ABSTRACT
BACKGROUND: The aim of this study was to assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free transobturator vaginal tape (TVT-O) from inside to outside for the surgical treatment of stress urinary incontinence (SUI) in women. METHODS: Retrospectively, 35 patients with SUI were recruited into this study; 18 patients were assigned to the TVT procedure and 17 patients to the TVT-O operation. Preoperative evaluation included subjective symptoms according to the SEAPI incontinence score (IC score), objective assessment by urodynamic study (including cystometry, electromyography, urethral pressure profile, uroflow), and bead chain voiding cystourethrogram. Patients with cystocele greater than grade II were excluded. The mean operative time, hospital stay, perioperative complications, and 1-year outcome including SEAPI IC score and late complications were compared. RESULTS: Patient characteristics and preoperative IC score were similar in the 2 groups. Mean operative time was significantly shorter in the TVT-O group (31.9 +/- 10 minutes vs. 55 +/- 12 minutes; p < 0.001). No bladder injury occurred in the TVT-O group versus 5.0% (n = 1) in the TVT group (p > 0.05). The rate of postoperative temporary dysuria was 28% (n = 5) in the TVT group versus 24% (n = 4) in the TVT-O group. The cure rate for SUI was 88%, similar for the TVT and TVT-O groups. As for late complications, no vaginal erosion was noted in the TVT-O group, but 1 bladder erosion with stone formation was found in the TVT group. In terms of bladder outlet obstruction, none developed in the TVT-O group, but 1 patient developed persistent dysuria in the TVT group. CONCLUSION: There appears to be equal efficacy between TVT and TVT-O for the surgical treatment of female SUI, but operative time was significantly shorter in the TVT-O group because intraoperative cystoscopic check-up is not required.
Subject(s)
Suburethral Slings , Urinary Incontinence, Stress/surgery , Vagina/surgery , Aged , Female , Follow-Up Studies , Humans , Middle Aged , Retrospective StudiesABSTRACT
Benign fibroepithelial polyps of the renal pelvis are extremely rare, and are frequently mistaken for transitional cell carcinoma. Diagnosis is usually made following nephrectomy or nephroureterectomy for an assumed malignancy of the renal pelvis. We report a 56-year-old female with a right renal pelvic fibroepithelial polyp successfully treated by percutaneous nephroscopic resection.
Subject(s)
Kidney Neoplasms/surgery , Kidney Pelvis/surgery , Polyps/surgery , Endoscopy , Female , Humans , Middle Aged , Nephrostomy, PercutaneousABSTRACT
BACKGROUND: This retrospective study was designed to determine the efficacy of broad-spectrum antibacterials combined with percutaneous renal drainage in the treatment of emphysematous pyelonephritis (EPN). METHODS: From July 1992 to September 2002, 10 patients (nine females and one male) with EPN were managed at our institution. All patients had diabetes and presented with fever and chills, flank pain or tenderness, vomiting, and altered consciousness. The diagnosis of EPN was confirmed by the presence of intraparenchymal and/or perinephric gas in imaging studies (kidney-ureter-bladder film, sonogram, and/or computed tomography scan). Broad-spectrum antibacterial therapy, combined with percutaneous renal drainage, was started in all patients. Follow-up studies consisted of computed tomography scan and technetium-labeled diethylenetriaminepentaacetic acid (DTPA) radioisotope renography. RESULTS: The outcome was good in all patients. Three patients underwent delayed nephrectomy due to non-functioning of the involved kidney. The DTPA radioisotope renography results (glomerular filtration rate of the diseased kidney/ contralateral healthy kidney) were 0/57 mL/min, 2.7/68.1 mL/min and 3.7/63.9 mL/min. CONCLUSION: Combined broad-spectrum antibacterial therapy and percutaneous renal drainage is a safe and effective treatment for EPN, especially in high-risk patients for whom nephrectomy under general anesthesia is not feasible.
