The Predictors of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Acute urinary retention is one of the most severe complications in patients with benign prostatic hyperplasia (BPH). We investigated the efficacy of age, International Prostatic Symptom Score (I-PSS), quality of life (QOL) score and various parameters obtained by transrectal ultrasonography (TRUS) as predictors of acute urinary retention. MATERIALS AND METHODS: Of 153 patients with BPH, who underwent transurethral resection of the prostate, 72 were treated due to acute urinary retention (retention group) and 81 due to lower urinary tract symptoms (symptomatic group). TRUS was used to calculate the total prostate (TP) and transitional zone (TZ) volumes, the transitional zone index (TZ index=TZ volume/TP volume) and the elongation ratio (ER=the ratio of the maximal anteroposterior to transverse diameter of the prostate). To compare the usefulness of various parameters between the retention and symptomatic groups, the area under the receiver-operating characteristic (ROC) curve was calculated for each parameter. RESULTS: There were significant differences in the TP and TZ volumes, the TZ index and the elongation ratio between both groups, but no significant differences in age, I-PSS or QOL score. In the retention group, the most effective cutoff values were 40cc, 20cc, 0.55 and 0.75 for the TP volume, the TZ volume, the TZ index and the elongation ratio, respectively. The area under the ROC curves were 0.894, 0871, 0843 and 0771 for the TZ index, the elongation ratio, the TZ volume and the TP volume, respectively. CONCLUSIONS: The TP and TZ volumes, the TZ index, and the elongation ratio are useful predictors of acute urinary retention in patients with BPH. The TZ index is the most useful predictor, and may be a useful parameter in selecting the treatment for BPH.

Multiple Cystic Lymphangiomas of the Penis, Scrotum and Lower Abdomen / 대한비뇨기과학회지

Lymphangiomas result from a failure of lymphatic drainage into the venous system due to atresia or an insufficiency of the efferent lymphatic channels. The neck and axillary regions are most commonly affected, while the condition is rarely found in the inguinal area, scrotum, retroperitoneal space, abdominal viscera, arm, pelvis or bones. We report a case of a cystic lymphangioma of the lower abdomen, penis and scrotum in a 29-year-old man.

Pubovaginal Sling Operation Using Cadaveric Fascia Lata for the Female Stress Urinary Incontinence

PURPOSE: Pubovaginal sling operation has been main treatment procedure for female stress urinary incontinence. Allografts have been substituted for autografts as the material of pubovaginal sling operation to decrease postoperative morbidity, although to our knowledge their long-term durability is unknown. Therefore, we investigated the outcome and efficacy of pubovaginal sling operation using allograft cacaveric fascia lata. MATERIALS AND METHODS: From September 2000 to December 2001, 47 patients with stress urinary incontinence underwent pubovaginal sling operation using cadaveric fascia lata and had been followed up more than 10 months. Preoperative evaluation included medical history, physical examination, SEAPI score and urodynamic study including Abdominal leak point pressure (ALPP). All patients were assessed for the outcome of the procedure with subjective satisfaction by scores of SEAPI classification. RESULTS: With a mean follow-up of 18.2 months(range 10 to 25), urinary incontinence completely disappeared in 42 patients(89.4%), significantly improved in 4 patients(8.5%), not improve in 1 patient(2.1%). Marked improvement was shown in all patients according to the SEAPI score. Postoperative de novo urge incontinence was not found. Complication included suprapublic pain in 4 patients and transient urinary retention in 7 patients, but these were disappeared later in all patients. Operations with allograft fascia lata slings were tolerated, and neither infection nor erosion was encountered. CONCLUSIONS: Pubovaginal sling operation with a allograft cadaveric fascia lata is an effective treatment for stress urinary incontinence with high cure rate and minimal complication.

The Effect of Pelvic Floor Muscle Exercise Using Biofeedback for Stress Urinary Incontinence

PURPOSE: Pelvic floor muscle exercise, biofeedback and electrical stimulation have been known as initial treatment options for women with stress urinary incontinence. We evaluated the clinical outcome of pelvic floor muscle exercise in combination with biofeedback and electrical stimulation as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Twenty three patients with stress urinary incontinence who had been treated with biofeedback and electrical stimulation from June 1999 to March 2000 were analyzed. Patients were evaluated with their medical history, physical examination, SEAPI score, and urodynamic study including Valsalva leak point pressure(VLPP). All patients were assessed for the outcome of the procedure with subjective satisfaction by scores of SEAPI classification and the relative strength of pelvic floor muscle by maximal vaginal pressure and contraction time. RESULTS: Among 23 women followed up for 6 month to 1 year, urinary incontinence completely disappeared in 6 patients(26.1%), significantly improved in 13(56.5%) and not improved in 4(17.4%). There was a significant increase in maximal vaginal pressure, contraction time and decrease in the scores of SEAPI classification. CONLUSIONS: Pelvic floor muscle exercise in combination with biofeedback and electrical stimulation is a simple, safe, and effective treatment of stress urinary incontinence. The patient compliance is closely related to the success rate.

The Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence: long-term follow-up results

PURPOSE: Sling operation has been known the best treatment of woman with anatomical urinary incontinence(AI) and intrinsic sphincteric deficiency(ISD). We evaluated the clinical outcome of anterior vaginal wall sling as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Thirty three patients with stress urinary incontinence who treated with anterior vaginal wall sling from October 1995 to March 2000 were analyzed. Patients were evaluated preoperatively with history, physical examination, voiding cystourethrography, evaluation with SEAPI classification and urodynamic study including of Valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). All patients were assessed for the outcome of the procedure and subjective satisfaction by questionnaires. Surgical outcomes were then analyzed in relation to VLPP , MUCP and subjective SEAPI score. Of the total 33 patients, 26(78.8%) had AI and 7(21.2%) had ISD. According to the Stamey grades, 6(18.2%) were grade I, 23(69.7%) were grade II and 4(12.1%) were grade III. RESULTS: With a mean follow-up of 42.4 months (range 14 to 66). Urinary incontinence completely disappeared in 20 patients(60.6%), significantly improved in 8 patients(24.2%), failed in 5 patients(15.2%). Complication included urinary retention in two patients, suprapubic pain in two patients, and urge incontinence in two patients. Pre- and postoperative urge incontinence was major factor for failure rate. CONCLUSIONS: Anterior vaginal sling operation is a simple, safe and effective procedure for treatment of both AI and ISD. The urge incontinence is closely related to success rate.

A Case of Renal Cholesteatoma Misdiagnosed as Renal Stone / 대한비뇨기과학회지

Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinizing desquamative squamous metaplasia (KDSM). Until now about 80 cases including one case from Korea have been reported. Cholesteatoma shows microscopic features of squamous metaplasia of the transitional epithelium and keratinization. These changes with subsequent desquamation of the superficial epithelial layers explain clinical manifestations of the disease. Flank pain, passage of cornified material in the urine and a filling defect on the IVP constitute the characteristic triad. Most cases were managed by extensive ablative surgery for fear of malignant potential. We report a case of renal cholesteatoma which was misdiagnosed as renal stone in 58 year-old female patient who had been suffered from intermittent left flank pain.