Management of urinary tract infection in geriatric hospital patients

As the elderly population increases, so does the prevalence of urinary tract infections in the elderly population in long-term care facilities and the associated medical costs. Screening tests and treatment for asymptomatic bacteriuria in elderly residents in the community or in long-term care facilities are not recommended. However, febrile urinary tract infections should be treated with proper antibiotics. Patients who have risk factors for urinary tract infections require prompt therapy. Catheter-associated bacteriuria is the most common hospital-acquired infection. The most important risk factor associated with an increased likelihood of developing catheter-associated bacteriuria is the duration of catheterization. Long-term catheter indwelling should be avoided, and it is necessary to reduce unnecessary catheter insertion. Most patients are asymptomatic, and they do not require treatment. Symptomatic catheter-associated infections should be treated. The best strategy for reducing catheter-associated infections involves careful aseptic insertion of the catheter and maintenance of a closed dependent drainage system. Steps must be taken to reduce urinary tract infections and urinary catheter-related infections in light of the increasing elderly population.

A Study on Physiological Index, Anxiety and Depression by the Severity of Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

PURPOSE: The purpose of this study was to investigate the physiological index, anxiety and depression by the severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia. METHODS: This research was conducted from the 4th to the 27th of May in 2016 on112 patients with benign prostatic hyperplasia. The data were analyzed using a chi-square test, ANOVA, and Pearson Correlation Coefficients. RESULTS: The results demonstrated a difference depending on the dysuria period of each lower urinary tract symptom, marital status, occupation and perceived health state of the patient. The physiological index by lower urinary tract symptoms showed a difference in the maximum flow rate, amount of post-void residual urine and Prostate-Specific Antigen (PSA), and anxiety and depression factors also revealed a difference. Lower urinary tract symptoms showed a positive correlation to the amount of post voided residual urine and PSA, a negative correlation to the maximum flow rate and also indicated a positive correlation to depression. CONCLUSION: The results of the study belonging to the moderate and severe categories were high when the result was based on the categorization of subjects with benign prostatic hyperplasia with lower urinary tract symptoms. Considering that depression levels increase as the symptom intensifies and the anxiety score is also high with mild symptoms, psychological support intervention is needed when a pattern of benign prostatic hyperplasia appears.

Cervical Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

Intracranial dural arteriovenous fistula (dAVF) usually results in various problems in the brain. But it can be presented as a myelopathy, which may make early diagnosis and management to be difficult. We recently experienced a case of cervical myelopathy caused by intracranial dAVF. A 60-year-old man presented with a 3-year history of gait disturbance due to a progressive weakness of both legs. Neurological examination revealed spastic paraparesis (grade IV) and Babinski sign on both sides. Magnetic resonance imaging showed serpentine vascular signal voids at C2-T1 on T2-weighted image with increased signal intensity and swelling of spinal cord at C1-C4. We performed a brain computed tomography angiography and found intracranial dAVF with multiple arteriovenous shunts. Venous drainages were noted at tentorial veins and cervical perimedullary veins. After Onyx embolization, the patient showed gradual improvement in motor power and gait disturbance. The venous drainage pattern is a well-known prognostic factor of dAVF. In our case, the intracranial dAVF drained to spinal perimedullary vein, which seemed to result in the ischemic myelopathy. Although it is rare condition, it sometimes can cause serious complications. Therefore, we should keep in mind the possibility of intracranial dAVF when a patient presents myelopathy.

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

Two Cases of Klippel-Feil Syndrome with Cervical Myelopathy Successfully Treated by Simple Decompression without Fixation

Klippel-Feil syndrome (KFS) is a congenital developmental disorder of cervical spine, showing short neck with restricted neck motion, low hairline, and high thoracic cage due to multilevel cervical fusion. Radiculopathy or myelopathy can be accompanied. There were 2 patients who were diagnosed as KFS with exhibited radiological and physical characteristics. Both patients had stenosis and cord compression at C1 level due to anterior displacement of C1 posterior arch secondary to kyphotic deformity of upper cervical spine, which has been usually indicative to craniocervical fixation. One patient was referred due to quadriparesis detected after surgery for aortic arch aneurysmal dilatation. The other patient was referred to us due to paraparesis and radiating pain in all extremities developed during gynecological examinations. Decompressive C1 laminectomy was done for one patient and additional suboccipital craniectomy for the other. No craniocervical fixation was done because there was no spinal instability. Motor power improved immediately after the operation in both patients. Motor functions and spinal stability were well preserved in both patients for 2 years. In KFS patients with myelopathy at the C1 level without C1-2 instability, a favorable outcome could be achieved by a simple decompression without spinal fixation.

The Effects of Spinopelvic Parameters and Paraspinal Muscle Degeneration on S1 Screw Loosening

OBJECTIVE: To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. METHODS: We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. RESULTS: Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was 7.3+/-4.1 months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). CONCLUSION: In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

Clinical Outcomes of CyberKnife Radiotherapy in Prostate Cancer Patients: Short-term, Single-Center Experience

PURPOSE: In this retrospective study, we analyzed the outcomes of prostate cancer patients treated with the CyberKnife radiotherapy system (Accuray). MATERIALS AND METHODS: Between 2007 and 2010, 31 patients were treated for prostate cancer by use of the CyberKnife radiotherapy system. After excluding six patients who were lost to follow-up, data for the remaining 25 patients were analyzed. Patients were divided into the CyberKnife monotherapy group and a postexternal beam radiotherapy boost group. Clinicopathologic features and treatment outcomes were compared between the groups. The primary endpoint was biochemical recurrence-free survival period based on the Phoenix definition. Toxicities were evaluated by using the Radiation Therapy Oncology Group scoring criteria. RESULTS: Of 25 patients, 17 (68%) and 8 (32%) were classified in the monotherapy and boost groups, respectively. With a median follow-up of 29.3 months, most of the toxicities were grade 1 or 2 except for one patient in the boost group who experienced late grade 3 gastrointestinal toxicity. The overall biochemical recurrence rate was 20% (5/25) and the median time to biochemical recurrence was 51.9 months. None of the patients with low or intermediate risk had experienced biochemical recurrence during follow-up. Among D'Amico high-risk populations, 16.7% (1/6) in the monotherapy group and 50.0% (4/8) in the boost group experienced biochemical recurrence. CONCLUSIONS: Our data support that prostate cancer treatment by use of the CyberKnife radiotherapy system is feasible. The procedure can be a viable option for managing prostate cancer either in a monotherapy setting or as a boost after conventional radiotherapy regardless of the patient's risk stratification.

Analyzing the Effect of Distance from Skin to Stone by Computed Tomography Scan on the Extracorporeal Shock Wave Lithotripsy Stone-Free Rate of Renal Stones

PURPOSE: To determine whether the distance from skin to stone, as measured by computed tomography (CT) scans, could affect the stone-free rate achieved via extracorporeal shock wave lithotripsy (ESWL) in renal stone patients. MATERIALS AND METHODS: We retrospectively reviewed the records 573 patients who had undergone ESWL at our institution between January 2006 and January 2010 for urinary stones sized from about 5 mm to 20 mm and who had no evidence of stone movement. We excluded patients with ureteral catheters and percutaneous nephrostomy patients; ultimately, only 43 patients fulfilled our inclusion criteria. We classified the success group as those patients whose stones had disappeared on a CT scan or simple X-ray within 6 weeks after ESWL and the failure group as those patients in whom residual stone fragments remained on a CT scan or simple X-ray after 6 weeks. We analyzed the differences between the two groups in age, sex, size of stone, skin-to-stone distance (SSD), stone location, density (Hounsfield unit: HU), voltage (kV), and the number of shocks delivered. RESULTS: The success group included 33 patients and the failure group included 10. In the univariate and multivariate analysis, age, sex, size of stone, stone location, HU, kV and the number of shocks delivered did not differ significantly between the two groups. Only SSD was a factor influencing success: the success group clearly had a shorter SSD (78.25+/-12.15 mm) than did the failure group (92.03+/-14.51 mm). The results of the multivariate logistic regression analysis showed SSD to be the only significant independent predictor of the ESWL stone-free rate. CONCLUSIONS: SSD can be readily measured by CT scan; the ESWL stone-free rate was inversely proportional to SSD in renal stone patients. SSD may therefore be a useful clinical predictive factor of the success of ESWL on renal stones.

Comparison of Clinical Efficacy of Finasteride and Dutasteride as 5-alpha Reductase Inhibitor / 대한남성과학회지

PURPOSE: To compare the clinical therapeutic efficacy of finasteride and dutasteride as 5-alpha reductase inhibitor (5-ARI) in the medical treatment of benign prostate hyperplasia. MATERIALS AND METHODS: From July 2007 to July 2010, 354 benign prostatic hyperplasia patients with combination medication : alpha blocker plus 5-ARI were enrolled. These patients were classified into a finasteride medication group (F group) and dutasteride medication group (D group) retrospectively. We initially measured the total prostate volume (TPV), prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), quality of life score (QoL), maximal flow rate (Qmax), and post-void residual urine (PVR). After at least twelve months of medication, we rechecked these clinical parameters and during medication, side effects related to medication were also recorded. RESULTS: The F group (n=129) and D group (n=225) showed no differences in baseline characteristics for age, TPV, IPSS, QoL scores, or PSA. After medication, decreases in TPV were relatively higher in the D group than the F group (28.2% vs 20.5%). In addition, the decrease in PSA (43.6% vs 39.2%) and IPSS score (4.6 vs 3.5) were also higher in the D group. There were no significant differences in QoL score, Qmax, PVR change, or side effects between the two groups. CONCLUSIONS: Dutasteride showed greater efficacy in reduction of TPV and PSA and in symptomatic improvement by IPSS score than finasteride. More large scale studies about the differences on clinical efficacy of finasteride and dutasteride are needed.

Prostate-Specific Antigen Density as a Powerful Predictor of Extracapsular Extension and Positive Surgical Margin in Radical Prostatectomy Patients with Prostate-Specific Antigen Levels of Less than 10 ng/ml

PURPOSE: To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. MATERIALS AND METHODS: From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. RESULTS: The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. CONCLUSIONS: PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.

Analysis of Initial Baseline Clinical Parameters and Treatment Strategy Associated with Medication Failure in the Treatment of Benign Prostatic Hyperplasia in Korea / 대한배뇨장애요실금학회지

PURPOSE: To analyze the baseline clinical factors and medication treatment strategy used in cases with medication treatment failure of benign prostatic hyperplasia (BPH). METHODS: From January 2006 to December 2009, 677 BPH patients with at least 3 months of treatment with medication were enrolled. We analyzed clinical factors by medication failure (n=161) versus maintenance (n=516), by prostate size (less than 30 g, n=231; 30 to 50 g, n=244; greater than 50 g, n=202), and by prostate-specific antigen (PSA) levels (less than 1.4 ng/mL, n=324; more than 1.4 ng/mL, n=353). RESULTS: Age, combination medication rate, PSA, and prostate volume were statistically different between the medication treatment failure and maintenance groups. By prostate size, the PSA and medication failure rates were relatively higher and the medication period was shorter in patients with a prostate size of more than 30 g. The combination medication rate was higher in patients with a prostate size of more than 50 g. The medication failure rate and prostate volume were higher in patients with a PSA level of more than 1.4 ng/mL. However, the combination treatment rate was not significantly different in patients with a PSA level lower than 1.4 ng/mL. Suggestive cutoffs for combination medication are a prostate volume of 34 g and PSA level of 1.9 ng/mL. CONCLUSIONS: The clinical factors associated with medication failure were age, treatment type, and prostate volume. Combination therapy should be considered more in Korea in patients with a PSA level higher than 1.4 ng/mL and a prostate volume of between 30 and 50 g to prevent medication failure.

Early Experience of Prostate Cancer Treated with CyberKnife(TM) Radiotherapy

PURPOSE: We investigated the outcome in patients with prostatic cancer treated by means of CyberKnife(TM) radiotherapy. MATERIALS AND METHODS: Between July 2007 and April 2009, 16 patients with prostate cancer underwent CyberKnife(TM) radiotherapy. The histologic diagnosis was established by transrectal ultrasonography-guided biopsy. Radiotherapy was performed for a dose of 34 Gy at 8.5 Gy per day over 4 to 18 days. Nine patients were treated with hormone therapy. After treatment, prostate-specific antigen (PSA) relapse was evaluated with periodic PSA follow-up. RESULTS: The numbers of patients in clinical stages T2 and T3 were 13 and 3, respectively. Two patients had lymph node metastasis with no distant metastasis. The numbers of patients with a Gleason grade of 5, 6, 7, 8, and 9 were 1, 5, 4, 3, and 2, respectively. The mean time to PSA nadir and the mean PSA at nadir were 7 months and 0.43 ng/ml, respectively. To date, there has been no biochemical failure or clinical recurrence. No severe complications were observed in any patients; observed minor complications [n (%)] were perianal pain [2 (12.5%)] and defecation discomfort [2 (12.5%)]. CONCLUSIONS: Generally good responses were observed in patients treated with CyberKnife(TM) radiotherapy for prostate cancer. No severe complications were observed. More patients and a longer follow-up are required for further conclusions.

The Effect of Finasteride on Microvessel Density and Expression of Vascular Endothelial Growth Factor and 5alpha-Reductase in Prostatic Hyperplasia

PURPOSE: Vascular endothelial growth factor (VEGF), a potent stimulator of angiogenesis and microvessel density (MVD), which is an important indicator of neoangiogenesis, were independently evaluated to elucidate the mechanism of decreased bleeding observed in patients treated with finasteride, an inhibitor of 5alpha-reductase (5AR). We evaluated MVD and the expression of VEGF and 5AR type II in patients with benign prostatic hyperplasia (BPH) treated with finasteride. MATERIALS AND METHODS: The study included 61 patients undergoing transurethral prostatectomy (TURP) for BPH. Among these patients, 29 had well-preserved paraffin blocks, 13 of whom were given finasteride for a minimum of 3 weeks before surgery; the remaining 16 patients served as controls. MVD was calculated by counting the number of positively stained blood vessels on 5 random, high-power fields within the prostatic section. Expressions of VEGF and 5AR type II were analyzed with a confocal laser scanning microscope and an image analyzer. RESULTS: Prostatic MVD was significantly lower in the finasteride-treated group (p<0.05). The expression of VEGF and 5AR type II at the level of the prostatic glandular epithelium and stroma was not significantly different between the 2 groups. VEGF and 5AR type II were more strongly expressed in the epithelium of both groups than in stromal smooth cells (p<0.05). CONCLUSIONS: Finasteride treatment had no clear effect on the expression of VEGF or 5AR type II. It is possible, however, that finasteride improves blood loss after TURP and BPH-induced hematuria by reducing MVD. Further study on the mechanism of MVD reduction is needed.

Association between Lower Urinary Tract Symptoms and Erectile Dysfunction in Aging Men: Hallym Aging Study / 대한비뇨기과학회지

PURPOSE: The aim of this study was to investigate the relationship between lower urinary tract symptoms(LUTS) and erectile dysfunction(ED) in a population-based cohort study, Hallym Aging Study(HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 300 men aged > or=50 years, who underwent detailed health evaluations, includeing health-related questionnaires, evaluation of the medical history and various life style factors as well as clinical measurements, were included in the study. LUTS and ED were assessed by validated questionnaires, the International Prostate Symptom Score(IPSS) and a 5-item version of the International Index of Erectile Function(IIEF-5). RESULTS: The prevalence and severity of LUTS and ED increased and significantly with age(p<0.001). The IIEF-5 score declined as the severity of LUTS increased in each age group. There was a significant negative correlation between the IPSS score and the IIEF-5 score(age adjusted r= ?0.275, p<0.001). The multivariate logistic regression analysis, controlling for age and comorbidities, showed that men with moderate/ severe LUTS were 4-9 times more likely to have ED than men with no/mild LUTS; in addition, men with ED were 5 times more likely have moderate/severe LUTS than men without ED. CONCLUSIONS: The presence and severity of LUTS were independent risk factors for ED and vice versa. These results highlight the clinical importance of evaluating LUTS in patients with ED, and the need to consider the presence of ED in the management of patients with LUTS

477 Bladder Calculi in a Patient with Benign Prostatic Hyperplasia

We report on a patient with 477 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.

Accessory Scrotum Associated with a Perineal Lipoma / 대한비뇨기과학회지

The presence of accessory scrotum is a condition characterized by additional scrotal tissue with a normally developed scrotum. The condition is extremely rare and can be associated with a perineal lipoma. Herein, a case of accessory scrotum associated with a perineal lipoma is reported in a 4-day-old boy. He presented with a perineal mass and the diagnosis was confirmed by surgical excision and subsequent histological analysis. This is the first Korean report of an accessory scrotum associated with perineal lipoma. (Korean J Urol 2007;48:1096-1098)

The Change of Bladder Function after Neurosurgery in Patients with Lipomyelomeningocele / 대한비뇨기과학회지

PURPOSE: To prevent further neurological deterioration by tethering of the spinal cord, an early surgical procedure for asymptomatic lipomyelomeningocele (LMMC) can be performed. The neurogenic bladder patterns, degree of improvement according to timing of surgery, and the relationship between the change in the upper urinary tract and neurogenic bladder pattern were evaluated. MATERIALS AND METHODS: A retrospective chart review was performed on all 39 patients, before and after primary neurosurgical repair of LMMC, who presented between 1996 and 2003. RESULTS: Preoperative urodynamics (UDS) revealed a neurogenic bladder in 23 patients (59%). Of these 23 patients, 16 had a hyperreflexic and 7 an areflexic bladder. Of the 16 who had a hyperreflexic bladder, 4 and 2 were changed to normal and areflexic bladders, respectively, but 10 remained unchanged postoperatively. In 3 patients repeated UDS was performed, with 1 remaining unchanged, but 2 changed to an areflexic bladder. Of the 7 patients with an areflexic bladder, 1 changed to a hyperreflexic bladder, but 6 remained unchanged postoperatively. All 3 patients who underwent a repeated UDS remained unchanged. Hydronephrosis was noted on ultrasonography in 3 patients. The degree of improvement according to the timing of surgery was not statistically significant. All 16 patients who had a normal bladder remained unchanged postoperatively, and 2 patients who underwent repeated UDS changed to a hyperreflexic bladder. CONCLUSIONS: Even when pre- and postoperative UDS reveal a normal bladder function, long-term follow-up through UDS is still required. The use of routine preoperative and periodic postoperative urodynamic evaluations is important in children with LMMC, but without clinically overt symptoms.

Neonatal Adrenal Hemorrhage Presenting as Acute Scrotum / 대한비뇨기과학회지

There has been only 23 cases of neonatal adrenal hemorrhage presenting as an acute scrotum and unnecessary surgical exploration was performed in nine of these case(39%) due to suspected testicular torsion. We report here on a case of a 2-day-old boy with neonatal adrenal hemorrhage, and he presented with an acute scrotum; this child's condition was managed conservatively.

The Effect of Tape-tension Change on Outcome of Tension-free Vaginal Tape Procedure and Voiding Function

PURPOSE: The aim of this study was to investigate the effect of tape-tension on outcome of tension-free vaginal tape(TVT) procedure and voiding function. MATERIALS AND METHODS: We included 62 women patients with stress urinary incontinence. The patients were randomized into two groups and underwent the TVT procedure according to the standard method with some modifications. In group I(n=28), the position of the tape was adjusted with no tension by placing Mayo scissors between the tape and urethra and in group II(n=34), the tape was placed in the same fashion except that create 5mm-long tape loop under urethra for more loosening the tape-tension than that of group I. The success rate of TVT, the rate of postoperative voiding dysfunction and pre- and postoperative quality of life(QOL), peak urinary flow rate(Qmax), post-void residual(PVR) were compared between the two groups. RESULTS: There were no significant differences in success rate and improvement of QOL between the groups. In group I, Qmax was significantly decreased and the PVR was significantly increased after TVT compared with group II. The voiding dysfunction after TVT occurred in 3(10.7%) and 1(2.9%) in group I, II respectively, and there was no significant difference. CONCLUSIONS: These data suggest that some loosening of the tape-tension in TVT procedure has no effect on the success of TVT and improvement of QOL. By some loosening of the tape-tension, postoperative voiding function could be improved and this finding would be helpful especially in patients with preoperative risk factor for voiding dysfunction after TVT.

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.