Natural Killer and CD8 T Cells Contribute to Protection by Formalin Inactivated Respiratory Syncytial Virus Vaccination under a CD4-Deficient Condition

Respiratory syncytial virus (RSV) causes severe pulmonary disease in infants, young children, and the elderly. Formalin inactivated RSV (FI-RSV) vaccine trials failed due to vaccine enhanced respiratory disease, but the underlying immune mechanisms remain not fully understood. In this study, we have used wild type C57BL/6 and CD4 knockout (CD4KO) mouse models to better understand the roles of the CD4 T cells and cellular mechanisms responsible for enhanced respiratory disease after FI-RSV vaccination and RSV infection. Less eosinophil infiltration and lower pro-inflammatory cytokine production were observed in FI-RSV vaccinated CD4KO mice after RSV infection compared to FI-RSV vaccinated C57BL/6 mice. NK cells and cytokine-producing CD8 T cells were recruited at high levels in the airways of CD4KO mice, correlating with reduced respiratory disease. Depletion studies provided evidence that virus control was primarily mediated by NK cells whereas CD8 T cells contributed to IFN-γ production and less eosinophilic lung inflammation. This study demonstrated the differential roles of effector CD4 and CD8 T cells as well as NK cells, in networking with other inflammatory infiltrates in RSV disease in immune competent and CD4-deficient condition.

Natural Killer and CD8 T Cells Contribute to Protection by Formalin Inactivated Respiratory Syncytial Virus Vaccination under a CD4-Deficient Condition

Respiratory syncytial virus (RSV) causes severe pulmonary disease in infants, young children, and the elderly. Formalin inactivated RSV (FI-RSV) vaccine trials failed due to vaccine enhanced respiratory disease, but the underlying immune mechanisms remain not fully understood. In this study, we have used wild type C57BL/6 and CD4 knockout (CD4KO) mouse models to better understand the roles of the CD4 T cells and cellular mechanisms responsible for enhanced respiratory disease after FI-RSV vaccination and RSV infection. Less eosinophil infiltration and lower pro-inflammatory cytokine production were observed in FI-RSV vaccinated CD4KO mice after RSV infection compared to FI-RSV vaccinated C57BL/6 mice. NK cells and cytokine-producing CD8 T cells were recruited at high levels in the airways of CD4KO mice, correlating with reduced respiratory disease. Depletion studies provided evidence that virus control was primarily mediated by NK cells whereas CD8 T cells contributed to IFN-γ production and less eosinophilic lung inflammation. This study demonstrated the differential roles of effector CD4 and CD8 T cells as well as NK cells, in networking with other inflammatory infiltrates in RSV disease in immune competent and CD4-deficient condition.

Respiratory Syncytial Virus Fusion Protein-encoding DNA Vaccine Is Less Effective in Conferring Protection against Inflammatory Disease than a Virus-like Particle Platform

Formalin-inactivated respiratory syncytial virus (RSV) vaccination causes vaccine-enhanced disease (VED) after RSV infection. It is considered that vaccine platforms enabling endogenous synthesis of RSV immunogens would induce favorable immune responses than non-replicating subunit vaccines in avoiding VED. Here, we investigated the immunogenicity, protection, and disease in mice after vaccination with RSV fusion protein (F) encoding plasmid DNA (F-DNA) or virus-like particles presenting RSV F (F-VLP). F-DNA vaccination induced CD8 T cells and RSV neutralizing Abs, whereas F-VLP elicited higher levels of IgG2a isotype and neutralizing Abs, and germinal center B cells, contributing to protection by controlling lung viral loads after RSV challenge. However, mice that were immunized with F-DNA displayed weight loss and pulmonary histopathology, and induced F specific CD8 T cell responses and recruitment of monocytes and plasmacytoid dendritic cells into the lungs. These innate immune parameters, RSV disease, and pulmonary histopathology were lower in mice that were immunized with F-VLP after challenge. This study provides important insight into developing effective and safe RSV vaccines.

Distinct Effects of Monophosphoryl Lipid A, Oligodeoxynucleotide CpG, and Combination Adjuvants on Modulating Innate and Adaptive Immune Responses to Influenza Vaccination

Monophosphoryl lipid A (MPL) and oligodeoxynucleotide CpG are toll-like receptor (TLR) 4 and 9 agonist, respectively. Here, we investigated the effects of MPL, CpG, and combination adjuvants on stimulating in vitro dendritic cells (DCs), in vivo innate and adaptive immune responses, and protective efficacy of influenza vaccination. Combination of MPL and CpG was found to exhibit distinct effects on stimulating DCs in vitro to secrete IL-12p70 and tumor necrosis factor (TNF)-α and proliferate allogeneic CD8 T cells. Prime immunization of mice with inactivated split influenza vaccine in the presence of low dose MPL+CpG adjuvants increased the induction of virus-specific IgG and IgG2a isotype antibodies. MPL and CpG adjuvants contribute to improving the efficacy of prime influenza vaccination against lethal influenza challenge as determined by body weight monitoring, lung function, viral titers, and histology. A combination of MPL and CpG adjuvants was effective in improving vaccine efficacy as well as in reducing inflammatory immune responses locally and in inducing cellular immune responses upon lethal influenza virus challenge. This study demonstrates unique adjuvant effects of MPL, CpG, and combination adjuvants on modulating innate and adaptive immune responses to influenza prime vaccination.

Efficacy of External Fixation and Transfixation Pinning of Distal Radioulnar Joint in Distal Radius Fracture

PURPOSE: The purpose of this study is to evaluate efficacy of percutaneous pinning of distal radioulnar joint in patient with distal radius fracture. METHODS: Thirty-eight patients who underwent percutaneous pinning and external fixation for distal radius fracture were included in this study. Radiologic and clinical outcomes were compared between the patients who underwent percutaneous pinning on the radius only (PD group) and the patients with supplementary pinning on distal radioulnar joint (DRU group) after percutaneous pinning on the radius. External fixation was performed in all patients. RESULTS: Twenty-three patients were PD group and fifteen patients were DRU group. Radial height and radial inclination was significantly higher in DRU group. There was no significant difference in ulnar variance, volar tilt and articular step off between two groups. Among the clinical outcome, there was no significant difference in range of motion between two groups but grip strength was significantly larger in DRU group. CONCLUSION: Percutaneous pinning with K-wires on distal radioulnar joint in distal radius fracture can be a useful procedure for prevention of radial shortening without loss of range of motion of the wrist.

Mechanisms of Cross-protection by Influenza Virus M2-based Vaccines

Current influenza virus vaccines are based on strain-specific surface glycoprotein hemagglutinin (HA) antigens and effective only when the predicted vaccine strains and circulating viruses are well-matched. The current strategy of influenza vaccination does not prevent the pandemic outbreaks and protection efficacy is reduced or ineffective if mutant strains emerge. It is of high priority to develop effective vaccines and vaccination strategies conferring a broad range of cross protection. The extracellular domain of M2 (M2e) is highly conserved among human influenza A viruses and has been utilized to develop new vaccines inducing cross protection against different subtypes of influenza A virus. However, immune mechanisms of cross protection by M2e-based vaccines still remain to be fully elucidated. Here, we review immune correlates and mechanisms conferring cross protection by M2e-based vaccines. Molecular and cellular immune components that are known to be involved in M2 immune-mediated protection include antibodies, B cells, T cells, alveolar macrophages, Fc receptors, complements, and natural killer cells. Better understanding of protective mechanisms by immune responses induced by M2e vaccination will help facilitate development of broadly cross protective vaccines against influenza A virus.

Quality of Life in Patients with Osteoporotic Vertebral Fractures

STUDY DESIGN: A case-control study. PURPOSE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women with osteoporotic vertebral fractures, compared with a control group. OVERVIEW OF LITERATURE: Osteoporotic vertebral fractures are a major cause of morbidity among postmenopausal women. There have been many reports of a decrease in the quality of life in patients with osteoporotic vertebral fractures. However,few reports have analyzed which dimensions contribute to the decline in quality of life. METHODS: One thousand five hundred forty-five postmenopausal women aged 50 years and older from 17 study sites in nationwide hospitals were in enrolled in the study (between April 2008 and January 2009). HRQL was measured using the European Quality of Life 5 Domains (EQ-5D), and visual analogue scale (VAS). RESULTS: The average VAS of the case group was 57.80, and that of the control group was 64.10 (p=0.001). All domains of the EQ-5D score were significantly worse in the case group (p=0.001). Among the case group, the average VAS of the 559 patients (45%) who were operated on was 56.8, and that of the remaining 680 patients (55%) who were treated conservatively was 58.6 (p=0.135). Among the case group, the averages of each EQ-5D domain of the 559 patients (45%) who were operated on were: 1.87 in mobility, 1.81 in self-care, 1.99 in usual activities, 2.11 in pain, and 1.62 in anxiety or depression. Those of the 680 patients (55%) who were treated conservatively were: 1.72 in mobility, 1.60 in self-care, 1.76 in usual activities, 1.98 in pain, and 1.57 in anxiety or depression. Except for the domain of anxiety or depression, scores for the other domains were all significantly worse in the patients who were operated on (p=0.001). CONCLUSIONS: Health related quality of life in the patients with osteoporotic vertebral fractures was significantly worse in both the EQ-5D domains and VAS. Among the osteoporotic vertebral fracture patients, the patients who were operated on had a worse quality of life in EQ-5D.

New vaccines against influenza virus

Vaccination is one of the most effective and cost-benefit interventions that prevent the mortality and reduce morbidity from infectious pathogens. However, the licensed influenza vaccine induces strain-specific immunity and must be updated annually based on predicted strains that will circulate in the upcoming season. Influenza virus still causes significant health problems worldwide due to the low vaccine efficacy from unexpected outbreaks of next epidemic strains or the emergence of pandemic viruses. Current influenza vaccines are based on immunity to the hemagglutinin antigen that is highly variable among different influenza viruses circulating in humans and animals. Several scientific advances have been endeavored to develop universal vaccines that will induce broad protection. Universal vaccines have been focused on regions of viral proteins that are highly conserved across different virus subtypes. The strategies of universal vaccines include the matrix 2 protein, the hemagglutinin HA2 stalk domain, and T cell-based multivalent antigens. Supplemented and/or adjuvanted vaccination in combination with universal target antigenic vaccines would have much promise. This review summarizes encouraging scientific advances in the field with a focus on novel vaccine designs.

Quality of Life Comparison between Vertebroplasty and Kyphoplasty in Patients with Osteoporotic Vertebral Fractures

STUDY DESIGN: Retrospective evaluation. PURPOSE: To compare quality of life in postmenopausal women with osteoporotic vertebral fractures (OVFs) who underwent vertebroplasty (VP) or kyphoplasty (KP). OVERVIEW OF LITERATURE: Patient with OVFs who do not respond to conservative treatment can be treated with VP or ballon KP for faster pain relief. There are controversies on which procedure is more effective. METHODS: Five hundred twenty-eight postmenopausal women in nationwide hospitals with age of 50 years or older who underwent VP of KP for OVFs were enrolled in this study. Health related quality of life was measured using the European Quality of Life 5 Domains (EQ-5D) and visual analogue scale (VAS). RESULTS: In the VP group, average EQ-5D dimension was 1.95 in mobility, 1.86 in self care, 2.02 in usual activity, 2.19 in pain, 1.69 in anxiety or depression. In the KP group, average EQ-5D dimension was 1.83 in mobility, 1.78 in self care, 1.98 in usual activity, 2.03 in pain, 1.55 in anxiety or depression. Quality of life of KP group was significantly better than that of the VP group in mobility (p=0.016), pain (p=0.001), and anxiety or depression (p=0.008). Average EQ-5D index of the VP and the KP group was 0.353 (+/-0.472) and 0.485 (+/-0.357), respectively. The EQ-5D index of the KP group was significantly (p<0.001) higher than that of the KP group. The difference of VAS between VP and KP group was not statistically significant (p=0.580). CONCLUSIONS: Quality of life in patient with OVFs who underwent KP was significantly better than that of patients who underwent VP.

Clinical Factors That Predict Successful Posterior Urethral Anastomosis With a Gracilis Muscle Flap

PURPOSE: We evaluated the preoperative clinical factors that affect the surgical outcome of posterior urethral anastomosis (PUA) with a gracilis muscle flap (GMF) to determine which factors predict benefit from the use of the GMF. MATERIALS AND METHODS: This was a retrospective analysis of 49 patients who underwent a delayed PUA with a GMF. A successful clinical outcome was defined as achieving a peak urinary flow rate greater than 15 mL/s at 3 and 12 months postoperatively without evidence of stricture recurrence on a retrograde urethrogram or cystourethroscopy at 3 months postoperatively. Multiple clinical factors were evaluated by use of univariate and multivariate analyses. RESULTS: The outcome of 21 of 49 patients (42.9%) was deemed successful. The mean age of the 49 patients was 37.2+/-13.5 years and the mean follow-up duration was 43.4+/-28.0 months. The length of the urethral defect was significantly shorter in patients with a successful outcome than in patients with an unsuccessful outcome (p=0.010). The outcome differed significantly depending on whether the patients had a previously successful urethroplasty (p=0.036) or whether they had suffered a pelvic bone injury (p=0.012). Multivariate logistic regression analyses revealed that a previous urethroplasty was the only preoperative clinical factor that significantly affected the surgical outcome in PUA with a GMF (odds ratio, 0.218; 95% confidence interval, 0.050 to 0.947; p=0.042). CONCLUSIONS: A history of previous urethroplasty is a preoperative clinical factor that significantly affects the surgical outcome in PUA with a GMF; the procedure is more likely to be successful in patients who have not previously undergone urethroplasty.

The Therapeutic Effect of Perineal Urethroplasty using a Gracilis Muscle Flap in a Recurrent Complete Posterior Urethral Stricture / 대한비뇨기과학회지

PURPOSE: To evaluate the usefulness of a gracilis muscle flap for the reconstruction of a complete posterior urethral stricture, where previous treatment had failed. MATERIALS AND METHODS: Between March 1998 and April 2006, 56 patients, in whom previous urethroplasty or visual internal urethrotomy had failed, were treated with a gracilis muscle flap. All patients had been referred from other institutions. Of the 56 treated patients, 32(group I) underwent perineal urethroplasty, using a stepwise approach of urethral mobilization, including bulbar urethra mobilization, separation of the corporal bodies, inferior pubectomy and retrocrural urethral re-routing 24(group II) underwent perineal urethroplasty, with a gracilis muscle flap for replacement of the dead space, using a stepwise approach. RESULTS: The mean stricture lengths were 2.7(0.5-5.5) and 3.5cm(1.0-6.5) in groups I and II, respectively(p=0.135). The success rates were 87.5 and 95.8% in groups I and II, respectively(p=0.279). The success rates of patients with urethral stricture of greater than 3cm were 71.4 and 100% in groups I and II, respectively(p=0.037). The success rates of patients who had undergone previous perineal urethroplasty were 82.6 and 100% in groups I and II, respectively(p=0.045). A gracilis muscle flap made no difference to the incidences of erectile dysfunction and incontinence. The incidences of restricture were 15.6 and 0% in groups I and II, respectively (p=0.042). CONCLUSIONS: Our results showed that a gracilis muscle flap can be useful method with a stricture greater than 3cm in length and in patients having undergone previous perineal urethroplasty.

Urethral Injury / 대한비뇨기과학회지

Urethral injury due to trauma remains one of the most challenging injuries in surgical practice. It is associated with considerable morbidity, including urinary incontinence, erectile dysfunction, and urethral strictures. Posttraumatic urethral injury have special features that warrant consideration in their management. The aim of rational therapy should be a continent and potent patient with no stricture. Currently urethral stricture disease is relatively common, most strictures being acquired from injury including trauma, iatrogenic causes such as urological instrumentation and placing indwelling catheters and infection, which result in strictures anywhere in the urethra, are probably the most common cause. When urethral stricture is occurred, selection of the appropriate procedure for each case is crucial for a successful result. The final decision to determine the correct procedure is generally made according to the actual findings at surgery. All types of surgical treatment were equally problematic, with similar complication rates and long-term morbidity. The procedure of choice should be individualized, depending on the anatomy and the extent of the urethral injury, stability of the patient, and presence of associated injuries.

Evaluation of Short Term Clinical Effects and Presumptive Mechanism of Botulinum Toxin Type A as a Treatment Modality of Benign Prostatic Hyperplasia

The purpose of this study was to evaluate the effect and investigate the putative mechanism of botulinum toxin type A (BTA) applied to the treatment of benign prostatic hyperplasia (BPH). A total of 52 patients with symptomatic BPH were evaluated. Transperineal intraprostatic injection under transrectal ultrasonography was carried out. BTA dissolved in 4 to 9 mL of saline was used from 100 U to 300 U, according to prostate volume. Twenty-six patients received only BTA (BT group), and 26 received both BTA and one month of an alpha-adrenergic antagonist (BTalpha group). The therapeutic outcomes were evaluated by comparing parameters such as international prostate symptom score (IPSS), quality of life, prostate specific antigen, prostate volume, post-void residual urine, and peak urinary flow rate. At the one month follow- up, 18 patients in the BT group and 21 in the BTalpha group had subjective symptomatic relief (p = 0.337). Only IPSS5 (weak stream) was significantly different between the BT group and BTalpha groups (p = 0.034). At the three month follow-up, 39 patients had subjective symptomatic relief. The storage symptoms were improved more than the voiding symptoms. Additionally, about 50 percent of the patients whose voiding symptom improved expressed improved erectile function. BTA injection seems to be an alternative treatment for BPH. The differences after the one month evaluation between the BT and the BTalpha groups might suggest that the adrenergic influence could be relatively reinforced by the anticholinergic effect of BTA. Nitric oxide would thus be involved in a BTA action mechanism in BPH.

The Initial Experience of Intraprostatic Injection of Botulinum Toxin Type A for Benign Prostatic Hyperplasia: A Comparative Study of Short-term Effect with Transurethral Resection of Prostate / 대한비뇨기과학회지

PURPOSE: To retrospectively compare the results of botulinum toxin type A (BTA) with those of transurethral resection of the prostate (TURP) in the treatment of benign prostatic hypertrophy (BPH) and to evaluate the effect of BTA. MATERIALS AND METHODS: The changes of symptom after BTA injection into prostate (BIP) and TURP in 26 patients treated with BIP and 81 patients treated with TURP were analysed retrospectively. All BPH-related medications were stopped immediately after BTA administration. To evaluate the effect of BIP, the parameters such as International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen (PSA), prostate volume, post-void residual urine and maximum flow rate were measured both before and 1 month after BIP. RESULTS: In both groups, IPSS and QoL were improved significantly after treatment, but the effectiveness of TURP was much superior to that of BIP. Among the patients with a prostate volume under 40ml, IPSS was improved by 27.5% in the BTA group and 38% in the TURP group. QoL was improved by 31.8% in the BTA group and 51% in the TURP group, but the difference between the two groups was not statistically significant. Among the patients with a prostate volume over 40ml, IPSS was improved by 24.7% in the BTA group and 47.6% in the TURP group. QoL was improved by 18.9% in the BTA group and 44.4% in the TURP group, and the difference was statistically significant between the two groups. CONCLUSIONS: Although both BIP and TURP significantly improved the clinical outcome, the latter was far superior to the former in improving voiding symptoms caused by BPH. However, BIP can be a new therapeutic option for patients with a small prostate volume or who want more minimally invasive treatment.

Removal of Penile Foreign Body using a Cast Cutter / 대한남성과학회지

Penile incarceration is a serious condition that requires prompt treatment to relieve various complications. A 67-year-old male complaining of penile swelling visited the emergency room for treatment. The penile swelling was caused by a plastic bottleneck which had been placed on the base of the penis 4 hours previously. The diameter of the plastic bottleneck was 2.5 cm. Because the swelling of the penis distal to the constricting bottleneck was so severe, the bottleneck was difficult to be removed. Several methods to remove the bottleneck were tried, such as squeezing, aspiration, and cutting using a metal saw. All of them were unsuccessful. Then a cutting method with a cast cutter was used. It was a great success. It took just 5 minutes to remove the bottleneck. Minimal abrasion of the penile skin was the only complication observed after the procedure.

Influence of Obesity on Left ventricular filling patterns in Hypertensives / 대한내과학회지

BACKGROUND: Left ventricular (LV) diastolic dysfunction has often been described in arterial hypertension in either the presence or the absence of LV hypertrophy. Impairment of LV relaxation have been recently described in obese normotensive individuals, and the prevalence of overweight to frank obesity in hypertensive populations is very high, obesity might well be an important confounder for the evaluation of LV diastolic dysfunction in the patients with hypertension. Accordingly, we designed this study to assess the effect of obesity on LV relaxation and filling in arterial hypertension. METHODS: We assessed the relations of left ventricular filling to load and geometry by Doppler echocardiography in 73 normotensive subjects (40 normal-weight [50 +/- 11 years, 22 women] and 33 obese [57 +/- 11 years, 27 women]) and 81 hypertensive subjects without silent coronary heart disease (23 normal-weight [59 +/- 7 years, 13 women] and 58 obese [54 +/- 13 years, 30 women]). RESULTS: Isovolumic relaxation time (IVRT) was prolonged in hypertensive subjects and normotensive obese subjects compared with normotensive normal-weight subjects (all p<0.01). After controlling for age, height, blood pressure, LV mass index, body mass index, between-group differences in IVRT, peak early transmitral flow velocity, the deceleration time (DT) of early filling velocity, and the ratio of early to late left ventricular filling were disappeared. CONCLUSION: Isovolumic relaxation time (IVRT) is prolonged in both arterial hypertension and obesity, and the presence of obesity does not significantly increase isovolumic relaxation time in hypertension, and abnormalities of left ventricular filling in arterial hypertension are offset after controlling for left ventricular mass.

Surgical Treatment of Female Stress Urinary Incontinence with a Transobturator Tape: Short Term Results

PURPOSE: The aim of the study was to assess the efficacy and safety of a new minimally invasive surgery with an outside-in transobturator tape (Monarc(R)). MATERIALS AND METHODS: 26 women with stress urinary incontinence associated with urethral hypermobility were operated and 6 months of mean follow-up was available. The mean age was 49.6 years (36~65). All patients were assessed before surgery by clinical and urodynamic examination: 6 patients presented with intrinsic sphincter deficiency (Valsalva leak point pressure 20% of volume voided. RESULTS: 22/26 patients (84.6%) were cured and 4/26 (15.4%) were improved. Mean operating time was 23 minutes. Only intra-operative complication was a vaginal wall penetration in one patient. Post-operative vaginal erosion lasting more than 2 weeks occurred in two patients. 2 cases of de novo urgency occurred. There was no bladder outlet obstruction after surgery. CONCLUSION: Monarc(R) tansobturator tape is a simple, safe and effective procedure confirmed by 6 months of mean follow-up. Longer follow-up is needed to validate this technique.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparative Study of Tension-free Vaginal Tape and Burch Colposuspension in the Surgical Management of Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the effectiveness, easiness, postoperative complications between tension-free vaginal tape (TVT) and Burch colposuspension (BC) in the surgical management of female genuine stress urinary incontinence. METHODS: A retrospective study of 77 cases with stress urinary incontinence at Department of Obstetrics and Gynecology and Urology, Pochon CHA University Medical College from January 2000 to December 2002, followed up more than 6 months. All of 77 cases were above grade 2 genuine stress urinary incontinence, 37 cases were performed tension-free vaginal tape, 40 cases were performed Burch colposuspension. RESULTS: Cure rate was 91.4% in the tension-free vaginal tape (TVT) group, 90% in the Burch colposuspension group. The mean operative time for TVT was 23.4 minutes and for Burch colposuspension was 47.2 minutes. The mean hospital stay in TVT was 1.8 days and in Burch colposuspension was 5.2 days. The incidence and severity of postoperative complication is similar in both groups. CONCLUSION: The cure rates of TVT were comparable with Burch colposuspension in the surgical management of female genuine stress urinary incontinence. And the incidence and severity of postoperative complication is similar in both groups. Moreover TVT is simple procedure more than Burch colposuspension.

Comparison between Pubovaginal Sling Using Cadaveric Fascia Lata and Tension-free Vaginal Tape Procedure for the Treatment of Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedure has been performed mainly for stress urinary incontinence (SUI) in women because of its simplicity and good outcome. We compared the efficacy of pubovaginal sling using cadaveric fascia lata with tension-free vaginal tape(TVT) procedure. MATERIAL AND METHODS: Between May 2000 and January 2003, 96 patients with SUI who had undergone sling procedure were analyzed. We compared 45 women treated with pubovaginal sling using cadaveric fascia lata(Group A) to 51 women treated with TVT procedure(Group B). All patients were evaluated preoperatively with detailed history, pelvic examination, urinalysis, voiding diary, urodynamic study, pad test, Q-tip test, transperineal ultrasound, and cystoscopy. Parameters of comparison included operation time, mode of anesthesia, duration of catheterization, length of hospital stay, postoperative presence of urgency, success rate by satisfaction, and complication. RESULTS: In group A, 33 patients(73.3%) were cured and 9(20.0%) showed improvement within a mean follow-up of 1.3 years, whereas in group B, 35 patients(68.7%) were cured and 12(23.5%) showed improvement within 1.5 years. Complications developed in 7 patients(15.6%) in group A and 7(13.7%) in group B. CONCLUSIONS: Both procedures are equally effective surgical treatments for SUI in women. However, long-term follow-up is necessary to determine the endurance of good results.