Surgical Considerations for Recurrent Stress Urinary Incontinence after the Midurethral Sling Procedure: Redo Midurethral Sling and Shortening of the Tape / 대한비뇨기과학회지

PURPOSE: There are no clear-cut guidelines of how to treat patients who have failed after a tension-free midurethral sling (MUS) procedure. We describe our experience with repeat MUS procedures and transvaginal shortening of the previously implanted tape for those patients with an initially failed MUS procedure. MATERIALS AND METHODS: We reviewed the medical records of the patients who failed with their initial MUS procedure and then had a second operation. Of the 20 women, 14 patients had repeat MUS and another 6 patients underwent shortening of the implanted tape. Repeated MUS was done by either the retropubic or transobturator pathway. Shortening of the tape was done with a metal hemoclip to shorten the previously implanted tape. The preoperative characteristics and the intraoperative and postoperative data were assessed by reviewing the operative notes, medical records and office notes. RESULTS: The mean interval between the first and repeat procedures was 8.4 months (range: 1-48). The mean follow up time after the second operation was 29.9 months (range: 7-70). Seven patients underwent repeat MUS instead of tape shortening because the implanted tape had migrated or severe adhesions were noted on the intraoperative findings. Ten (71.4%) of 14 patients who underwent repeat MUS achieved full continence, while 4 patients (28.6%) had significant improvement. Of the patients with tape shortening, 4 (66.6%) achieved full continence, one (16.7%) improved and one (16.7%) was failed. CONCLUSIONS: Based on our limited experience, a repeat MUS sling procedure or tension revision of the tape might be an effective treatment for the patients with failed MUS.

Ureteral Obstruction Caused by Periureteral Tuberculous Granuloma after Intravesical BCG Therapy for Superficial Bladder Tumors / 대한비뇨기과학회지

Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis (M. bovis) that has been used to treat transitional cell carcinoma. Since the initial report by Morales and associates on the use of intravesical BCG for the treatment of recurrent superficial bladder tumors, intravesical therapy with BCG has proved to be more effective for prophylaxis and the treatment of superficial bladder tumors and carcinoma in situ than most of the standard chemotherapeutic agents. While the majority of patients tolerate BCG treatments well, a number of adverse reaction (e.g., fever, hematuria, dysuria, nausea and malaise) have been reported. More serious complications occur on rare occasions and they include pneumonitis/hepatitis, ureteral obstruction, renal abscess and sepsis. We report here on a case of ureteral obstruction that was caused by periureteral tuberculous granuloma after intravesical BCG therapy for superficial bladder tumors, and the condition required distal ureterectomy & ureteroneocystostomy.

Vesicosigmoidal Fistula Caused by Diverticulitis / 대한비뇨기과학회지

Enterovesical fistula is a relatively uncommon complication involving colorectal and pelvic malignancies, intestinal diverticulitis, inflammatory bowel disease, radiotherapy and trauma in Asian countries. A 77-year-old male was referred with complaints of difficult urination, frequency, nocturia and abdominal discomfort. On admission, fever and fecaluria were present. Various diagnostic procedures such as excretory urography, cystography, cystoscopy, rectoscopy and pelvic computed tomography (CT) scan were performed. Under the impression of vesicosigmoidal fistula, segmental resection of the sigmoid colon with partial cystectomy was performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesicosigmoidal fistula.