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.

Clear Cell Sarcoma of the Kidney: A case in 39 year old man

Clear cell sarcoma of kidney(CCSK) is a rare pediatric neoplasm characterized by a predominating component of clear cells, a predilection for metastases to bone, and a poor prognosis. The incidence of CCSK peaks during the 2nd year of life and adult cases are very rare. We report a case of CCSK encountered in the right kidney of a 39-year-old man. Grossly, it was a lobulated mass showing infiltrative margin, measured 7x5.5x5cm and had a homogeneous gray-tan color with a soft, fish-flesh consistency. Microscopically, about half of the tumor revealed the classic pattern of CCSK, having tumor cell cords or nests separated by the characteristic alveolar capillary networks. The tumor cells had clear pale cytoplasm, bland looking round nuclei and inconspicuous nucleoli. The other half showed the epithelioid-trabecular pattern forming pseudorosette or cord-like structures. Immunohistochemically, there was only a focal positive reaction to vimentin. Ultrastructurally, the tumor cells showed the primitive nephrogenic mesenchymal differentiation such as electron lucent cytoplasm, a small amount of organelles, scanty heterochromatin, inconspicuous nucleoli, and a lack of flocculant basal lamina material around the cytoplasmic membrane. We consider that this is a case of CCSK occuring in the oldest patient ever reported, confirmed by both immunohistochemistry and electron microscopy.

A Case of Bilateral Adrenal Ganglioneuroma / 대한비뇨기과학회지

The great chain of sympathetic ganglia which extends from the base of the skull to the pelvis, including the suprarenal medulla, accounts for the origin of the ganglioneuroma which compound with the matured ganglion cells and neural elements. The ganglioneuroma is non-functioning tumor, but occasionally this tumor accompanies with hypertension and diarrhea and increased excretion of vanilmandelic acid in urine. Recently we experienced a housewife with the bilateral ganglioma which developed at both suprarenal medulla and after successful removal of the tumors hypertension was controlled.