Changes in Sexual Function after the Midurethral Sling Procedure for Stress Urinary Incontinence: Long-term Follow-up / 대한배뇨장애요실금학회지

PURPOSE: It is known that 50% to 68% of women with stress urinary incontinence (SUI) have sexual function impairment and avoid sexual intercourse. Reports of sexual function after SUI surgery vary, with reports of both improved function and deteriorated function. The goal of this study was to evaluate the impact of midurethral sling procedures on the sexual function of women suffering from SUI preoperatively and 36 months postoperatively. MATERIALS AND METHODS: Among 75 patients who were diagnosed with SUI and underwent the midurethral procedure, 47 patients who answered the Korean version of the Female Sexual Function Index (FSFI) Questionnaire were analyzed prospectively. The retropubic route (RPR) was used in 26 patients, whereas the transobturator route (TOR) was used in 21 patients. Fifteen patients underwent concomitant posterior colporrhaphy. The FSFI was completed before surgery and 36 months after surgery. RESULTS: The patients' mean age was 44.9 years (range, 30-59 years) and their mean parity was 2.8 (range, 0-6). There were no significant differences in the individual FSFI domain scores between before surgery and 36 months (36.8+/-4.57) after surgery. There were no significant differences in sexual satisfaction between the patients with concomitant posterior colporrhaphy and patients with the midurethral sling procedure only. There were no significant differences in domain score between the TOR and the RPR, but patients experienced less pain after the RPR than after the TOR. CONCLUSION: There was no significant change in overall sexual function in women undergoing the midurethral sling procedure. Attention must be paid when performing the TOR procedure because it can cause pain during intercourse.

The Effect of Renal Scarring on Spontaneous Resolution and Breakthrough Infection in Children with Vesicoureteral Reflux

PURPOSE: Primary treatment of children with vesicoureteral reflux (VUR) is antibiotic prophylaxis until the reflux resolves. But, it is not easy to determine in which patients the reflux resolves. We sought to determine whether renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. MATERIALS AND METHODS: A total of 90 children, 54 boys and 36 girls, mean age 15.1 (range: 1-98) months, with VUR were analyzed retrospectively. Eighty-six presented with febrile urinary tract infection (UTI) and 4 with prenatal hydronephrosis. Technetium Tc 99m dimercaptosuccinic acid (DMSA) scans were performed at 4 months after resolution of a febrile UTI. All children were initially treated with antibiotic prophylaxis (Bactrim(R); TMX-SMX 2 mg/kg/day) and 40 underwent antireflux surgery. Median follow-up was 26.1 (range: 6-52) months. Reflux grade was defined by use of the International Classification System. We analyzed the incidence of renal scarring according to reflux grade, reflux resolution, and reason for antireflux surgery. RESULTS: Normal DMSA scans were documented in 63 (70%) children and renal scarring in 27 (30%). Children with renal scarring presented high grade (III-V) VUR. VUR with renal scarring was not resolved spontaneously and increased the risk for breakthrough UTI. Renal scarring could help to predict the prognosis of reflux regarding reflux resolution and breakthrough infection. VUR grade, however, did not help to predict the prognosis of reflux. CONCLUSIONS: We conclude that VUR with renal scarring has a low spontaneous resolution rate and a high risk for breakthrough UTI. This information would be helpful when counseling the families of patients with VUR.

A Patient with Hinman's Syndrome who Underwent Renal Transplantation Using a Pre-existing Cutaneous Ureterostomy / 대한비뇨기과학회지

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.

Mixed Gonadal Dysgenesis Mimicking True Hermaphroditism

A differential diagnosis between the true hermaphroditism (TH) and mixed gonadal dysgenesis (MGD) has important clinical implications for gender assignment and the decision for early gonadectomy; however, variable clinical and histological features frequently lead to the confusion of TH with MGD. A 17- month-old boy was presented with proximal hypospadias with chordee and right non-palpable testis in his scrotum. He also had right auricular anomaly including a separated tragus with skin tag. Left testis was well palpable in his left scrotum. Diagnostic right inguinal exploration showed Mullerian structures such as a gonad like an ovary and a fallopian tube with a uterus, which were removed. Repair of hypospadias and right auricular anomaly was also done. Following ultrasonography (USG) showed a normal looking testis in left scrotum. His chromosome was 45, XO/46, XY. We report a difficult case of mixed gonadal dysgenesis mimicking true hermaphroditism which combines ipsilateral congenital auricular anomaly.