Urodynamic Detrusor Overactivity in Patients with Overactive Bladder Symptoms / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the relationship between urodynamic detrusor overactivity (DO) and overactive bladder (OAB) symptoms in men and women. METHODS: We reviewed the records of adult males and females who attended a tertiary referral center for urodynamic evaluation of OAB syndrome symptoms with the presence or absence of DO. DO was calculated for symptoms alone or in combination. RESULTS: The overall incidence of DO was 76.1% and 58.7% in male and female OAB patients, respectively. Of men 63% and 61% of women with urgency (OAB dry) had DO, while 93% of men and 69.8% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Of women, 58% who were OAB wet had stress urinary incontinence symptoms with 26.4% having urodynamic stress incontinence. 6% of men and 6.5% of women with OAB symptoms had urodynamic diagnosis of voiding difficulties with postvoid residual greater than 100 mL. Combination of symptoms is more accurate in predicting DO in OAB patients. The multivariate disease model for males included urge urinary incontinence (UUI) and urgency while for females it included UUI and nocturia. CONCLUSIONS: There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women, more so in OAB wet than in OAB dry. Combination of symptoms of the OAB syndrome seems to have a better correlation with objective parameters from the bladder diary, filling cystometry, and with the occurrence of DO.

Hypospadias repair using skin flaps: analysis of 50 cases

To analyze the outcome of primary one-stage hypospadias repair using skin flaps [Mathieu, Onlay, Duckett] with particular reference to technique and current related literature. The study comprised 50 patients who underwent primary skin flap hypospadias repair with at least one year follow-up. All were operated by the authors and in the same institution during the period form 1995-2002. Their medical records were retrospectively reviewed for age, type or hypospadias, and nature of skin flap. Main related morbidity and success are reported after an average follow-up of 28.3 months. Reference to technique was also made. Majority of patients were between 2 and 4 years of age. 70% of them had distal anomaly with a mild degree of chordee. 23, 19 and 8 underwent Mathieu's Onlay's and Duckett's repair, respectively. 24% were circumcised at the time of surgery. Overall morbidity was noted in 16 patients [32%]. The commonest complications were meatal stenosis [14%] and fistula [8%]. Comparable morbidity was noted in both Mathieu's [17.4%] and Onlay's [15.8%] flaps. Unacceptable complication rate was associated with Duckett's tabularized skin flap repair. The overall success rate was markedly improved after the year 1998 with a rise from 80% at a mean of 1.22 procedures to 93.1% at a mean of 1.07 procedures. Our outcome data compared well with the literature except for Duckett's form of repair. Skin flaps have an established and valuable place in hyposadias repair. Meatus-based and onlay flaps have fairly better outcome than both grafts and tabularized flaps. Attention to technique, selection, auditing and experience are keys to better anatomical, functional and cosmetic results

Cryptorchidism and testicular neoplasia

Traditionally there is a concern about the possibility of developing testicular tumors as a consequence of undescended testis. This study was conducted to investigate the correlation between testicular tumors and undescended testis. Medical records of all patients with testicular germ cell cancer were seen and examined at the Princess Basma Teaching Hospital, Jordan University of Science and Technology, Irbid, Jordan, between 1990 and 2000 [group 1] for any evidence of undescended testis. All males with undescended testis attending the infertility clinic during the period 1999-2001 [group 2] were re-evaluated for any evidence of testicular tumors. The operative records of all patients who had surgery for undescended testis during the past 30 years [group 3] were reviewed and the patients were contacted to see if any of them developed testicular tumor as expected. Forty-four patients with testicular germinal cell tumors; mean age at diagnosis were 32.6 years [range 20-50] were identified. All patients had unilateral involvement and none of them were found to have tumors in undescended testis. The tumor was in the scrotum in all patients. None of the 117 infertile patients with undescended testis had clinical or ultrasonic evidence of testicular tumors. Two thousand nine hundred and nineteen patients had an operation for undescended testicle in the past 30 years, average of 97.3 operations annually. Median age at surgery for undescended testis was 7.7 years [range 2-29 years]. None of the 2071 patients who were traceable developed testicular tumor. We found no evidence to support that patients with undescended testis are at a higher risk than the general population to develop testicular cancer

Ureteric injuries during obstetric and gynecologic procedures

To review the ureteric injuries resulting from obstetric and gynecologic procedures with a comparative analysis of current pertinent literature. From January 1994 - December 1997, the medical records of all patients who sustained ureteric injuries as a result of obstetric or gynecologic procedures and managed at the Princess Basma Teaching Hospital, North of Jordan were reviewed. The clinical presentations, investigations, features of injury and treatment modalities were studied. There were 17 patients with 19 ureteric injuries incurred during obstetric or gynecologic procedures during the study period. Patients were relatively young and presented with loin pain. The left lower ureter was injured in 11 cases. Hysterectomy, alone, accounted for 13 injuries mainly in association with malignancy. Deliveries, in general, were associated with very low rate of injury. Ureteric ligation was the most common mechanism of injury [47%]. Injuries were intraoperatively recognized in 41.2% [7/17] of cases. Patients were treated by either endourological or formal surgical repair. The overall success rate after an average of 32.3 months of follow-up was achieved in 89.5% [17/19]. This outcome was not significantly altered by either the features of injury or by the treatment schedules. Iatrogenic ureteric injury is still a major cause of harm and concern. The time taken to detect the injury remains the most important morbidity-related factor. Recent trends towards earlier intervention and the use of various endourological means of repair deserve support and promotion