The Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence: long-term follow-up results

PURPOSE: Sling operation has been known the best treatment of woman with anatomical urinary incontinence(AI) and intrinsic sphincteric deficiency(ISD). We evaluated the clinical outcome of anterior vaginal wall sling as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Thirty three patients with stress urinary incontinence who treated with anterior vaginal wall sling from October 1995 to March 2000 were analyzed. Patients were evaluated preoperatively with history, physical examination, voiding cystourethrography, evaluation with SEAPI classification and urodynamic study including of Valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). All patients were assessed for the outcome of the procedure and subjective satisfaction by questionnaires. Surgical outcomes were then analyzed in relation to VLPP , MUCP and subjective SEAPI score. Of the total 33 patients, 26(78.8%) had AI and 7(21.2%) had ISD. According to the Stamey grades, 6(18.2%) were grade I, 23(69.7%) were grade II and 4(12.1%) were grade III. RESULTS: With a mean follow-up of 42.4 months (range 14 to 66). Urinary incontinence completely disappeared in 20 patients(60.6%), significantly improved in 8 patients(24.2%), failed in 5 patients(15.2%). Complication included urinary retention in two patients, suprapubic pain in two patients, and urge incontinence in two patients. Pre- and postoperative urge incontinence was major factor for failure rate. CONCLUSIONS: Anterior vaginal sling operation is a simple, safe and effective procedure for treatment of both AI and ISD. The urge incontinence is closely related to success rate.

The Effect of Hyperthermia on Chemosensitivity of Renal Cell Carcinoma Cell Lines in vitro / 대한비뇨기과학회지

PURPOSE: Cellular biology of response to hyperthermia was understood and localizing hyperthermic equipments were developed recently. It was known that hyperthermia suppressed renal cell carcinoma cell growth in vitro and increased the sensitivity of chemotherapeutic agents in malignant melanoma. We investigated the effect of hyperthermia on chemosensitivity of renal cell carcinoma cell lines in vitro. MATERIALS AND METHODS: Human renal cell carcinoma cell lines, Caki-1(negative multidrug-resistance) and A-498(positive multidrug-resistance) were used. Chemotherapeutic agent(cisplatin or adriamycin) was added to media with appropriate cell counts and hyperthermia(43oC) was applied in 2 and 4 hours duration. The cell growth was measured by MTT colorimetric assay and each experiment was repeated eight times. The effects of hyperthermia on chemosensitivity of renal cell carcinoma cell lines were compared using dose modification factor(DMF) of IC50 of chemotherapeutic agents. RESULTS: In 2-hour treatment at 43oC, the cell growth suppression of Caki-1 and A-498 were 15% and 16% respectively and in 4-hour treatment, the suppression percentage was increased to 36% and 46% respectively. In Caki-1 cell lines, DMFs of cisplatin treated groups in 2 and 4 hour hyperthermia were 0.9 and 0.8 respectively and DMFs of adriamycin treated groups were 0.9 and 0.9 respectively. There was no change of chemosensitivity in Caki-1. In A-498 cell lines, DMFs of cisplatin with 2 and 4 hour hyperthermia groups were 0.7 and 0.4 respectively and DMFs of adriamycin treated groups were 0.9 and 0.5 respectively. Thus, 4 hours hyperthermia increased the chemosensitivity in A-498 cell lines. CONCLUSIONS: These results suggest that hyperthermia increased the chemosensitivity of renal cell carcinoma cell lines in vitro but there was some difference in each cell line. It is necessary to investigate what the mechanism of increasing chemosensitivity is and what affects a difference of chemosensitivity in each cell line.

Acute Renal Infection: Recent Experience and Clinical Value of Renal Ultrasonography / 대한비뇨기과학회지

PURPOSE: We investigated if there are some differences in characteristic of recent renal infection from the past one and evaluated the need of ultrasonography in acute renal infection and the efficiency of antibiotics that have been used primarily in treatment of past renal infection. MATERIALS AND METHODS: We reviewed charts of 232 patients with acute renal infection retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The laboratory tests such as complete blood count, urinalysis and urine culture with sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory urography or voiding cystourethrography were performed. RESULTS: The most common age groups were 3rd decade(26.7%) and 4th decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal ultrasonography was done in 90.5%, but 74.8% of them were completely normal and most of abnormal findings at abdominal ultrasonography were clinically insignificant. Result of ultrasonography did not affect the outcome of the disease or the treatment plan. The significant bacterial isolation(more than 10(5)CFU/ml) in urine culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to some drugs such as ampicillin or bactrim which have been usually used for urinary tract infection. CONCLUSIONS: Routine ultrasonography in renal infections without urinary tract obstruction was not helpful in treatment plan or outcome of this disease and selection of antibiotics in treatment of recent renal infection should be changed from the past one.

Long-term Followup of Clean Intermittent Catheterization in Spinal Cord Injury Patients / 대한비뇨기과학회지

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.

Long-term Followup of Clean Intermittent Catheterization in Spinal Cord Injury Patients / 대한비뇨기과학회지

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.

Clincal Significance of Urodynamic Test in Korea Spinal Cord Injured Patients

No abstract available.

Color Doppler Ultrasonography in the Evaluation of the Acute Scrotum / 대한비뇨기과학회지

Thirty seven patients with acute scrotal pain were evaluated by color doppler ultrasonography. The diagnosis was made by clinical finding in 26 cases and surgical finding in 11 cases. There were inflammatory diseases in 22 cases, testicular torsion in 5 cases, other diseases in 10 cases. 20 cases of inflammatory disease showed increased blood flow in color doppler ultrasonography and 4 cases of testicular torsion showed absent blood flow. Thus, color doppler ultrasonographic evaluation had diagnostic value that was 80% in sensitivity and 96% specificity in differentiation of testicular torsion from other acute scrotal diseases. We think that color doppler ultrasonography in acute scrotum is a valuable diagnostic method for differentiation of testicular torsion from other acute scrotal diseases.