Surgical results of stress incontinence treated by Trans-obturator tape (TOT): Clinical analysis of 80 cases / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the efficacy and safety of Trans-obturator tape (TOT) in the surgical treatment of stress incontinence and analyze the postoperative clinical outcome. METHODS: Between August 2004 and September 2005, females diagnosed as having stress incontinence (pure or mixed) were operated on using TOT. Eighty cases with more than three-month follow-up period were included for this study. RESULTS: Patient age ranged from 28 to 74 years (mean, 58). After surgical treatment using TOT, 74 cases (92.5%) of stress incontinence showed complete recovery, 4 cases (5%) showed partial recovery, and 2 cases (2.5%) were unchanged without further functional deterioration. Urgency in the mixed incontinence was improved in 30 in 36 cases (83.3%) and frequency was changed for the better in 20 of 27 cases (62.9%). The mean operation time was 14.3 minutes and the mean hospital stay was six hours. Postoperative evaluation with cystoscope was unnecessary. The postoperative complication rate was 10% (8/80). Postoperative wound bleeding occurred in one case and intraoperative bladder perforation happened in one case. Postoperative transient urgency was developed in one case and postoperative transient frequency developed in three cases. Two patients complained of weak urinary stream. CONCLUSION: The surgical treatment using TOT is thought to be a safe and efficient means for the outpatient management of stress incontinence. And also, this method appears to have an effect on urgency and frequency.

Clinical Review on 93 Cases of Laparoscopic Myomectomy / 대한산부인과학회잡지

OBJECTIVE: The study was undertaken to evaluate clinical safety and usefulness of laparoscopic myomectomy with analyzing clinical course and postoperative complications of 93 patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital and to introduce operative methods executed in this hospital. METHODS: Total number of patients underwent laparoscopic myomectomy at Yosu Chon-nam Hospital from May 2001 to December 2002 was 93. With ward chart and admission recordings, Age, parity, symtom, size of myoma, number of myoma, location operation time and hemoglobin change were recorded. Data were analyzed with Microsoft Excel. RESULTS: The mean age of patients was 42.68 ( +/- 6.05) years. The mean parity was 2.02 ( +/- 0.96). The mean number of myoma was 1.70 ( +/- 1.27). The mean weight of myoma was 71.7 ( +/- 56.4) gm. The most common symtom was hypermenorrhea. The location of myoma was submucosal, intramural, subserosal in large order. The mean operation time was 101.1 ( +/- 30.2) minutes. The mean hemoglobin change after operation was 1.40 ( +/- 0.81) g/dL. Mean hospital stay was 3.90 ( +/- 1.20) days. The operative complication was trocar site bleeding (2 cases), surgical emphysema (2 cases). In 2 cases, Laparoscopic procedure was converted to laparotomic method. CONCLUSION: Indication of operation was extended in almost all age (including reproductive age) and 93 Laparoscopic myomectomy was done safely and effectively without severe complications. However, to obtain more safety and usefulness of laparoscopic myomectomy, adequate laparoscopic instrument and expertized operative technic should be demanded. In near future, laparoscopic myomectomy will be more popular and effective by variable technical development and ordered discipline.

A Case of metastatic choriocarcinoma diagnosed at 34th week of pregnancy / 대한산부인과학회잡지

Choriocarcinoma associated with a normal pregnancy is rare. Especially, choriocarcinoma coexistent with a viable pregnancy is even rarer and commonly presents with widespread metastatic disease. We experienced a patient at 34th week of pregnancy with dyspnea and sputum production due to pulmonary metastasis of choriocarcinoma. The serum B-hCG level was extremely elevated and the placenta had multifocal choriocarcinoma. After vaginal delivery, the patient was successfully treated with combination chemotherapy (EMA-CO). The patient is receiving follow up with monthly measurement of hCG values. We report one case of metastatic choriocarcinoma with viable pregnancy with review of literature.

A Clinical Study on the Incompetent Internal Os of the Cervix / 대한산부인과학회잡지

OBJECTIVE:Our goal was to evaluate the clinical characteristics and statistical analysis in incompetent internal os of the cervix(IIOC) METHOD: At Department of Obstetrics and Gynecology, Eulgi Hospital and Eulgi university Hospital from January 1, 1991 to December 31, 1997, 296 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation. Of this, 38cases were follow up lost, so 252 cases were analayzed. Diagnostic criteria was previous history of painless cervical dilatation, followed by spontaneous abortion or preterm birth, and acceptance without resistance at the internal os of No. 8 Hegar dilator. RESULT: Incidence of IIOC was 1.61%, 1 in 60 deliveries. Most frequent age group was in 28-30 years old group and mean age was 30 years old. Total number and mean number of gravida was 818 and 3.2. The most common contributing factor was previous artificial abortion(77%), and cervix dilatation(9%), old cervical laceration(4.3%) etc, was followed. Operation methods were McDonald operation(56%) and modified Shirodkar operation(44%). The Success rate of McDonald and modified Shirodkar was 78.1% and 88.1%. Successful fetal salvage rate was 82.5%, and the highest success rate was 86.9% in 14-18th weeks of gestation group. The more cervix dilate, the more failure occured. Causes of operation failure was premature rupture of membrane(54.5%), preterm labor(43.2%) and fetal death in utero(2.3%). Delivery method after operation was vaginal delivery(146cases, 70.9%) and cesarean delivery(60cases, 29.1%). Cause of cesarean delivery was previous cesarean section(43.3%), breech presentation(16.7%), cephalopelvic disproportion(15%), prolonged labor(6.7%), fetal disttess(6.7%), twin(5%), placenta previa(3,3%) and abruptio placenta(3.3%). CONCLUSION: The 14-18th weeks of gestation group & no cervical dilatation group has higher success rate, which indicate early diagnosis and appropriate timing of operation is probably associated with a greater operation

A Case of Antenatally Diagnosed Fetal Ovarian Cyst / 대한산부인과학회잡지

Ovarian cysts in the newborn are uncormnon. Fetal ovarian cysts are being diagnosed with inaeasing fiequency with development of obstetrical sonography. Most of these cysts are found within the first few months of life and have no clinical significance. But, a large ovarian cyst would be founded antenatally with sonography. A large ovarian cyst can cause life-theatening complications during parturition and in the neonatal period. We have experienced a case of fetal ovarian cyst in a 32-year-old primiparous woman with antenatal sonography and report our experience with a brief review of literatures.