Efficacy and Safety of Cystocele Repair Reinforced with a Monofilament Polypropylene Mesh / 대한비뇨기과학회지

PURPOSE: Although surgical options for a cystocele repair have changed diversely over the past twenty years, a 29% recurrence rate after an operation has been reported. We assessed the efficacy and safety of a cystocele repair using monofilament polypropylene mesh (MPM) to reinforce the weakened muscular pelvic floor. MATERIALS AND METHODS: 28 women underwent a cystocele repair using MPM. According to the International Continence Society (ICS) stage classification, 5, 20 and 3 women had stages II, III and IV cystocele, respectively. The operations were performed through the vaginal approach. An anterior colporrhaphy was performed, and mesh (15x5cm), with the lateral extensions, was then positioned into the retropubic space, without fixation, for tension free support of the bladder. The cure of cystocele was defined as stage 0, improvement as stage I, and failed treatment as stage II or greater. RESULTS: The mean follow-up, catheterization time and hospital stay were 20.4+/-3.2 months, 2.4+/-1.2 days and 6.6+/-3.4 days, respectively. The anatomical cure rate of cystocele was 89.3% (25/28). The cystocele repair improved 2 patients, but failed in 1. No significant intraoperative complications occurred. The postoperative complications included voiding difficulty (2 cases), vaginal bleeding around the suture site (1 case) and de novo urgency (2 cases). There were no mesh related complications. CONCLUSIONS: Cystocele repair using MPM showed a success rate of 89.3%, with no complications associated with the use of mesh. This procedure seems to be safe and efficient, but a prospective randomized trial and longer follow-up will be required to confirm these results.

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.

Quality of Life and Sexual Outcomes: Radical Prostatectomy and External Beam Radiation Therapy for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We assessed the impact of treatment modalities, such as radical prostatectomy or external beam radiation therapy, for prostate cancer on the health related quality of life (HRQoL) and sexual function of patients. MATERIALS AND METHODS: 137 eligible patients, with localized or locally advanced prostate cancer, were enrolled from two treatment groups: radical prostatectomy (RP) and external beam radiation therapy (EBRT). To compare changes in the HRQoL and sexual function after treatment with these two modalities, an interview or postal survey was performed for the patients that were followed up at least 12 months after treatment. Finally, 57 patients (RP 34 and EBRT 23) were eligible to remain on the study. Standardized questionnaires, including the EORTC QLQ-C30 (version 3.0) and QLQ-PR25, for evaluation of HRQoL, and the International Index of Erectile Function (IIEF), for sexual function, were employed. RESULTS: On global health status and functional scales, the progression in the mean scores between the baseline and treatment were worse in the PR group. The PR group also had worse urinary incontinence, erection and ejaculation problems than the EBRT group. EBRT was associated with adverse bowel function. The IIEF demonstrated significant changes between the baseline and post-treatment scores across all five domains with the two treatment modalities, especially with a RP. CONCLUSIONS: The majority of prostate cancer patients were unable to return to functional sexual activity after both a RP and EBRT. The assignment of patients to the two treatment modalities entails different risks of urinary leakage and bowel dysfunction. These findings will help facilitate counseling, with regard to sexual function and HRQoL expectations, for prostate cancer patients.

The Efficacy of Botulinum Toxin Injection to the External Urethral Sphincter for Detrusor External Sphincter Dyssynergia / 대한비뇨기과학회지

PURPOSE: Botulinum toxin (BTX) acts by inhibiting acetylcholine (ACh) release at the presynaptic cholinergic neuromuscular junction, and is applied in various urethral and bladder dysfunctions, including detrusor external sphincter dyssynergia (DESD). We investigated the use of BTX in DESD patients as a reversible chemical sphincterotomy. MATERIALS AND METHODS: A total of 6 patients (male 3, female 3) with DESD were included. Their mean age was 45.5 years. The underlying diseases were multiple sclerosis (1), meningomyelocele (1), spinal cord injury (1), multiple systemic atrophy (1) and transverse myelitis (2). All the patients had severe voiding symptoms and large residual urine, despite anticholinergics and alpha-adrenoceptor antagonists with clean intermittent catheterization (CIC). Urodynamic studies were performed before and 1 month after treatment. A total of 100 units of BTX-A (Botox(R)) were injected at 4 sites, 3, 6, 9 and 12 o'clock relative to the external sphincter, under anesthesia, on an outpatient basis. The alpha-adrenoceptor antagonist medication was discontinued for evaluation after surgery. RESULTS: At 1 month after the injection, the mean maximal flow rate was increased (from 8.4 to 12.2ml/sec) and mean residual urine was decreased (from 258 to 120ml) compared to the baseline values. The external sphincter pressure was decreased. All patients were able to discontinue the CIC. There were no systemic complications, such as respiratory distress or myasthenic crisis. CONCLUSIONS: Transurethral BTX-A injections were safe and effective for releasing or ameliorating a lower urinary tract obstruction due to DESD, and a safe and valuable therapeutic option in DESD patients not desiring surgery or CIC, and who are resistant to medications. (Korean J Urol 2005;46:604-609)