The Comparison of Therapeutic Effectiveness According to the Location of Tension-free Vaginal Tape (TVT) Procedure for Stress Urinary Incontinence in Females / 대한비뇨기과학회지

PURPOSE: A sling operation using tension-free vaginal tape (TVT) has been recently developed and popularized. In order to overcome the problem that the location of the TVT procedure is limited to the mid-urethra, the therapeutic effectiveness of the TVT sling through bladder neck approach was investigated and compared with that through the mid-urethra approach. MATERIALS AND METHODS: Out of 127 stress urinary incontinence patients, 78 patients were assigned to Group A (the mid-urethra approach) and 49 patients were assigned to Group B (the bladder neck approach). The data was analyzed according to age, grade, time of operation, postvoiding residual urine volume, postoperative complications, success rate and the patient's satisfaction. RESULTS: Both groups were mainly Grade I in Stamey grade. There was no significant difference in the surgery time between the two groups, with an average of 23 minutes and 24 minutes, respectively. Of the total number of SUI patients, 12% of Group B patients had a postvoiding residual urine volume larger than 100ml while 6% of Group A patients had a similar residual urine volume. In both groups, severe complications and discomfort were very rare. The success rates of the two groups were similar, 95% versus 96% respectively, and similar results were shown in the patients' satisfaction. Overall, there was no significant difference between two groups. CONCLUSIONS: In the TVT sling operation, the mid-urethra approach is the standard for SUI treatment. However, bladder neck approach has an equivalent effect. Therefore, it is believed that this site for the TVT will lead to more surgical approaches.

The Clinical Significance of Infrared Thermography in Patients with Chronic Pelvic Pain / 대한비뇨기과학회지

PURPOSE: Infrared thermography is a diagnostic procedure that can objectively visualizes the status of muscle, in musculoskeletal disease, as myofascial pain syndrome. Thus, we evaluated the clinical significance of infrared thermography in patients with chronic pelvic pain. MATERIALS AND METHODS: Forty-five patients with chronic pelvic pain were enrolled in this study as patient group, with thirty-three normal persons as the control group. The patients with a urinary tract infection and an organic disease were excluded. Before the thermography was checked, we made all patients mark the subject pain site, and inform of the pain severity, on the visual analogue scale (VAS) sheet. We analyzed hot spots on the thermographic images, pain sites and VAS sheets, and the thermographic changes, before and after a 2% lidocaine injection at the tender point, on the physical examination. RESULTS: The sensitivity, specificity and the false positive and negative of infrared thermography were 79.5 (M:F=76.5:81.8), 64.1 (M:F=66.7:61.9), 24.2 (M:F=25.0:23.5) and 32.6% (M:F=31.6:30.8), respectively. However there was no clinical significance between the pain severity and the temperature difference of the thermography. The concordance rate of thermographic and symptomatic changes, after the 2% lidocaine injection at the tender point, was 78.9%. CONCLUSIONS: Infrared thermography can objectively demonstrate the subjective pain, and is a useful method in follow-up, after treatment for chronic pelvic pain with a tender point.

The Use of Permeability of Potassium in the Diagnosis of Interstitial Cystitis

PURPOSE: The Aim of this study was to find the value of intravesical permeability of potassium as a diagnostic measure of the interstitial cystitis and to find importance of intravesical mucosal layer by intravesical instillation of potassium chloride solution. MATERIALS AND METHODS: 20 patients with interstitial cystitis and 20 normal subjects without UTI, frequency and urgency underwent intravesical challenge with 40ml water and 40ml of 400meq/L potassium chloride solution. After 5 minutes, patients were asked about increase or decrease of urgency or suprapubic pain and subjective response of urgency or suprapubic pain were recorded on a scale of 0 to 5. RESULTS: Neither normal subjects nor patients with interstitial cystitis reacted to water administered intravesically. There was marked sensitivity to intravesical potassium in 85% of patients with interstitial cystitis versus 10% of normal controls (p<0.05). CONCLUSIONS: Diffusion of urinary potassium ion into the bladder interstitium may induce sensory symptoms, damage the tissue and be a major toxic factor in the pathogenesis of interstitial cystitis. Intravesical potassium sensitivity can be a reliable method for detecting abnormal epithelial permeability and useful diagnostic test for interstitial cystitis.

Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer / 대한방사선종양학회지

PURPOSE: To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. METHOD AND MATERIALS: From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by 39.6~45 Gy pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. RESULT: The patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients (81%) successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients (58%) were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were 80% and 14%, respectively (p=0.001). CONCLUSION: In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

Clinical Characteristics of Frequency-Anxiety Syndrome / 대한비뇨기과학회지

PURPOSE: Lower urinary tract symptom in elderly person leads to their psychological anxiety and stress in their travel and further, loss of self esteem that can set limitation during their social activities and their lives. we coined a frequency-anxiety syndrome (FAS) for the patients with lower urinary tract symptom and anxiety. This study was performed to characterize the clinical characteristics of FAS. MATERIALS AND METHODS: 24 FAS patients and 20 controls were included in this study. For the analysis and comparisons, we investigated frequency, urgency, i-nternational prostate symptom score (I-PSS), cystoscopy, and urodynamic study in both groups. We also performed semi-structured psychiatric interview and state-Trait Anxiety Inventory (STAI). RESULTS: In the average I-PSS, FAS group had significantly higher score of 22.9+/-10.9 than control group of 10.6+/-6.5 (p<0.001). The control group had significantly higher quality of life herving problems (QOL) value of 1.8+/-1.2 as compared to FAS group of 5.1+/-0.1 (p<0.005). In STAI, FAS group had significantiy higher score than control group. CONCLUSIONS: There were significant differences between FAS group and control group in regard to lower urinary tract symptom, I-PSS, QOL, and anxiety. The above results suggest that FAS could be considered as independent syndrome.

The Experience After Operation Using Tension-free Vaginal Tape for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The object was to study prospectively the results of a modified intravaginal sling operation for the surgical treatment of female stress urinary incontinence using tension-free vaginal tape (TVT) as a new continence procedure. MATERIALS AND METHODS: 55 women with demonstrable stress urinary incontinence underwent a nonrandomized, prospective study using the TVT sling operation. Preoperatively the patients were evaluated with Stamey grade and urodynamic testing. After having TVT sling operation, we observed the postoperative results throughout the 1-year follow-up. RESULTS: The mean age of the patients was 52.8 years and mean operation time was 26.6 minutes. Mean duration of postoperative catheterization was 1.1 days. 35 patients (63.6%) were completely cured throughout the 1-year follow-up period, and 18 patients (32.7%) were significantly improved. They did not loose urine apart from an occasional leakage during severe cold. CONCLUSIONS: TVT sling operation is a safe, simple and effective procedure for the treatment of stress incontinence.

Correlation between Genetic Polymorphism of CYP2D6 and CYP1A1 and Susceptibility of Renal Cell Carcinoma in Korean / 대한암학회지

PURPOSE: Many of the enzymes handling environmental factors are polymorphic and may confer variable susceptibility to renal cell carcinoma (RCC). Among those, the author studied genetic polymorphisms of CYP2D6 (B & T) and CYP1A1 in RCCs and controls in Korean. MATERIALS AND METHODS: Using 132 RCCs and 94 controls, first PCR products were obtained in 104 RCCs and 94 controls with CYP2D6, and 74 RCCs and 56 controls with CYP1A1. Res triction enzyme - BstN I/EcoN I for CYP2D6 (B & T), and NCo I for CYP1A1-digestion was followed to analyze constitutive DNA. RESULTS: In both RCCs and controls, no mutant allele of CYP2D6 (B & T) was detected and the susceptibility for occurrence of RCC was unable to evaluate. With CYP1A1 RFLP, homozy gous wild type (WW) was seen in 68 (52.3%; 37 RCCs, 31 controls), heterozygous mutant type (WM) in 54 (41.5%; 32 RCCs, 22 controls) and homozygous mutant type (MM) in 8 (6.2%; 5 RCCs, 3 controls). The odds ratios (95% CI) of RCC susceptibility for CYP1A1 genotype were 1.15 for WM and 1.36 for MM. Even though not significant statistically, higher tendency in MM presented. CONCLUSION: There is no association between susceptibility for the occurrence of RCC and genetic polymorphism of CYP2D6 (B & T) and CYP1A1.

Values of Valsalva Leak Point Pressure Test in Stress Incontinence / 대한비뇨기과학회지

No abstract available.

Pudendal Somatosensory Evoked Potential in Korean Women: Reference Values

OBJECTIVE: To obtain reference values of early potential latency and amplitude of pudendal SEP in Korean normal women and to correlate those values with height and age. METHOD: Twenty-three normal female with mean age of 45.27 years were evaluated for pudendal SEP. Stimulation was applied on the dorsal aspect of the clitoris with a bar electrode. Onset, P1, N1, P2 latencies and P0-P1, P1-N1, N1-P2 amplitudes were measured and those of both sides were analyzed. RESULTS: The mean latency of P0, P1, N1, P2 were 29.0+/-2.83 msec, 35.5+/-2.91 msec, 45.1+/-4.10 msec, 56.3+/-5.20 msec by the right pudendal nerve, and 28.6+/-3.11 msec, 35.2+/-2.93 msec, 45.0+/-3.83 msec, 56.5+/-5.33 msec by the left pudendal nerve. The amplitude ranges of P0-P1, P1-N1, N1-P2 were 0.31~2.45 uV, 0.11~2.24 uV, 0.21~2.62 uV by the right pudendal nerve, and 0.29~2.46 uV, 0.25~2.21 uV, 0.12~5.07 uV by the left pudendal nerve. There was tendency of prolongation of the latency with increasing the height. There is no difference of amplitude according to the height and the age. There was no significant difference between right and left sides in mean latency and range of amplitude of pudendal nerve SEPs, and between premenopause and postmenopause. CONCLUSION: Normal reference of female pudendal SEP were established. We suggest that pudendal SEP can be used as one of useful diagnostic tools for female urogenital and neurologic disease.

Effect of Glucose Deprivation on the Contractility Response of the Rabbit Bladder / 대한비뇨기과학회지

PURPOSE: The urinary bladder requires an adequate energy supply to maintain contractile function. The primary metabolic fuel is glucose. Through glycolysis and oxidative phosphorylation, high energy phosphate are generated, which in turn supply the metabolic energy for the contractile activities of the urinary bladder. The aim of this study was to determine the effects of glucose deprivation and recovery from glucose deprivation on the phasic and tonic components of the contractile responses of rabbit bladder strips to field stimulation, bethanechol, and KCl. MATERIALS AND METHODS: The urinary bladder bodies of mature male New Zealand White rabbits were separated from the base above the level of the ureteral orifices, and placed in Tyrode`s solution containing glucose in 37degrees C and equilibrated with 95% O2 and 5% CO2. Bethanechol(250microM) was left in contact with the strips for 4 minutes. KCI(120 mM) was left in contact with the strips for 4 minutes. Field stimulation(31Hz, 80V, 1ms) was maintained for 2 minutes. At the end of each incubation in glucose-free medium(100 minutes for FS, 180 minutes for KCl and bethanechol), the medium was changed to Tyrode`s solution containing glucose(1mg/ml) and stimulations continued for additional 90 minutes. Changes in muscle tension were measured and recorded on a Grass model 7D polygraph. RESULTS: The results can be summarized as follow : In response to glucose deprivation, (1) the tonic responses to field stimulation, bethanechol, and KCl all decreased at a significantly greater rate than the phasic responses; (2) the phasic and tonic responses to field stimulation were both reduced to less than 10% of control within 70 minutes of glucose deprivation; (3) the tonic response to bethanechol and KCl were reduced to approximately 10% of control within 180 minutes whereas the phasic responses remained stable at 40 and 30%, respectively; and (4) glucose replacement stimulated a rapid and nearly complete recovery of the phasic and tonic components of the response to field stimulation, bethanechol, and KCl. Concolusions: These results indicate that the tonic responses to all forms of stimulation are more sensitive to glucose deprivation than phasic responses.

Effect of Dimethyl Sulfoxide (DMSO) Monotherapy in Treatment of Interstitial Cystitis

No abstract available.

The Diagnostic Value of Mast Cell Count in Interstitial Cystitis / 대한비뇨기과학회지

PURPOSE: In this study we attempted to find the value of mast cell index as a diagnostic purpose of the interstitial cystitis (IC) MATERIALS AND METHODS: We compared clinical symptoms and the mast cell index in the IC and chronic cystitis patients. 16 cases of the IC patients, determined by Parson's criteria, were monitored. Under the spinal anesthesia and bladder overdistension with pressure of 60-80cmH2O, bladder wall was checked under cystoscopy. The biopsies of the bladder mucosa and detrusor muscle were obtained. The mast cell index was estimated under light microscope(x400 magnification) after it was stained with toluidine blue. RESULTS: In the IC patients, there was significant correlation between the bladder capacity and mast cell index(p <0.01). Seven patients with 100-199ml bladder capacity range had mast cell index of 62.94+/-3.66, and 8 patients in 200-299ml range had 44.78+/-9.12 mast cell index. In relation between the frequency of nocturia and mast cell index, frequency of 1-2 nocturia patients had mast cell index of 53.75+/-11.45(8 cases), 3-4 nocturia had 44.82+/-8.42(5 cases), 4 or more nocturia had 60.13+/-17.94 mast cell index(3 cases). 10 patients with urgency had 46.41+/-10.29 mast cell index, while 6 patients with no urgency problem had 61.73+/-9.92. 9 patients with lower abdominal pain had mast cell index of 51.37+/-11.79, while 7 patients with lower abdominal pain had 53.16+/-11.79. In comparison between the IC and chronic cystitis, there was significant difference between them. In IC, mast cell index was 52.09+/-12.49 and in chronic cystitis, mast cell index was 23.51+/-7.10(p <0.01). CONCLUSIONS: In this study, the results were showed that there is no direct correlation of mast cell index with nocturia, urgency and lower abdominal pain in IC patients, however there is inverse relationship between mast cell index and the bladder capacity, and we also found significant mast cell index differences between the IC and chronic cystitis. Therefore, we suggest that mast cell index is one of the pathological characteristics of IC and useful method to diagnose the interstitial cystitis.

Female Sexual Dysfunction

No abstract available.

Continet, Korea on the World Wide Web

No abstract available.

The Effects of Partial Outlet Obstruction on Bladder Strip Sensitivity to Glucose Deprivation: An In-Vitro Study in the Rat / 대한비뇨기과학회지

The specific aim of the current study was to correlate the effects of partial outlet obstruction on the contractile responses of isolated strips of bladder smooth muscle to repetitive stimulation in the presence and absence of glucose. Adult male Sprague Dawley rats were subjected to partial outlet obstruction by the surgical placement of silk ligatures around the urethra. After two weeks, each rat was anesthetized and the bladder excised and isolated strip studies performed. After equilibration the strips were subjected to repetitive stimulations with FS, bethanechol, or KCI in the presence or absence of glucose. Both phasic and contractile responses were measured. The results are follows: 1. The maximal phasic response to FS was significantly decreased in the obstructed strips when compared to controls; no differences were noted for responses to bethanechol or KCI. 2. The tonic responses to all forms of stimulation were significantly decreased after obstruction; the tonic response to FS was decreased to a greater degree than were the tonic responses to bethanechol and KC1. 3. In the presence of glucose, the magnitude of phasic and tonic responses to bethanechol and KCl were well maintained in control strips during repetitive stimulation. 4. However, the phasic responses to FS were well maintained during repetitive stimulation whereas the tonic responses progressively decreased by approximately 60%. 5. In the absence of glucose, the tonic responses of control strips to all forms of stimulation were reduced to a greater degree than the phasic responses. 6. Partial outlet obstruction significantly reduced the phasic responses to FS, bethanechol, and KCI by 28.5%, 28.8% and 37.4% respectively and tonic response to FS was reduced to 28.6% of control value in glucose containing Tyrodes solution. Clinically significant reduction of bladder contraction is related to the reduction of glucose metabolism in obstructed bladder. Considering significant reduction of tonic response to FS, we think that neurotransmitter is major factor in contraction reduction in obstructed bladder.

Chromophobe Cell Renal Carcinoma: A report of 3 cases

Chromophobe cell renal carcinoma is an uncommon variety of renal cell carcinoma first described in humans in 1985 by Thoenes and his colleagues. It is a distinct type of renal cancer presumably derived from the intercalated cells of the collecting duct system and exhibiting a better prognosis than other types of renal cell carcinoma. This type of renal cell carcinoma has not been reported in Korean literature. We experienced three cases of chromophobe cell renal carcinoma from surgical pathology files of Dong-A medical center. The patients were a 65-year-old female, a 54-year-old female, and a 50-year-old male who had 8.2x6 cm, 4x2.5 cm and 4.3x3.2 cm sized, yellowish gray, beige to tan colored masses in the kidneys, respectively. Microscopically, the tumor cells were arranged in sheets or nests with delicate intervening vasculature. The cells were voluminous, uniform in appearance and contained finely reticulated cytoplasms delineated by prominent cell borders. With Hale's iron colloid staining the cytoplasm showed positive reaction; with PAS staining the result was negative. Immunohistochemically, the tumor cells showed positive reaction for cytokeratin but negative for vimentin. Electron microscopy showed numerous small, round to oval cytoplasmic vesicles, 150-300nm in size. All the patients received only radical nephrectomy and survived without evidence of recurrence or metastasis during follow-up intervals ranging from 4 months to 5 years.

Clinical Results of Overdistention in the Treatment of Interstitial Cystitis / 대한비뇨기과학회지

Interstitial cystitis is prevalent in the 5th decade women, characterized by frequency, urgency and pelvic pain. To diagnose interstitial cystitis, NIH diagnostic criteria was used. Patients underwent overdistention and all patients were evaluated with IPSS symptom score and urodynamic study in preoperative period, post operative(POD) 1 week and 1 month. The age distribution was 4th decade in 1 patient, 5th decade in 3, 6th decade in 2, 7th decade in 4 and then above 7th decade in 2. Symptom durations was less than 7 years in 7 patients, between 7-10 years in 2 and more than 10 years in 3. Changes in bladder irritative symptom score between preop. and POD 1 week, and preop. and POD 1 month were 6.00+/-4.40(p0.05) but statistically insignificant. However, the change between pre op. and POD 1 month was 97.45+/-90.29(p<0.05) with statistical significance. Difference in maximal capacity between preop. and POD 1 week was statistically significant as 87.55+/-126.39(p<0.05). Bladder functional capacity changes between with and without anesthesia was statistically significant(p<0.05) Postop. complications were bladder rupture in 1 case, and hematuria in 12. The results of overdistention was useful in the diagnosis and treatment of interstitial cystitis. Then more evaluation and follow up will be needed.

Clinical Significance of Pressure-Flow Plot in Infravesical Obstruction / 대한비뇨기과학회지

The diagnostic methods of evaluating infravesical obstruction, especially in BPH, are based on symptoms, history, digital rectal examination, intravenous pyelography, ultrasonography, uroflowmetry and residual urine, etc. But these methods cannot accurately and objectively evaluate infravesical obstruction. We measured voiding cystometry with uroflowmetry and urethral pressure profile in 24 BPH patients by Dantec UD5500. We classified the degree of obstruction into obstructive, equivocal and nonobstructive types by Griffiths' obstructive nomogram and Type 0 - VI by Schaefer's nomogram after computer assisted pressure-flow analysis. Among 24 patients, obstructive type was in 12, equivocal type in 6, and nonobstructive type in 6 by Griffiths' obstructive nomogram. Based on Schaefer's nomogram, type 0 was in 4 patients, type I in 6, type III in 4, type IV in 2, type V in 4 and type VI in 4. In our analyzed urodynamic parameters, Qmax, Pdet, Pmuo, Atheo and URA had statistical significance(p<0.05). We consider Griffiths' obstructive nomogram and Schaefer's nomogram based on pressure flow plot are objective methods of accurately evaluating infravesical obstruction.

A Case of Leiomyoma of Renal Pelvis / 대한비뇨기과학회지

A 47-years-old woman visited our hospital with the chief complaint of painless gross hematuria. IVP, RGP and CT showed a soft tissue tumor in left renal pelvis. Left radical nephrectomy was performed. The pathological diagnosis was leiomyoma. Leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system but are uncommon neoplasm, especially leiomyomas of the renal pelvis are very rare tumors. To date 5 cases diagnosed by histological appearance only have been reported. All 5 tumors were composed of spindle cells that resembled mature smooth muscle cells. The preoperative diagnosis of leiomyoma of renal pelvis is very difficult because of the absence of the characteristic diagnostic signs, and the only definite method to distinguish between a leiomyoma and other renal tumor is histological evaluation. We herein report the sixth case of leiomyoma of renal pelvis in a 47-years-old woman, with a brief review of literature.

An Experience of Augmentation Gastrocystoplasty in the Treatment of a Child with Spastic Neurogenic Bladder / 대한비뇨기과학회지

A small capacity, poor compliant neurogenic bladder is a difficult problem in children. Bladder augmentation with intermittent catheterization offers an alternative to indwelling catheterization. Ileum, cecum, and sigmoid colon have been most commonly used for enterocystoplasty but may, however, cause hyperchloremic metabolic acidosis. The use of the stomach to create urinary reservoir has several theoretical and real advantages. Electrolyte reabsorption is diminished which makes the stomach the selected reservoir. Hyperchloremic metabolic acidosis would not be a problem. In fact, in addition to presenting a barrier against the absorption of chloride and ammonium, the gastric mucosa secretes chloride ions. Gastric segment was isolated with right gastroepiploic artery as a pedicle. Bladder was opened vertically and augmented with gastric segment. This case had increased bladder volume and the dilatation of upper urinary tract decreased in size, including loss of VUR. Laboratory examination showed no metabolic derangement in blood gas analysis and electrolytes. We did not encounter any troubles in CIC such as the obstruction caused by mucus produced by gastric segment. Also, in patients in whom shortening of the bowel may be expected to lead to variable degrees of malabsorption, stomach is an attractive alternative. So, gastrocystoplasty is a reliable method of a creating a large and compliant urinary reservoir. We report a case of augmentation gastrocystoplasty in the treatment of spastic neurogenic bladder in a 6-year-old female.