Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices

OBJECTIVE: To compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine. METHODS: We conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks. RESULTS: The LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles. CONCLUSION: A new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.

Efficacy and Safety of the TVT-SECUR(R) and Impact on Quality of Life in Women with Stress Urinary Incontinence: A 2-Year Follow-Up

PURPOSE: As recently reported, the short-term results of the tension-free vaginal tape SECUR(R) (TVT-S) procedure seem to be similar to those of the conventional transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are insufficient in patients with more than 1 year of follow-up. Therefore, we evaluated the results of the TVT-S procedure in women with stress urinary incontinence (SUI) during 2 years. MATERIALS AND METHODS: We evaluated 51 patients with clinical and urodynamic diagnoses of SUI who underwent the TVT-S procedure from March 2008 to February 2009. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) questionnaire. Following the postoperative period, urinary incontinence status was examined through a physical examination and the I-QoL questionnaire was completed in an outpatient setting or by telephone. RESULTS: Data from 2 years of follow-up were available for 46 of 51 patients. The cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The cure or improvement rate was 93.5% at 1 month after TVT-S and 86.8% at 2 years after TVT-S. The mean total I-QoL score increased by 42 points at 1 month after TVT-S (p<0.026) and by 32 points at 2 years after TVT-S (p<0.013). Most patients reported significant improvements in quality of life. At the 2-year follow-up, there were no significant complications related to TVT-S. CONCLUSIONS: The results of this study suggest that TVT-S is an efficient and safe procedure for the improvement of both the quality of life of the patients and the SUI itself.

The Value of Magnetic Resonance Imaging in the Diagnosis of Penile Fracture / 대한비뇨기과학회지

Penile fracture is known as a rupture of the tunica albuginea occurring during erection. Diagnosing a penile fracture is usually not difficult, and often is based on the patients history and a physical examination. However, patients with atypical clinical findings may require an accurate diagnostic procedure. Immediate surgical intervention is normally used for treating a penile fracture due to the high risk of complications associated with conservative management. The authors recently experienced 2 cases of a penile fracture and the superiority of magnetic resonance imaging (MRI) over ultrasonographic imaging for diagnosing a suspected penile fracture was shown. Therefore, MRI is recommended for diagnosing a suspected atypical penile fracture.

Renal Pseudoaneurysm after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Renal hemorrhage is a most distressing complication of percutaneous renal surgery. Two cases of renal pseudoaneurysm that occurred as a complication of percutaneous nephrolithotomy (PNL) for staghorn calculi are presented. Two male patients were admitted to our hospital for treatment of staghorn calculi. Laboratory data on admission revealed no significant abnormality. They underwent PNL, and most of the calculi were removed. Two nephrostomys were placed in the middle and lower calyces, and were removed at two and three days postoperatively, respectively. Significant bleeding, uncontrolled by the usual measures, developed for six and eight days following the removal of the nephrostomy tubes. Renal angiography was performed and demonstrated pseudoaneurysms. At the same time the pseudoaneurysms were treated by superselective embolization with a coil. We keep in mind the late hemorrhage after PNL, even when there was no hemorrhage from nephrostomy removal.

The Effects of Estrogen on Calcium Oxalate Crystal Deposition in Rat Kidney / 대한비뇨기과학회지

PURPOSE: The effect of female sex hormones in urinary stone formation has not been known. Sexual difference in the incidence and crystaline composition of urinary stones in human are well known, especially calcium oxalate stone occurs more frequently in men than women. These findings imply that sex hormone may be related to the pathogenesis of urolithiasis. The present study was conducted to investigate the effects of estrogen on stone formation by using an ethylene glycol (EG) and ammonium chloride-induced urolithiasis model in rat. MATERIALS AND METHODS: Adult Sprague-Dawley female rats were divided into 3 groups, containing 8 rats each. Group I were fed with normal diet for 7 days. Group II were fed with the 0.8% EG and 1.0% ammonium chloride for 7 days. Group III were oophorectomized and 7 days later were fed with the 0.8% EG and 1.0% ammonium chloride for 7 days more. Right kidneys were used for examining the crystal deposits by polarizing microscope and left kidneys were used for tissue calcium content. RESULTS: The concentration of estradiol in group III is lower than that of group I and II (p<0.05). There was a significant difference between control (179.03+/-45.46microgram/g) and lithogenic diet groups in tissue calcium contents (p<0.05). Also, there was a significant difference of tissue calcium contents between group II (318.68+/-46.86microgram/g) and group III (703.05+/-121.51microgram/g) (p<0.05). CONCLUSIONS: These data suggest that estrogen can inhibit calcium oxalate stone formation in EG and ammonium chloride diet rats.

Clinical Outcome Between Fixations of the Rectus Fascia to the Cooper's Ligament and Abdominal Wall in Pubovaginal Sling Operation

PURPOSE: Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. MATERIALS AND METHODS: We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were evaluated preoperatively with detailed history, physical examination, urodynamic study and incontinence staging. Postoperative outcome measures and complications were checked. RESULTS: Preoperative parameters, such as clinical and urodynamic data were comparable for both groups. With a mean follow-up of 5.4 months(range 1-14) for group I, 27(90%) were cured. In group II, with a mean follow-up of 6.7 months(range 1-11), 28(93%) were cured. Postoperative de novo urge incontinence was present in 6(20%) patients in group I. The hospital stays, periods of residual urine below 50ml and postoperative lower abdominal pain of group II were significantly lower than those of group I. Each group(97%) was either very satisfied or somewhat satisfied with their outcome. CONCLUSION: Modified pubovaginal fascial sling operation including the use of small piece of rectus fascia and fixation of sling to the Cooper's ligament is an effective treatment for stress incontinence with high cure and low complication rate. However, larger followup is needed to confirm our results.