The Efficacy of Botulinum Toxin Injection to the External Urethral Sphincter for Detrusor External Sphincter Dyssynergia / 대한비뇨기과학회지

PURPOSE: Botulinum toxin (BTX) acts by inhibiting acetylcholine (ACh) release at the presynaptic cholinergic neuromuscular junction, and is applied in various urethral and bladder dysfunctions, including detrusor external sphincter dyssynergia (DESD). We investigated the use of BTX in DESD patients as a reversible chemical sphincterotomy. MATERIALS AND METHODS: A total of 6 patients (male 3, female 3) with DESD were included. Their mean age was 45.5 years. The underlying diseases were multiple sclerosis (1), meningomyelocele (1), spinal cord injury (1), multiple systemic atrophy (1) and transverse myelitis (2). All the patients had severe voiding symptoms and large residual urine, despite anticholinergics and alpha-adrenoceptor antagonists with clean intermittent catheterization (CIC). Urodynamic studies were performed before and 1 month after treatment. A total of 100 units of BTX-A (Botox(R)) were injected at 4 sites, 3, 6, 9 and 12 o'clock relative to the external sphincter, under anesthesia, on an outpatient basis. The alpha-adrenoceptor antagonist medication was discontinued for evaluation after surgery. RESULTS: At 1 month after the injection, the mean maximal flow rate was increased (from 8.4 to 12.2ml/sec) and mean residual urine was decreased (from 258 to 120ml) compared to the baseline values. The external sphincter pressure was decreased. All patients were able to discontinue the CIC. There were no systemic complications, such as respiratory distress or myasthenic crisis. CONCLUSIONS: Transurethral BTX-A injections were safe and effective for releasing or ameliorating a lower urinary tract obstruction due to DESD, and a safe and valuable therapeutic option in DESD patients not desiring surgery or CIC, and who are resistant to medications. (Korean J Urol 2005;46:604-609)

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.

The Long-term Efficacy of Laparoscopic Burch Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.