Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay

PURPOSE: Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival. MATERIALS AND METHODS: Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. RESULTS: Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p < 0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p < 0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p < 0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p < 0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14). CONCLUSIONS: This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.

How Serious Is Erectile Dysfunction in Men's Lives? Comparative Data From Korean Adults

PURPOSE: Whereas sexual function has long been assumed to be an important component of adult men's lives, the impact of sexual dysfunction has not been estimated in parallel to other modern disease entities. We compared the seriousness of erectile dysfunction (ED) with that of other diseases by use of self-administered questionnaires. MATERIALS AND METHODS: Between January 2012 and July 2012, 434 healthy male volunteers (group 1) and 263 ED patients (group 2) were enrolled. The questionnaire consisted of the following: "If you must undergo only one disease in all your life, which disease could you select among these items or ED?" The comparative disease entities included hypertension, diabetes mellitus (oral hypoglycemic agent/insulin injection), hemodialysis, myocardial infarction, herpes zoster, chronic sinusitis, chronic otitis media, gastric cancer (early/late), lung cancer (early/late), liver cancer (early/late), and dementia. RESULTS: Group 1 recognized ED as being a more serious disease than hypertension, diabetes mellitus (oral hypoglycemic agent), herpes zoster, chronic sinusitis, and chronic otitis media. In comparison, group 2 recognized ED as being a more serious condition than diabetes mellitus (insulin injection) and dementia (p<0.001 and p<0.001, respectively). In particular, ED was deemed to be more serious than hemodialysis, gastric cancer (early), lung cancer (early), and liver cancer (early) by men in group 2 in their 30s to 40s, and these results were statistically significant compared with the same age subgroups in group 1 (p<0.001, p<0.007, p<0.02, and p<0.007, respectively). CONCLUSIONS: In contrast with their healthy counterparts, Korean men with ED recognized ED as being as serious as hemodialysis, dementia, and early stage cancer, which reflects the severe bother of ED in Korean patients.

Bicycle Riding: Impact on Lower Urinary Tract Symptoms and Erectile Function in Healthy Men / 대한배뇨장애요실금학회지

PURPOSE: Recently, reports in the mass media have implicated that bicycle riding increases the risk of erectile dysfunction and prostatic diseases. So, we evaluate the impact of bicycle riding on erectile function and lower urinary tract symptoms (LUTS) in healthy general men. METHODS: From 26 June 2010 to 20 July 2010, we investigate degree of LUTS (voiding and storage symptoms), using International Continence Society-male Questionnaire (ICS-mQ) and erectile function using International Index of Erectile Function-5 Questionnaire (IIEF-5) in 5 work places (personnel of public office, hospital, university, etc.) of which bicycle riding club members were doing active club activities. Respondents, who participated in club activities for 6 months and longer, were classified as the bicycle club (142 men; age, 44.02+/-8.56). Ones who do not ride bicycles were classified as the control group (83 men; age, 42.13+/-7.85). People who were having the history of urological and other chronic diseases (diabetes, vascular disease, heart disease, etc) were excluded from both groups. RESULTS: Bicycle club is not significantly associated with increased prevalence of LUTS (bicycle club, 2.1 to 57.7% control, 4.8 to 73.5%) and erectile dysfunction (bicycle club, 46.1% control, 55.4%). The total mean score (storage/voiding/erectile function) of bicycle club (13.93+/-1.95/11.14+/-3.49/20.46+/-5.30) were not significantly different from control (14.35+/-2.49/11.52+/-3.38/20.40+/-4.07) (P=0.190 to 0.968). CONCLUSIONS: These results suggested that bicycle riding as exercise or hobby has no negative effect on LUTS and erectile function in healthy general men, although this research data were limited to the questionnaire analysis.

Urethral Erosion and Perineal Cellulitis after Midurethral Sling Procedure / 대한배뇨장애요실금학회지

Midurethral tension-free sling procedure has become one of the most popular techniques for the treatment of stress urinary incontinence. As the time elapsed, however, complications associated with a synthetic tape have been reported to occur. Recently, we experienced a rare case of urethral erosion with perineal cellulitis at anterior wall of vagina after midurethral sling procedure. So our experience was presented with a review of literature.

A Prospective Multi-center Trial of Escherichia coli Extract for the Prophylactic Treatment of Patients with Chronically Recurrent Cystitis

We have assessed the efficacy and safety of Escherichia coli extract (ECE; Uro-Vaxom(R)) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2+/-5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.

Long-Term Study of the Effects of the Tension-Free Vaginal Tape Procedure for Female Stress Urinary Incontinence on Voiding, Storage, and Patient Satisfaction: A Post-Hoc Analysis

PURPOSE: We assessed the long-term effects of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) on voiding, storage, and patient satisfaction. MATERIALS AND METHODS: This retrospective study examined the records of 134 patients who had undergone the TVT procedure for SUI and were followed up for more than 5 years. Voiding function was evaluated by measuring maximum urinary flow rate (MFR), post-void residual urine volume (PVR), and storage function by using a voiding diary. Patients were asked to describe their satisfaction with the operation. RESULTS: MFR was lower at 1 month compared with the preoperative level, but had recovered to preoperative levels by 5 years postoperatively. However, some patients with >50%, 25-50%, and 50% at 5 years. PVR increased over the 5 postoperative years. Of the patients with urgency and urgency incontinence, 43.8% and 48.1% showed improvement, respectively, whereas new patients developed postoperatively. Thus, the total number of patients with urgency or urgency incontinence remained similar over the 5 years. In those with a changed voiding pattern, patient satisfaction was negatively affected by de novo urgency and urgency incontinence and decreased MFR. CONCLUSIONS: Any obstructive effect of the TVT procedure diminished over time in most patients, although a decrease in the MFR was sustained in some patients. With regard to overactive bladder symptoms, some patients were cured and some patients complained of de novo symptoms. The most major factor affecting patient satisfaction was de novo urgency.

Impact of the Midurethral Sling Procedure on Quality of Life in Women with Urinary Incontinence

PURPOSE: This study was designed to objectively assess the impediment of incontinence to quality of life (QoL) in females and its improvement by the midurethral sling (MUS) procedure. MATERIALS AND METHODS: From June 2006 to June 2007, 93 female patients underwent the MUS procedure at our institute because of urinary incontinence. The incontinence quality of life (I-QoL) questionnaire was administered to measure the QoL of the incontinent patients before and 1 and 12 months after the MUS procedure. Preoperative data and urodynamic factors were analyzed retrospectively by I-QoL scores to identify factors that may affect the QoL of incontinent patients. RESULTS: The average preoperative I-QoL score of the 93 patients was 61.1+/-21.0 points. At 1 year after surgery, the average I-QoL score was found to have improved to 98.4+/-20.7 points. There were no significant differences between stress and mixed urinary incontinence in terms of cure and satisfaction (p>0.05). I-QoL scores of the cured and improved patients increased at 1 year after surgery (p0.05). Although urinary urgency and large urine leak amounts significantly reduced preoperative QoL in incontinent patients, the MUS procedure effectively improved the QoL regardless of these factors. CONCLUSIONS: Preoperative I-QoL assessment revealed a significant impairment of QoL in incontinent women, but the MUS procedure effectively improved these women's QoL.

A Case of Inflammatory Myofibroblastic Tumor of the Urethra with Overactive Bladder

Inflammatory myofibroblastic tumor (IMT) of the urethra is a tumor composed of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. The etiology and the biologic behaviors of IMTs are still unknown. Extensive pathologic examination is important to prevent misdiagnosis and the need for long-term follow up is emphasized. Recently, we experienced a case of a inflammatory myofibroblastic tumor of the urethra in a young female. To our knowledge, this is the first documentation of such an entity in published reports. So we present our experience with a review of literature.

Efficacy of Ureteroscopic Removal of Stones with an Ureteral Access Sheath for the Treatment of Ureteral Calculi

PURPOSE: The ureteral access sheath (UAS) was developed to facilitate difficult ureteroscopic procedures. However, some have questioned the safety of the UAS and its likelihood of causing significant ureteral traumas. We evaluated the efficacy and safety of a UAS for managing ureteral calculi. MATERIALS AND METHODS: From July 2005 to June 2008, a total of 122 patients underwent ureteroscopic removal of stones (67 patients with UAS, 55 patients without UAS). Under local, spinal, or general anesthesia, all patients were treated by using a semirigid ureteroscope with or without UAS. The operative results of the patients were assessed with KUB, and excretory urography or ultrasonography were assessed postoperatively after 2 to 4 weeks. We also analyzed the success rates of stone removal and the complication rates for each procedure. RESULTS: Mean stone size and mean operation time were 9.3 mm and 38.8 minutes, respectively, with UAS and 8.9 mm and 40.4 minutes, respectively, without UAS. Overall stone-free rates were 89.6% and 76.4%. Mean hospital stay was 2.0 days and 2.2 days. The time for operation was significantly decreased for upper ureteral stones treated with UAS (p=0.022). The stone-free rates were higher for upper ureteral stones treated with UAS (28/32, 87.5%, p=0.027), especially for stones greater than 10 mm in size (p=0.048). CONCLUSIONS: The use of UAS is effective and safe. The stone-free rates of ureteroscopic removal of stones with UAS were significantly higher than the rates without UAS for large (> or =10 mm) upper ureteral calculi.

Five-Year Outcomes of the IRIS Procedure for the Treatment of Female Stress Urinary Incontinence: Comparison with the TVT Procedure

PURPOSE: We evaluated the long-term efficacy and safety of the innovative replacement of incontinence surgery (IRIS) procedure and compared these with the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence. MATERIALS AND METHODS: We included 111 consecutively treated women who underwent IRIS (n=51) or TVT (n=60) between January 2002 and December 2003 and followed them up for at least 5 years postoperatively. We analyzed the 5-year success rate and postoperative complications of the IRIS procedure and compared these with the results of the TVT procedure. RESULTS: The 5-year success rate was 92.2% for the IRIS procedure and 93.3% for the TVT procedure, and the satisfaction rates were 90.2% and 85.0%, respectively. Intraoperative complications for the IRIS group included 4 cases of bladder perforation, and there were 5 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 3 patients with de novo urgency, 2 patients with mesh exposure, and 1 patient with temporary urinary retention. Four patients in the TVT group developed de novo urgency, 2 patients had mesh exposure, and 2 patients showed temporary urinary retention. CONCLUSIONS: Our results suggest that IRIS may be an effective and safe procedure compared with the TVT procedure for more than 5 years.

Current Trend of the Primary Treatment in Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia / 영남의대학술지

Clinical benign prostatic hyperplasia (BPH) is a multifaceted phenomenon that is due to prostatic and bladder influences as well as nonurological causes. It is also important to differentiate between the more common voiding or obstructive symptoms as well as the more bothersome storage or irritative symptoms. Lower urinary tract symptoms (LUTS) and BPH may be two separate conditions with different underlying pathologies. However, they are often treated incorrectly as one entity. Both conditions are very common and they represent chronic conditions of the aging male. They are often associated with a significant reduction in the patients' quality of life. Although these are not new conditions, there have been enormous changes in the methods of assessing and managing the patients with these conditions. This review describes some of the influential studies in this area and the current trends of the primary treatment for LUTS/BPH.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Three-year Outcomes of the Innovative Replacement of Incontinence Surgery Procedure for Treatment of Female Stress Urinary Incontinence: Comparison with Tension-free Vaginal Tape Procedure

Innovative replacement of incontinence surgery (IRIS) is a polypropylene tape that is placed beneath the midurethra to restore urinary continence. We evaluated the long-term efficacy and safety of the IRIS procedure and compared it with tensionfree vaginal tape (TVT) for the treatment of female stress urinary incontinence. We included all 66 consecutive women who underwent IRIS (n=34) or TVT (n=32) between February 2002 and April 2003 and followed them up for at least 3 yr postoperatively. The 3-yr success rate was 94.1% for the IRIS and 93.8% for the TVT, and the satisfaction rates were 91.2% and 90.6%, respectively. Intraoperative complications for the IRIS group included 3 cases of bladder perforation, and there were 3 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 2 patients with de novo urgency and one patient with mesh erosion. Three patients with TVT developed de novo urgency. One case of each group showed temporary voiding difficulty. On the basis of our results, the IRIS may be an effective and safe procedure as compared to TVT, with a high success rate and a low complication rate.

Safety and Efficacy of Bipolar TURP in Large Volume Prostate

PURPOSE: With the development of bipolar device, which complement the weak points of conventional monopolar device, TURP became more appliable in large volume prostate. We evaluated the possibility and effectivity of bipolar TURP in large volume prostate by analysing treatment results. MATERIALS AND METHODS: Total 78 male patients who received bipolar TURP in our center between April 2004 and December 2006, were divided into two groups based on prostate volume (>75g = large volume prostate group, 75g) using bipolar device is as effective as of general (<75g) prostate hyperplasia. Bipolar TURP can be another therapeutic option of large volume prostate, which in the past indicated open prostatectomy, to escape from higher surgical morbidity.

The Effects of Ginseng Saponin on Relaxation of Smooth Muscle in the Lower Urinary Tract and the Corpus Cavernosum / 영남의대학술지

BACKGROUND: Korean ginseng (KG) has been used as a general tonic, and for voiding dysfunction for a long time in oriental society. However, scientific basic studies on the use of KG, have been rare, especially for voiding and erectile dysfunction. This study was performed to investigate the effects of KG on voiding and erectile function by examining the effects of total saponin (TS) on the bladder, urethral and penile cavernosal smooth muscle. MATERILAS AND METHODS: To examine the effects of TS, NewZeland white rabbits were used to obtain tissue strips from the smooth muscle of the bladder, proximal urethra and corpus cavernosum. Adult Sprague Dawley rats were used to examine the changes in urodynamic findings and penile erection after administration of TS. RESULTS: In proximal urethral strips, the rate of relaxation of the proximal urethra was increased from 9.0+/-2.9 to 33.7+/-4.8% in a dose-dependent manner when the concentration of TS was added accumulatively from 0.25 mg/ml to 4.0 mg/ml (p<0.05). However, no significant response was observed in the bladder strips within these concentration ranges. For the corpus cavernosal strips, the rate of relaxation ranged from 5.8+/-2.1 to 36.7+/-5.8%, increasing in a dose-dependent manner when TS was increased from 1.0 mg/ml to 4.0 mg/ml (p<0.05). After administration of 0.1 ml of TS (32 mg/ml) in the rat, the bladder pressure was 37.5+/-8.5 mmHg at 52.1+/-7.0 sec. during isovolumetric bladder contraction, showing no significant differences from 35.7+/-7.8 mmHg and 50.7+/-7.2 sec, respectively, before treatment. However, when 0.1 ml of TS (32 mg/ml) was administered, the relative reduction of urethral pressure was 6.9+/-0.5 mmHg at 62+/-7.5 sec, which was significantly higher compared to 4.6+/-1.1 mmHg at 45+/-10 sec before treatment (p<0.05). For the cavernosal injection study, the change in intracavernosal pressure (delta ICP) was examined after administering 0.1 ml of TS. The cumulative additions of TS at concentrations from 0.5 mg/ml to 32 mg/ml increased delta ICP from 1.3+/-0.5 to 21.3+/-7.8 mmHg in a dose-dependent manner (p<0.05). The duration of tumescence was from 0.3+/-0.1 to 5.2+/-0.2 min, showing dose-dependent increase (p<0.05). Furthermore, the cumulative addition of TS at concentrations from 0.5 mg/ml upto 32 mg/ml did not cause any significant change in systemic blood pressure. CONCLUSION: These results suggest that ginseng improves voiding functions, which is mainly achieved by TS relaxing the proximal urethra, the most important part of the bladder outlet function. In addition, ginseng safely induced a penile erection hemodynamically by relaxing the corpus cavernosum.

The Efficacy of IRIS Procedure in Stress Urinary Incontinence: Comparison with TVT and SPARC

PURPOSE: To compare IRIS procedure with TVT and SPARC in the treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: Among 96 patients with SUI who underwent sling procedure, we retrospectively compared IRIS procedure(n=34) to TVT(n=32) and SPARC(n=30). All patients were evaluated preoperatively with a detailed history, pelvic examination, voiding cystourethrography, urodynamic study and incontinence staging with SEAPI classification. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, complication, success rate and satisfaction rate. RESULTS: The success rates were 97%, 96.9% and 96.7% in the IRIS, TVT and SPARC group, respectively. The satisfaction rates were 94.1%, 96.9% and 96.6% in the IRIS, TVT and SPARC group. The complication rates were 23.5%, 21.8% and 23.3% in the IRIS, TVT and SPARC group. There was no statistically significant difference among the 3 groups in terms of success rates, satisfaction rates, complication rates, and postoperative subjective SEAPI scores. CONCLUSION: IRIS procedure was equally effective compared to conventional mid urethral sling procedure such as TVT and SPARC in the management of female SUI with high cure rates and acceptably low complication rates.

Transurethral Resection of the Prostate with a Bipolar Tissue Management System Compared to Conventional Monopolar Resectoscope: One-Year Outcome

The purpose of the present study was to evaluate the efficacy and safety of bipolar transurethral prostatectomy (TURP) using the GyrusTM PlasmaKinetic System compared with conventional monopolar TURP. This study included 102 patients with benign prostatic hyperplasia (BPH) who underwent TURP from January 2003 to March 2005. In all, 49 consecutive patients had bipolar and 53 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, change in serum sodium and hemoglobin, duration of catheter use, length of hospital stay, and complication rates. Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in serum sodium and hemoglobin, improvement of IPSS and peak flow rate (Qmax), or complication rates over the 12-month follow-up in both groups. There was, however, a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.28 days vs. 3.12 days) and hospital stay (3.52 days vs. 4.27 days) were shorter in the bipolar group (p = 0.012 vs. p = 0.034, respectively). Our results demonstrate that bipolar TURP using the Gyrus(TM) Plasma Kinetic System is as effective as conventional monopolar TURP with the additional advantage of reduced length of catheter use and hospital stay. Bipolar TURP is a promising new technique that may prove to be a good alternative to conventional TURP in the future.

The Factors that Influence the Clinical Outcomes after Trial without Catheter for Acute Urinary Retention due to Benign Prostatic Hyperplasia: a Multicenter Trial / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) is a common problem that's experienced by aging men, and it can lead to serious outcomes, including acute urinary retention (AUR). We studied the factors that influence the clinical outcomes after trial without catheter (TWOC) for AUR due to BPH. MATERIALS AND METHODS: The medical records of all 455 BPH patients who visited the emergency room for the first time with AUR from March 2001 through February 2005 were retrospectively reviewed. The patients were divided into two groups: the success group (group I) or failure group (group II) that underwent trial without catheter. The patient's characteristics were compared between the two groups using logistic regression analysis and the chi-square test. RESULTS: From the 292 cases of group I and the 163 cases of group II, the multivariate analysis revealed statistically significant differences in the retention volume (p<0.01), the prostate volume (p<0.01) and the previous use of alpha-blockers before AUR (p<0.01). CONCLUSIONS: The prostate volume, retention volume and previous use of alpha-blockers before AUR were thought to influence the clinical outcomes of TWOC for the BPH patients with AUR, and these factors should be considered in future treatment planning.

A Case of Bladder Stone and Vesicovaginal Fistula after McDonald Operation / 영남의대학술지

The frequency of a bladder foreign body in the female is lower than in the male, and bladder stones attached to foreign bodies such as non-absorbable suture material are not common. Moreover, vesicovaginal fistulas due to migration or puncture of suture materials into the bladder are rare. In this report, we present a case of bladder stone and vesicovaginal fistula formation in a 29-year-old female patient who had been treated with the McDonald operation for an incompetent internal os of the cervix (IIOC) during pregnancy. The patient was successfully treated by cystoscopic removal of the bladder stone with suture material and conservative treatment for the vesicovaginal fistula.

Predictive Factors Affecting Long-term Cure and Patient Satisfaction of the Tension-free Vaginal Tape Procedure for the Treatment of Female Stress Urinary Incontinence

PURPOSE: We evaluated predictive risk factors affecting the long-term efficacy of the tension-free vaginal tape(TVT) procedure for the treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: We included 138(mean age 52.4+/-9.3) women who underwent the TVT procedure and followed up for at least 5 years. We analyzed parameters including patient characteristics, history, physical examination, 1-hour pad test, and urodynamic studies using univariate and multivariate analyses with respect to the cure rates. The patients were regarded as cured in the absence of any episodes of involuntary urine leakage during stressful activities and stress cough test. RESULTS: The overall 5-year cure rate was 76.8%, with an 86.9% patient satisfaction rate. On univariate and multivariate analyses, there were no significant parameters affecting the cure rate. The urgency negatively impacted patients' satisfaction(p=0.017, OR=4.114). According to the subgroup analyses, cure rates were lower in patients with high body mass index(BMI=25 kg/m(2), 68.3% vs 83.3%, p=0.044), lower Valsalva leak point pressure(VLPP<60 cmH2O, 51.6% vs 82.8%, p=0.003), and high-grade incontinence(40.0% vs. 69.7%, 86.6%, p=0.012). CONCLUSION: the TVT procedure is an effective and safe surgery for SUI without any independent predictive factors affecting long-term cure execept urgency affecting satisfaction. However, higher BMI, low VLPP and high- grade incontinence may impair the efficacy of the TVT procedure.