Correlation between urodynamic test results, perineal ultrasound and degree of stress urinary incontinence.

OBJECTIVE: To evaluate whether the results of urodynamic tests and the perineal ultrasound were different between grade 1 and 2 stress urinary incontinence. STUDY DESIGN: Forty premenopausal women with a diagnosis of stress urinary incontinence according to urodynamic tests were enrolled in this study. Stress urinary incontinence was defined as urine leakage during stress without detrusor contraction. Twenty patients had grade 1 and 20 had grade 2 stress urinary incontinence. We compared the parameters of uroflowmetry, filling cystometry, urethral pressure profile, dynamic urethral function test, perineal ultrasound and stress urethral axis between grade 1 and 2 levels of stress urinary incontinence. RESULTS: There were no significant differences in age, parity or body mass index between the grade 1 and 2 patients. Uroflowmetry results showed that there were no significant differences in maximal flow rate, average flow rate, voided volume or residual urine between grade 1 and 2. As to cystometry results, only the first desire to void was significantly increased in grade 2 over 1 (304 +/- 113.65 vs. 194 +/- 48.24 [mL], P = .04). There were no significant differences in any of the urethral pressure profile parameters. In the dynamic test, the Valsalva leak point pressure and cough leak point pressure were not significantly different between the 2 groups. There were no significant differences in perineal ultrasound parameters or the stress urethral axis. CONCLUSION: Most stress urinary incontinence-related parameters showed no difference between the grade 1 and 2, and no urodynamic or ultrasonographic evidence for a difference between the grade 1 and 2 was demonstrated.

Surgical outcome of female genital fistula in Korea.

This purpose of this study was to establish a new standard for the surgical management of female genital fistula in Korea. From January 1992 to October 2001, 117 patients with female genital fistula who were admitted to the departments of obstetrics and gynecology, urology and general surgery were analyzed. Nine patients with congenital etiologies and 48 patients who were treated conservatively were excluded. The relationships between surgical outcome and the cause of fistula, the location of fistula, and the various surgical methods were analyzed. In spite of appropriate surgical treatment, fistulas due to cervix cancer management had the worst prognosis. In terms of location, fistula recurrence after surgical repair was most common in the bladder fundus and base. The transvaginal and transrectal approaches are suitable for fistulas located in the lower vagina. The transabdominal approach is appropriate for fistulas located in the functional portions such as the bladder and ureter, for fistulas which are difficult to expose surgically by either the vaginal or rectal approach, or in cases with severe adhesions. In cases of cervix cancer, extra care should be taken during surgical expiration or definitive radiotherapy, especially when the areas involved are the bladder fundus and base. The nature of the surgical approach should be decided by the location of the fistula, the functional importance of the area, and the degree of surgical exposure during the corrective procedures.

Relationship between obesity and the risk of gynecologic laparoscopy in Korean women.

STUDY OBJECTIVE: To determine whether obesity increases risk of performing laparoscopic gynecologic surgery in Korean women. DESIGN: Retrospective analysis over 35 consecutive months (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Two hundred seventy-seven women who underwent gynecologic laparoscopic surgery. INTERVENTION: Patients were analyzed by chart review. MEASUREMENTS AND MAIN RESULTS: Obesity was defined as body mass index (BMI) 25 kg/m(2) or greater. Patients were categorized on the basis of BMI [weight (kg)/height(2) (m(2))] as obese (BMI > or =25, 74 women) or nonobese (BMI < 25, 203). Each group was further divided into three subgroups according to operation difficulty. No significant differences in patient age, parity, menopausal status, medicosurgical illness, or history of intraabdominal surgery were apparent between groups, except for distribution of operation difficulty and adhesion grade; however, the adhesion grade was evenly distributed in each operation grade subgroup. In the two BMI groups, no significant differences were seen in surgical values (estimated blood loss, operating time, operative complications, postoperative complications, hospital stay, rate of conversion to laparotomy). CONCLUSION: Obesity had generally been thought to increase the risk of laparoscopic surgery. In our study in obese Korean women, however, it did not seem to increase the risk, and gynecologic laparoscopic surgery was performed safely.