Transobturator Tape for Female Stress Urinary Incontinence: Preoperative Valsalva Leak Point Pressure Is Not Related to Cure Rate or Quality of Life Improvement

PURPOSE: We investigated whether the Valsalva leak point pressure (VLPP) is valuable for predicting postoperative outcome measurement after transobturator suburethral tape (TVT-O) implantation for treating stress urinary incontinence (SUI) in women. MATERIALS AND METHODS: A total of 204 female patients who underwent TVT-O placement for treatment of SUI from March 2008 to February 2012 were enrolled in this retrospective study. All patients completed the incontinence quality of Life questionnaire (I-QoL), a self-reported quality of life measure specific to urinary incontinence, and the cure rate of incontinence was measured before and 6 months after surgery. Cure was defined as no leakage of urine postoperatively both subjectively and objectively. We compared pre- and postoperative I-QoL scores according to preoperative VLPP and Stamey grade. RESULTS: The numbers of patients with Stamey grades I, II, and III were 99 (48.5%), 84 (41.2%), and 21 (10.3%), respectively. A total of 30 (14.7%), 87 (42.6%), and 87 patients (42.6%) showed VLPP90 cm H2O, respectively. Preoperative VLPP was not significantly different according to preoperative I-QoL or change in I-QoL after surgery. However, I-QoL after surgery improved in patients with a high preoperative Stamey grade (p=0.001). CONCLUSIONS: VLPP was not a factor related to surgical outcome from the midurethral sling procedure. Stamey grade rather than VLPP was important for predicting subjective quality of life and improved incontinence-related quality of life after surgery.

Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

PURPOSE: To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. MATERIALS AND METHODS: We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. RESULTS: A univariate analysis indicted that hypoalbuminemia ( or =1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS > or =1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. CONCLUSIONS: A mid or lower ureteral obstruction, GPS > or =1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Osteoblastoma of the mandible: A case report

Osteoblastoma is a relatively rare benign bone tumor representing less than 1% of all bone tumors. The tumor usually involves the spine and sacrum of young individuals, less than 10% being localized to the skull, and nearly half of these affect the mandible, especially the posterior segments. In clinical finding, osteoblastoma present mainly with pain, swelling, and expansion of bone cortex. Radiographic appearances are variable, but frequently a well-delineated radiolucent lesion containing varying amounts of mineral deposits is seen. Histologically, ostoeblastoma is consists of irregular trabeculeae of osteoid and immature bone present within highly vascular connective tissue matrix. Osteoblastoma must be differentiated from a number of bone-producing lesions, including osteoid osteoma, fibrous dysplasia, ossifying fibroma, fibrous dysplasia, and osteosarcoma. If diagnosis may be mistaken for osteosarcoma, there are risks of more aggressive and irreversible treatment. Differential diagnosis of osteoblastoma is important. The preferred treatment of osteoblastoma is conservative approach and surgical excision. Recurrence following surgical intervention is rare. We treated osteoblastoma located in premolar area of mandible by excision with preservation of vital structure, such as nerves and teeth. So we report our clinical treatment with literature review