Evaluation of the correlation between gross lung score and microscopic diagnosis for swine pneumonia in Korean slaughterhouses

To reduce swine production costs, a slaughter check system has been developed in countries with an advanced swine industry. Evaluation of lung lesions in carcasses is a critical part of the slaughter check system. This study was performed to collect background information for use in developing a slaughter check system in Korea. Lung tissues and their gross images were collected from slaughterhouses in Gyeonggi-do, Korea. Scoring of the gross lung lesions was performed on the lung images. Histopathologic examination was conducted to classify the pulmonary lesions as bronchopneumonia or interstitial pneumonia. Scores of the gross lung lesions were significantly different between bronchopneumonia and interstitial pneumonia groups (p < 0.001). A 90% confidence interval of gross lung lesion scores was established for the bronchopneumonia group, and the lesion scoring had a sensitivity of 100% and specificity of 77.3%. The gross lung lesion scoring test was subjected to a diagnostic distinction evaluation by examining the receiver operating characteristic curve and was appraised as having good discrimination for bronchopneumonia. Establishment of a gross lung lesion scoring test for the diagnosis of bronchopneumonia could be valuable as a screening test of macroscopic bronchopneumonia in swine slaughter check system.

Isolation and characterization of antimicrobial-resistant Escherichia coli from national horse racetracks and private horse-riding courses in Korea

Limited information is available regarding horse-associated antimicrobial resistant (AR) Escherichia (E.) coli. This study was designed to evaluate the frequency and characterize the pattern of AR E. coli from healthy horse-associated samples. A total of 143 E. coli (4.6%) were isolated from 3,078 samples collected from three national racetracks and 14 private horse-riding courses in Korea. Thirty of the E. coli isolates (21%) showed antimicrobial resistance to at least one antimicrobial agent, and four of the AR E. coli (13.3%) were defined as multi-drug resistance. Most of the AR E. coli harbored AR genes corresponding to their antimicrobial resistance phenotypes. Four of the AR E. coli carried class 1 integrase gene (intI1), a gene associated with multi-drug resistance. Pulsed-field gel electrophoretic analysis showed no genetic relatedness among AR E. coli isolated from different facilities; however, cross-transmissions between horses or horses and environments were detected in two facilities. Although cross-transmission of AR E. coli in horses and their environments was generally low, our study suggests a risk of transmission of AR bacteria between horses and humans. Further studies are needed to evaluate the risk of possible transmission of horse-associated AR bacteria to human communities through horse riders and horse-care workers.

Dissimilarity of ccrAB gene sequences between methicillin-resistant Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus among bovine isolates in Korea

The sequences of the ccrAB genes from bovine-, canine- and chicken-originating methicillin-resistant Staphylococcus (S.) epidermidis (MRSE) and bovine methicillin-resistant Staphylococcus (S.) aureus (MRSA) were compared to investigate the frequency of intra-species horizontal transfer of the staphylococcal cassette chromosome mec (SCCmec) complex. Nineteen MRSE strains were isolated from bovine milk, chickens, and dogs, and their genetic characteristics were investigated by multilocus sequence typing and SCCmec typing. Among the animal MRSE strains, the most frequent SCCmec type was type IV, which consisted of the type B mec complex and ccrAB type 2. The ccrA2 and ccrB2 genes were sequenced from the bovine, chicken and canine MRSE strains and compared with those of the bovine MRSA strains. The sequences generally clustered as MRSA and MRSE groups, regardless of the animal source. Additionally, no bovine MRSE sequence was associated with the bovine MRSA groups. Although most of the bovine MRSE and MRSA isolates possessed SCCmec type IV sequences, our results suggest that the intra-species gene transfer of the SCCmec complex between bovine S. aureus and bovine S. epidermidis strains is not a frequent event.

Prevalence and antibiotic resistance of mastitis pathogens isolated from dairy herds transitioning to organic management

Changes in udder health and antibiotic resistance of mastitis pathogens isolated from dairies upon conversion from conventional to organic management over a 3-year period was studied. Coagulase-negative staphylococci (CNS) were the most prevalent mastitis pathogens isolated. CNS were significantly less resistant to beta-lactam antibiotics when isolated from milk after the herd transitioned to organic management. Cessation of the use of antimicrobial therapies in dairies in combination with organic management could lead to a reduction in the antimicrobial resistance of mastitis pathogens.

spa typing and enterotoxin gene profile of Staphylococcus aureus isolated from bovine raw milk in Korea

Staphylococcus aureus is a major etiological pathogen of bovine mastitis, which triggers significant economic losses in dairy herds worldwide. In this study, S. aureus strains isolated from the milk of cows suffering from mastitis in Korea were investigated by spa typing and staphylococcal enterotoxin (SE) gene profiling. Forty-four S. aureus strains were isolated from 26 farms in five provinces. All isolates grouped into five clusters and two singletons based on 14 spa types. Cluster 1 and 2 isolates comprised 38.6% and 36.4% of total isolates, respectively, which were distributed in more than four provinces. SE and SE-like toxin genes were detected in 34 (77.3%) isolates and the most frequently detected SE gene profile was seg, sei, selm, seln, and selo genes (16 isolates, 36.3%), which was comparable to one of the genomic islands, Type I nuSabeta. This is a first report of spa types and the prevalence of the recently described SE and SE-like toxin genes among S. aureus isolates from bovine raw milk in Korea. Two predominant spa groups were distributed widely and recently described SE and SE-like toxin genes were detected frequently.

A Protocol for Transrectal, Ultrasonography-guided, 41-core Prostate Needle Biopsy / 대한비뇨기과학회지

PURPOSE: We evaluated the rate of prostate cancer detection using the transrectal ultrasound(TRUS) guided, 41-core prostate needle biopsy protocol. MATERIALS AND METHODS: Between May 2006 and May 2007, 110 patients received a 12-core prostate needle biopsy(Group I) and 62 patients underwent a 41-core prostate needle biopsy(Group II) under local anesthesia. In addition to sextant biopsy, 41-core prostate needle biopsies were obtained from the each lateral peripheral zone(base, mid, and apex glands), midline peripheral zone(base, mid, and apex glands) and each transition zone. RESULTS: There were no significant differences between the two groups for age, prostate-specific antigen(PSA), or prostate volume. The cancer detection rate in the Group I and Group II was 19.1% and 24.2%, respectively. We found a significantly higher detection rate in the 41-core biopsy with prostate volumes of more than 40cc(28.1% vs 11.3%). The intraoperative pain score was lower in Group II than Group I(1.57+/-1.45 vs 3.17+/-1.73, p<.01). CONCLUSIONS: The 41-core prostate needle biopsy protocol is safe and intraoperative pain is low. The cancer detection rate of the 41-core prostate needle biopsy was higher than the 12-core prostate needle biopsy in patients with a prostate volume of more than 40cc.

Female Stress Urinary Incontinence

Stress urinary incontinence (SUI) is a significant health problem world.wide with considerable social and economic impact on individuals and society. The initial evaluation of urinary incontinence begins with a thorough detailed history taking, physical examination including stress test and Q-tip test, and routine laboratory studies. The pelvic examination demonstrates laxity of pelvic support, presence of any degree of prolapse. A neurologic examination should be done if neuropathy is suspected. The urodynamic study can be helpful to confirm the classic features of urinary incontinence and determine its cause. Conservative managements have been used to treat stress urinary incontinence and seem to make common sense, especially in less severe and bothersome cases. Pelvic floor muscle training appeared to be an effective treatment for adult women with stress or mixed incontinence. In pharmacologic treatment, duloxetine appears to be a promising new option for the treatment of SUI. There are literally hundreds of surgical procedures used to treat incontinence, and they are consistently being revised in going attempts to improve outcomes. Burch colposuspension and sling procedures still are the main stream but recently tension.free vaginal tape procedure and its variants are developed and widely performed all over the world. Mid.urethral slings showed good outcomes and are safe and brief to perform and have a relatively short learning curve. Remeex system is a relatively new surgical device introduced for the cure of SUI. Its main advantage is the possibility to adjust the sling tension if urine loss or voiding difficulties manifest after surgery. TVT.secur procedure needs only one vaginal incision and minimal periurethral dissection for small sized mesh. Therefore, it can help make the surgery quicker and simpler. As the population of aging women increases, it is inevitable that these women's disorders will become more prevalent. This will pose a major challenge to the health care systems.

Analysis of Complications and Causes of Revision of Penile Prosthesis / 대한남성과학회지

PURPOSE: Penile prosthesis implantation to correct the irreversible erectile dysfunction is a common. We investigated complications and causes of revision after implantation of the penile prosthesis. MATERIALS AND METHODS: We followed 72 patients who underwent penile prosthesis implantation performed by the same surgeon from January 1993 to July 2006. The medical records of all patients were retrospectively reviewed. The mean follow up duration was 30.3 months, and average age at operation was 56.7+/-11.0 years. RESULTS: The malleable penile prosthesis was implanted on 8 patients. The inflatable penile prosthesis was implanted on 63 patients and Dynaflex was implanted in the one patient. Of the patients implanted inflatable penile prosthesis, complications were developed in the 14 patients and 17 cases of complications were developed. Of the complications, mechanical complications were broken of connecting tubing(7), mulfunction of Dynaflex(1) and difficulty of deflation(1). Of 17 complications, non-mechanical complications were urethral stricture(5), erosion of urethra(1), migration of reservoir into the bladder(1) and SST deformity(1). CONCLUSIONS: Penile prosthesis has high complications rates, and revision rate also is high. Mechanical failure was the most common cause of surgical revision. Although urethral stricture is rare complication, it was developed in the 5 patients due to mal-rotation of the cylinder.

Predictive Factors Affecting Urethral Stricture Development after Transurethral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

PURPOSE: To evaluate possible factors affecting urethral stricture development after TURP in patients with BPH. MATERIALS AND METHODS: We reviewed retrospectively medical records of patients who underwent TURP for 6 years. All operations were performed by 2 experienced doctors who have minimum 200 practices. Patients were classified into 2 groups. Group A included patients with urethral stricture required periodic urethral dilation or urethrotomy. Group B included those without urethral stricture development after TURP. We analyzed all possible factors such as resection time, prostate volume, resection volume, resectoscope size, preoperative catheterization duration due to AUR, postoperative catheterization duration, preoperative pyuria, prostate needle biopsy performed preoperatively and PSA level, age and co-morbid systemic diseases. RESULTS: 595 patients underwent TURP between 2000 and 2005. 76 of them were excluded because of preexisting urethral stricture or secondary TURP. 110 were categorized into group A and 409 into group B. There was no statistical difference between group A and B with respect to age, preoperative catheterization duration in patients with AUR, postoperative catheterization duration, prostate volume, resection volume, preoperative PSA level, preoperative pyuria, preoperative biopsy history, resectoscope size(22F vs 24F) and anesthesia method (general vs spinal), respectively. However, there is significant difference between group A and B in comparison of resection time(58.5+/-21.6 min vs 48.5+/-23.2 min, p=0.02). CONCLUSION: Our data demonstrate that the shortening of resection time is the most important single factor to decrease urethral stricture formation after TURP in patients with BPH.

Analysis of Prognostic Factors in Patients with Fournier's Gangrene

BACKGROUND: To evaluate prognostic factors such as age, associated disease, laboratory and clinical data, which can affect prognosis of patients with Fournier's gangrene. MATERIALS AND METHODS: 27 patients were included in this study. All underwent treatment during past 15-year in our department. Medical records were reviewed with respect to age at presentation, extent of disease, laboratory data and bacteriology, associated disease, and clinical course. Also involved surface area was measured by the rule used in burn patients. Statistical analysis was made by Mann Whitney U test and Fisher's exact test. RESULTS: Of 27 patients, 4 died and 23 survived. The mean age was 55.4+/-13.7. The most common underlying disease was diabetes mellitus. In comparison of survival and non-survival groups, there were significant differences in duration of symptom before hospitalization, total surface area involved, laboratory data including serum albumin, creatinine, and WBC count on CBC. However, there was no difference in hospital stay, age, underlying disease, serum BUN, infected organisms, and urinary or fecal diversion. CONCLUSION: We conclude that the unfavorable factors affecting survival are duration of symptom before hospitalization, total surface area involved, serum albumin and creatinine level, and WBC count on CBC. The survival was, however, not associated with bacteriological factors, hospital stay, age, urinary or fecal diversion, and underlying diseases such as diabetes, and cancer.

Analysis of Prognostic Factors in Patients with Fournier's Gangrene

BACKGROUND: To evaluate prognostic factors such as age, associated disease, laboratory and clinical data, which can affect prognosis of patients with Fournier's gangrene. MATERIALS AND METHODS: 27 patients were included in this study. All underwent treatment during past 15-year in our department. Medical records were reviewed with respect to age at presentation, extent of disease, laboratory data and bacteriology, associated disease, and clinical course. Also involved surface area was measured by the rule used in burn patients. Statistical analysis was made by Mann Whitney U test and Fisher's exact test. RESULTS: Of 27 patients, 4 died and 23 survived. The mean age was 55.4+/-13.7. The most common underlying disease was diabetes mellitus. In comparison of survival and non-survival groups, there were significant differences in duration of symptom before hospitalization, total surface area involved, laboratory data including serum albumin, creatinine, and WBC count on CBC. However, there was no difference in hospital stay, age, underlying disease, serum BUN, infected organisms, and urinary or fecal diversion. CONCLUSION: We conclude that the unfavorable factors affecting survival are duration of symptom before hospitalization, total surface area involved, serum albumin and creatinine level, and WBC count on CBC. The survival was, however, not associated with bacteriological factors, hospital stay, age, urinary or fecal diversion, and underlying diseases such as diabetes, and cancer.

Short Term Results of Modified Ingelman-Sundberg Denervation Procedure for Female Mixed Urinary Incontinence

PURPOSE: We evaluated the clinical efficacy, safety and satisfaction of patients with modified Ingelman-Sundberg bladder denervation procedure for female mixed urinary incontinence. MATERIALS AND METHODS: Forty two women with mixed urinary incontinence were randomly assigned to the transobturator tape(TOT, n=20), or modified Ingelman-Sundberg bladder denervation procedure(MISD) with TOT (n=22) procedures, between August 2005 and July 2006. Preoperatively, the patients were evaluated with history taking, physical examination, urine analysis, urine culture, voiding diary, uroflowmetry, postvoid residual(PVR) and urodynamic evaluations. The procedures were carried out using a previously established method under spinal anesthesia for 36 patients and under general anesthesia for 6 patients. The postoperative evaluation included a questionnaire, uroflowmetry and PVR. The mean follow-up period was 8.2 months. RESULTS: 20 underwent TOT procedure alone and 22 underwent TOT procedure with MISD. Two groups were similar in their preoperative characteristics. The mean operation time was longer in the TOT procedure with MISD group compared to TOT procedure alone (36 min vs 26 min). There was significant difference between the 2 groups in terms of the success rate(cure+improvement, 30% vs 82%, p=0.03): cure(20% vs 50%), improvement(10% vs 32%), persistent(70% vs 18%) for TOT group and TOT with MISD group, respectively. In addition, the patient satisfaction rate was significantly different between TOT and TOT with MISD group(> or = Satisfied, 20% vs 64%, p=0.04). The main complication was voiding difficulty, including retention, was 10%(n=2) in the TOT group, versus 18%(n=4) in the TOT with MISD group, but this was improved by conservative treatment. CONCLUSION: Despite the short term follow-up period, the modified Ingelman- Sundberg bladder denervation procedure is simple, effective and less invasive for the treatment of mixed urinary incontinence, which is able to perform with TOT procedure in terms of the high success and the low complication rates.

A Prospective Randomized Trial Comparing Transobturator Vaginal Tape and Tension Free Vaginal Tape Obturator Inside-Out for Surgical Treatment of Stress Incontinence

PURPOSE: The aim of our study was to compare the outcomes of the transobturator vaginal tape(TOT) and tension free vaginal tape obturator inside-out(TVT-O) procedures in patients with stress urinary incontinence. MATERIALS AND METHODS: Between August 2004 and March 2005, 77 women with stress incontinence were randomly assigned to either TOT(n=36) or TVT-O(n=41). The preoperative evaluation included a careful history taking, physical examination, stress test, a quality of life questionnaire and a comprehensive urodynamic examination. Follow up evaluation was carried out after 1 month, 6 months. Patients assessment was made by a clinical examination in the first 1 month and satisfaction rate expressed and uroflowmetry with postvoid residual urine to compare voiding disorder suggesting bladder outlet obstruction after 6 months. RESULTS: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar between the 2 groups. Mean operative time was similar between the 2 groups(17 min vs 16 min). The rate of postoperative urinary retention was 8.3%(n=3) in the TOT group and 9.8%(n=4) in the TVT-O group. The cutting of tape was required to treat urinary retention in 2.8%(n=1) of the TOT group and 4.9%(n=2) of the TVT-O group at 14 days after the procedure. The rates of cure(66.7% vs 65.9%), improvement(27.8% vs 29.3%), and failure (5.6% vs 4.9%) were similar for the TOT and TVT-O groups, respectively. In terms of bladder outlet obstruction, no difference were found after TOT and TVT-O. CONCLUSION: Both procedures are equally a simple, safe and effective treatment for female stress urinary incontinence in terms of rate of cure, operation time and complications. However, further studies and long term follow-up are needed for the complications and cure rate.

The Long-term Outcome of Fascial Sling Operation in Female Stress Urinary Incontinence: Multicenter Study in Korea / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term outcomes of fascial sling operation conducted at multicenters in Korea. MATERIALS AND METHODS: 564 patients, who underwent fascial sling operation for stress urinary incontinence, between December 1996 and May 2001, at 10 institutions in Korea, were included in this study. They were all followed up for a period of at least 2 years. History taking, a physical examination, and urodynamic studies, including Valsalva leak point pressure (VLPP), were conducted before the operation. Postoperative symptoms and satisfaction were assessed using a questionnaire. The 269 (47.7%), 266 (47.2%) and 29 (5.1%) patients underwent operations with autologous rectus fascia, cadaveric allograft fascia and autologous fascia lata, respectively. RESULTS: The mean follow up period was 43.6 months, ranging from 24 to 77 months. Stress urinary incontinence was cured in 485 (86.0%) patients and improved in 31 (5.5%). In autologous fascia group, 252 (84.6%) patients were cured and 18 (6.0%) improved; whereas, in allograft fascia group 233 (87.6%) patients were cured and 13 (4.9%) improved. 253 (84.9%) patients with autologous fascia and 228 (85.7%) patients with allograft fascia were satisfied, making a total of 481 patients (85.3%) that were satisfied with the operation. According to the fascia length and preoperative VLPP value, there were no differences in the success and patient satisfaction rates. There were 197 (34.9%) patients with preoperative urge urinary incontinence, and 92 (46.7%) of these were either cured or improved postoperatively. However, de novo urge urinary incontinence was noted in 8 patients (1.4%). CONCLUSIONS: Our results suggest that the long-term outcome of fascial sling operation for the treatment of stress urinary incontinence was satisfactory.

Experience of Colpopexy Using a Modified TVT Device in Patients with Marked Cystocele / 대한비뇨기과학회지

PURPOSE: To evaluate the results of colpopexy using a modified tension- free vaginal tape(TVT) device and simultaneous TVT in patients with marked cystocele, with or without stress urinary incontinence. MATERIALS AND METHODS: A total of 34 patients who underwent a colpopexy and TVT procedure for marked cystocele, with or without stress urinary incontinence, were included. Initially, colpopexy, using a modified TVT device, was completed followed by the TVT procedure. A modified TVT needle, which had two pinholes at the end of the needle, for the suture materials to be threaded through, was used for transfer of thread to the ipsilateral suprapubic incision through the retropubic space. Each side of the ligature was tied together in the subcutaneous space, thereafter the TVT procedure was completed in the usual manner. RESULTS: A total of 34 patients were available to follow-up for more than 6 months. The mean operation time and postoperative hospital stay were 57.5+/-15.3 minutes and 3.5+/-1.7 days, respectively. The cystocele was completely corrected in 31 patients(91.2%), and diminished to grade I in 3. Also, 25 of the 26 patients who had stress urinary incontinence were successful with the combined operation. There were no significant intraoperative or postoperative complications. CONCLUSIONS: Our data suggest that the simultaneous cystocele repair using a modified TVT device and TVT procedure is effective in patients with marked cystocele, with or without stress urinary incontinence. Furthermore, it seems to be a very simple procedure, with low morbidity.

4 Cases with Complications Necessitating Surgical Correction of Tension- Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

The tension-free vaginal tape procedure has become a state of the art operation for female urinary stress incontinence and is a simple surgical procedure with good postoperative outcomes. Cases of complication requiring surgical correction are reported to be rare. There are possibilities of major complications, which should be corrected with surgery, such as bowel perforation, obturator nerve injury, vascular injury, persistent urinary retention. We report on 4 patients with complications necessitating surgery, of which obturator nerve injury, vaginal erosion, cystocele, urinary retension.

Grade IV Cystocele with Unilateral Hydronephrosis

A cystocele is present when the bladder base descends below the inferior ramus of the symphysis pubis either at rest or with straining. A severe cystocele can combined with voiding difficulty, back pain, hydronephrosis, and renal failure and it must be corrected surgically. We report a case of grade IV cystocele with unilateral hydronephrosis which was incidentally found in 67-year-old female. She was asymptomatic and underwent cystocele repair using prolene mesh and TVT (Tension-free Vaginal Tape). The left hydronephrosis and marked cystocele were normalized 3 months after operation.

Correlation of Valsalva Leak Point Pressure and Maximum Urethra Closure Pressure in Patients with Stress Urinary Incontinence

PURPOSE: The valsalva leak point pressure (VLPP), a quantitative measure of sphincteric function, is used widely to diagnose intrinsic sphincter deficiency (ISD). This study was to evaluate the correlation between VLPP and maximum urethra closure pressure (MUCP) in patients with stress urinary incontinence. MATERIALS AND METHODS: We divided the patients into two categories: 60 patients affected by ISD as they had stress incontinence; 80 patients suffering from stress incontinence without ISD. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery, VLPP, MUCP, and functional urethral length (FUL). This two groups were compared VLPP with MUCP to evlauate their correlation. RESULTS: The statistical analysis showed close correlation between ISD and age (p=0.045), urogynecological surgery (p=0.013), VLPP (p=0.000), MUCP (p=0.000), FUL (p=0.000). There was statistically significant relationship between VLPP and MUCP (p=0.01), however a correlation coefficient of 0.303 demonstrated poor clinical relationship. When the cut-off value of MUCP were 20, 30, 40 cmH2O, there was no the diagnostic value of ISD. CONCLUSION: The MUCP has statistically significant relationship with VLPP but, low correlation coefficient demonstrated poor clinical relationship. Therefore, it is not clinically useful to evaluate urethral sphincter function.

The Correlation of Supine Stress Test and Valsalva Leak Point Pressure to Detect Intrinsic Sphincter Dysfunction / 대한비뇨기과학회지

PURPOSE: The Valsalva leak point pressure (VLPP) has been suggested to be an objective tool for diagnosing female stress urinary incontinence (SUI) accompanied by intrinsic sphincter dysfunction (ISD). However, measuring the VLPP is difficult, complex and expensive. A new clinical test, supine stress test to measure the VLPP, was compared. MATERIALS AND METHODS: Fifty-one patients with SUI were evaluated prospectively with a urodynamic study. A supine stress test using cough and Valsalva's maneuvers was performed after bladder filling to 200ml with sterile normal saline by gravity. A urodynamic study, including measuring the VLPP and the maximum urethral closure pressure, was performed. ISD was diagnosed as Blaivas type III and Stamey grade III, and the sensitivity, specificity, positive and negative predictive values of the supine stress test and the VLPP were calculated. RESULTS: Forty-two patients with SUI were enrolled this study and were evaluated with the VLPP and supine stress test. When the radiological findings were divided into Blaivas type III, and type I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 95.0%/90.0%, 86.4%/73.9%, 86.4%/78.3%, 95.0%/89.5%, respectively. When the symptom severity was diagnosed as being Stamey classification grade III, and grade I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 94.7%/89.5%, 82.6%/73.9%, 81.8%/73.9%, 95.0%/80.9%, respectively. CONCLUSIONS: The supine stress test is easy, quick and inexpensive, and is a positive test to reliably predict ISD as precise as the VLPP. This simple, non-invasive supine stress test is recommended as a screening test to detect ISD, especially at an outpatient department.

The Clinical Outcome of Tension-Free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence

PURPOSE: We evaluated the clinical outcome of a tension free vaginal tape(TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: One hundred-nine women(94 with genuine stress urinary incontine : and 15 with mixed urinary incontinence) underwent a TVT procedure under spinal, general anesthesia. Mean age was 48.6+/-9.3 years. The mean follow-up period was 13.5+/-2.0 months. Two women had experienced failed antiincontinence surgery and seven women had experienced pelvic surgery. RESULTS: The mean operation time was 35.6+/-1.6 minutes and mean hospital stay was 2.03+/-0.4 day. Mean duration of postoperative indwelling catheter was 10.4+/-2.5 hours. Sixteen patients(14.6%) had immediate postoperative voiding difficulties necessitating an extra procedure(soundation with Hegar dilator). Nine patients(8.3%) with de novo detrusor instability were improved by anticholinergics medication. Nine(66.7%) of 15 women with urge incontinence were significantly improved or cured after surgery. Success rate was 96.3% and 95.4% in postoperative 3 and 6 months, respectively. The patients satisfied with this procedure were 103(94.5%) in postoperative 3 months and 102(93.6.%) in postoperative 6 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.