Urodynamic Detrusor Overactivity in Patients with Overactive Bladder Symptoms / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the relationship between urodynamic detrusor overactivity (DO) and overactive bladder (OAB) symptoms in men and women. METHODS: We reviewed the records of adult males and females who attended a tertiary referral center for urodynamic evaluation of OAB syndrome symptoms with the presence or absence of DO. DO was calculated for symptoms alone or in combination. RESULTS: The overall incidence of DO was 76.1% and 58.7% in male and female OAB patients, respectively. Of men 63% and 61% of women with urgency (OAB dry) had DO, while 93% of men and 69.8% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Of women, 58% who were OAB wet had stress urinary incontinence symptoms with 26.4% having urodynamic stress incontinence. 6% of men and 6.5% of women with OAB symptoms had urodynamic diagnosis of voiding difficulties with postvoid residual greater than 100 mL. Combination of symptoms is more accurate in predicting DO in OAB patients. The multivariate disease model for males included urge urinary incontinence (UUI) and urgency while for females it included UUI and nocturia. CONCLUSIONS: There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women, more so in OAB wet than in OAB dry. Combination of symptoms of the OAB syndrome seems to have a better correlation with objective parameters from the bladder diary, filling cystometry, and with the occurrence of DO.

Immediate surgical repair of penile fracture: experience in 14 cases

The aim of this study is to detect the results of immediate surgical repair of penile fracture. In the period from 1998 to 2008, 14 patients were treated at Princess Basma Hospital and King Abdullah University Hospital with the diagnosis of penile fracture. Patient's age ranged between 23 and 39 years [mean 30.1 years]. The diagnosis was based on clinical history and physical findings. In the case with urethral bleeding, retrograde urethrogram was obtained. All patients underwent surgical exploration and repair within a few hours after presentation. Under general anesthesia, circumferential degloving incision was carried out, along the circumcision scar. Diazepam 10mg at night was used to prevent complications for 10 days. Patients were advised to avoid sexual intercourse for 8 weeks after surgical repair. The cause of penile fracture in these patients was rigorous masturbation in 4 patients, enthusiastic sexual intercourse in 3, trauma during rolling over in bed in 2 patients, manipulation of erected penis in 3 patients, during trying to lift up a watermilon by putting the erected penis in a whole made in it in 1 case, and direct trauma to erect penis in 1 patient. Only 7.1% experienced complications [decreased sensation was noticed on the left side of the penis in 1 patient] erectile function was preserved in all patients without pain. Immediate surgical repair of penile fracture gives an excellent long-term outcome. Most cases of penile fracture can be diagnosed on the basis of clinical findings. Blood at the tip of the penis indicates urethral injury, and so retrograde urethrogram is indicated in such cases

Single breath vital capacity induction of anesthesia with 8% sevoflurane versus intravenous propofol for laryngeal tube insertion in adults

To compare the conditions for laryngeal tube airway insertion obtained by the inhalation of 8% sevoflurane using a vital capacity breath [VCB] technique with propofol intravenous induction. We carried out a prospective, randomized, single blind study at King Abdullah University Hospital, Irbid, Jordan from September 2005 to April 2006. Involved in this study were 80 adult [ASA physical status I and II] patients aged 26-70 years undergoing elective surgery under general anesthesia. The patients were randomized into 2 groups. An independent observer noted the time to loss of consciousness, the presence of adverse events, time to successful laryngeal tube placement and the number of attempts needed until a successful laryngeal tube insertion. With the single VCB method, sevoflurane produced a loss of consciousness faster than propofol did [51.6 +/- 4.4 versus 59.7 +/- 4.9 seconds, p<0.001]. The insertion of laryngeal tube was faster in the propofol group [77.2 +/- 20.2 versus 122.2 +/- 33.3 seconds, p<0.001] and required fewer attempts [1.2 +/- 0.4 versus 1.6 +/- 0.7, p<0.02]. The overall incidence of complications during the induction of anesthesia as well as during the laryngeal tube insertion, especially apnea [42% versus 0%; p<0.001], was more frequent in the propofol group [82.5% versus 27.5%; p<0.001]. We conclude that vital capacity breath induction with sevoflurane produces a faster loss of consciousness and fewer side effects than propofol and efficient for laryngeal tube insertion, but takes slightly longer than propofol due to the prolonged jaw tightness