The Influence of Preoperative Bladder Outlet Obstruction on Continence and Satisfaction in Patients with Stress Urinary Incontinence after Midurethral Sling / 대한배뇨장애요실금학회지

PURPOSE: We studied the influence of preoperative bladder outlet obstruction (BOO) on postoperative continence rates and patient satisfaction after the midurethral sling procedure. METHODS: A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction), Group II (n=89, mild obstruction), or Group III (n=33, moderate to severe obstruction). Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. RESULTS: There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05) but not in Group III. CONCLUSIONS: BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.

Effectiveness of Emergency Ureterorenoscopic Lithotripsy for Distal Ureter Stones / 대한비뇨기과학회지

PURPOSE: We performed this study to determine the efficacy between the use of emergency ureterorenoscopic lithotripsy(URSL) and emergency shock wave lithotripsy(SWL) for distal ureter stones in terms of stone-free rates, complication rates and patient satisfaction. MATERIALS AND METHODS: This prospective study included 145 patients with distal ureter stones who underwent emergency URSL(URSL group, n=64) and emergency SWL(SWL group, n=81). All emergency URSL and SWL procedures were performed within eight hours of admission. Stone status was evaluated with either an intravenous pyelogram or the use of non- enhanced CT. URSL was performed with 7.5 Fr semi-rigid ureterorenosope and SWL was performed with Sonolith PRACTIS V.5.0(EDAP TECHNOMED). The stone-free rates, complication rates, visual analogue pain scale and patient satisfaction scores were analyzed for each group of patients. RESULTS: The overall stone-free rates of the URSL and SWL group of patients at two weeks were 96.8% and 74%, respectively(p=0.001). Complication rates were similar(28.1% versus 27.1%, p=0.897). The patient satisfaction score was statistically significant in favor of patients that underwent emergency URSL. CONCLUSIONS: In our single-center study, treatment with emergency URSL provided higher stone-free rates and superior patient satisfaction, as compared with treatment with emergency SWL. Emergency URSL was considered as attractive modality for the management of distal ureter stones.

Feasibility and Safety of Performing Hand-assisted Laparoscopic Donor Nephrectomy for Patients with Multiple Renal Arteries / 대한비뇨기과학회지

PURPOSE: We wanted to present the feasibility and safety of hand-assisted laparoscopic donor nephrectomy(HALDN) for treating patients with multiple renal arteries. MATERIALS AND METHODS: Between February 2000 and July 2006, 252 patients underwent HALDN. The results for the patients with a single renal artery (n=187)(Group I) and those patients with multiple renal arteries(n=65) (Group II) were compared in terms of the donor and recipient outcomes. A retrospective chart review was performed and statistical analysis included Student's t-test, the chi square test and Kaplan-Meier survival probability analysis. RESULTS: HALDN was technically successful in 251 patients(1 patient had to be converted to open donor nephrectomy). The operative times were increased in group II, but the differences between the groups were not statistically significant. The warm ischemic times were significantly longer in group II. The intraoperative blood loss, postoperative hospital stay and complication rate in the donor group were not associated with the number of renal arteries. The recipients' renal function and overall graft survival were similar between groups I and II. CONCLUSIONS: In our single-center study, the presence of renal artery multiplicity when performing HALDN does not have a significant impact on the outcomes of the renal donors or recipients.

Feasibility and Safety of Performing Hand-assisted Laparoscopic Donor Nephrectomy for Patients with Multiple Renal Arteries / 대한비뇨기과학회지

PURPOSE: We wanted to present the feasibility and safety of hand-assisted laparoscopic donor nephrectomy(HALDN) for treating patients with multiple renal arteries. MATERIALS AND METHODS: Between February 2000 and July 2006, 252 patients underwent HALDN. The results for the patients with a single renal artery (n=187)(Group I) and those patients with multiple renal arteries(n=65) (Group II) were compared in terms of the donor and recipient outcomes. A retrospective chart review was performed and statistical analysis included Student's t-test, the chi square test and Kaplan-Meier survival probability analysis. RESULTS: HALDN was technically successful in 251 patients(1 patient had to be converted to open donor nephrectomy). The operative times were increased in group II, but the differences between the groups were not statistically significant. The warm ischemic times were significantly longer in group II. The intraoperative blood loss, postoperative hospital stay and complication rate in the donor group were not associated with the number of renal arteries. The recipients' renal function and overall graft survival were similar between groups I and II. CONCLUSIONS: In our single-center study, the presence of renal artery multiplicity when performing HALDN does not have a significant impact on the outcomes of the renal donors or recipients.

The Difference of Pelvic Floor with Dynamic MRI before and after Tension Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

PURPOSE: Tension-free vaginal tape(TVT) procedure is an effective surgical procedure for the treatment of female urinary stress incontinence. The purpose of this study was to evaluate the changes of pelvic floor MR imaging findings after tension-free vaginal tape procedure on stress urinary incontinent women. MATERIALS AND METHODS: Thirty two women with complaint of stress urinary incontinence(mean age, 56 years; age range 32~73 years) were included in this study. Pelvic floor MR imaging were performed preoperatively and one month after surgery. The position of the bladder neck in relation to the pubococcygeal line, the position of the bladder neck in relation to a perpendicular line through the posterior edge of symphysis pubis, the angle of urethral inclination were measured. We also measured the position of anterior wall of the urethra in relation to posterior edge of the symphysis pubis and cystocele during resting and pelvic straining and thickness of the anterior wall. We compared all parameters between resting and stress. RESULTS: Twenty nine patients(91%) had normal voiding pattern after TVT procedure. three patients(9%) had voiding difficulty. The position and mobility of the bladder neck during straining showed significant improvement after surgery(p<0.01). During straining, the length between the urethra and the inferior edge of the pubic symphysis with mid-urethra angulation was shorten in twenty eight patients(88%). There is no significant difference among three groups in all parameters. However, 3 patients with voiding difficulty had the significant high bladder neck and moderate cystocele. CONCLUSION: The TVT procedure provides decrease of urethral hypermobility and increase of mid-urethral angulation. MR imaging demonstrate well that urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed at stress. Postoperative voiding difficulty may be related to remaining cystocele and high bladder neck.

Pelvic Hematoma following a Transobturator Vaginal Tape Surgery for Treating Stress Urinary Incontinence

The transobturator tape surgery is the most recent minimally invasive midurethral sling procedure. This technique is introduced with the expect of decreasing some of the complications such as bladder, bowel and blood vessel injury that is associated with retropubic passage of needles. Reported is a 48-year-old woman who underwent a transobturator tape(TVT-O) procedure and who developed a retropubic hematoma at the pelvic cavity.