Outcomes of the Holmium Laser Enucleation of the Prostate for Patients With Prior Benign Prostatic Hyperplasia Surgery

BACKGROUND: To assess the functional outcomes and morbidity in patients undergoing holmium laser enucleation of the prostate (HoLEP) with and without previous transurethral prostate surgery. METHODS: Patients were stratified into two groups, 558 patients who underwent primary HoLEP (group I) and 50 patients who underwent 'secondary-HoLEP' with prior transurethral prostate surgery (group II). RESULTS: There were no significant differences in the preoperative parameters (median age, International Prostate Symptom Score [IPSS], prostate-specific antigen [PSA], prostate volume, maximum urinary flow rate [Qmax], and postvoid residual urine volume [PVR]). No significant intraoperative differences were noted in the use of total energy, resected volume, enucleation time, resection efficiency, and mean catheterization time. There were significant improvements in Qmax, PVR, and IPSS in both groups. Complications in groups I and II included 19 (3.1%) and 1 (2.0%) bladder injuries, 25 (4.4%) and 2 (4.0%) recatheterization for transient voiding difficulty, 20 (3.5%) and 2 (4%) cases of severe hematuria requiring additional treatment, and 5 (0.8%) and 0 cases for remorcellation due to remaining adenoma. Transient incontinence was the most common complication for both groups I and II, 30 cases (5.4%) and 3 cases (6.0%) respectively. Urinary tract infection showed improvement subsequent to antibiotic treatment. During the 6 month follow-up period, urethral stricture occurred in 7 cases (1.3%) for group I and in 1 case (2.0%) for group II. CONCLUSION: There were no significant differences in functional outcomes and morbidity between the two groups. 'Secondary-HoLEP' seems to be effective and safe for patients with prior BPH surgery.

Application of the Modified Clavien Classification System to 402 Cases of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

PURPOSE: We attempted to evaluate the perioperative complications of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by using the modified Clavien classification system (MCCS). MATERIALS AND METHODS: Targeting 402 patients who underwent HoLEP for benign prostatic hyperplasia performed by a single surgeon between July 2008 and January 2011, we investigated complications that occurred during and within 1 month after surgery and classified them into grade I to grade V on the basis of the MCCS. If two or more complications occurred in one patient, each complication was graded and counted. RESULTS: The mean age, prostate volume, operation time, hospital stay, and average follow-up period of 402 patients who underwent HoLEP were 68.8 years (range, 52-84 years), 53.2 g (range, 23-228 g), 58.2 minutes (range, 20-230 minutes), 4.5 days (range, 2-7 days), and 9 months (range, 4-27 months), respectively; 78 complications occurred in 71 of the patients (morbidity rate, 17.6%). In MCCS grade I, complications occurred in 54 cases (69.2%); in grade II, complications occurred in 19 cases (24.3%); in grade III, complications occurred in 4 cases (5.1%); and in grade IV, 1 patient required intensive care unit care because of cerebral infarction (1.2%). There were no grade V complications. CONCLUSIONS: The HoLEP-based MCCS complications classification was performed very quickly. However, MCCS, when compared with other measures of endoscopic prostate surgery experiences, including HoLEP, exposed the lack of accuracy in low grade classification and the inability to include late complications.

Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Holmium Laser Enucleation of the Prostate: Modified Morcellation Technique and Results

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Are There Risk Factors for Persistent Urge Urinary Incontinence after the Transobturator Tape (TOT) Procedure in Mixed Urinary Incontinence?

PURPOSE: We wanted to identify factors predicting persistent urge urinary incontinence (UUI) after the transobturator tape (TOT) procedure in patients with mixed urinary incontinence (MUI). MATERIALS AND METHODS: Of 293 patients who underwent a TOT procedure from May 2007 to August 2010, 175 MUI patients had at least one 6-month follow-up visit. Preoperative evaluations including history taking, physical examination, urinalysis, urine culture, uroflowmetry, postvoid residual (PVR), urodynamic studies (UDS), and symptom questionnaire were performed. After the operation, surgical outcome and patient satisfaction were assessed by symptom questionnaire, uroflowmetry, PVR, and stress test. Statistical analysis was carried out to determine the possible factors influencing persistent UUI after the TOT procedure. RESULTS: Of 175 patients with MUI, 51 (29.1%) had persistent UUI after the TOT procedure. In a univariate analysis, age (p=0.012) and previous anticholinergic use (p=0.040) were found to be associated with persistent UUI. However, only age (adjusted odds ratio, 3.317; 95% confidence interval, 1.015-12.060; p=0.036) was an independent risk factor in the multivariate analysis. CONCLUSIONS: Our findings suggested that women who are older than 65 years may have an increased likelihood of persistent UUI after a TOT procedure. Clinicians should consider the possibility of persistent postoperative UUI in elderly women with mixed incontinence.

Acute Urinary Retention due to Aseptic Meningitis: Meningitis-Retention Syndrome / 대한배뇨장애요실금학회지

Acute urinary retention in aseptic meningitis is rarely encountered, and the diagnosis of aseptic meningitis may be less than straightforward, because its symptoms and neurological signs are occasionally mild or absent. We report a case in which acute urinary retention provided an appropriate indication for the diagnosis of aseptic meningitis as the cause of an undiagnosed fever.

Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: Effectiveness, Safety, and Overcoming of the Learning Curve

PURPOSE: To examine the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the surgical treatment of benign prostatic hyperplasia and to estimate the time to overcome the learning curve. MATERIALS AND METHODS: From May 2008 to October 2009, 164 consecutive patients treated with HoLEP were enrolled in this study. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and at 6 weeks and 3, 6, 12, and 18 months postoperatively. The 164 study subjects were divided into 3 groups (group 1 the first 50 patients treated, group 2 the second 50, and group 3 the third 64), and perioperative data and complications were analyzed in these groups to determine the learning curve. In addition, the inverse and upward techniques were compared in terms of the effects and the stability of morcellation. RESULTS: The mean patient age was 69 years, and the average operation time was 62 minutes (range, 20-208 minutes). Mean prostate volume was 54.2 ml and mean resected tissue weight was 18.6 g. Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence (8.5%), urinary retention (4.3%), hematuria (3.0%), urinary tract infection (1.2%), and urethral stricture (0.6%), and intraoperative complications were minor capsular perforation (4%) and bladder injury (8%). CONCLUSIONS: HoLEP was found to be effective and safe regardless of prostate size. We recommend that a systematic educational program be established to reduce the learning curve.

Differential alternative splicing of human transglutaminase 4 in benign prostate hyperplasia and prostate cancer

Transglutaminase 4 is a member of enzyme family that catalyzes calcium-dependent posttranslational modification of proteins. Although transglutaminase 4 has been shown to have prostate-restricted expression pattern, little is known about the biological function of transglutaminase 4 in human. To gain insight into its role in prostate, we analyzed the expression status of human transglutaminase 4 in benign prostate hyperplasia (BPH) and prostate cancer (PCa). Unexpectedly, RT-PCR and nucleotide sequence analysis showed four alternative splicing variants of transglutaminase 4: transglutaminase 4-L, -M (-M1 and -M2) and -S. The difference between transglutaminase 4-M1 and -M2 is attributed to splicing sites, but not nucleotide size. The deduced amino acid sequences showed that transglutaminase 4-L, -M1 and -M2 have correct open reading frames, whereas transglutaminase 4-S has a truncated reading frame. RT-PCR analysis of clinical samples revealed that transglutaminase 4-M and -S were detected in all tested prostate tissue (80 BPH and 48 PCa). Interestingly, transglutaminase 4-L was found in 56% of BPH (45 out of 80) and only in 15% of PCa (7 out of 48). However, transglutaminase 4-L expression did not correlate with serum prostate-specific antigen (PSA) level, prostate volumes or PSA densities. These results will provide a clue to future investigation aiming at delineating physiological and pathological roles of human transglutaminase 4.

The Relationship of Pressure-Flow Parameters and Urethral Pressure in Female Patients with Lower Urinary Tract Symptoms

PURPOSE: This study aimed to evaluate the relationship between pressure-flow parameters and urethral pressure in women with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Urodynamic traces of women with stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and detrusor overactivity (DO) were retrospectively studied. The urodynamic parameters such as detrusor opening pressure (DOP), detrusor pressure at maximum flow rate (PdetQmax), maximum flow rate (Qmax), detrusor closing pressure (DCP), and maximal urethral closing pressure (MUCP) were measured and compared. The relationship between pressure-flow parameters and MUCP were evaluated as well as the differences between each urodynamic group. RESULTS: One hundred fifty-one women were investigated between June 2004 and May 2008. One hundred twenty-one (80%) women had good-quality urodynamic studies and were included in the present study. The mean age was 56 years (range, 32-77). Women with DO had higher DOP, PdetQmax, and MUCP than did women with SUI (p<0.05). Qmax was significantly greater in women with SUI than in women who had DO (p<0.05). Women with MUI had DOP, PdetQmax, and Qmax that were intermediate between women with SUI and those with DO. There was a significant positive correlation between DOP, PdetQmax, DCP, and MUCP measurements and a significant negative correlation between Qmax and MUCP measurements (p<0.01). CONCLUSIONS: Pressure-flow parameters are reliable surrogates of urethral pressure. Therefore, an accurate evaluation of the pressure-flow parameters might give important information in the assessment of urethral and detrusor function in women with LUTS. Further study is needed to confirm our results.

The Efficacy and Safety of Combination Therapy with Alpha-Blocker and Low-Dose Propiverine Hydrochloride for Benign Prostatic Hyperplasia Accompanied by Overactive Bladder Symptoms

PURPOSE: We evaluated the efficacy and safety of combined therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) in patients with benign prostatic hyperplasia (BPH) accompanied by overactive bladder (OAB) symptoms. MATERIALS AND METHODS: This prospective study enrolled 119 male patients with lower urinary tract symptoms (LUTS) with prostate volume of 20 ml or greater, International Prostate Symptom Score (IPSS) of more than 8, and OAB symptoms from May 2007 to April 2008. Patients with post-void residual volume (PVR) over 100 ml were excluded. Among these patients, 74 patients were treated with tamsulosin 0.2 mg plus propiverine HCl 10 mg (group A) and 45 patients were treated with tamsulosin 0.2 mg only (group B). The clinical parameters, including IPSS, quality of life (QoL) score, uroflowmetry, and PVR were re-evaluated after 3 months. RESULTS: A total of 115 patients, including 70 in group A and 45 in group B, completed the study. IPSS, QoL score, voided volume, maximum flow rate (Qmax), and PVR showed significant improvement after 3 months of treatment (p0.05). Changes in the QoL score were -1.9+/-1.1 and -1.5+/-0.9 for group A and group B, respectively (p=0.043). Changes in all other parameters were not significantly different between the 2 groups (p>0.05). CONCLUSIONS: For those patients with LUTS due to BPH and concomitant OAB, combination therapy with an alpha-blocker (tamsulosin 0.2 mg) and low-dose anti-cholinergics (propiverine HCl 10 mg) may be a reasonable and effective therapeutic option as an initial therapy.

Iatrogenic Ureteral Injury: When and How to Treat?

Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries. The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing opinions on whether an initial conservative or immediate operative intervention is the best line of action. Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral injury may be associated with serious complications, so prompt recognition of ureteral injuries is important. Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best prevention.

Treatment of Renal Injury: Practical Approach / 대한비뇨기과학회지

Traumatic injuries are the leading cause of death in young people, and the renal injury is one of the major abdominal trauma. Hematuria is the most common sign of renal trauma, however the degree of hematuria and the severity of renal injury do not correlate consistently. Criteria for radiographic investigation is somewhat different according to the injury mechanism and an age. Excellent imaging modality such as computerized tomograph has made it possible to delineate not only detailed anatomic configuration for renal laceration itself but the presence of associated intra- abdominal organ injury. Renal injury may be presented as one of the multiple trauma, thus full evaluation for the overall injury severity of the patient is mandatory. Advanced supportive care techniques and awareness of the kidney's capacity for healing have facilitated non-operative management. Nowadays, operative exploration is indicated only in selected patients with major renal injury even in the patients with penetrating trauma, and high rates of renal reconstruction is possible through early vascular control. Urologic surgeon, as a major member of the trauma team, should be expertized in the surgical skills for reconstruction as well as acquiring up-to-date knowledge on diagnosis and management of renal trauma.

Endoscopic Primary Realignment under Open Cystostomy in the Patients with Posterior Urethral Rupture that were Impossible for Lithotomy Position, Accompanied by Pelvic Bone Fracture : Long-term Results / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the long-term results of endoscopic primary realignment of a posterior urethral rupture accompanied by a pelvic bone fracture. MATERIALS AND METHODS: Our study population consists of 7 patients who were able to be followed up for at least 5 years, of an initial 8 that underwent endoscopic primary realignment of a posterior urethral rupture due to a pelvic bone fracture. Operations were carried out in the following order; the bladder was incised to allow a metal sound, with stitching fiber then tied at its end so it could be advanced into the injured proximal urethra through the bladder neck. The fiber was then traced using a cystoscope and connected to a urethral catheter, which could be indwelled in the bladder by pulling the sound back. RESULTS: The mean follow-up period was 8.1 (5.2-9.7) years. The mean operation time was 48.3 (28-71) minutes. There were no severe disruptions of the pelvic hematoma, transfusions or other additive injuries during the operations. Post-operation complications were observed in 4 patients; 3 cases of mild urethral stricture, which were treated with an endoscopic intra-urethrotomy followed by clean intermittent catheterization, 3 cases of erectile dysfunction and 1 case each of urinary incontinence and a urethral stone. CONCLUSIONS: This study clearly implies that endoscopic primary realignment of a severe posterior urethral rupture accompanied by a pelvic bone fracture is less invasive and a safer method, without pelvic hemorrhage or additional injuries. Early endoscopic intervention also improves the quality of life by reducing the possibility of an invasive procedure, and also prevents severe urethral stricture and the resultant complications by maintaining the continuity of the urethra.

The Results of Performing the SPARC Procedure for Treating Female Stress Urinary Incontinence: A 14 Month Study / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the results of performing the suprapubic arc (SPARC) procedure during 14 months at our hospital for treating female stress urinary incontinence. MATERIALS AND METHODS: Between October 2002 and December 2003, 114 consecutive women who suffered with stress urinary incontinence underwent the SPARC procedure. All the patients were followed up for at least 1 year. The patients were preoperatively evaluated via taking their medical history, physical examinations, and conducting urinalysis and voiding cystourethrography and urodynamic studies, including determining the Valsalva leak point pressure (VLPP). Evaluations were conducted by questionnaires and interviews for determining the surgical outcome and the patients' satisfaction. RESULTS: The mean age was 48.6 years (30-70), the mean follow-up period was 16.4 months (12-25), the mean hospital stay was 3.8 days (2-10) and the mean operation time was 38.7 minutes. For 114 patients, 92 (80.7%) were cured and 17 (14.9%) were significantly improved. 99 patients (86.8%) were satisfied with the SPARC procedure, and 95 patients (83.3%) would like to recommend the SPARC procedure to others. Intraoperative complications included 9 (7.9%) bladder perforations and 1 (0.9%) urethral injury. Postoperative complications showed 14 cases (12.3%) of urinary retention, 2 cases (1.8%) of vaginal wound infections and 1 case (0.9%) of vaginal erosion due to tape. De novo urge incontinence was noted in 3 patients (2.6%). CONCLUSIONS: Favorable results were obtained from the SPARC procedure. This procedure is an effective and safe technique for the treatment of female stress urinary incontinence in terms of the low morbidity and the high success rate.

Comparison of Blunt Renal Injury between Children and Adults: Effect of the Causes on Severity of Renal Injury / 대한비뇨기과학회지

PURPOSE: This study was performed to determine whether pediatric patients are more susceptible for major renal injury than adults, and the reasons evaluated. MATERIALS AND METHODS: The medical records of 209 consecutive patients (47 children and 162 adults) with a blunt renal injury were retrospectively reviewed. The renal injuries were graded on a five point scale based on the results of computerized tomography. The causes of the blunt renal injury were classified into three groups; traffic accidents, falls and other blunt trauma. The degree of renal injury was compared according to the cause, and whether there were differences in the causes of renal injury and the number of patients with major renal injury between children and adults determined. RESULTS: The main cause of the renal injuries was traffic accidents in adult, but falls in pediatric patients. Overall 21 of the 47 children (44.7%) and 45 of the 162 adults (27.8%) had major renal injuries (p<0.05). 38 (52.8%) of the 72 patients were injured by falls, as opposed to traffic accidents, so there were significantly more fall induced major renal injuries (p<0.05). CONCLUSIONS: Children are more likely to sustain major renal injury from a blunt abdominal trauma, and the patients injured by falls have more severe renal injuries than those of other causes. Also, the main cause of a renal injury was traffic accidents in adult, but falls in pediatric patients. From the different origins of the causes of injury, as well as the unique pediatric anatomic structures, pediatric patients are more susceptible to major renal injury than adults.

The Long-term Outcome of Fascial Sling Operation in Female Stress Urinary Incontinence: Multicenter Study in Korea / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term outcomes of fascial sling operation conducted at multicenters in Korea. MATERIALS AND METHODS: 564 patients, who underwent fascial sling operation for stress urinary incontinence, between December 1996 and May 2001, at 10 institutions in Korea, were included in this study. They were all followed up for a period of at least 2 years. History taking, a physical examination, and urodynamic studies, including Valsalva leak point pressure (VLPP), were conducted before the operation. Postoperative symptoms and satisfaction were assessed using a questionnaire. The 269 (47.7%), 266 (47.2%) and 29 (5.1%) patients underwent operations with autologous rectus fascia, cadaveric allograft fascia and autologous fascia lata, respectively. RESULTS: The mean follow up period was 43.6 months, ranging from 24 to 77 months. Stress urinary incontinence was cured in 485 (86.0%) patients and improved in 31 (5.5%). In autologous fascia group, 252 (84.6%) patients were cured and 18 (6.0%) improved; whereas, in allograft fascia group 233 (87.6%) patients were cured and 13 (4.9%) improved. 253 (84.9%) patients with autologous fascia and 228 (85.7%) patients with allograft fascia were satisfied, making a total of 481 patients (85.3%) that were satisfied with the operation. According to the fascia length and preoperative VLPP value, there were no differences in the success and patient satisfaction rates. There were 197 (34.9%) patients with preoperative urge urinary incontinence, and 92 (46.7%) of these were either cured or improved postoperatively. However, de novo urge urinary incontinence was noted in 8 patients (1.4%). CONCLUSIONS: Our results suggest that the long-term outcome of fascial sling operation for the treatment of stress urinary incontinence was satisfactory.

Surgical Management of Chronic Lymphedema of Penis and Scrotum / 대한비뇨기과학회지

Chronic lymphedema of the penis and scrotum is a rare disease in Korea. Lymphedema can be defined as an accumulation of excessive lymph, proteins, chronic inflammation, edema and fibrosis, secondary to the impairment of the lymph vessels, which can be classified into primary, which is the result of inadequate drainage of lymph caused by agenesis and hypogenesis of lymph vessels, and secondary, which could be due to an obstruction or interruption of the lymphatic system, caused by malignancies, post-operative, post-radiation fibrosis, infection, trauma or excision. The treatment method for a lymphedema of the genitalia is determined by cause, which is crucial to the natural course of the disease. In contrast to a primary lymphedema without soft tissue changes and injury, which could be treated conservatively, surgical excision is the best method to treat a chronic lymphedema with soft tissue changes. In this article, a case of penile and scrotal chronic lymphedema of unknown cause, treated with surgical methods, is reported.

Incidence of Concomitant Procedures for Pelvic Organ Prolapse and Reconstruction in Women Who Undergo Sling Operation for Stress Urinary Incontinence

PURPOSE: To determine the incidence of concomitant procedures performed for pelvic organ prolapse or vaginal reconstruction at the time of surgery for stress urinary incontinence in contemporary urologic practice. MATERIALS AND METHODS: We retrospectively examined all concomitant procedures for pelvic organ prolapse or vaginal reconstruction in 279 women who had underwent sling operation for stress urinary incontinence at our institution. The subjects presented with stress urinary incontinence underwent history taking, physical examination and urologic investigations such as standing cystourethrography and urodynamic study including Valsalva leak point pressure. RESULTS: Of 279 women, 64(22.9%) had at least one concomitant procedure performed for pelvic organ prolapse or vaginal reconstruction, including 43(15.4%) cystocele repairs, 24(8.6%) rectocele repairs, 6(2.2%) cystocele and rectocele repairs concurrently, 2(0.7%) vaginal hysterectomy and 1(0.4%) urethral diverticulectomy. CONCLUSION: We found that women who undergo surgery for stress urinary incontinence had a high incidence(22.2%) of associated pelvic organ prolapse requiring surgical repair. These additional maneuvers contributed to the overall success of surgery and should not be overlooked.

The Change of Urgency and Effect on Patient Satisfaction after Sling Operations for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Persistence of urgency in women after anti-incontinence surgeries is a distressing problem. We compared post-operative outcome of urgency according to clinical factors and urodynamic findings. And we evaluated the effects of post-operative persistent or de novo urgency on patient satisfaction. MATERIALS AND METHODS: Medical records of 279 consecutive women who had undergone modified fascial sling operation were reviewed. Motor urge defined as urgency with detrusor instability, and patients with urgency but no demonstrable detrusor instability on urodynamic study were diagnosed as sensory urge. Post-operative symptoms and satisfaction were assessed by questionnaire. RESULTS: Of the 279 patients, 53 with motor urge and 115 with sensory urge had pre-operative urgency. Cure or improvement in urgency occurred in 45 (84.9%) and 5 (9.4%) of the motor urge, and 70 (60.9%) and 23 (20.0%) of sensory urge cases, respectively (p<0.05). 105 (84.0%) of 125 patients with cure or improvement of urgency were satisfied for the operation, however, de novo urgency was noted in 8 patients (2.9%) and only 34 (66.7%) of 51 patients with persistent urgency or de novo urgency were satisfied (p<0.05). CONCLUSIONS: Our results suggest that we can predict cure or improvement of urgency with resolution of stress urinary incontinence after sling operation in many patients, and patients with motor urge are more likely to have urgency resolution after sling operations than those with sensory urge. Among various factors, post-operative outcome of urgency has a considerable effect on patient satisfaction.

Different Clinical Manifestations of Penile Fracture According to Patients Age / 대한비뇨기과학회지

PURPOSE: Penile fracture is a traumatic injury of the tunica albuginea of the corpus cavernosum during the erectile state. The aims of this study were to evaluate whether the differences of clinical manifestations according to age is present or not in the patients with penile fracture. MATERIALS AND METHODS: This study included 52 patients that were admitted to the department of urology after being diagnosed with penile fracture. History taking, physical examination, radiographic study, and operation were performed as needed. We divided patients into two groups on the basis of 40 years old, and we compared clinical manifestations and operative findings between the two groups. RESULTS: The mean age of patients was 41.4, and the most common cause of injury was sexual intercourse in both groups, but the elapsed time from the injury to arrival at hospital was longer in the young age group than the middle age group (p<0.05). In the aspect of the rupture of tunica albuginea, injury to the right and proximal part of the penis was most common in both groups. Transverse rupture was more prevalent, and the length of the rupture line was also longer in the middle and old age group (p<0.05). CONCLUSIONS: This study supports that sexual intercourse is the most common cause of penile fracture in our country, and the majority of both groups have rupture of tunica albuginea at the right proximal part of the penis. However, the degree of rupture is severe, and elapsed time from the injury to arrival at hospital was relatively shorter in the middle and old age group than the young age group.