Preliminary Report on Distal Urethral Polypropylene Sling (DUPS) in the New Surgical Management of Stress Urinary Incontinence in Korea / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to introduce and evaluate new anti-incontinence surgical procedure, Distal Urethral Polypropylene Sling (DUPS) for stress urinary incontinence in Korea. METHODS: DUPS were performed on 12 patients with stress urinary incontinence at Kangbuk Samsung Hospital from Feb. 2005 to May 2005. Patients were evaluated preoperatively with history, physical examination, standardized symptom questionnaire, voiding diary, post-void residual urine and urodynamics. We reviewed medical records and clinical characteristics and evaluated the efficacy of the sling procedure, retrospectively. RESULTS: The mean age was 48.08+/-9.3 years. The average operative time was 29.00+/-15.8 minutes for the sling procedure. The average hemoglobin change is 1.57+/-1.14 g/dL. The mean hospital stay day is 3.74+/-0.88 days. Concomitant procedures were performed including rectocele repair (n=5), LAVH with rectocele repair (n=2), LAVH (n=1), VTH with cystocele and rectocele repair (n=1). There was no intraoperative complications or major postoperative complications. The cure rate (patients' satisfaction) was 94.7%. CONCLUSION: DUPS is a new, inexpensive, safe and simple alternative treatment for patients with stress urinary incontinence.

Human chorionic gonadotropin and invasion of trophoblast into the tubal wall in tubal pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between gestational age, tubal ultrasonographic diameter, and serum beta-hCG levels and different stages of trophoblastic infiltration of the tubal wall in tubal pregnancy. METHODS: The 45 cases of fallopian tube containing tubal pregnancy were reviewed. Gestational age, diameter of the tubal mass, and beta-hCG level on the day of surgery were calculated by transvaginal sonography and immunoassay respectively. The tubal pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III). RESULTS: 14 patients (31.1%) had stage I tubal infiltration, 10 patients (22.2%) had stage II infiltration, 21 patients (46.7%) had stage III infiltration. There was no relationship between gestational age, tubal diameter and stage, but there was a predictable correlation between beta-hCG and the depth of trophoblastic invasion. The median beta-hCG level was 1,332.1 mIU/mL (range, 215-2,995 mIU/mL) for patients with stage I infiltration, 9,548.0 mIU/mL (range, 569-43,989 mIU/mL) for stage II infiltration, and 23,087.9 mIU/mL (range, 1,373-98,000 mIU/mL) for stage III infiltration. Cut off level of beta-hCG for each stage were 1,996.5 mIU/mL (stage I vs II, III) and 5,665 mIU/mL (stage I, II vs III) respectively. CONCLUSION: These findings may explain why beta-hCG is a important predicting factor for invasion of trophoblast in tubal pregnancy.

Clinical Evaluation on 154 Cases of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To evaluate the indications, advantages and complications of laparoscopically assisted vaginal hysterectomy (LAVH), retrospectively. METHODS: From Mar. 2003 to Feb. 2004, clinical trials of LAVH (n=154) were performed in the Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, School of Medicine, University of Sungkyunkwan, Seoul, Korea. Medical records of patients who underwent LAVH were reviewed. The results were evaluated according to characteristics of patients, history of previous abdominal surgery, preoperative surgical indications, postoperative diagnosis, mean operation times, weight of uterus, change of hemoglobin, hospital stay, associated diseases, concomitant procedures and complications. RESULTS: The mean age was 46.09 +/- 6.67 years. The mean parity was 2.08 +/- 0.94. Tubal ligation, vaginal bleeding, leiomyoma was the most common previous abdominal surgery, preoperative surgical indication, and postoperative diagnosis, respectively. The mean operation time was 130.66 +/- 67.68 minutes. The mean uterine weight was 259.27 +/- 123.48 gm. The mean hemoglobin change was 1.61 +/- 1.12 g/dL. The mean hospital stay was 3.44 +/- 1.83 days. The complication rate was 3.2% (5 cases); bladder injury (3 cases) being the most common complication. CONCLUSION: LAVH appears to be beneficial in many aspects. The further development of laparoscopic instruments and skills will reduce limitations and complications of LAVH and will hopefully allow the utilization of this technique to expand to include other clinical indications and concomitant procedures.

A Study on the Improvement of Urinary Incontinence Symptoms and Sexual Function in Patients with Urinary Incontinence before and after Extracorporeal Magnetic Innervation (ExMI) Therapy / 대한산부인과학회잡지

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.

A Study on the Improvement of Urinary Incontinence Symptoms and Sexual Function in Patients with Urinary Incontinence before and after Extracorporeal Magnetic Innervation (ExMI) Therapy / 대한산부인과학회잡지

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.

A Case of Tubo-ovarian Actinomycosis Associated with Fitz-Hugh-Curtis Syndrome / 대한산부인과학회잡지

Actinomycosis is a chronic suppurative and granulomatous disease. Actinomyces is a gram positive, anaerobic and non-acid fast bacterium. Many actinomycotic pelvic infection in women used intrauterine device(IUD) with long duration were reported, in contrast, others suggest that actinomycosis develop opportunistic infection irrespective of intrauterine device. One to ten percents of patients with acute pelvic inflammatory disease(PID) develop perihepatic inflammation and adhesion---the Fitz-Hugh-Curtis syndrome. Although in the past Neisseria gonorrhea was thought to be the only etiological agent, recent data indicate that chlamydia trachomatis produces the majority of cases. We have experienced the case of tubo-ovarian actinomycosis(case with IUD(Cu-T)) associated with Fitz-Hugh-Curtis syndrome in a 29years old woman, and reported that with a review of related literatures.