Ureteral Obstruction Caused by Crohn's Disease / 대한비뇨기과학회지

Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. This complication is treacherous, since symptoms of urinary tract disease are mostly absent. Inflammatory ureteral engagement should always be suspected in patients with Crohn's disease, particularly when located in the terminal ileum. The treatment for this condition is still controversial. We report a case of a 25 year-old man who presented with intermittent diarrhea, weight loss, and RLQ pain. Diagnostic studies confirmed Crohn's disease, and revealed an abdominal mass obstructing the right ureter with hydroureteronephrosis. The patient was successfully treated with corticosteroid and mesalamine, without resection of the ileocecal lesion, drainage of the iliopsoas abscess and ureterolysis. We discuss a ureteral obstruction as a complication of Crohn's disease, with emphasis on conservative treatment.

The Clinical Outcome of Tension-Free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence

PURPOSE: We evaluated the clinical outcome of a tension free vaginal tape(TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: One hundred-nine women(94 with genuine stress urinary incontine : and 15 with mixed urinary incontinence) underwent a TVT procedure under spinal, general anesthesia. Mean age was 48.6+/-9.3 years. The mean follow-up period was 13.5+/-2.0 months. Two women had experienced failed antiincontinence surgery and seven women had experienced pelvic surgery. RESULTS: The mean operation time was 35.6+/-1.6 minutes and mean hospital stay was 2.03+/-0.4 day. Mean duration of postoperative indwelling catheter was 10.4+/-2.5 hours. Sixteen patients(14.6%) had immediate postoperative voiding difficulties necessitating an extra procedure(soundation with Hegar dilator). Nine patients(8.3%) with de novo detrusor instability were improved by anticholinergics medication. Nine(66.7%) of 15 women with urge incontinence were significantly improved or cured after surgery. Success rate was 96.3% and 95.4% in postoperative 3 and 6 months, respectively. The patients satisfied with this procedure were 103(94.5%) in postoperative 3 months and 102(93.6.%) in postoperative 6 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.

Renal Pseudoaneurysm after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Renal hemorrhage is a most distressing complication of percutaneous renal surgery. Two cases of renal pseudoaneurysm that occurred as a complication of percutaneous nephrolithotomy (PNL) for staghorn calculi are presented. Two male patients were admitted to our hospital for treatment of staghorn calculi. Laboratory data on admission revealed no significant abnormality. They underwent PNL, and most of the calculi were removed. Two nephrostomys were placed in the middle and lower calyces, and were removed at two and three days postoperatively, respectively. Significant bleeding, uncontrolled by the usual measures, developed for six and eight days following the removal of the nephrostomy tubes. Renal angiography was performed and demonstrated pseudoaneurysms. At the same time the pseudoaneurysms were treated by superselective embolization with a coil. We keep in mind the late hemorrhage after PNL, even when there was no hemorrhage from nephrostomy removal.

The Correlation of Supine Stress Test and Valsalva Leak Point Pressure to Detect Intrinsic Sphincter Dysfunction / 대한비뇨기과학회지

PURPOSE: The Valsalva leak point pressure (VLPP) has been suggested to be an objective tool for diagnosing female stress urinary incontinence (SUI) accompanied by intrinsic sphincter dysfunction (ISD). However, measuring the VLPP is difficult, complex and expensive. A new clinical test, supine stress test to measure the VLPP, was compared. MATERIALS AND METHODS: Fifty-one patients with SUI were evaluated prospectively with a urodynamic study. A supine stress test using cough and Valsalva's maneuvers was performed after bladder filling to 200ml with sterile normal saline by gravity. A urodynamic study, including measuring the VLPP and the maximum urethral closure pressure, was performed. ISD was diagnosed as Blaivas type III and Stamey grade III, and the sensitivity, specificity, positive and negative predictive values of the supine stress test and the VLPP were calculated. RESULTS: Forty-two patients with SUI were enrolled this study and were evaluated with the VLPP and supine stress test. When the radiological findings were divided into Blaivas type III, and type I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 95.0%/90.0%, 86.4%/73.9%, 86.4%/78.3%, 95.0%/89.5%, respectively. When the symptom severity was diagnosed as being Stamey classification grade III, and grade I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 94.7%/89.5%, 82.6%/73.9%, 81.8%/73.9%, 95.0%/80.9%, respectively. CONCLUSIONS: The supine stress test is easy, quick and inexpensive, and is a positive test to reliably predict ISD as precise as the VLPP. This simple, non-invasive supine stress test is recommended as a screening test to detect ISD, especially at an outpatient department.

Clinical Outcome Between Fixations of the Rectus Fascia to the Cooper's Ligament and Abdominal Wall in Pubovaginal Sling Operation

PURPOSE: Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. MATERIALS AND METHODS: We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were evaluated preoperatively with detailed history, physical examination, urodynamic study and incontinence staging. Postoperative outcome measures and complications were checked. RESULTS: Preoperative parameters, such as clinical and urodynamic data were comparable for both groups. With a mean follow-up of 5.4 months(range 1-14) for group I, 27(90%) were cured. In group II, with a mean follow-up of 6.7 months(range 1-11), 28(93%) were cured. Postoperative de novo urge incontinence was present in 6(20%) patients in group I. The hospital stays, periods of residual urine below 50ml and postoperative lower abdominal pain of group II were significantly lower than those of group I. Each group(97%) was either very satisfied or somewhat satisfied with their outcome. CONCLUSION: Modified pubovaginal fascial sling operation including the use of small piece of rectus fascia and fixation of sling to the Cooper's ligament is an effective treatment for stress incontinence with high cure and low complication rate. However, larger followup is needed to confirm our results.