Evaluation of diagnostic methods in children with nonpalpable undescended testis / 소아과

PURPOSE: Numerous methods exist for diagnosing nonpalpable testis in treatment of cryptochidism. However, there is no clinically established data for the rational diagnostic tool of nonpalpable testis in terms of expenses. We tried to establish a current conventional diagnostic course of nonpalpable testis. We then evaluated the efficacy of ultrasonography, physical examination under general anesthesia and laparoscopy for diagnosing nonpalpable testis. METHODS: Between March 2000 and February 2005, 103 boys(129 testes) with undescended testes were treated in our department. There were 31 testes(24.0%) that were not palpable at physical examination. These patients were evaluated with ultrasonography and repeated physical examination under general anesthesia. In the cases where testes could not be detected with ultrasonography and physical examination under general anesthesia, laparoscopy was performed to diagnose nonpalpable testis. RESULTS: In 31 cases of nonpalpable testis, 13 testes were detected with ultrasonography and 15 testes became palpable with physical examination under general anesthesia. All of the remaining 16 nonpalpable testes were confirmed with laparoscopy. CONCLUSION: Physical examination under general anesthesia was superior to ultrasonography in making a diagnosis of nonpalpable testis. Ultrasonography and physical examination under general anesthesia could reduce the incidence of diagnostic laparoscopy. Therefore, it is recommended that ultrasonography, physical examination under general anesthesia and laparoscopy must be performed conventionally in order to diagnose nonpalpable testis.

Causes of Reoperation after Midurethral Sling Procedures in Female Stress Urinary Incontinence

PURPOSE: Midurethral sling procedure has become one of the most commonly performed procedures for the treatment of female stress urinary incontinence(SUI). Although complication rate is very low, some patients are required further treatment to correct unwanted problems after surgery as it continues to be more widely used. We evaluated the mesh-related complications in those who required further procedures after midurethral sling procedures. MATERIALS AND METHODS: From January 2000 to December 2005, female patients who underwent additional surgery because of complications after midurethral sling procedures for stress urinary incontinence were evaluated in this study. RESULTS: In 675 patients, 298 received a tension-free vaginal tape(TVT) and 377 received a Monarc(transobturator route, TOT) as a sling material at 3 different hospitals. 34(5.0%) out of 675 patients required additional surgery to correct complications including obstructive voiding symptoms, mesh extrusion, failed or recurred SUI, wound pain and mesh in the bladder. Mean age of 34 patients was 54.7, and TVT was used in 21(7.0%) out of 298 patients, Monarc was used in 12(3.4%) out of 377 as midurethral sling materials. In 19 patients who showed obstructive voiding symptoms, all were cured by mesh cutting and in 8 patients who complained of immediate recurrence of SUI, 7 showed complete dryness by shortening the loosen mesh. Mesh extrusion with vaginal erosion were observed in 3 and all were cured by segmental resection of mesh without recurrence of SUI. 2 patients who showed recurrence of SUI after 2 years of TVT received Monarc procedure. Mesh in the bladder which was found after 6 months of TVT was managed by endoscopic resection of mesh with Monarc procedure in 1, and suprapubic pain after TVT was improved by resection of TVT segment through suprapubic incision in 1. All reoperation procedures were performed by local anesthesia except 1(mesh in the bladder). CONCLUSION: These data demonstrate that midurethral sling is an excellent surgical procedure with low complication rate, high success rate in reoperation. However, care must be taken to reduce reoperation rate in applying tension of mesh on urethra because most patients(27 out of 34) who required reoperation have complained of obstructive voiding symptoms(19) and persistent incontinence(8).

Clinical Outcome of Transobturator Monarc Procedures for Treating of Women with Stress Urinary Incontinence: The 2-Year Follow Up / 대한비뇨기과학회지

PURPOSE: The transobturator Monarc procedure is a new minimally invasive treatment for female stress urinary incontinence (SUI), and this is known to be safe and convenient because serious complications such as bladder or bowel perforation and vascular injury, which can happen during a tension-free vaginal tape (TVT) procedure, can be avoided and cystoscopic examination is not necessary. We evaluated the 2 year clinical outcome of transobturator Monarc sling procedures for female SUI. MATERIALS AND METHODS: There were 114 women who underwent the transobturator Monarc procedure for SUI at 3 different hospitals of The Catholic University of Korea from December 2003 to February 2004. After 2 years following surgery, all the patients were asked about their voiding symptoms as well as any recurrence by conducting detailed telephone interviews. RESULTS: For the 114 patients, 86 patients (75.4%) stated that they had complete resolution of SUI, and 22 patients (19.3%) stated they were continent with only a small amount of leakage when coughing. The overall success rate of the Monarc procedure was 94.7% (108/114). 36 (64.3%) out of 56 patients who had urgency or urge incontinence before surgery indicated the improvement of their symptoms following surgery. For 62 patients who had frequency, the symptom was improved in 48 patients (77.4%), and for the 44 patients who had nocturia, the symptom was improved in 32 (72.7%). CONCLUSIONS: These data demonstrates that the transobturator Monarc procedure is a safe and effective treatment for women with SUI, which is comparable with TVT, and the patients' voiding symptoms can be expected to be improved after the transobturator Monarc procedure as well. However, we do not know how long the improvement of the voiding symptoms will last, and so additional longer term follow-up should be done.

Female Urethral Prolapse Treated by Simple Ligation over a Foley Catheter: A Case Report

Urethral prolapse is rarely diagnosed. We have reported a case of urethral prolapse that was successfully managed by a simple ligation of prolapsed urethra over a Foley catheter in a postmenopausal woman who was suffering from advanced lung cancer.