Efficacy and Safety of "Tension-free" Placement of Gynemesh PS for the Treatment of Anterior Vaginal Wall Prolapse / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the efficacy and safety of the tension-free placement of a monofilament polypropylene mesh for the repair of an anterior vaginal wall prolapse (AVWP). MATERIALS AND METHODS: Women aged > or = 30 years with an AVWP stage of II or greater were included. Forty-nine women underwent trans-vaginal repair using a Gynemesh(TM) PS. Forty-six women who had symptomatic stress urinary incontinence received a midurethral sling (MUS). At the 12-month follow-up, evaluations were made for changes in the Pelvic Organ Prolapse Quantification (POP-Q) stage and Pelvic Floor Distress Inventory. Cure was defined as a POP-Q stage of 0 and improvement as a stage of I. Complications were also evaluated. RESULTS: The cure rate was 71.4%, and the improvement rate was 18.4%. Obstructive/discomfort, irritative, and stress subscale scores of the Urinary Distress Inventory anterior and posterior subscale scores of the POP Distress Inventory and the obstructive subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. Thirty-two of the 46 women (69.6%) who received MUS procedures reported no leakage after surgery. Complications were 2 cases of increased intraoperative bleeding and 1 case of vaginal erosion. CONCLUSIONS: Trans-vaginal repair using a Gynemesh(TM) PS is a feasible and effective procedure for the treatment of AVWP with no significant complications.

A Comparison of Traditional Anterior Colporrhaphy and Cystocele Repair with Monofilament Polypropylene Mesh Repair (Gynemesh PSTM) / 대한비뇨기과학회지

PURPOSE: Traditional anterior colporrhaphy repair can have a high recurrence rate. Therefore, the use of synthetic mesh to reinforce the anterior vaginal wall support has been proposed to prevent recurrence. The objective of our study was to compare the anatomic recurrence rates in patients that underwent the traditional anterior colporrhaphy with patients who add a monofilament polypropylene mesh repair(Gynemesh PSTM). MATERIALS AND METHODS: We reviewed the charts of patients who underwent transvaginal cystocele repair between January 2003 and June 2006. All patients had a physical examination and staging of the prolapse; the International Continence Society(ICS) system was used for the staging. Mid urethral sling operations were performed when stress incontinences was an associated feature. An anatomic recurrence was defined as an ICS stage 2 or greater anterior prolapse on the last recorded physical examination. The subjective patient satisfaction was also recorded. RESULTS: Seventy-one patients were available for study with a mean follow- up of 18.4 months. Thirty-eight patients underwent traditional anterior colporrhaphy, while 33 patients underwent cystocele repair using the monofilament polypropylene mesh(Gynemesh PSTM). Among the 71 patients, 9(12.7%) had recurrence of the cystocele. Based on the type of repair, 21.1%(8/38) of the patients with traditional repair had a recurrence compared to 3.0%(1/33) of the patients with the polypropylene mesh repair(p=0.03). With regard to satisfaction, 76.3%(29/38) of the patients with anterior colporrhaphy and 97.0%(32/33) with the mesh repair were satisfied with the outcome of the surgery(p=0.02). One patient had erosion of the mesh, at the midline, in front of the vaginal scar, at 12 months after the procedure. CONCLUSIONS: Our results suggest that the monofilament polypropylene mesh(Gynemesh PSTM) repairs improved the outcomes of anterior colporrhaphy with regard to the prevention of recurrent cystoceles.

Current Trends in the Surgical Management of Stress Urinary Incontinence and Pelvic Organ Prolapse

Female stress urinary incontinence is composed of anatomical incontinence and intrinsic sphincter deficiency. The goals of surgical treatment in patient with stress urinary incontinence are creation of a strong hammock against which urethra can be compressed with sudden changes of abdominal pressure in case of anatomical incontinence and compression and coaptation of deficient sphincteric unit in case of intrinsic sphincter deficiency. Restoration and reinforcement of the pubourethral ligaments and the suburethral vaginal hammock at the mid-urethra have become basic strategy of surgical treatment after integral theory by Ulmsten. Retropubic or transobturator mid-urethral sling procedure is mainstream of surgical treatment of female stress urinary incontinence in recent days. Tension free readjustable tape, named REMEEX system(R) and the TVT-secur(R) procedure were introduced recently. REMEEX system(R) allows readjustment of urethral suspension level postoperatively that can minimize postoperative urinary retention. TVT-secur procedure needs only one vaginal incision and minimal periurethral dissection for small sized mesh. Therefore, It can help make the surgery quicker and simpler. There are some advances in surgical treatment in pelvic organ prolapse. Robotic sacral colpopexy is one of that. It will be more popular surgery because robotic surgery has a lot of merits than previous conventional surgery.

A Case of Kerion Celsi Caused by Trichophyton tonsurans in Adult Female Patient / 대한피부과학회지

Trichophyton (T.) tonsurans is an anthrophophilic dermatophyte and children are the primary target population. The "seborrheic" type is the most common clinical type of tinea capitis caused by T. tonsurans but kerion celsi is much less common. We report a case of kerion celsi caused by T. tonsurans in a 21-year-old woman. The patient had various-sized, erythematous nodules and pustules with irregular alopecia on the scalp. On mycological investigation, T. tonsurans was identified within the lesion. The patient did not respond to itraconazole therapy but was successfully treated with ultramicronized griseofulvin.

Biological Variation of Serum Prostate Specific Antigen Levels in Men Aged 50 or Older without Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To evaluated the effect of the intra-individual variation in the serum prostate specific antigen (PSA) level in men without prostate cancer to decide on the requirement of a prostate biopsy. MATERIALS AND METHODS: Patients, aged between 50 and 80 years, were screened for prostate cancer or lower urinary tract symptoms at least 2 times within 3 months using PSA or free PSA measurements. Patients with an initial PSA level between 2.0 and 10.0ng/ml were included. Those with prostate cancer, urinary tract infection or 5-alpha reductase inhibitor medication were excluded. The coefficient of variation (CV) was evaluated in each PSA range. RESULTS: The analysis included 139 patients, with a mean age 62.1 years. The level of free PSA was measured in 56 patients. The mean interval between the two PSA measurements was 36.6 days. The mean CVs for the total PSA and % free PSA were 21.5 and 22.2%, respectively. 20% of patients show a CV of more than 30%, implying a large variation. In our study, the 95% confidence interval of initial PSA levels between 3.0 and 4.9ng/ml included the PSA cut-off point (4.0ng/ml) in the visit results. CONCLUSIONS: The variation the PSA level was relatively small, but some patients showed a CV greater than 30%. Therefore, the intra-individual PSA variation should become part of interpreting the PSA test results, especially for men with a PSA value near the cut-off point.

Occult Intraperitoneal Bladder Injury after a Tension-Free Vaginal Tape Procedure

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.

Psychometric Properties of the Korean Version of the King's Health Questionnaire in Women with Stress Urinary Incontinence

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.

Suprarenal Filter Placement in the Inferior Vena Cava to Prevent Tumor Emboli During Radical Nephrectomy in Renal Cell Carcinoma Invading the Inferior Vena Cava / 대한비뇨기과학회지

A renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5 percent of cases. Despite invasion of the inferior vena cava, an aggressive surgical approach for these neoplasms is recommended, but pulmonary and tumor embolisms have been common complications. Therefore, the prevention of tumor emboli during operation is necessary. Placement of a suprarenal filter in the inferior vena cava has become the procedure of choice for preventing tumor emboli during a radical nephrectomy.

Comparison between Autologous Rectus Fascial Pubovaginal Sling and Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence: Outcome and Quality of Life / 대한비뇨기과학회지

PURPOSE: To evaluate and compare the outcomes and patients' quality of life (QOL) between autologous rectus fascial pubovaginal sling and tension free vaginal tape (TVT) procedures. MATERIALS AND METHODS: 130 women treated with an autologous rectus fascial pubovaginal sling were prospectively compared to 105 women treated with the TVT procedure. The mean follow-ups were 17.2 and 16.1 months, ranging from 3 to 55 and 2 to 36 months, for autologous rectus fascial pubovaginal sling and TVT procedure, respectively. All patients were preoperatively evaluated, with a detailed history, pelvic examination, urine analysis, abdominal leak point pressure and 1-hour pad test. A modified validated outcome questionnaire by Hassouna and Ghoniem was used to evaluate the incontinence and QOL after the incontinence procedures. The questionnaire included 14 questions related to the amount and types of leakage, the presence of voiding symptoms and the degree of bother from any symptoms. Six of the questions dealt with the patients overall satisfaction with the procedure and the impact of the procedure on the patient's social and sexual life. Cure was defined as no urinary loss at any time. Failure was defined as no improvement and use of more than one pad per day. RESULTS: With an autologous rectus fascial pubovaginal sling, 108 patients (83.1%) were cured and 5 (3.8%) failed; whereas, with the TVT procedure, 81 patients (77.1%) were cured and 6 (5.7%) failed. In type III patients, there were no failures with an autologous rectus fascial pubovaginal sling. However, 2 patients failed with the TVT procedure. The operation satisfactions were attained with an autologous rectus fascial pubovaginal sling and the TVT procedure in 115 (88.5%) and 95 (90.5%) patients, respectively. No significant differences were noted in the continence, satisfaction or QOL in both groups. CONCLUSIONS: Both procedures had equally high rates of cure and satisfaction in the surgical treatment of female stress urinary incontinence. However, an autologous rectus fascial pubovaginal sling should first be considered with type III SUI to avoid failure. A further long-term follow- up study of these procedures is required. (Korean J Urol 2004;45:690-695)

Gangioneuroma Misdiagnosed as Ovarian Tumor / 대한비뇨기과학회지

A ganglioneuroma is a rare neoplasm in adults, which is most commonly locating in the posterior mediastinum, but can also be located in the retroperitoneum, pelvis, adrenal medulla and neck. They predominantly occur in females, with 60-70% of diseases originating before the age of 20 years. Herein, a case of a 51-year-old woman suffering from a pelvic mass, with a history and physical findings similar to those of an ovarian tumor, is reported.

Post Prostatectomy Prognostic Factors in Patients with Acute Urinary Retention due to Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Multiple parameters were preoperatively examined to determine if any could predict successful voiding after a prostatectomy in male patients presenting with acute urinary retention due to a benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 93 men, between 58 and 87 years old (mean age 72.9 years), who presented with acute urinary retention were investigated pre and post-operatively with an urodynamic study, transrectal ultrasonography (TRUS) and a completed International Prostatic Symptom Score (IPSS). RESULTS: 3 months postoperatively, 6 patients (15.8%) with detrusor hyporeflexia or detrusor instability required clean intermittent catheterization to empty their bladders. All patients with a prostate volume over 40 gm were able to void without catheterization after the prostatectomy. The IPSS, age, residual urine, cystoscopic findings, preoperative creatinine and resected prostate weight were not predictive of voiding failure after a prostatectomy. CONCLUSIONS: The urodynamic study and TRUS findings are important predictors of the improvements in symptoms and flow rates for the acute urinary retention associated with a benign prostatic hyperplasia. (Korean J Urol 2004;45:998-1001)

Hematologic Toxicity of Gemcitabine and Cisplatin Combination Therapy in Advanced Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: To evaluate the hematologic toxicity of gemcitabine and cisplatin (GC) in patients with advanced transitional cell carcinomas. MATERIALS AND METHODS: From 25 patients, with advanced transitional cell carcinomas, 8 had previously received M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) chemotherapy for a metastatic disease, and were scheduled to receive gemcitabine, 1,000mg/m2, intravenously, over 30 minutes, on days 1, 8 and 15, and cisplatin, 70mg/m2, over 1 hour, on day 2 of a 28-day cycle. The hematological toxicities of each cycle were evaluated. RESULTS: The main hematological toxicities were thrombocytopenia (grade 3 in 24% and grade 4 in 16% of patients), leukopenia (grade 3 in 14% of patients) and anemia (grade 3 in 12% of patients). Four of the patients that experienced grade 4 thrombocytopenia had a tendency for recurring grade 4 thrombocytopenia during the GC chemotherapy. However, there was no evidence of bleeding. CONCLUSIONS: The most severe hematological toxicity of the GC chemotherapy was thrombocytopenia. The careful observation of the patients that experience grade 4 thrombocytopenia is recommended.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

Usefulness of Rapid PSA Kit(R) / 대한비뇨기과학회지

PURPOSE: The incidence rate of prostate cancer has increased remarkably in Korea. The serum prostate specific antigen (PSA) value has been used for screening, although its clinical significance in prostate cancer screening is still inconclusive. However, if the measurement time was short and the cost was low, such an assay kit should be sufficient for prostate cancer screening. MATERIALS AND METHODS: We developed pared monoclonal antibodies against PSA which could be used in assay kits for PSA. The Rapid PSA Kit(R) used an immunochromatographic method to qualitatively judge a positive or negative result. Serum specimens from 78 men with benign prostate hyperplasia or prostate cancer were tested using the kit. RESULTS: The sensitivity of the kit was determined to be 4ng/ml. 33 samples had a value of greater than 5ng/ml, so were considered positive. 5 samples had values between 4ng/ml and 5ng/ml, of which 3 were positive. The other 40 samples had values less than 4ng/ml, and 11 of these were judged positive. These results indicated that the sensitivity and specificity of the Rapid PSA Kit(R) were 94.7 and 72.5%, respectively. CONCLUSIONS: Tests using the Rapid PSA Kit(R) can be easily performed at outpatient clinics or elsewhere. This kit is useful in the initial screening of prostate cancer as the results can be obtained within 15 minutes and the cost is lower than with ordinary serum PSA tests.

An Economic Evaluation of Pharmacological Therapy and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: An economic analysis of pharmacological therapy and transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH) was conducted. MATERIALS AND METHODS: Twenty six patients had undergone TURP from January to June 2000 were enrolled in this study. The costs associated with this group of patients were compared with those of 7 patients treated with medication (doxazosin, terazosin, tamsulosin, and finasteride only and alpha-blocker with finasteride). RESULTS: The mean cost for TURP was 1,900,000 won. The most expensive medical therapy was finasteride, which was followed by tamsulosin, terazosin, and doxazosin, with an estimated 12-month cost of 817,000won, 695,000won, 396,000won, and 372,000won respectively. The costs associated with doxazosin remained lower than those associated with TURP for approximately 5.3 years (the corresponding break-even point was 2.4 years for finasteride vs. TURP). CONCLUSIONS: Among the pharmacological therapies, doxazosin is the most cost effective. TURP was more cost effective than doxazosin therapy after 5.3 years. In view of the cost-effectiveness, TURP may be considered as the mode of primary therapy for the patients with severe symptoms of BPH.

TVT Folding Technique in Patients with Failed Stress Urinary Incontinence after TVT Procedure

PURPOSE: Tension-free vaginal tape(TVT) procedure in patient with stress urinary incontinence has become a favorable technique to many urologists because it has many advantages including short duration of admission, low complication and high success rates. We performed TVT folding technique in 2 patients with failed TVT procedure. MATERIALS AND METHODS: In the 52 cases who have received TVT procedure in our institute, 2 patients with failed TVT procedure were received TVT folding technique. After midline incision in the anterior vaginal wall under local anesthesia, TVT was dissected from the periurethral tissue. Folding TVT with Z-shape with proper tension was done. RESULT: 2 patients who had received TVT folding technique since march 2001 in our institute became dry day and night after 3 months follow up. CONCLUSION: TVT folding technique shows a new promising technique in case of loosely placed TVT.

Two Cases of Crossed Testicular Ectopia / 대한비뇨기과학회지

No abstract available.

A Case of Testicular Tunica Albuginea Cyst with Psammoma Body / 대한남성과학회지

We report a case of testicular tunica albuginea cyst with psammoma body which was treated with excision and testicular preservation. The presumptive diagnosis of a simple intratesticular cyst was made by ultrasound. The intraoperative pathological diagnosis was benign serous cyst and then simple excision of the lesion with testicular masses, and it may permit identification of lesions that can be excised locally with testicular preservation. To our knowledge tunica albuginea cyst with psammoma body, a characteristic histological finding, has not been reported. Its histogenesis was also discussed.

A Study on the Renal Damage after Repeated Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients with Renal Stone / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy (ESWL) is chosen as a primary treatment modality due its non-invasiveness and high effectiveness. But renal damage is reported in 65-85% of patients with renal stone after ESWL. It is Know that the renal collecting tubular enzyme, N-acety1-glucosaminidase (NAG), is increased in urine and 3-4 weeks are needed to be normal in most patients in case of damage by ESWL. Nevertheless, ESWL is performed repeatedly with 1 or 2 weeks interval and moreover daily without checking the renal damage in most ESWL centers. So, this study is performed to know how severely the renal damage is caused by ESWL and to know the safe interval of ESWL in patients with renal stones. We measured the urinary NAG/Creatinine ratio to check the renal damage in 9 patients with renal stone after repeated ESWL (19kV, 2000-3000 shock wave/session) using Lithostar Ultra manufactured by Siemens. The results are as follows; 1. In 3 patients who received ESWL once a day for 2 days repeatedly, one patient had normal urinary NAG/Creatinine ratio, one patient had rapidly increased urinary NAG/Creatinine ratio immediately and the ratio decreased from two weeks later and it needed 4 weeks to be normal. The other one patient had rapidly increased urinary NAG/Creatinine ratio immediately and the ratio was normal 1 week later. 2. All 6 patients who received ESWL with one or two weeks interval had normal urinary NAG/ Creatinine ratio. In conclusion, it is thought that repeated ESWL by Lithostar Ultra (Siemens) with more than 1 week interval is safe. In case of repeated ESWL more than 3 times with one day interval, it is needed to confirm the normal urinary NAG/Creatinine ratio before procedure.

A Study on the Possibility of Reducing Corneal Haze with Topical Application of Human Amniotic Fluid in the Wounds Induced by Excimer Laser Keratectomy in Rabbits

Scarless wound healing with minimal inflammation obscured in the fetal skin rpay be due to the fact that amniotic fluid contains factors that may modulate the wound healing process. To examine this possibility, We examined the effect of topical application of human amniotic fluid on the healing of rabbit corneal wounds induced by excimer laser stromal ablation. The right eye received undiluted human amniotic fluid(AF) drops(13th week gestational age) and the left eye received the BSS as a control five times a day for one month. Epithelial healing completed within three days. The wound healing rate was not significant in the early phase but was significant in the late phase(p<0.05). Keratometric regression was significantly less in human amniotic fluid treated(AF group) eyes than BSS treated(control group) eyes. Corneal opacity was significantly less in AF group than control group at one and three months after laser ablation using Scheimpflug camera photography and MacDonald-Schadock class ification(p<0.05). Morphological examination revealed convoluted basement membrane, discontinued hemidesmosome and increased number of activated keratocytes in BSS-treated eyes. These results indicate that corneal scarring(haze) can be reduced by topical application of human amniotic fluid. We speculate that amniotic fluid may contain factors that can facilitate the restoration of fetal environment for wound healing by inhibiting fibroblast activation, thus preventing scar formation.