A Predictive Factor in Overactive Bladder Symptoms Improvement after Combined Anterior Vaginal Wall Prolapse Repair: A Pilot Study

PURPOSE: We aimed to determine whether a preoperative urodynamic parameter is a valuable predictor for the persistence of OAB symptoms after the AVP repair. MATERIALS AND METHODS: 65 OAB patients with concomitant POP-Q stage III, IV anterior vaginal wall prolapse underwent a surgical repair were involved. All the patients were subjected to a preoperative urodynamic study, for whom the OABSS on questionnaire were preoperatively recorded. We firstly analyzed the correlation between the BOOI and the OABSS, then randomly divided patients into two groups: the group A (high PdetQmax, BOOI> or =20) and the group B (low PdetQmax, BOOI<20). In each group, the OABSS was repeatedly measured post-operatively and the change were analyzed. RESULTS: 31 patients were classified as the group A and 34 patients were classified as the group B. The group B showed significant decrease of symptom score in daytime frequency (p<0.01), urgency (p=0.04), urge incontinence (p=0.03), nocturnal frequency (p=0.01) and total score (p=0.01). The group A showed no significant decrease of symptom score in daytime frequency (p=0.42), urgency (p=0.61), urge incontinence (p=0.3), total score (p=0.15) except nocturnal frequency (p=0.01). CONCLUSIONS: A preoperative pressure-flow study can be a valuable tool in predicting the OAB symptoms change after the combined AVP repair. While the AVP repair leads to the improvement of OAB symptoms generally, some patients with a higher preoperative PdetQmax are still in need of the additional medical treatment.

Comparative Analysis of the Efficacy and Safety of Conventional Transurethral Resection of the Prostate, Transurethral Resection of the Prostate in Saline (TURIS), and TURIS-Plasma Vaporization for the Treatment of Benign Prostatic Hyperplasia: A Pilot St

PURPOSE: This study was conducted to perform a comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate (TUR-P), transurethral resection in saline (TURIS), and TURIS-plasma vaporization (TURIS-V) when performed by a single surgeon for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The clinical data of 73 consecutive men who underwent conventional TUR-P (39), TURIS (19), or TURIS-V (15) for BPH were retrospectively analyzed. All procedures were carried out by a single surgeon between October 2007 and April 2010. The patients were assessed preoperatively and perioperatively and were followed at 1, 3, and 6 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared, and major complications were recorded. RESULTS: In all groups, significant improvements in subjective and objective voiding parameters were achieved and were sustained throughout follow-up. TURIS-V had the shortest operation time compared with conventional TUR-P and TURIS (p=0.211). TURIS-V significantly decreased procedural irrigation fluid volume, postoperative irrigation duration, catheter duration, and hospital stay compared with conventional TUR-P and TURIS. There were no significant differences between the groups in hemoglobin levels or serum sodium levels before and after the operations. There were three transfusions and four clot retentions in the TUR-P group, and one transfusion and one clot retention in the TURIS group. The TURIS-V group had no complications. CONCLUSIONS: TURIS and TURIS-V were effective for the surgical treatment of BPH in addition to conventional TUR-P. TURIS-V was not inferior to conventional TUR-P or TURIS in terms of safety.

A Prospective Trial Comparing Tension-Free Vaginal Tape and Transobturator Vaginal Tape Inside-Out for the Surgical Treatment of Female Stress Urinary Incontinence: One-Year Follow up

PURPOSE: To compare prospectively and randomly tension-free vaginal tape(TVT) with transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: One hundred twenty women with SUI were alternately assigned to either the TVT group(n=60) or TVT-O group(n=60). The preoperative evaluation included urodynamic study and a Korean version of the incontinence quality of life questionnaire(I-QoL). At 1-year after operation, surgical outcome, patient I-QoL parameters, long-term complications and uroflowmetry were evaluated in 2 groups. RESULTS: Preoperative patient characteristics including I-QoL and urodynamic study were comparable in the two groups. The rates of cure(86.8% for TVT vs. 86.8% for TVT-O), improvement(6.6% for TVT vs. 8.2% for TVT-O), and failure (6.6% for TVT vs. 5.0% for TVT-O) were similar for the two groups. The I-QoL parameters one year after surgery were improved significantly in both groups(p0.05). The rates of the patient satisfaction with the procedure were 93.4% in the TVT group versus 95.0% in the TVT-O group(p>0.05). Mean operation time(11.5+/-1.4 min versus 15.2+/-1.8 min, p<0.05) was significantly shorter in the TVT-O than TVT. There were no long-term complications, such as vaginal erosion and prolonged voiding difficulty, in either group. CONCLUSION: TVT-O appears to be equally effective as TVT for the surgical treatment of stress urinary incontinence in women at a 1-year follow-up.

The Change of Enuresis in Children / 대한비뇨기과학회지

PURPOSE: Lower self-esteem, if present in enuretic children, might be an indicator of present and possible later psychological dysfunction. We tried to study the change of self-esteem before and after the treatment in children with nocturnal enuresis. MATERIALS AND METHODS: We recruited 32 enuretic children between september, 1998 and april, 2000. Mean age was 7.3 years old (range 4-12). We investigated the effect of self-esteem after 3 months treatment by Harter's self conception profile for children (SPPC) by total score and 6 subscales scores (scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth). The patients were divided in two groups: the response group defined as greater than 50% reduction of wet night and the non response group defined as less than 50% reduction of wet night. A paired t-test was used for the improvement of Harter's SPPC at total score and subscales after treatment and student t-test was used for the comparison of the improvement of SPPC between groups. RESULTS: After treatment, the overall Harter's SPPC did not show statistically significant improvement. Among the 32 enuretic children, 22 children (69%) were in response group and 10 children (31%) were in non-response group. We could not find any statistically significant self-esteem change in Harter's SPPC in responders and also even in non-responders. CONCLUSIONS: Our data suggested that Harter's SPPC did not show significant improvement after treatment of enuresis.

Effects of Various Tricyclic Antidepressants on Contractile Response of the Rat Vas Deferens to Electrical Stimulation of Hypogastric Nerve / 대한비뇨기과학회지

PURPOSE: To compare the inhibitory effects of various tricyclic antidepressants (TCAs) on contractile response of the rat vas deferens to electrical stimulation of hypogastric nerve. MATERIALS AND METHODS: A total of forty Spraque Dawley rats (weight 300-350gm) were divided into 8 groups (n=5 in each): doxepine, amitriptyline, trimipramine, desipramine, imipramine, clomipramine, protriptyline, and prazosin treated groups. Before (baseline pressure) and 20 minutes after intravenous injection of each agent (0.1-, 1-, 10-, and 20-fold of therapeutic doses for human in each agent), the hypogastric nerves, iden tified under operative microscope, were electrically stimulated with rectangular pulses of 0.5 mseconds duration, 10 Hz, and 10 V for 10 seconds. Dose of drug administered was gradually increased in order of 0.1- to 20-fold dose. RESULTS: All drugs tested in this study caused dose-dependent inhibition of the rat intravasal pressure induced by the electrical stimulation of hypogastric nerve. Inhibitory potency of each drug was doxepine (88.5% and 96.5% at 10- and 20-fold dose)> OR = amitriptyline (76.8% and 91.8%)>clomipramine (66.7% and 74.4%)> OR =imipramine (48.2% and 67.0%)=prazosin (45.6% and 63.5%)=trimipramine (52.7% and 65.4%)> OR =desi pramine (45.3% and 49.0%)> protriptyline (18.9% and 19.9%). CONCLUSIONS: Inhibitory effects of TCAs on contractile response of the rat vas deferens to electrical stimulation of hypogastric nerve would increase in proportion to their potency of alpha1-adrenoceptor blocking actions.

Two Cases of Female Sexual Dysfunction Treated by Estrogen and Testosterone / 대한남성과학회지

Female sexual dysfunction is now of great concern and have a relatively high prevalence. It is related with psychosocial disorder, organic disease and iatrogenic cause. But until recently, basic science and clinical study on it is limited and medical therapy stays in early experimental steps except conventional hormone replacement therapy. Hormonal based female sexual dysfunction can be caused by dysfunction of the hypothalamic-pituitary axis, surgical or medical castration, menopause and premature ovarian failure. We report two cases of female sexual dysfunction derived from hormonal deficiency. One case is about premature menopause induced and the other is about rare form of adult onset idiopathic hypogonadotropic hypogonadism.