The Efficacy of Intravaginal Pelvic Floor Electrical Stimulation with Microchip for the Treatment of Female Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The effect and safety of new intravaginal pelvic floor electrical stimulation, with a distal microchip (PIC16C74), for precision and comfort, in the treatment of female stress, urge and mixed incontinence, were evaluated. MATERIALS AND METHODS: Thirty-eight incontinent women were divided into three groups: stress incontinence (13), urge incontinence (12) and mixed incontinence (13). Evaluations, both before and after treatment, including history taking, a physical examination, a stress provocation test, a 1-hour pad test, voiding diaries, female lower urinary tract symptom and quality of life questionnaires, were conducted. All patients were treated by pelvic floor electrical stimulation, twice a week, for 6 weeks. The success rate, complications, satisfaction and quality of life were evaluated 1 month later. RESULTS: The overall success rate was 60.5%. 53.8 (7/13), 66.7 (8/12) and 61.5% (8/13) success rates were found in patients with stress, urge, and mixed type incontinence, respectively. Success rates of 58.8 (10/17) and 55.6% (5/9) were also found in grades I and II, respectively. There were no significant differences in the success rates between the types and grades of incontinence. 73.7% (28/38) of the patients were satisfied with the treatment, and their quality of life improved from 2.4 to 7.2, on the visual analog scales. CONCLUSIONS: It was concluded that the new intravaginal electrical stimulation, with the microchip (PIC16C74), is an effective and safe treatment for female urinary incontinence, although a longer follow-up period will be required to determine the long term effects.

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence / 영남의대학술지

BACKGROUND: The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.

Tension Free Vaginal Tape Procedure for the Treatment of Female Stress Urinary Incontinence: 1 Year Follow Up / 대한비뇨기과학회지

PURPOSE: We evaluated the efficacy and safety of a tension free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: Forty-one women (32 with genuine stress urinary incontinence and 9 with mixed urinary incontinence) underwent a TVT procedure under spinal, epidural or general anesthesia. Three women experienced previously failed anti-incontinence surgery and nine women experienced previous pelvic surgery. The mean follow-up period was 17.1 0.4 months. RESULTS: The mean operation time was 31.8 1.2 minutes and mean hospital stay was 1.7 0.2 days. There were no significant intra- and postoperative complication. Four patients (9.8%) had immediate postoperative voiding difficulties necessitating an extra procedure (cutting or release of the tape) under local anesthesia. Six patients (14.6%) with de novo detrusor instability were improved by anticholinergics medication and release of the tape. Six (66.7%) of 9 women with urge incontinence were significantly improved or cured after surgery. Success rate was 97.6% in postoperative 3 months, 95.1% in postoperative 12 months. The patients satisfied with this procedure were 38 (92.7%) in postoperative 3 months and 37 (90.2%) in postoperative 12 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.

Suprameatal Transvaginal Urethrolysis in Urethral Obstruction Associated with Anti-incontinence Surgery: A Case Report / 영남의대학술지

We report our experience with a case of urethrolysis using a transvaginal suprameatal approach without lateral perforation of the urethropelvic ligament. A 43-year-old woman suffered from voiding difficulties such as hesitancy, frequency, urgency, decreased urinary flow, residual urine sensation after Marshall-Marchetti-Krantz operation concurrent with hysterectomy. The results of multidisciplinary work-ups of urethral obstruction such as history, vaginal examination, voiding cystourethrography, urodynamic study, showed that she had urethral obstruction due to a previous operation. Since clean intermittent catheterization and alpha-blocker therapy did not improve her symptoms, suprameatal transvaginal urethrolysis was performed to resolve the symptoms. Postoperative follow-up for 5 months showed that the patient remained free from voiding difficulty in their life. We believe that suprameatal transvaginal urethrolysis is worth attempting for urethral obstruction associated with anti-incontinence surgery.

Four Cases of Foreign Body in Lower Urinary Tract / 영남의대학술지

Foreign bodies in genitourinary tract are common and almost of then are within the bladder. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Foreign bodies(a thermometer and a piece of cloth) in the bladder were inserted as a mean of masturbation in two cases, and a cooper wire in the posterior urethra was introduced by iatrogenic causes in one case. In one case, four magnets were inserted into the bladder for the purpose of forceful penile erection. Clinical history, symptom, radiologic study, and endoscopic examination were required to diagnose foreign body. They were easily removed by endoscopic manipulation or open surgical procedure.