Posterior Tibial Nerve Magnetic Stimulation in Patients with Neurogenic Bladder / 대한비뇨기과학회지

PURPOSE: To evaluate the effect of posterior tibial nerve magnetic stimulation (PTNS), using a newly developed magnetic arm stimulator, for the treatment of patients with neurogenic bladder. MATERIALS AND METHODS: 25 patients with urgency, frequency and voiding difficulty symptoms of a neurogenic cause were enrolled in this study. Of these patients, 19 and 6 had neurogenic detrusor overactivity and detrusor areflexia, respectively. The patients underwent a total of 16 PTNS sessions, twice a week, using an Arm type Magnetic Stimulator (BioCon 1000, Mcube, Korea). Subjective success was defined as the request to continue treatment, whereas objective success was defined as a significant reduction (>or=50%) in the total number of leakage episodes per 24 hours. RESULTS: 13 of the 16 patients with neurogenic detrusor overactivity (81.2%) reported subjective success, and 8 (50%) reported objective success. A statistically significant decrease in leakage episodes and voiding frequency (p<0.05), and an increase in the mean volume voided were observed (p<0.05). Statistically significant improvements were noted in quality of life score (p<0.05). In patients with detrusor areflexia, no significant improvements were observed in the frequency/volume chart data, quality of life scores or urodynamic data. No significant adverse events were noted in relation to the treatment. CONCLUSIONS: PTNS can be considered to be a safe, non-invasive and effective treatment for neurogenic detrusor overactivity.

Vaginal Erosion Associated with Tension Free Vaginal Tape Procedure

PURPOSE: Vaginal erosion is known complication of synthetic sling material, Most series report a relatively low erosion rate, ranging from 0 to 11%. but few report on management of only vaginal erosion after TVT procedure have been described. We estimated the incidence of vaginal erosion associated with the use of TVT and investigated clinical outcomes. MATERIALS AND METHODS: Between 1999~2002, 296 cases (mean age: 48.8 yrs; range: 31~67 yrs) of TVT performed by 2 university were retrospectively reviewed. Post-operative vaginal erosion as well as their management and surgcial outcomes were investigated. We performed only TVT on 173 patients with grade 1, 2 cystocele, and TVT combined cystocele repair on 123 patients with cystocele grade 3, 4. RESULTS: 11 women (3.72%) required secondary interventions due to vaginal erosion. The interval between insertion and removal varied from 1 to 14 months (mean 6.24), 6 patients developed before postoperative three months. Among 11 patients, 7 patients had TVT combined cystocele repair (one vertical incision), and the others had TVT only. A transvaginal approach was used for vaginal flap over TVT in 2 patients (secondary vaginal erosion developed after 2 months) and a vaginal flap in 1 patient (secondary vaginal erosion developed after 7 months), and TVT removal in 8 patients. Before and after secondary intervention, all patients were totally dry (mean FU period: 12.5 months). CONCLUSION: We suggest that vaginal erosion after TVT procedure should be treated with complete removal of the tape.