates, including persistent pain and de novo urgency, in the Group II (n=9, 19.6%) was higher than in Group I (n=6, 8.3%). The rate of postoperative transient urinary retention was also higher in Group II (p<0.05). The rate of the patients who answered [satisfied] were significantly high in Group I (95.8%) compared to Group II (80.4%). CONCLUSIONS: By using the Babcock clamp technique, the complications can be minimized, and satisfaction increased. Our findings suggest that this technique does assure the proper tension for the normal voiding postoperatively.

Effect of Tamsulosin on the Expected Treatment of Upper and Lower Ureteral Stones / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of tamsulosin on upper and lower ureteral stones that were smaller than 10mm to identify the patient groups for which tamsulosin was most applicable. MATERIALS AND METHODS: 85 patients who were diagnosed with ureteral stones smaller than 10mm in size were enrolled in this randomized prospective study. The patients were diagnosed via intravenous pyelography and then they were followed with weekly plain abdomen films for 4 weeks. The control group(Group 1) was given an nonsteroidal antiinflammatory drug(NSAID) for pain medication, and they were instructed to ingest at least 2l of fluids daily. For the treatment group(Group 2) once daily 0.2mg tamsulosin was added. Both groups were compared for the size of stone and the days to expulsion and pain control, based upon the number of emergency room(ER) visits. The proximal and distal ureteral stones were separately evaluated, and the patients' gender, age, stone size and stone position were analyzed to identify treatment efficacy. RESULTS: The average stone size was 5.2+/-2.6mm in group 1 and 4.7+/-1.5mm in group 2(p=0.344). The success rate was 42.9% in group 1 and 76.5% in group 2(p=0.005). Group 2 showed a significant reduction for the time to stone expulsion at 12.7+/-6.6 days compared to 18.5+/-6.9 days for group 1(p=0.008). Among the subset of patients, those with distal ureteral stones smaller than 5mm alone showed a significant increase in the expulsion rate(100%, p=0.047) and a decrease of the days to expulsion(12.1+/-5.1 days, p=0.018). CONCLUSIONS: Tamsulosin increases the spontaneous expulsion rate and reduces the time to expulse ureteral stones, and it was most effective for distal stones less than 5mm in size.

Changes of Causative Organisms and Antimicrobial Sensitivity of Urinary Tract Infection between 1979 and 2001 / 대한비뇨기과학회지

PURPOSE: We studied the changes in the antibiotic sensitivity to the causative organisms of urinary tract infection, between 1979 and 2001, in order to provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI). MATERIALS AND METHODS: We retrospectively analysed 1,370 uropathogens, and their antimicrobial sensitivities, in 647 patients admitted to, or visiting our hospital, between January 1979 and December 2001, that had more than 105cfu/ml in urine culture. RESULTS: The incidence of UTI increased with age, and was highest in the 6th decades (21.0%). Mixed infections increased from 6.1%, in 1979, to 18.4%, by 2001. The common pathogens were E. coli (37.8%), enterococcus (15.0%), Pseudomonas (10.1%) and Klebsiella (9.1%). E. coli was the most important uropathogen during the stated time period. However, the incidence of Gram positive organisms increased from 14.2%, in 1979, to 26.0%, by 2001. In the Gram negative stained uropathogens, the antibiotic sensitivity was changed: ampicillin (11.8 to 14.6%), cephalothin (40.6 to 46.3%) and amikacin (80.5 to 74.8%). For E. coli, trimethoprim/Sulfamethoxazole (TMP/SMX) and ampicillin showed decreased sensitivities of 37.3 and 18.5%, respectively. However, sulbactam/cefoperazone, cefepime and imipenem showed high sensitivities of 96.1, 97.5 and 100%, respectively. CONCLUSIONS: Prior to receiving the bacteriological report, the use of TMP/SMX and ampicillin, as the first choices of treatment for UTI, should be reconsidered. Our results implied that amikacin, which showed the best effects, and was cheaper than fluoroquinolones, can be used as an alternative to these drugs as a primary empirical antibiotic for UTI.