The Effect of Transurethral Resection of the Prostate in Detrusor Underactivity / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of transurethral resection of the prostate (TUR-P) in men with detrusor underactivity (DUA) who do not respond to conservative medical treatment. MATERIALS AND METHODS: Of the patients who underwent TUR-P for LUTS at our institution, we reviewed the records of 71 patients who had undergone preoperative urodynamic study. According to the bladder outlet obstruction index and the bladder contractility index, the patients were divided into two groups: group A (25 patients) with unobstructed and underactive detrusor function, and group B (46 patients) with obstructed and/or normal detrusor contractility. We evaluated the difference of International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post void residual (PVR) volume and the subjective satisfaction after TUR-P. RESULTS: There were no significant differences preoperatively between the groups for age, Qmax and PVR. The total IPSS/QoL score was higher and the prostatic size was smaller in group A. After TUR-P in group A, the IPSS/QoL score and PVR were significantly improved; the Qmax was also improved, but this was not significant. There were significant improvements in all parameters in group B. Patients in group B showed the more significant improvement rate of the IPSS score and they were more satisfied after TUR-P than those in group A. CONCLUSIONS: Patients with DUA had less improvement in their symptom score and operative satisfaction than those with obstructed and/or normal detrusor contractility after TUR-P. However, there was significant improvement in IPSS/QoL and PVR after TUR-P in former group and 64% of these patients were satisfied. Therefore, TUR-P is thought to be an optional surgical procedure for treating the men with DUA who do not respond to conservative medical treatment.

High Flow Priapism Developed after Treatment of Low Flow Priapism / 대한비뇨기과학회지

Priapism is a pathologic state of persistent penile erection in the absence of sexual stimulation. Low flow priapism is more common, which is caused by a venous outflow obstruction. However, high flow priapism is rare, and is caused by uncontrolled arterial flow into penis following perineal or penile blunt injuries. We report a case of high flow priapism secondary to the treatment of low flow priapism.

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.