Effect of Extracorporeal Magnetic Innervation (ExMI) Pelvic Floor Therapy on Urinary Incontinence after Radical Prostatectomy / 대한비뇨기과학회지

PURPOSE: To evaluate the safety and clinical effects of extracorporeal magnetic innervation (ExMI) for urinary incontinence after radical prostatectomy. MATERIALS AND METHODS: Thirty-two patients with urinary incontinence after radical prostatectomy were randomly assigned to receive either ExMI treatment or pelvic floor training alone. For the ExMI group, treatment was initiated 1 week after catheter removal and the treatment sessions were for 20 minutes, twice a week, for 8 weeks. For the control group, only pelvic floor muscle exercises were performed. Patients were followed up at 1 week and 1, 2, 3, and 6 months. Outcomes were assessed by 24-hour pad weight testing, the number of pads used daily, and a quality-of-life survey (I-QoL). RESULTS: Leakage weight during the 24 hours after removing the catheter was 655g and 646g for the ExMI and control groups, respectively. At 1 month, it was 147g and 187g; at 2 months, 33g and 81g (p=0.001); and at 3 months, 9g and 45g (p=0.001), respectively. Finally, 6 months later, leakage weight was less than 10g in both groups. The number of pads used daily after removing the catheter was 4.2 and 4.1 for the ExMI and control groups, respectively. At 1 month, it was 1.5 and 1.8; at 2 months, 0.6 and 0.9 (p=0.033); and at 3 months, 0.1 and 0.6 (p=0.002), respectively. Finally, 6 month later, pads counts were 0 and 0.1. I-QoL scores decreased after surgery, but gradually improved in both groups. No other side effects or adverse events were observed. CONCLUSIONS: ExMI provided earlier recovery of continence than in the control group after radical prostatectomy.

Five Year Follow-up Results of the Pubovaginal Fascial Sling Surgery in the Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The long term results of pubovaginal fascial sling surgery were evaluated in female stress urinary incontinence (SUI), and were compared with concomitant surgery in pelvic organ prolapse. MATERIALS AND METHODS: A total of 47 SUI patients were treated with pubovaginal fascial sling surgery between 1997 and 2000. A satisfaction evaluation and success grading of the operation were studied. A postoperative evaluation was performed via a survey questionnaire, uroflowmetry and post-void residuals. RESULTS: Forty-five patients (95.7%) showed successful results at the 2- & 5-year follow-ups, but 2 patients (4.3%) failed. There were no significant differences in success rates according to Valsalva leak point pressure (VLPP) and the pelvic organ prolapse surgery. Thirty-one patients (66.0%) were satisfied with their result, while 16 (34.0%) were unsatisfied at the 2-year follow up. Those unsatisfied with the result included 8 with a urethral obstruction, 6 with urge incontinence and 2 with persistent SUI. Two patients with prolonged urinary retention had undergone urethrolysis. Postoperative de novo and persistent urge incontinence occurred in 2 and 4 patients, respectively. Two patients with persistent SUI were cured using the midurethral sling. Finally, forty-one patients (87.2%) were satisfied with the results, while 6 (12.8%) were unsatisfied at the 5-year follow-up. CONCLISIONS: The 5-year follow-up results of the pubovaginal fascial sling surgery showed a high success rate and relatively good results with respect to satisfaction with the procedure. If a urethral obstruction and urge incontinence are treated carefully, sling surgery can be considered as an efficient method for any type of urinary incontinence.

The Evaluation of a Dissolvable Ureteral Catheter in a Rabbit Model / 대한비뇨기과학회지

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.

Management of Voiding Dysfunction after Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.