Classification of endometriosis / 영남의대학술지

Endometriosis is a chronic disease associated with pelvic pain and infertility. Several classification systems for the severity of endometriosis have been proposed. Of these, the revised American Society for Reproductive Medicine classification is the most well-known. The ENZIAN classification was developed to classify deep infiltrating endometriosis and focused on the retroperitoneal structures. The endometriosis fertility index was developed to predict the fertility outcomes in patients who underwent surgery for endometriosis. Finally, the American Association of Gynecological Laparoscopists classification is currently being developed, for which 30 endometriosis experts are analyzing and researching data by assigning scores to categories considered important; however, it has not yet been fully validated and published. Currently, none of the classification systems are considered the gold standard. In this article, we review the classification systems, identify their pros and cons, and discuss what improvements need to be made to each system in the future.

Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute / 영남의대학술지

Background@#Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital. @*Methods@#We retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. @*Results@#A total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). @*Conclusion@#Minimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

Clinical and histopathologic analysis of gynecological cancer: a single institute experience over 7 years / 영남의대학술지

Background@#Approximately 100,000 women are diagnosed with cancer each year in Korea. According to a survey by the Korean central cancer registry in 2016, uterine cervical cancer, uterine corpus cancer, and ovarian cancer were the 5th, 7th, and 8th most prevalent cancers respectively among Korean women. The present study aims to review the clinico-pathologic characteristics of patients who were treated for major gynecological malignancies at Yeungnam University Medical Center. @*Methods@#Patients with invasive gynecological cancers from January 2012 to February 2019 were retrospectively identified. We analyzed the clinical features, demographic profiles, pathologic data, treatment modality used, adjuvant treatment used, complications, recurrence, and survival outcomes. @*Results@#A total of 287 patients (cervical cancer 115; corporal cancer 86; and ovarian, tubal, or primary peritoneal cancer 90) were included. Most cervical (82.7%) and corporal cancers (89.5%) were diagnosed in the early stages (stage I or II), while more than half (58.9%) the cases of ovarian, tubal or peritoneal cancers were diagnosed in the advanced stages (stage III or IV). Surgical complications were observed in 12.2% of cervical cancers, 16.3% of uterine corpus cancers, and 11.1% of ovarian, tubal, and peritoneal cancers, respectively. The 5-year overall survival rate was 94.1%, 91.0%, and 77.1% for cervical, corporal, and ovarian, tubal, or peritoneal cancers, respectively. @*Conclusion@#Surgical treatment was satisfactory in terms of the incidence of complications, and survival outcomes were generally good. Clinicians should be aware of the clinical and histopathological characteristics of patients with gynecological cancers to be able to provide optimal strategies and counseling.

Ovarian Gynandroblastoma with a Juvenile Granulosa Cell Tumor Component in a Postmenopausal Woman: A Case Report and Literature Review

Gynandroblastoma is an extremely rare sex cord-stromal tumor with both female (granulosa cell tumor) and male (Sertoli-Leydig cell tumor) elements. Juvenile granulosa cell tumors are also very rare and are so named because they usually occur in children and adolescents. A 71-year-old woman with right upper quadrant abdominal pain visited our hospital. Pelvic computed tomography showed a large multilocular cystic mass, suspected to be of ovarian origin. We performed a total abdominal hysterectomy (total abdominal hysterectomy was performed) with bilateral salpingo-oophorectomy. A 13-cm multilocular cystic mass with serous fluid was observed in her right ovary. Upon microscopic examination, the solid component of the mass showed both Sertoli-Leydig cell and juvenile granulosa cell differentiation, which we diagnosed as gynandroblastoma. Gynandroblastoma with a juvenile granulosa cell tumor component is extremely rare and, until now, only six cases have been reported in the English literature. We report the first gynandroblastoma with a juvenile granulosa cell tumor component diagnosed in an elderly patient, along with a literature review.

Prognostic Value of Elevated Homocysteine Levels in Korean Patients with Coronary Artery Disease: A Propensity Score Matched Analysis

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.

Hypertension in pregnancy

Hypertension is the most common medical disorder encountered in pregnancy, complicating 5% to 10% of all pregnancies. It is a major cause of maternal, fetal and newborn morbidity and mortality, increasing the risk of cerebrovascular events, organ failure and placenta abruptio in mothers and the risk of intrauterine growth restriction, prematurity and intrauterine death in fetuses. There are four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia and eclampsia syndrome, chronic hypertension of any etiology, and Preeclampsia superimposed on chronic hypertension. The decision to treat hypertension in pregnancy should consider the benefit-harm balance for both mother and fetus, and depends on gestational age, blood pressure levels, and presence of preeclampsia. As termination of pregnancy is the only cure for preeclampsia, there is general agreement that delivery rather than observation is suggested in women with severe preeclampsia, eclampsia, or mild hypertension at term. However, it is not clear whether women with mild hypertension at near term can be managed expectantly as well as whether antihypertensive therapy for mild to moderate hypertension should be initiated. In 2013, the American College of Obstetricians and Gynecologists provided evidence-based recommendations for the management of patients with hypertension during and after pregnancy, but it concluded that the final decision should be individualized and made by the health care provider and patient in all instances. Therefore, well-designed large trials are needed to clarify the indication for antihypertensive use and the selected population who would benefit from expectant management for mild to moderate hypertension at preterm.

Prevalence and Relationships of Iron Deficiency Anemia with Blood Cadmium and Vitamin D Levels in Korean Women

Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) are common disorders. This study was undertaken to determine the prevalence of anemia, ID, and IDA in Korean females. We examined the associations between IDA, heavy metals in blood, vitamin D level and nutritional intakes. The study was performed using on data collected from 10,169 women (aged > or =10 yr), including 1,232 with anemia, 2,030 with ID, and 690 with IDA during the fifth Korea National Health and Nutrition Examination Survey (KNHANES V; 2010-2012). Prevalence and 95% confidence intervals were calculated, and path analysis was performed to identify a multivariate regression model incorporating IDA, heavy metals in blood, vitamin D level, and nutritional intakes. The overall prevalence of anemia, ID and IDA was 12.4%, 23.11%, and 7.7%, respectively. ID and IDA were more prevalent among adolescents (aged 15-18 yr; 36.5% for ID; 10.7% for IDA) and women aged 19-49 yr (32.7% for ID; 11.3% for IDA). The proposed path model showed that IDA was associated with an elevated cadmium level after adjusting for age and body mass index (beta=0.46, P<0.001). Vitamin D levels were found to affect IDA negatively (beta=-0.002, P<0.001). This study shows that the prevalence of anemia, ID, and IDA are relatively high in late adolescents and women of reproductive age. Path analysis showed that depressed vitamin D levels increase the risk of IDA, and that IDA increases cadmium concentrations in blood. Our findings indicate that systematic health surveillance systems including educational campaigns and well-balanced nutrition are needed to control anemia, ID, and IDA.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

BACKGROUND AND OBJECTIVES: Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke or transient ischemic attack (TIA) due to paradoxical embolism, and in the pathogenesis of migraine. This paper reports the intermediate and long-term results of transcatheter closure of PFO associated with cerebrovascular accidents (CVAs), TIAs and migraine, using the Amplatzer PFO occluder. This paper also reports a case of pulmonary embolism which developed in one patient after PFO closure. SUBJECTS AND METHODS: From January 2003 to May 2010, 16 patients with PFO (seven males and nine females) with a history of at least one episode of cryptogenic stroke/TIA, CVA, or migraine and who underwent percutaneous transcatheter closure of PFO using the Amplatzer occluder. All the procedures were performed under general anesthesia and were assisted by transesophageal echocardiography. RESULTS: The device was implanted without any significant complications in all the patients, and the PFOs were effectively closed. At an average follow-up period of 54 months, the 15 patients with TIA/CVA had no recurrence of any thromboembolic event. The symptoms in one patient with migraine subsided after occlusion of the PFO. In this study, pulmonary embolism occurred five months after PFO closure in one patient, but the cause of pulmonary embolism was not identified. However, it is believed that the pulmonary embolism occurred without stroke recurrence because occlusion of the PFO was performed when the patient had a stroke event. CONCLUSION: It can be concluded that according to the intermediate and long-term follow-up results, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events, especially in the patients with cryptogenic stroke/TIA, and PFO closure is helpful in the treatment of migraine. However, this study involved a small number of patients and also the follow-up period was not long enough. Hence, randomized, controlled trials are necessary to determine if this approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with migraine headache.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.

Production of the Acetylcholinesterase Inhibitor from Yarrowia lipolytica S-3

The acetylcholinesterase (AChE) inhibitor of Yarrowia lipolytica S-3 was maximally produced when it was incubated at 30degrees C for 36 h in an optimal medium containing 1% yeast extract, 2% peptone and 2% glucose, with an initial pH 6.0. The final AChE inhibitory activity under these conditions was an IC50 value of 64 mg/ml. After partial purification of the AChE inhibitor by means of systematic solvent extraction, the final IC50 value of the partially purified AChE inhibitor was 0.75 mg/ml. We prepared a test product by using the partially purified AChE inhibitor and then determined its stability for the development of a new antidementia commercial product. The test product was stable at room temperature for 15 weeks.

Necrotizing Fasciitis Secondary to Infected Bedsore

Necrotizing fasciitis is a progressive soft tissue infection involving the superficial fascia which can be a lethal disease without proper treatment. The predisposing factors of necrotizing fasciitis are diabetes mellitus, alcohol abuse, drug abuse, obesity, malnutrition and immunocompromised state. Most of the recently reported cases of necrotizing fasciitis were caused by perianal disease. We treated a young woman with necrotizing fasciitis secondary to infected bedsore who had been held in hospital for 15 years due to schizophrenia and epilepsy. Here, we emphasize the specific concern when treating patients with bedsore.

CMV antigenemia following pediatric hematopoietic stem cell transplantation:risk factors and outcomes / 소아과

PURPOSE: Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided pre-emptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. METHODS: We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. RESULTS: CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade > or=II) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade > or=II) were the independent risk factors for positive CMV antigenemia. CONCLUSION: Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.

The Clinical Manifestations and the Risk Factors of Seizures after Hematopoietic Stem Cell Transplantation in Children

PURPOSE:This study was designed to assess the clinical manifestations and the risk factors of seizures after hematopoietic stem cell transplantation(HSCT) in children. Also we analyzed the 3-year survival rates of those who experienced such seizures and those who did not. METHOD:The study group consisted of 28 patients(21 males and, 7 females) who experienced seizures out of the 197 patients(113 males and, 84 females) who underwent HSCT at St. Mary's Hospital HSCT Center of the Catholic University of Korea. RESULTS:The overall incidence of seizures developing after HSCT was 13.8%, with boys reporting a higher incidence than girls. No significant difference was found with regards to the onsets and the types of seizures. In terms of the possible risk factors for seizures, the age of the patient and the stage of acute graft versus host disease(aGVHD) were statistically significant. The patients who were 5 years or more showed a 4.2 times greater incidence rate of seizures(P=0.025) than those who were younger. Also, the patients with stage 2-4 aGVHD showed a 2.77 times greater incidence of seizures(P= 0.034) than those with stage 0-1 aGVHD. The 3-year survival rate of the patients experiencing seizures was 37+/-18%, while the rate increased to 67+/-8% for those who did not(P< 0.001). CONCLUSION:Among the recipients of HSCT in children, the patients aged 5 years or older and aGVHD of the stage 2 or above showed a greater likelihood of seizures occurring after HSCT. The patients who experienced seizures should undergo a close observation and an intensive care since those patients reported a lower 3-year survival rate than those who did not.

Extensive Condyloma Acuminatum Managed by Cauterization under Microscopic and Hysteroscopic Visualization to Lessen Injury of Skin and Mucosa / 대한산부인과학회잡지

Condyloma acuminatum is a manifestation of human papillomavirus (HPV) infection. The genital warts tend to occur in areas most directly affected by coitus, namely external genitalia, perineum and perianal areas. The warts are highly contagious; more than 75% of sexual partners developed when exposed. We have experienced one case of microscopic and hysteroscopic cauterization of extensive condyloma acuminatum to lessen injury of skin and mucosa. We presented this case with a brief review of literature.

A Case of Suburethral Leiomyoma of the Vagina / 대한산부인과학회잡지

Vaginal leiomyoma is rare. They usually arise from the anterior vaginal wall and may be confused with a variety of vaginal tumors. Correct preoperative diagnosis is difficult. We experienced leiomyoma of suburethral area. We report this case with a brief review of literature.

The Efficacy of Biofeedback and Electrical Stimulation by Kontinence HMT2000 in the Treatment of Stress Urinary Incontinence Patients / 영남의대학술지

BACKGROUND: To evaluate the efficacy of EMG biofeedback and pelvic floor electrical stimulation in the stress urinary incontinence patients by Kontinence HMT2000. MATERIALS AND METHODS: A group of 14 patients with stress urinary incontinence were treated with combined biofeedback and intravaginal electrical stimulation during 12 sessions from 2 weeks to 6 weeks. RESULTS: At immediate post treatment, subjective cure rate was 28% and improvement rate was 57% and failure rate was 15%. Thus the overall success rate for this treatment was 85%. The result of 3 months after treatment showed cure rate 14% and improvement rate was 43%. Intravaginal pressure increased by an average of 11.9 cmH2O. Increased vaginal pressure was found in 93% of the patients and more than 50% increment of intravaginal pressure was 71%. CONCLUSIONS: Combined biofeedback and pelvic floor electrical stimulation by use of Kontinence HMT2000 is effective for the patients who have good compliance, relative low degree stress urinary incontinence. In order to attain good results, a well structured program that teaches specific muscle exercise and the patients should be followed by regular interval reinforcement treatment.