The Difference of Pelvic Floor with Dynamic MRI before and after Tension Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

PURPOSE: Tension-free vaginal tape(TVT) procedure is an effective surgical procedure for the treatment of female urinary stress incontinence. The purpose of this study was to evaluate the changes of pelvic floor MR imaging findings after tension-free vaginal tape procedure on stress urinary incontinent women. MATERIALS AND METHODS: Thirty two women with complaint of stress urinary incontinence(mean age, 56 years; age range 32~73 years) were included in this study. Pelvic floor MR imaging were performed preoperatively and one month after surgery. The position of the bladder neck in relation to the pubococcygeal line, the position of the bladder neck in relation to a perpendicular line through the posterior edge of symphysis pubis, the angle of urethral inclination were measured. We also measured the position of anterior wall of the urethra in relation to posterior edge of the symphysis pubis and cystocele during resting and pelvic straining and thickness of the anterior wall. We compared all parameters between resting and stress. RESULTS: Twenty nine patients(91%) had normal voiding pattern after TVT procedure. three patients(9%) had voiding difficulty. The position and mobility of the bladder neck during straining showed significant improvement after surgery(p<0.01). During straining, the length between the urethra and the inferior edge of the pubic symphysis with mid-urethra angulation was shorten in twenty eight patients(88%). There is no significant difference among three groups in all parameters. However, 3 patients with voiding difficulty had the significant high bladder neck and moderate cystocele. CONCLUSION: The TVT procedure provides decrease of urethral hypermobility and increase of mid-urethral angulation. MR imaging demonstrate well that urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed at stress. Postoperative voiding difficulty may be related to remaining cystocele and high bladder neck.

Efficacy of Renal Artery Embolization using a Mixture of Histoacryl(R) and Lipiodol in a Rabbit Model / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the efficacy and computed tomography(CT) findings of renal artery embolization with using a mixture of Histoacryl(R) and lipiodol in rabbit depending on the mixture proportions and the temporal course. MATERIALS AND METHODS: Eighteen rabbits were equally divided into two groups: group A received a 1:3 mixture and group B received a 1:5 mixture of Histoacryl(R) and lipiodol. We subdivided each group as follows: the 1-day group, the 10-day group and the 20-day group according to the elapsed days after embolization, respectively. As a result, the experimental groups were composed of six subgroups. Afterright renal artery embolizations, plain abdominal radiographs were obtained from all the rabbits. On the first day, the 10th day and the 20th day after embolization, abdominal CT was performed in each subgroup. RESULTS: On the post-embolization radiographs, the embolic casts were formed only at the main or segmental renal arteries in 7 cases of group A. On the other hand, the embolic casts were formed at the entire arterial trees in two cases of group A and all the cases of group B. On the pre- contrast-enhanced CT scans, there were radiopaque densities of embolic casts, residual lipiodol flecks and calcifications in the embolized kidneys. On the contrast-enhanced CT scans, global perfusion defects of the kidneys were noted in 17 rabbits. The cortical rim signs were noted in all rabbits of the 10-day and 20-day groups, except for one rabbit. CONCLUSIONS: The mixture of Histoacryl(R) and lipiodol is effective for renal artery embolization. The CT findings of the embolized kidneys are characteristic depending on the mixture proportions of the embolic agents and the temporal courses.

Effects of Rho Kinase Inhibitor on Detrusor Overactivity after Bladder Outlet Obstruction in Rats / 대한비뇨기과학회지

PURPOSE: A partial bladder outlet obstruction(PBOO) related detrusor hypertrophy is associated with up-regulation of the Rho kinase activity in an experimental animal model, and has been implicated in PBOO induced bladder dysfunction. The effect of a Rho kinase inhibitor on the voiding function in anesthetized rats with PBOO was investigated. MATERIALS AND METHODS: Eighteen Sprague-Dawley rats were divided into control(9 rats) and experimental(9 rats) groups. The experimental group was partially obstructed for 6 weeks, with cystometrograms(CMG) then were performed. The number of voids, and the intercontraction interval (ICI) and peak pressure(PP) were recorded. Rho kinase inhibitors were administered to the experimental group. An additional CMG was performed to observe the effects of Rho kinase inhibition. Bladder tissues were immunohistochemically(IHC) evaluated for the expression of RhoA protein. RESULTS: The bladder weights of the PBOO group were significantly increased compared with the control group(p<0.05). Significant increases in the voiding frequency and PP, but a significant decrease in the ICI was observed in the PBOO group compared to the control group on the CMG (p<0.05). The voiding frequency of the PBOO group was significantly decreased after Rho kinase inhibitor treatment(p<0.05). The Rho kinase inhibitor treated group showed a decrease in the PP and an increase in the ICI compared to the PBOO group. The IHC showed a higher RhoA protein expression in the bladder tissues of the PBOO group. CONCLUSIONS: H-1152, a specific inhibitor of Rho kinase, attenuates the PBOO-related detrusor overactivity in a rat model. The Rho kinase inhibitor appears to be a novel strategy for the management of bladder overactivity.

The Antihyperplastic Effect of Oral Catechin Ingestion in a Rat Model of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) is one of the common diseases in elderly men. Recently, the old-aged population has increased, with the interest in the clinical importance of BPH ever growing. Catechin, an extract of green tea, has the effect of the 5-alpha reductase inhibitor. Typically, BPH has been shown to be influenced by 5-alpha reductase. Therefore, the relationship between BPH and catechin was evaluated. MATERIALS AND METHODS: An experimental prostatic hyperplasia was induced in male Wistar rats by the administration of testosterone propionate, 3mg/kg sc, for 4 weeks. The Wistar rats were divided into four experimental groups: the control, BPH-induced, oral finasteride ingestion and oral catechin ingestion groups. After 4 weeks, the prostates were removed, and analyzed for their prostatic weight and histological examination. RESULTS: The prostate weights were measured in each group, and found to be 330.0+/-40.7, 970.0+/-1.1, 358.0+/-39.9 and 415.0+/-45.3mg in the control, BPH-induced, oral finasteride ingestion and oral catechin ingestion groups, respectively. The oral finasteride and catechin ingestion groups showed statistically significant decreases in their prostatic weights compared with the BPH-induced group (p0.05). Histologically injected testosterone lead to prostatic hyperplasia in rats, but oral catechin ingestion decreased this change. CONCLUSIONS: These results suggest that catechin may be effective in BPH, and the consumption of green tea may be effective in preventing BPH.

Change of Symptom Characteristics with Time in Patients with Indwelling Double-J Ureteral Stents / 대한비뇨기과학회지

PURPOSE: This study was designed to assess the prevalence of various urinary tract symptoms and the development of tolerance over time in patients with short term, indwelling, double-J (D-J) ureteral stents using a specially designed questionnaire and a 10cm linear visual analogue scale (VAS). MATERIALS AND METHODS: Fifty-nine patients (median age 46.0 years, range 18-65; 32 men and 27 women) who underwent ureteroscopic surgery for ureteral obstruction caused by benign conditions (stone or stricture) completed the study. All patients received polyurethane D-J ureteral stents (5 or 6Fr, 24 or 26cm) which were removed 19-55 days postoperatively. Urinary symptoms and pain questionnaires were obtained from each patient at postoperative 24 hours, one week, and on the day before stent removal. Tolerance to the stent was also assessed. RESULTS: All patients reported one or more urinary symptoms. Flank and suprapubic pain were reported more often on voiding or when walking than at rest. Although urgency was reported more frequently over time, the other urinary symptoms remained unchanged. There was no significant difference between the VAS scores for 24 hours, the first week and the day before removal, either overall or when stratified by gender or type of occupation. A factorial analysis of variance analyzing the VAS score for the first week as a function of gender and type of occupation showed no significant effect. CONCLUSIONS: Almost all patients with short-term placement of indwelling D-J ureteral stent had untoward symptoms. Although the prevalence of urgency was significantly increased over time, the general tolerance remained unchanged.

Multiple Ureteral Valves in Adult / 대한비뇨기과학회지

A congenital ureteral valve is a rare disease, with the first case presented in 1887, since when, only 42 cases have subsequently been reported. From a review of the reported cases, this abnormality was often found to be associated with other urological disorders, such as vesicoureteral reflux, ectopic ureter, complete and incomplete duplication of the kidney, and contralateral renal atrophy. Here, the case of an adult patient with multiple congenital ureteral valves and renal atrophy is reported.