High urinary flow in women with stress incontinence: corrected flow-age nomogram evaluation after a transobturator tape procedure.

INTRODUCTION AND HYPOTHESIS: We noninvasively compared urinary flow in both pre- and post-transobturator tape (TOT) procedures in stress urinary incontinence (SUI) patients using previously reported corrected flow-age nomograms in healthy women. METHODS: This retrospective cohort study included patients who underwent a successful TOT procedure to treat SUI. Non-instrumented uroflowmetry was performed before and 3 months after surgery. Corrected maximum flow rate (cQmax) and average flow rate (cQave) were calculated using Qmax/√voided volume (VV) and Qave/√VV respectively. The ratio of corrected flow to age-adjusted corrected flow in healthy women was calculated in each patient. Each parameter was compared against pre-TOT and 3-months post-TOT values. RESULTS: Sixty-two patients were eligible for study inclusion. All urinary flow parameters were significantly higher pre-TOT than at 3 months post-TOT. The number of patients with cQmax and cQave over mean flow-age nomogram, compared with healthy women, before the TOT procedure decreased 3 months post-TOT; however, in many patients, cQmax and cQave were higher than in the corrected flow-age nomogram post-TOT. No significant difference in the ratio of cQmax to age-adjusted cQmax between pre- and post-TOT in the normal urinary flow group was observed, but significantly decreased in the high urinary flow group 3 months after TOT. CONCLUSIONS: Urinary flow rates were higher in SUI patients compared with age-matched controls and successful TOT procedures normalized urinary flows in patients with high urinary flow. A simple evaluation of urinary flow using a corrected flow-age nomogram may be clinically useful in SUI patients.

Predictor of de novo stress urinary incontinence following TVM procedure: a further analysis of preoperative voiding function.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate the predictors of de novo stress urinary incontinence (SUI) in patients undergoing a tension-free vaginal mesh procedure (TVM) for pelvic organ prolapse (POP). METHODS: Sixty-five patients without SUI were assessed with regard to voiding function by a pressure flow study and clinical characteristics. RESULTS: The mean age of the patients was 67 ± 8.3. Of the 65 patients, 41 (63 %) maintained urinary continence postoperatively and 24 (37 %) showed de novo SUI. In univariate analysis, the de novo SUI group included a significantly higher proportion of patients with preoperative obstruction, defined as moderate or greater obstruction according to the Blaivas nomogram (29 vs 7 %, P = 0.035). In multivariate analysis, urethral obstruction was an independent predictor of de novo SUI with an odds ratio of 12.616 (95 % confidence interval 1.580-268.731). CONCLUSIONS: Preoperative evaluation of urethral obstruction will contribute to prediction of de novo SUI combined with a conventional diagnosis of occult SUI.

A case study of human papillomavirus-associated bladder carcinoma developing after urethral condyloma acuminatum.

We report a 35-year-old man with bladder carcinoma developing 2 months after urethral condyloma acuminatum, with an 8-year history of persistent human papilloma virus-58 infection in the urinary tract. DNA was extracted from paraffin-embedded tissue specimens. Human papilloma virus-6 and -58 were detected in the condyloma, whereas human papilloma virus-58 was detected in the carcinoma. In situ hybridization analysis also demonstrated high-risk human papilloma virus-DNA signals in the condyloma and carcinoma tissues. Immunohistochemistry showed that p16-INK4a and mcm-7, surrogate markers of oncogenic human papilloma virus E7 protein, were weakly expressed in the condyloma tissue but were strongly expressed in the carcinoma tissues, suggesting that human papilloma virus-58 was present in the episomal state in the condyloma, whereas human papilloma virus-58 DNA was integrated into the host cells and its infection may have a role in the development of bladder carcinoma. Human papilloma virus-58 was continuously detected in the urethral brushing samples 8 years after treatment for urethral condyloma, and human papilloma virus-58 infection was still persistent in the urethra.

Fluoroscopic imaging of needle position in the tension-free vaginal mesh procedure for pelvic organ prolapse: two case reports.

The tension-free vaginal mesh (TVM) procedure has become one of the commonly used treatments for pelvic organ prolapse (POP) due to good clinical outcome. However, there are several technical difficulties associated with this procedure. We performed fluoroscopy for imaging of the surgical procedure on the TVM to resolve the technical problems regarding needle penetration. Fluoroscopic imaging with rectogram and cystogram demonstrated the positions of the needle, pelvic organs and index finger for needle guidance in the TVM procedure. Fluoroscopic imaging may be useful to understand the movement of surgical devices in the blind space, objectively evaluate the surgeon's skill, avoid injury to the pelvic organs, and detect any such injury immediately should it occur.

Postoperative voiding function in patients undergoing tension-free vaginal mesh procedure for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: We compared pre- and postoperative voiding function in patients with POP and assessed the efficacy of urodynamic studies in these cases. METHODS: Forty-six patients treated with the tension-free vaginal mesh (TVM) procedure between January 2009 and February 2010 underwent pressure flow study pre- and postoperatively. Pre- and postoperative voiding functions were assessed according to Schäfer nomograms. RESULTS: The mean postoperative detrusor pressure at maximal flow was decreased significantly compared with that preoperatively. The mean maximum flow rate was also improved significantly and the proportion of normal contractility was increased significantly after the operation, as was the proportion of non-obstructive patients. CONCLUSIONS: The TVM procedure for pelvic organ prolapse improved both detrusor contractility and urethral obstruction.

Immediate effect on overactive bladder symptoms following administration of imidafenacin.

INTRODUCTION: One of the factors influencing the treatment compliance of patients with overactive bladder (OAB) symptoms is thought to be the time to reach clinical effectiveness after administering drugs. We investigated the immediate effect of imidafenacin on OAB symptoms. PATIENTS AND METHODS: Imidafenacin (0.1 mg) was administered. OAB symptom scores (OABSS) were evaluated before administration, and at 2 and 4 weeks after administration. The subjective efficacy in patients was examined by recording daily changes for 2 weeks. RESULTS: Twenty patients were evaluated for efficacy using OABSS and uroflowmetry with postvoid residual volume. Nineteen patients completely recorded daily changes in subjective efficacy. The mean total OABSS decreased gradually during 2 weeks after administration. Patients reported the drug's efficacy to begin 3 days after the commencement of administration. Urinary flow and postvoid residual volume did not change after administration. CONCLUSION: The subjective efficacy of imidafenacin was observed from 3 days after the commencement of administration.

[Primary mucosa-associated lymphoid tissue lymphoma of the urinary bladder successfully treated by radiotherapy and rituximab].

A 64-year-old woman visited our hospital in December 2005 because of general malaise. Her hemoglobin level was 9.0 g/dl. Gastrointestinal fiberscopy detected a hemorrhagic gastric ulcer, which was considered as etiology of anemia. Abdominal ultrasonography showed bilateral hydronephroses and hydroureters. A urine test revealed pyuria and macroscopic hematuria, and urine culture revealed 10(8) colony-forming units of Escherichia coli per ml. Pelvic MRI showed thickening of the posterior wall and trigone of the urinary bladder. Transurethral resection was peformed, and biopsy of the mucous of the bladder gave a diagnosis of primary mucosa-associated lymphoid tissue (MALT) lymphoma of the urinary bladder. Ann Arbor clinical stage was IEA. It was planned to administer irradiation at a total dose of 36 Gy to the whole bladder and part of the tumor; however, radiotherapy was discontinued at a dose of 26 Gy because of the development of pollakisuria. Pelvic MRI and pathologic examination of the urinary bladder after radiotherapy showed that the lymphoma was in complete remission; however, she received retuximab therapy at a dose of 375 mg/m2/week, 8 times additionally, because of the reduced radiotherapy. The patient has remained in complete remission for 14 months.

Piezoelectric extracorporeal shockwave lithotripsy for bile duct stone formation after choledochal cyst excision.

We report a case of bile duct stones in which piezoelectric extracorporeal shockwave lithotripsy (ESWL) was highly effective for the clearance of stones. A 16-year-old girl, who had undergone excision of a choledochal cyst when she was 3 years old, presented a spiking fever and colic abdominal pain. Radiological investigations showed two large stones incarcerating to the proximal end of hepatico-jejunostomy anastomosis. Massive debris was also present in intrahepatic bile duct proximal to the anastomosis. She underwent piezoelectric ESWL with an EDAP LT02 lithotripter. An average of 40 min ESWL session was repeated at intervals of 2 or 3 days. Neither anesthetic nor sedative treatment was required. By the end of the sixth session, the stones incarcerated were fragmented and the debris in the intrahepatic bile duct was completely eliminated. We conclude that piezoelectric ESWL is a less invasive, effective and repeatable method, therefore, it could be a treatment of choice for bile duct stone formation after choledochal cyst excision.