Vaginal Wall Sling for Female Stress Urinary Incontinence: Efficacy and Outcome Analysis

PURPOSE: The objective of this study was to assess the efficacy and clinical outcome of vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: A total of 37 patients with stress urinary incontinence underwent vaginal wall sling procedure by a single surgeon from January 1998 to December 2001. All patients were evaluated preoperatively with detailed history, physical examination, urinalysis, abdominal ultrasonography, Q-tip test and stress provocation test. The 4 sutures comprising vaginal wall sling (two at the level of mid-urethral complex and two at the level of bladder neck) provide a rectangle of support and compression from the bladder neck to the mid-urethra. The efficacy and clinical outcomes of this procedure were evaluated. RESULTS: With a mean follow-up of 19.2 months(5 to 46 months), 30 patients(81%) failed. Mean operation time was 63.3 minutes. Mean duration of indwelling catheter was 5.2 days and mean duration of hospitalization was 7.2 days. One patient(2.7%) suffered from prolonged voiding difficulty for 30 days. One patient(2.7%) had postoperative bleeding necessitating blood transfusion. De novo urge incontinence developed in 3 patients(8.1%). Other transient minor complications were urinary tract infection(13 cases), suprapubic discomfort(5 cases), and urgency(4 cases). CONCLUSIONS: We consider that vaginal wall sling is a simple and effective procedure for the treatment of stress urinary incontinence, though longer follow-up is necessary to assess the long term effect.

Change of 24-hour Urinary Citrate Level after Dietary Manipulation with Lemon Juice in Urolithiasis Patients / 대한비뇨기과학회지

PURPOSE: Citrate is a well recognized inhibitor of the formation of calcium oxalate and calcium phosphate stones. Hypocitraturia is a common etiology of recurrent calcium nephrolithiasis, with an incidence of 19 to 63%. Potassium citrate therapy can be a useful therapeutic approach for the management of calcium nephrolithiasis. But pharmacological treatment of hypocitraturic calcium nephrolithiasis requires taking too many tablets, or numerous crystal package or liquid supplements throughout the day. This cumbersome regimen often decreases patient compliance. We administered dietary citrate via lemon juice to stone former and evaluated the change of citrate levels. MATERIALS AND METHODS: The prospective study included 7 women and 8 men with documented recurrent or multiple urinary stone disease. None of the subjects suffered from renal impairment, urinary tract infection and other metabolic disorder. Controls comprised 6 voluntary men. They had no previous stone history and no evidence of stone. Patients ingested total 1 liter of lemon juice(containing 4.0gm/L.citrate) divided at 6 hours interval without strict diet restriction. Urine specimens were obtained for urinary citrate levels after 2-3days of lemon juice therapy and compared to pre-lemon juice baseline values. RESULTS: All 15 patient showed increased urinary citrate levels during lemon juice therapy. Average urinary citrate levels increased from 146+/-109mg/day at baseline to 453+/-226mg/day during treatment(p0.05). Urinary pH increased from 5.9+/-0.4 at baseline to 6.8+/-0.6 during treatment(p<0.05). No patient complained of gastrointestinal discomforts. CONCLUSIONS: Citrate supplementation with lemon juice increased urinary citrate levels and urinary pH. Lemon juice is well tolerated dietary source of citrate and would be beneficial in the control of calcium urolithiasis.

A Case of Retroperitoneal Extragonadal Germ Cell Tumor with Cryptorchidism / 대한비뇨기과학회지

We experienced one case of extragonadal germ cell tumor of retroperitoneal origin. The patient had orchiopexy of left cryptorchidism twenty years ago. The left testis was atrophied and the right testis was normal on palpation. Retroperitoneal exploratory surgery and complete excision of the mass were performed. The pathologic report identified seminoma. There was no evidence of metastasis computed tomography and bone scan. Then left orchiectomy and right testicular biopsy were performed. The left testis demonstrated hyalinization of seminiferous tubules and right testis demonstrated normal finding, but both specimens showed no malignancy or carcinoma in situ. The patient was treated with BEP(bleomycin, etoposide, cisplatin) combination chemotherapy. With a follow-up of 24 months the patient remains disease free.

Sequential Involvement of Carcinosarcoma in the Ureter, Bladder and Kidney: A Case Report / 대한비뇨기과학회지

We report a case of carcinosarcoma involving the ureter, bladder and kidney in a 63-year-old woman. The diagnosis of carcinosarcoma was confirmed by immunohistochemical stain.

Bladder Mucosal Mast Cell Response in Bladder Tumor / 대한비뇨기과학회지

Mast cells are immune-mediators producing cells and involved in neovascularization of some tumors. Such roast cell is divided into two cell types: mucosal mast cell and connective tissue mast cell. There are controversies about the roles of mast cells in suppression and metastasis of some tumors (including bladder tumor). We performed bladder mucosal biopsies in 28 patients (from September 1994 to July 1996) and observed bladder mucosal mast cell responses in bladder tumor (TCC) under toluidine blue stain (x 400). Patients were divided into 2 groups: group A was consisted of bladder tumor patients (21 cases), whereas group B was the control group (7 cases). Mast cell responses, average mucosal mast cell counts in high power field, in group A and B were 1.75+/-0.25 cells/HPF, 0.29+/-0.20 cel1/HPF respectively. We observed more mast cell responses in bladder tumor patients group. But fundamental researches will be needed to elucidate the causes of mast cell activation in bladder tumor.