ABSTRACT
OBJECTIVES: To evaluate the role of preoperative abdominal straining in predicting de novo overactive bladder (OAB) and voiding dysfunction in female patients undergoing suburethral taping by trans-obturator approach (TVT-O) for uncomplicated stress urinary incontinence (SUI). METHODS: Data from patients who underwent TVT-O surgery for SUI were retrospectively analyzed. Inclusion criteria included: history of pure SUI. Exclusion criteria included previous surgery for urinary incontinence, pelvic radiation, pelvic surgery within the last 3 months, and anterior or apical pelvic organ prolapse (POP) ⩾ +1 cm. Voiding dysfunction has been defined through symptoms and or urodynamics (UDS) signs. Accordingly, patients were divided into group A and group B according to the presence of abdominal straining during UDS. Patients were observed clinically and with UDS at a 3-year follow-up. RESULTS: A total of 192 patients underwent TVT-O surgery for uncomplicated SUI. Preoperative abdominal straining was identified in 60/192 patients (Group A: 31.2% vs Group B: 68.8%). Qmax was not different in the two groups (Group A: 19.5 vs Group B: 20.5 mL/s, p = 0.76). Demographics was similar for the two groups regarding age, parity. At 3-year follow-up, voiding dysfunction was reported in Group A: 9 and Group B: 8 patients (p = 0.056), de novo OAB was significantly reported in Group A: 23 and Group B: 26 patients (p = 0.007). CONCLUSION: Preoperative abdominal straining was found to be related to a significant incidence of de novo OAB. A significant correlation was not assessed for postoperative voiding dysfunction. Further studies may better define the impact of preoperative abdominal straining.
ABSTRACT
Tuberous sclerosis complex has several renal manifestations like angiomyolipomas. We report a case of a giant AML and discuss its diagnosis and treatment. A 42-year-old woman was admitted to emergency department due to flank pain and hematuria. The patient had history of mental retardation and epilepsy. Abdominal CT without contrast medium revealed a large mass with a fat/blood content inside. On those findings, we diagnosed the patient a bleeding giant AML. We performed selective embolization of the bleeding source with subsequent conservative management. TSC-associated AMLs occur more frequently as multiple lesions and grow to larger size than idiopathic AML.