Needle Aspiration Biopsy of Seminiferous Tubules (NABST) as a Diagnostic Method in Korea / 전남의대학술지

To evaluate the diagnostic efficacy of needle aspiration biopsy of seminiferous tubules (NABST) and to represent the redistributed diagnostic results corresponding to testicular volumes and follicle-stimulating hormone (FSH) levels. In this retrospective study, we investigated 65 infertile men with either azoospermia or oligoasthenoteratozoospermia. Following NABST, specimens were stained with hematoxylin and eosin and classified into five histological types. With pre-procedure FSH levels and testicular volumes, we evaluated the probabilities of detecting sperms within biopsy specimens. NABST led to the classification of normal spermatogenesis in 31 cases (47.7%), hypospermatogenesis in 23 cases (35.4%), maturation arrest in 4 cases (6.2%), and Sertoli cell only syndrome in 4 cases (6.2%). The success rate of reaching a histological diagnosis using NABST was 95.4% (62 out of 65 cases). Fourteen patients (21.5%) had a testicular volume <15 cc; of these, 8 patients (57.1%) had normal spermatogenesis, 2 patients (14.3%) had hypospermatogenesis, 2 patients (14.3%) had maturation arrest and 2 patients (14.3%) had Sertoli cell-only syndrome (SCO). Twelve patients (18.5%) had an FSH level ≥10 IU; of these, 6 (50%) had normal spermatogenesis, 2 patients (16.7%) had maturation arrest and 4 patients (33.3%) had SCO. Cases with an FSH level <10 IU were positively associated with a probability of detecting sperm using NABST (p<0.001). NABST is a reliable tool for the histological diagnosis of azoospermic and oligoasthenoteratozoospermic patients. The diagnostic success rate was high and associated with pathological accuracy. NABST is a convenient procedure with few complications.

Needle Aspiration Biopsy of Seminiferous Tubules (NABST) as a Diagnostic Method in Korea / 전남의대학술지

To evaluate the diagnostic efficacy of needle aspiration biopsy of seminiferous tubules (NABST) and to represent the redistributed diagnostic results corresponding to testicular volumes and follicle-stimulating hormone (FSH) levels. In this retrospective study, we investigated 65 infertile men with either azoospermia or oligoasthenoteratozoospermia. Following NABST, specimens were stained with hematoxylin and eosin and classified into five histological types. With pre-procedure FSH levels and testicular volumes, we evaluated the probabilities of detecting sperms within biopsy specimens. NABST led to the classification of normal spermatogenesis in 31 cases (47.7%), hypospermatogenesis in 23 cases (35.4%), maturation arrest in 4 cases (6.2%), and Sertoli cell only syndrome in 4 cases (6.2%). The success rate of reaching a histological diagnosis using NABST was 95.4% (62 out of 65 cases). Fourteen patients (21.5%) had a testicular volume <15 cc; of these, 8 patients (57.1%) had normal spermatogenesis, 2 patients (14.3%) had hypospermatogenesis, 2 patients (14.3%) had maturation arrest and 2 patients (14.3%) had Sertoli cell-only syndrome (SCO). Twelve patients (18.5%) had an FSH level ≥10 IU; of these, 6 (50%) had normal spermatogenesis, 2 patients (16.7%) had maturation arrest and 4 patients (33.3%) had SCO. Cases with an FSH level <10 IU were positively associated with a probability of detecting sperm using NABST (p<0.001). NABST is a reliable tool for the histological diagnosis of azoospermic and oligoasthenoteratozoospermic patients. The diagnostic success rate was high and associated with pathological accuracy. NABST is a convenient procedure with few complications.

Management of Pelvic Organ Prolapse

Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.

Reversible Infertility Associated with Testosterone Therapy for Symptomatic Hypogonadism in Infertile Couple

PURPOSE: Androgen replacement therapy has been shown to be safe and effective for most patients with testosterone deficiency. Male partners of infertile couples often report significantly poorer sexual activity and complain androgen deficiency symptoms. We report herein an adverse effect on fertility caused by misusage of androgen replacement therapy in infertile men with hypogonadal symptoms. MATERIALS AND METHODS: The study population consisted of 8 male patients referred from a local clinic for azoospermia or severe oligozoospermia between January 2008 and July 2011. After detailed evaluation at our andrology clinic, all patients were diagnosed with iatrogenic hypogonadism associated with external androgen replacement. We evaluated changes in semen parameters and serum hormone level, and fertility status. RESULTS: All patients had received multiple testosterone undecanoate (NebidoR) injections at local clinic due to androgen deficiency symptoms combined with lower serum testosterone level. The median duration of androgen replacement therapy prior to the development of azoospermia was 8 months (range: 4-12 months). After withdrawal of androgen therapy, sperm concentration and serum follicle-stimulating hormone level returned to normal range at a median 8.5 months (range: 7-10 months). CONCLUSION: Misusage of external androgen replacement therapy in infertile men with poor sexual function can cause temporary spermatogenic dysfunction, thus aggravating infertility.

Detection of Y Chromosome Microdeletion is Valuable in the Treatment of Patients With Nonobstructive Azoospermia and Oligoasthenoteratozoospermia: Sperm Retrieval Rate and Birth Rate

PURPOSE: We evaluated clinical characteristics, sperm retrieval rates, and birth rates in a relatively large number of infertile patients with Y chromosome microdeletions. MATERIALS AND METHODS: We retrospectively reviewed clinical data from 213 patients with nonobstructive azoospermia (NOA) and 76 patients with oligoasthenoteratozoospermia (OATS) who were tested for Y chromosome microdeletion from March 2004 to June 2011. RESULTS: Of the 289 patients, 110 patients presented with Y chromosome microdeletion and 179 patients presented with no microdeletion. Among the patients with Y chromosome microdeletions, 83/110 (75.4%) were NOA patients and 27/110 (24.5%) were OATS patients. After subdividing the patients with Y chromosome microdeletion, 29 had azoospermia factor (AZF)b-c microdeletion and 81 had AZFc microdeletion. The sperm retrieval rate was similar between patients with Y chromosome microdeletion and those with no microdeletion (26.6% vs. 25.6%, p=0.298) after multiple testicular sperm extraction (TESE). Excluding 53 patients who did not undergo TESE, 30 patients were analyzed. All of the 9 men with AZFb-c microdeletion had a complete absence of sperm despite multiple TESE. However, multiple TESE was successful for 9 of 21 patients with only AZFc microdeletion (p=0.041). Twenty patients with Y chromosome microdeletion gave birth. CONCLUSIONS: In NOA and OATS patients, no significant difference in the sperm retrieval rate was shown between patients with Y chromosome microdeletion and those with no microdeletion. Patients with short Y chromosome microdeletion such as AZFc microdeletion have better prognoses for sperm retrieval and an increased chance of conception than do patients with larger microdeletions such as AZFb-c microdeletion.

Laparoscopic Treatment of Appendicovesical Fistula

A 23-year-old man had a history of intermittent episodes of urinary tract infection with associated low abdominal pain for 15 years. Persistent bacteriuria even with prolonged antibiotics was the reason why he was referred to our hospital. Laboratory tests were normal except pyuria and growth of Escherichia coli in the urinary samples. Cystoscopy revealed a small slit-like opening on the right lateral wall of bladder dome. We found some air within the bladder and a suspicious communicating tract between the appendix and bladder on a CT scan. With a strong impression of appendicovesical fistula, a laparoscopy was performed to confirm a diagnosis and to remove the appendicovesical fistula resulting in a satisfactory result without any complication.

Efficacy of In Vitro Germ Cell Culture in Nonobstructive Azoospermic Patients with Sertoli Cell Only Syndrome

PURPOSE: We determined the usefulness of in vitro germ cell culture in nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome, no sperm in testicular sperm extraction. MATERIALS AND METHODS: This study included 44 patients (45 testicular tissues) with nonobstructive azoospermia who were diagnosed with Sertoli cell only syndrome and were found to have no sperm in testicular sperm extraction between January 2006 and July 2008. Among the 45 testicular tissues, 22 tissues were processed for culture. In the in vitro cultures, the testicular tissues were dissociated and plated on gelatin-coated dishes. Patients were divided into 2 groups according to culture success: group I, culture positive (+; n=10); and group II, culture negative (-; n=12). RESULTS: The mean patient ages were 31.73 and 31.68 years for groups I and II, respectively. The mean testicular sizes were 10.19 and 10.42 cc, respectively; the semen volumes were 2.86 and 3.04 cc, respectively; and the mean FSH, LH, and testosterone levels were 18.86 mIU/ml, 5.99 mIU/ml, and 4.46 ng/ml vs. 21.02 mIU/ml, 6.29 mIU/ml, and 4.32 ng/ml for groups I and II, respectively, with no significant differences between the groups (p>0.05). The culture rate of nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome was 45.5% (10/22). Round spermatid injection was done in 2 patients with consent of the patients, but implantation failed. Among the 45 tissues, germ cells were found in 8 tissues after pathologic reexamination. CONCLUSIONS: The in vitro culture of germ cells would be useful in the advanced treatment of nonobstructive azoospermic patients.

Development of a Korean Version of the Urinary Tract Infection Symptoms Assessment Questionnaire

PURPOSE: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. MATERIALS AND METHODS: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. RESULTS: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proof-reading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. CONCLUSIONS: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection.

Clinical Trial with Tamsulosin and Doxazosin for the Treatment of Premature Ejaculation in Patients with Co-morbid LUTS: a Comparative Study / 대한남성과학회지

PURPOSE: We wanted to evaluate the therapeutic potential of a low dose of tamsulosin, as compared with doxazosin, for the treatment of premature ejaculation in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Ninety-six patients (mean age: 55 years) who had LUTS with premature ejaculation were randomly assigned to receive 0.2 mg of tamsulosin and 4 mg of doxazosin daily for a period of 3 months. Patients were evaluated by taking the medical history, the International Prostatic Symptom Score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) for ejaculatory function. The intravaginal ejaculatory latency time (IELT) measured by the patient's estimation and the sexual satisfaction ratio of both the partner and patient were investigated twice during the screening period and after treatment. At 3 months later, we assessed the differences in the IPSS score, the MSHQ score, the IELT and the sexual satisfaction ratio between the two groups. RESULTS: The two alpha 1-adrenoceptor antagonists had significant effects on the IPSS (p<0.05). However, we failed to find a statistically significant difference for each medication and the total MSHQ ejaculatory function score after medication in each group. The IELT was prolonged from 2.7+/-1.6 to 3.5+/-1.5 minutes and from 2.9+/-1.8 to 3.5+/-1.9 minutes in the tamsulosin and doxazosin groups, respectively. However, there was also no statistically significant difference of the IELT and the sexual satisfaction ratio in either group. CONCLUSIONS: For patients with premature ejaculation and LUTS, 0.2mg of tamsulosin improved the voiding symptoms, as assessed with the IPSS, as 4mg of doxazosin did, but neither medication seemed to be effective for the treatment of premature ejaculation.

Clinical Significance of Sensory Nerve Tests on External Genitalia for Diagnosis of Female Sexual Dysfunction / 대한비뇨기과학회지

PURPOSE: It is thought that neurological disorders are one of the main causes of organic female sexual dysfunction. However, it is difficult to diagnose due to the lack of measuring tools for assessing genital neural function. Sensory nerve tests on external genitalia is a new challenge for diagnosing female sexual dysfunction. In this study, we aimed to evaluate the clinical significance of the quantitative measurement of the genital sensory threshold in female sexual dysfunction. MATERIALS AND METHODS: Forty women with complaints of sexual dysfunction were evaluated with physical and vagina examination, serum hormonal tests, routine urinalysis and a questionnaire (the brief index of sexual function for women). A genitosensory analyzer (GAS, Medoc, Israel) was used to quantitative measure the vaginal and clitoral warm, cold and vibratory sensory thresholds. RESULTS: Of the 40 women, an arousal disorder was reported in 40%, orgasmic disorder in 82.5%, sexual pain disorder in 17.5% and a decreased libido in 17.5%. Of the 40 women, 86.4 and 91.2% showed impairment of vaginal cold (A-delta fiber) and warm (unmyelinated C fiber) sensations, respectively. However, the touch and vibratory sensations (A-beta fiber) showed relatively lower impairments; vagina and clitoris in 20.0 and 89.2% of the patients, respectively. CONCLUSIONS: In this study, most of the patients with sexual problems had significant vaginal and clitoral sensory nerve fiber impairments. The results support the significance of organic origins in female sexual dysfunction and the usefulness of quantitative analysis of genital sensation in diagnosing the etiology. (Korean J Urol 2005;46:610-615)

Comparative Study of the Pelvic Floor Magnetic Stimulation with BIOCON-2000TM in Female Urinary Incontinence Patients / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to determine the effect of pelvic floor magnetic stimulation with BIOCON for the treatment of patients with stress urinary incontinence. MATERIALS AND METHODS: Forty-nine patients with urinary incontinence were randomly assigned to two treatment groups (20 patients in the NEOCONTROL group and 29 in the BIOCON group). The patients were treated for 20 minutes, twice or three times a week for 12 weeks; each patient was fully clothed and seated on a special chair, a NEOCONTROL or BIOCON chair with a magnetic field therapy head in the seat. Objective measures included the symptom score, vaginal pressure and quality of life survey. RESULTS: Both NEOCONTROL and BIOCON ExMI offered an effective modal for frequency, urgency and urinary incontinence. No statistical difference was seen between the two groups when comparing their vaginal pressures. In the NEOCONTROL group, the score for the quality of life improved 2.4 to 6.05 and 2.21 to 6.03 for the BIOCON group. CONCLUSIONS: ExMI is painless. There is no need for a probe, nor for the need to undress for treatments. BIOCON ExMI therapy is as effective in stress and urge incontinence as the NEOCONTROL type. A longer follow-up is required to determine the benefits of treatment.

A Randomized Prospective Study Comparing the Outcome of the New Vaginal Cone and Functional Electrical Stimulation(FES)-Biofeedback in Female Stress Urinary Incontinence

INTRODUCTION: Several different methods of enhancing pelvic floor functions have been developed and modified. The aim of this investigation was to compare the usage of a new vaginal cone (double cone) with conventional FES-Biofeedback therapy for female urinary incontinence cases with respect to the effects on pelvic floor rehabilitation. MATERIALS AND METHODS: It was performed on a multi-center based study. One hundred patients, who desired a non-surgical treatment for their urinary incontinence, were divided into two groups randomly. They were: (1) the FES-Biofeedback group (or BFB group); and (2) the new vaginal cone group (or cone group). For a period of six weeks, two sessions each week were carried out for the BFB group. The new 150-gram dumbbell- shaped vaginal cone, made up of fine ceramics material, was developed domestically. A therapist instructed these patients in the cone group for using the new cone for pelvic floor exercises and directed them to repeat the exercises at home daily, as these patients had follow-up visits every week. RESULTS: Objective improvements were obvious in both of these groups. 88% of the cone group and 92% of the BFB group showed an improvement after treatment. There was no significant difference in the improvement of dissatisfaction scores between the two groups. CONCLUSION: The new vaginal cone is relatively easy to use at home and aids in pelvic floor muscle exercises. Consequently, the new vaginal cone could be another treatment modality in non-surgical approaches to female stress urinary incontinence.

Questionnaire Based Evaluation of Sexual Activity and Sexual Dysfunction in Korean Women / 대한비뇨기과학회지

PURPOSE: Sexual activity is a highly personal matter and uneasy to measure their problems objectively in view of clinical field. Many investigators have been continued to rely on self-report measures of sexual function. However, there have been few report measuring female sexual function in general population in Korea. This study was aimed to investigate function by self-report measures. MATERIALS AND METHODS: 347 married women was randomly selected and asked to fill the Brief Index of Sexual Function for Women (BISF-W) which was translated into Korean and modified by authors. Three factors-interest/desire, sexual activity, and satisfaction were analyzed. RESULTS: Women were grouped by age at 10-year intervals. 21.5% of women reported to be sexually active during the past moth, and 78.5% was inactive. Most common coital frequency in all age groups pas one-two times per month. 76.1% of women showed passive response in their initiation of sexual activities. Mostly they reach orgasm only by the vaginal intercourse, and overall satisfaction rate was 55.2% including only 25% of fifties groups followed by pain. CONCLUSIONS: In general, Korean women showed less active in their sexual lives, however, they were relatively satisfied to their sexual lives. A larger study and more sophisticated, modified questionnaire, which is more considering specific social, psychological interpersonal factors would be required.

Early Experience with Extracorporeal Magnetic Innervation (ExMI) Therapy for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The purpose of this study is to assess if extracorporeal magnetic innervation (ExMI) can be successful in treating stress urinary incontinence (SUI). MATERIALS AND METHODS: We studied 38 women with demonstrable stress urinary incontinence. Evaluation before treatment included history, physical examination, voiding diary, perineometer that measures the strength and endurance of pelvic floor muscle contractions, urodynamic study and quality of life questionnaires. Treatments were performed for 20 minutes (10Hz for 10 minutes and 50Hz for 10 minutes), twice a week for 6 weeks. After ExMI therapy, all of the evaluations were repeated at the eighth week. RESULTS: The follow up care was continued on the patients for longer than 2 months. Fourteen out of the 38 patients (36%) were dry after the ExMI treatment. The frequency of leak episodes was reduced from 2.8 to 1.7 in 2 months. Pelvic floor muscle contraction (PMC) pressure was increased from 10.42 4.35 to 17.02 4.04mmHg. CONCLUSIONS: Our early results suggest that ExMI therapy is an effective approach for the treatment of SUI. However, longer follow-up is required to determine how long the benefits of treatment last, whether re-treatment will be necessary, and what the effective treatment strategies are.

FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p>0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p>0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise.

FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p>0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p>0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise.

The effect of pelvic floor muscle exercises on genuine stress incontinence among Korean women--focusing on its effects on the quality of life

This study's purpose was to compare the treatment efficacy and the effects on the patients' quality of life of the pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback method. Ninety female incontinence patients were randomly selected and evenly divided into three groups: control, intensive PFM exercise, and FES-biofeedback groups. They were treated for 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of Jackson's Bristol female urinary symptom questionnaire. Objective changes of pelvic muscle contraction force were measured by perineometer. Pre and post-treatment maximal pelvic floor muscle contractile pressure (PMC pressure) among the three groups showed statistically significant differences (p < 0.001). Especially the FES-biofeedback group showed significantly increased maximal PMC pressure compared with other groups (p < 0.001). From the questionnaire, pre and post-treatment changes in the severity of urinary incontinence and discomfort due to incontinence showed significant differences among the three groups (p < 0.001). The level of discomfort in daily life, social activity, physical activity, personal relations and discomfort due to urinary symptoms had largely changed and the FES-biofeedback group, in particular, showed a significant decrease after treatment. In conclusion, when PFM exercise and FES-biofeedback were compared in terms of their effects on the patients' quality of life, FES-biofeedback proved to be more effective than verbal explanation or simple PFM exercise.

The Early Experiences of Dermofat Strip Pubovaginal Sling / 대한비뇨기과학회지

No abstract available.

Surgical Management of the Failed Anti-incontinence Surgery / 대한비뇨기과학회지

PURPOSE: Various surgical methods have been using to treat female stress urinary incontinence. However, significant numbers of those patients suffered from immediate or delayed recurrences. The aims of this study were to analyze the etiology of recurrent stress urinary incontinence and evaluate the efficacy of each operation which was used as methods of treating recurrent stress urinary incontinence. MATERIALS AND METHODS: Data of 16 female patients with recurrent stress urinary incontinence who visited and treated at our urologic department from January 1995 to March 1998 were analyzed. All patients were assessed for their age, types of previous and current anti-incontinence operations, urodynamic findings and final outcomes. RESULTS: Mean age was 48.8 years old. 12 patients were taken anti-incontinence operations only once before recurrence, and 4 patients experienced two times of anti-incontinence operations. Two of 16(12%) patients were diagnosed as anatomic incontinence(AI), 3(19%) patients were diagnosed as intrinsic sphincteric dysfunction(ISD), and 11(69%) patients had both AI and ISD. Two AI patients were finally managed by Raz bladder neck suspension with anterior and posterior colporrhaphy(APR), and Burch colposuspension, respectively. Three ISD patients were treated by sling operation & APR, collagen injection, and Burch colposuspension, repectively. 11 mixed incontinence patients were treated by sling operations & APR(7), Burch colposuspension(3), Stamey`s needle suspension & APR(1). None of 16 patients has developed recurrent urinary incontinence so far. CONCLUSIONS: Basic principle in treating AI is the correction of the urethral hypermobility. However, 81%(13/16) of patients still had urethral hypermobility in spite of previous anti-incontinence surgery, and it seems that those anti-incontinence surgeries were improperly selected or urethral hypermobility reappeared. Patients who showed urinary incontinence in spite of well supported bladder neck suggest the possibility of undetected or secondary ISD. These findings support the importance of selection of proper initial surgical management. In recurrent urinary incontinence, majority of them show undetected or newly appeared ISD component regardless of urethral hypermobility. In those situations, sling operation can be a safe and effective procedure in the management of patients with failed anti-incontinence surgery.

The Comparison of the Effectiveness of Pelvic Floor Muscle Exercise and Biofeedback Treatment for Stress Incontinence in Korean Women / 간호학회지

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows: 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P=0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P=0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P=0.000). 3. The lower urinary symptoms Daily frequency(P=0.000), nocturia(P=0.000), urgency(P=0.000), bladder pain(P=0.000), unexplained incontinence(P=0.048), wearing protection(P=0.022), changing outer clothing(P=0.005), hesitancy(P=0.008), intermittent stream(P=0.000), abnormal strength of stream(P=0.004), retention(P=0.000), incomplete emptying(P=0.000), and inability to stop mid steam(P=0.006) of the lower urinary symptoms in the biofeedback group were significantly decreased. 4. The sexual matters The dry vagina(P=0.004) and pain during sexual intercourse(P=0.002) in the biofeedback group was significantly decreased. 5. The life style. The fluid intake restriction(P=0.007), affected daily task(P=0.003), avoidance of places & situation(P=0.003), interference in Physical activity(P=0.002), interference in relationship with other people(P=0.01), and feeling about the rest of life with urinary symptom(P=0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.