Necrotizing fasciitis following transobturator tape procedure: a case report and literature review.

A 51-year-old diabetic woman was referred to our unit with a history of increasing pain in her right thigh and gait disturbance, 10 days following surgery for treatment of stress urinary incontinence with a transobturator tape. Examination elicited a tender right thigh associated with swelling and erythema. Inspection of the vagina revealed an exposed mesh through the vaginal erosion. Plain radiographs and magnetic resonance imaging revealed large thigh abscesses suggestive of gas gangrene from the pelvis to the calf. The mesh was completely removed; extensile incisions, as well as aggressive debridement of all necrotic tissue in the thigh and calf, were performed. A diagnosis of necrotizing fasciitis with gas extending to the lower leg level was confirmed. After mesh removal, abscess drainage and debridement, the patient recovered with antibiotics and daily wound care. Three months after the operation, the patient showed no recurrence of the infection.

Clinical and urodynamic effect of methylphenidate for the treatment of giggle incontinence (enuresis risoria).

AIMS: We retrospectively investigated the efficacy of methylphenidate (MPH) in giggle incontinence (GI), and the relationship between GI and urodynamic parameters. METHODS: Nine (n = 9) female GI patients underwent 1 year of treatment with 5 mg MPH. Three questionnaires, voiding diaries, and UDS were conducted before and after treatment. The severity of GI was classified into mild, moderate, and severe. Clinical success was characterized as: full response, response, partial response, and non-response. RESULTS: The mean age of all patients was 16.2 ± 2.3 years. Five patients had mild, one had moderate, and three had severe grade incontinent. All patients reported complete cessation of wetting after MPH treatment. The mean duration of asymptomatic period was 7 ± 3.2 months. There were no statistically significant score changes in all three questionnaires: Urgency Perception Scale (UPS), Overactive Bladder Symptom Score (OABSS) and Primary Overactive Symptom Questionnaire (POSQ), and voiding diaries (P > 0.05). In UDS, there were no statistically significant altered parameters, except maximum urethral closure pressure (MUCP) and maximum urethral pressure (MUP). After treatment, the mean MUCP was increased from 52.2 ± 6.8 to 73.0 ± 5.4 cmH(2) O (P < 0.05), and the mean MUP was increased from 48.6 ± 7.3 to 70.2 ± 5.0 cmH(2) O (P < 0.05). CONCLUSIONS: MPH can be a viable option for the primary treatment of GI, and it may be related to increasing urethral closure pressure. It was not possible to establish if a relationship between GI and detrusor overactivity exists.

Effect of Treadmill Exercise on Leak-point pressure and Neuronal Activation in Brain of Rats with Stress Urinary Incontinence.

PURPOSE: Stress urinary incontinence (SUI) commonly occurs in women, and it causes enormous impact on quality of life. Surgery, drugs, and exercise have been recommended for the treatment of this disease. Among these exercise is also known to be effective for relieving thesymptoms of SUI, however, the efficacy and underlying mechanisms of exercise on SUI are poorly understood. In the present study, we investigated the effect of treadmill exercise on abdominal leak-point pressure and neuronal activity in the medial preoptic nucleus (MPA), ventrolateral periaqueductal gray (vlPAG), and pontine micturition center (PMC) following urethrolysis in rats. MATERIALS AND METHODS: Adult female Sprague-Dawley rats, weighing 250±10 g (9 weeks old), were used in this study. After having undergone transabdominal urethrolysis to induce SUI, the rats were divided into three groups (n=6 in each group): a sham operation group, an SUI-induced group, and an SUI-induced and treadmill exercise group. The rats in the exercise group performed treadmill running for 30 min once a day starting 2 weeks after the induction of SUI and continuing for 4 weeks after surgery. For this study, determination of abdominal leak point pressure and immunohistochemistry for c-Fos in the brain were performed. RESULTS: Induction of transabdominal urethrolysis significantly reduced the abdominal leak point pressure, thereby contributing to the induction of SUI. In contrast, abdominal leak point pressure was significantly improved by treadmill exercise. The expression of c-Fosin the MPA, vlPAG, and PMC, the brain areas relating to micturition, was enhanced by the induction of SUI, whereas treadmill exercise significantly suppressed SUI-induced c-Fos expression, suggesting that neuronal activation in the micturition centers was suppressed by treadmill exercise. CONCLUSION: The present results suggest that treadmill exercise may be an effective therapeutic modality for ameliorating the symptoms of SUI.

Intermediate versus low or high prostate-specific antigen density level: comparison of cancer detection rate between 12- and 18-core prostate biopsy.

OBJECTIVE: To compare the diagnostic values of 12- and 18-core biopsies with respect to prostate-specific antigen (PSA) levels, prostate volumes (PV) and prostate-specific antigen density (PSAD). MATERIAL AND METHODS: Transrectal ultrasound-guided prostate biopsies were performed on 233 patients at a single tertiary academic center. Patients were prospectively randomized to the two protocols (12 or 18 core). The cancer detection rates achieved using these two methods were analyzed at different PSA levels, PVs and PSADs. RESULTS: Considering PSA level and PV simultaneously, patients were stratified into four groups (group A: PSA < 7 ng/ml and PV ≥ 45 cm(3); group B: PSA < 7 ng/ml and PV < 45 cm(3); group C: PSA ≥ 7 ng/ml and PV ≥ 45 cm(3); group D: PSA ≥ 7 ng/ml and PV < 45 cm(3)). 18-core biopsy had a higher cancer detection rate than 12-core biopsy only in group C (55.2% vs 24.1%, p = 0.015). The 233 patients were also stratified into three groups according to PSAD level: the low PSAD group (PSAD < 0.15 ng/ml/cm(3)), the intermediate PSAD group (0.15 ng/ml/cm(3) ≤ PSAD < 0.25 ng/ml/cm(3)) and the high PSAD group (PSAD ≥ 0.25 ng/ml/cm(3)). In the intermediate PSAD group, 18-core biopsy had a higher cancer detection rate than 12-core biopsy (54.2% vs 28.9%, p = 0.048). CONCLUSION: An 18-core biopsy is more useful than a 12-core biopsy for detecting prostate cancer in patients with high PSA and large PV, that is, with intermediate PSAD level.

Life-threatening complication after extracorporeal shock wave lithotripsy for a renal stone: a hepatic subcapsular hematoma.

Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since it was first introduced in 1980. ESWL is a well-established, safe and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. We present a case of a young female patient who developed a huge hepatic subcapsular hematoma accompanied by hypovolemic shock after ESWL for a 9 mm stone in the right kidney. The hematoma measured 13x6 cm. Conservative care with no surgical intervention was chosen because there was no evidence of active bleeding on the computed tomography. After conservative therapy, the hematoma was gradually absorbed and the patient was discharged.

Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study.

The aim of this study was to establish hazard ratios for the risk of complications of the upper urinary tract in relation to bladder management methods in patients with spinal cord injury. A total of 179 male patients were eligible for this investigation which was followed-up on a yearly basis until 2003. The average age at which the lesion occurred was 25.2 years (range 18-57). The average duration of follow-up since SCI was 29.3 years (range 10-53). During follow-up, the incidence of vesicoureteral reflux (VUR) was 15.1%. A total of 61 (34.1%) and 44 (24.6%) patients were diagnosed with pyelonephritis and renal stones, respectively. There were no significant differences in these complications among groups. Upper tract deterioration (UTD) was observed in 58 patients (32.4%). The incidence of UTD in the urethral catheter group (51.7%) was higher than that in other groups (P=0.008). Using multivariate analysis, patients with VUR were shown to have a higher risk of pyelonephritis (odds ratio 2.78; 95% confidence interval 1.16-6.68), and UTD (odds ratio 22.10; 95% confidence interval 6.92-70.56). We also found that UTD was more common for patients with an indwelling urethral catheter than for patients using other methods. For other variables, no positive association was observed. In cases which cannot undergo intermittent catheterization, or when the bladder cannot empty spontaneously, a suprapubic catheter is better than a urethral catheter for reducing UTD in this population. These findings suggest that even at a late stage post injury, bladder management methods are still important.