Needle Aspiration Biopsy of Seminiferous Tubules (NABST) as a Diagnostic Method in Korea / 전남의대학술지

To evaluate the diagnostic efficacy of needle aspiration biopsy of seminiferous tubules (NABST) and to represent the redistributed diagnostic results corresponding to testicular volumes and follicle-stimulating hormone (FSH) levels. In this retrospective study, we investigated 65 infertile men with either azoospermia or oligoasthenoteratozoospermia. Following NABST, specimens were stained with hematoxylin and eosin and classified into five histological types. With pre-procedure FSH levels and testicular volumes, we evaluated the probabilities of detecting sperms within biopsy specimens. NABST led to the classification of normal spermatogenesis in 31 cases (47.7%), hypospermatogenesis in 23 cases (35.4%), maturation arrest in 4 cases (6.2%), and Sertoli cell only syndrome in 4 cases (6.2%). The success rate of reaching a histological diagnosis using NABST was 95.4% (62 out of 65 cases). Fourteen patients (21.5%) had a testicular volume <15 cc; of these, 8 patients (57.1%) had normal spermatogenesis, 2 patients (14.3%) had hypospermatogenesis, 2 patients (14.3%) had maturation arrest and 2 patients (14.3%) had Sertoli cell-only syndrome (SCO). Twelve patients (18.5%) had an FSH level ≥10 IU; of these, 6 (50%) had normal spermatogenesis, 2 patients (16.7%) had maturation arrest and 4 patients (33.3%) had SCO. Cases with an FSH level <10 IU were positively associated with a probability of detecting sperm using NABST (p<0.001). NABST is a reliable tool for the histological diagnosis of azoospermic and oligoasthenoteratozoospermic patients. The diagnostic success rate was high and associated with pathological accuracy. NABST is a convenient procedure with few complications.

Needle Aspiration Biopsy of Seminiferous Tubules (NABST) as a Diagnostic Method in Korea / 전남의대학술지

To evaluate the diagnostic efficacy of needle aspiration biopsy of seminiferous tubules (NABST) and to represent the redistributed diagnostic results corresponding to testicular volumes and follicle-stimulating hormone (FSH) levels. In this retrospective study, we investigated 65 infertile men with either azoospermia or oligoasthenoteratozoospermia. Following NABST, specimens were stained with hematoxylin and eosin and classified into five histological types. With pre-procedure FSH levels and testicular volumes, we evaluated the probabilities of detecting sperms within biopsy specimens. NABST led to the classification of normal spermatogenesis in 31 cases (47.7%), hypospermatogenesis in 23 cases (35.4%), maturation arrest in 4 cases (6.2%), and Sertoli cell only syndrome in 4 cases (6.2%). The success rate of reaching a histological diagnosis using NABST was 95.4% (62 out of 65 cases). Fourteen patients (21.5%) had a testicular volume <15 cc; of these, 8 patients (57.1%) had normal spermatogenesis, 2 patients (14.3%) had hypospermatogenesis, 2 patients (14.3%) had maturation arrest and 2 patients (14.3%) had Sertoli cell-only syndrome (SCO). Twelve patients (18.5%) had an FSH level ≥10 IU; of these, 6 (50%) had normal spermatogenesis, 2 patients (16.7%) had maturation arrest and 4 patients (33.3%) had SCO. Cases with an FSH level <10 IU were positively associated with a probability of detecting sperm using NABST (p<0.001). NABST is a reliable tool for the histological diagnosis of azoospermic and oligoasthenoteratozoospermic patients. The diagnostic success rate was high and associated with pathological accuracy. NABST is a convenient procedure with few complications.

Management of Pelvic Organ Prolapse

Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.

Detection of Y Chromosome Microdeletion is Valuable in the Treatment of Patients With Nonobstructive Azoospermia and Oligoasthenoteratozoospermia: Sperm Retrieval Rate and Birth Rate

PURPOSE: We evaluated clinical characteristics, sperm retrieval rates, and birth rates in a relatively large number of infertile patients with Y chromosome microdeletions. MATERIALS AND METHODS: We retrospectively reviewed clinical data from 213 patients with nonobstructive azoospermia (NOA) and 76 patients with oligoasthenoteratozoospermia (OATS) who were tested for Y chromosome microdeletion from March 2004 to June 2011. RESULTS: Of the 289 patients, 110 patients presented with Y chromosome microdeletion and 179 patients presented with no microdeletion. Among the patients with Y chromosome microdeletions, 83/110 (75.4%) were NOA patients and 27/110 (24.5%) were OATS patients. After subdividing the patients with Y chromosome microdeletion, 29 had azoospermia factor (AZF)b-c microdeletion and 81 had AZFc microdeletion. The sperm retrieval rate was similar between patients with Y chromosome microdeletion and those with no microdeletion (26.6% vs. 25.6%, p=0.298) after multiple testicular sperm extraction (TESE). Excluding 53 patients who did not undergo TESE, 30 patients were analyzed. All of the 9 men with AZFb-c microdeletion had a complete absence of sperm despite multiple TESE. However, multiple TESE was successful for 9 of 21 patients with only AZFc microdeletion (p=0.041). Twenty patients with Y chromosome microdeletion gave birth. CONCLUSIONS: In NOA and OATS patients, no significant difference in the sperm retrieval rate was shown between patients with Y chromosome microdeletion and those with no microdeletion. Patients with short Y chromosome microdeletion such as AZFc microdeletion have better prognoses for sperm retrieval and an increased chance of conception than do patients with larger microdeletions such as AZFb-c microdeletion.

Reversible Infertility Associated with Testosterone Therapy for Symptomatic Hypogonadism in Infertile Couple

PURPOSE: Androgen replacement therapy has been shown to be safe and effective for most patients with testosterone deficiency. Male partners of infertile couples often report significantly poorer sexual activity and complain androgen deficiency symptoms. We report herein an adverse effect on fertility caused by misusage of androgen replacement therapy in infertile men with hypogonadal symptoms. MATERIALS AND METHODS: The study population consisted of 8 male patients referred from a local clinic for azoospermia or severe oligozoospermia between January 2008 and July 2011. After detailed evaluation at our andrology clinic, all patients were diagnosed with iatrogenic hypogonadism associated with external androgen replacement. We evaluated changes in semen parameters and serum hormone level, and fertility status. RESULTS: All patients had received multiple testosterone undecanoate (NebidoR) injections at local clinic due to androgen deficiency symptoms combined with lower serum testosterone level. The median duration of androgen replacement therapy prior to the development of azoospermia was 8 months (range: 4-12 months). After withdrawal of androgen therapy, sperm concentration and serum follicle-stimulating hormone level returned to normal range at a median 8.5 months (range: 7-10 months). CONCLUSION: Misusage of external androgen replacement therapy in infertile men with poor sexual function can cause temporary spermatogenic dysfunction, thus aggravating infertility.

Laparoscopic Treatment of Appendicovesical Fistula

A 23-year-old man had a history of intermittent episodes of urinary tract infection with associated low abdominal pain for 15 years. Persistent bacteriuria even with prolonged antibiotics was the reason why he was referred to our hospital. Laboratory tests were normal except pyuria and growth of Escherichia coli in the urinary samples. Cystoscopy revealed a small slit-like opening on the right lateral wall of bladder dome. We found some air within the bladder and a suspicious communicating tract between the appendix and bladder on a CT scan. With a strong impression of appendicovesical fistula, a laparoscopy was performed to confirm a diagnosis and to remove the appendicovesical fistula resulting in a satisfactory result without any complication.

Development of a Korean Version of the Urinary Tract Infection Symptoms Assessment Questionnaire

PURPOSE: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. MATERIALS AND METHODS: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. RESULTS: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proof-reading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. CONCLUSIONS: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection.

Efficacy of In Vitro Germ Cell Culture in Nonobstructive Azoospermic Patients with Sertoli Cell Only Syndrome

PURPOSE: We determined the usefulness of in vitro germ cell culture in nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome, no sperm in testicular sperm extraction. MATERIALS AND METHODS: This study included 44 patients (45 testicular tissues) with nonobstructive azoospermia who were diagnosed with Sertoli cell only syndrome and were found to have no sperm in testicular sperm extraction between January 2006 and July 2008. Among the 45 testicular tissues, 22 tissues were processed for culture. In the in vitro cultures, the testicular tissues were dissociated and plated on gelatin-coated dishes. Patients were divided into 2 groups according to culture success: group I, culture positive (+; n=10); and group II, culture negative (-; n=12). RESULTS: The mean patient ages were 31.73 and 31.68 years for groups I and II, respectively. The mean testicular sizes were 10.19 and 10.42 cc, respectively; the semen volumes were 2.86 and 3.04 cc, respectively; and the mean FSH, LH, and testosterone levels were 18.86 mIU/ml, 5.99 mIU/ml, and 4.46 ng/ml vs. 21.02 mIU/ml, 6.29 mIU/ml, and 4.32 ng/ml for groups I and II, respectively, with no significant differences between the groups (p>0.05). The culture rate of nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome was 45.5% (10/22). Round spermatid injection was done in 2 patients with consent of the patients, but implantation failed. Among the 45 tissues, germ cells were found in 8 tissues after pathologic reexamination. CONCLUSIONS: The in vitro culture of germ cells would be useful in the advanced treatment of nonobstructive azoospermic patients.

Clinical Trial with Tamsulosin and Doxazosin for the Treatment of Premature Ejaculation in Patients with Co-morbid LUTS: a Comparative Study / 대한남성과학회지

PURPOSE: We wanted to evaluate the therapeutic potential of a low dose of tamsulosin, as compared with doxazosin, for the treatment of premature ejaculation in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Ninety-six patients (mean age: 55 years) who had LUTS with premature ejaculation were randomly assigned to receive 0.2 mg of tamsulosin and 4 mg of doxazosin daily for a period of 3 months. Patients were evaluated by taking the medical history, the International Prostatic Symptom Score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) for ejaculatory function. The intravaginal ejaculatory latency time (IELT) measured by the patient's estimation and the sexual satisfaction ratio of both the partner and patient were investigated twice during the screening period and after treatment. At 3 months later, we assessed the differences in the IPSS score, the MSHQ score, the IELT and the sexual satisfaction ratio between the two groups. RESULTS: The two alpha 1-adrenoceptor antagonists had significant effects on the IPSS (p<0.05). However, we failed to find a statistically significant difference for each medication and the total MSHQ ejaculatory function score after medication in each group. The IELT was prolonged from 2.7+/-1.6 to 3.5+/-1.5 minutes and from 2.9+/-1.8 to 3.5+/-1.9 minutes in the tamsulosin and doxazosin groups, respectively. However, there was also no statistically significant difference of the IELT and the sexual satisfaction ratio in either group. CONCLUSIONS: For patients with premature ejaculation and LUTS, 0.2mg of tamsulosin improved the voiding symptoms, as assessed with the IPSS, as 4mg of doxazosin did, but neither medication seemed to be effective for the treatment of premature ejaculation.

Clinical Significance of Sensory Nerve Tests on External Genitalia for Diagnosis of Female Sexual Dysfunction / 대한비뇨기과학회지

PURPOSE: It is thought that neurological disorders are one of the main causes of organic female sexual dysfunction. However, it is difficult to diagnose due to the lack of measuring tools for assessing genital neural function. Sensory nerve tests on external genitalia is a new challenge for diagnosing female sexual dysfunction. In this study, we aimed to evaluate the clinical significance of the quantitative measurement of the genital sensory threshold in female sexual dysfunction. MATERIALS AND METHODS: Forty women with complaints of sexual dysfunction were evaluated with physical and vagina examination, serum hormonal tests, routine urinalysis and a questionnaire (the brief index of sexual function for women). A genitosensory analyzer (GAS, Medoc, Israel) was used to quantitative measure the vaginal and clitoral warm, cold and vibratory sensory thresholds. RESULTS: Of the 40 women, an arousal disorder was reported in 40%, orgasmic disorder in 82.5%, sexual pain disorder in 17.5% and a decreased libido in 17.5%. Of the 40 women, 86.4 and 91.2% showed impairment of vaginal cold (A-delta fiber) and warm (unmyelinated C fiber) sensations, respectively. However, the touch and vibratory sensations (A-beta fiber) showed relatively lower impairments; vagina and clitoris in 20.0 and 89.2% of the patients, respectively. CONCLUSIONS: In this study, most of the patients with sexual problems had significant vaginal and clitoral sensory nerve fiber impairments. The results support the significance of organic origins in female sexual dysfunction and the usefulness of quantitative analysis of genital sensation in diagnosing the etiology. (Korean J Urol 2005;46:610-615)

State-Trait Anxieties and Depression in Patients with Female Urinary Incontinence / 대한비뇨기과학회지

Studies of urinary incontinence have so far paid little attention with female urinary incontinence (FUI). The aims of this study are to define the nature and extent of psychological stress in women with FUI in the absence of other abnormality. Thirty women aged 24 to 51 were diagnosed as FUI and 30 women as control group without FUI. Diagnostic procedure included a history taking, physical examination, and urodynamic evaluation. Personality traits were assessed by means of the state-trait anxiety inventory (STAI) and the Beck depression inventory (BDI) in 30 FUI women. The results were compared with a control group of c,0ntinent women. The mean patient age were 39.6 years in FUI and 40.5 years in control group. Among the FUI patients, 23 (77%) were genuine stress incontinence (GSI), and 7 (23%) were GSI with urge incontinence (UI). State anxiety inventory was 44.78 +/-10.27 in FUI group and 39.97 +/- 4.49 in control group, there was a significant difference (p=0.025). Depression inventory were 8.67 +/- 7.91 in FUI and 4.47 + 2.09 in control group, with a significant difference also (p=0.007). However, trait-anxiety inventory was 44.70 +/-9.54, and 40.80 +/- 5.31, respectively without no significant difference (p>0.05). The results of this study were that FUI was `associated with state-anxiety and depression. Although FUI is not a severe physical disability, many psychological problems are associated with it.

The Efficacy of Pelvic Floor Muscle Exercise in Patients with Genuine Stress Incontinence / 대한비뇨기과학회지

In 1948, Kegel first described biofeedback therapy with perineometer for the treatment of genuine stress incontinence and reported a 90% improvement in 455 patients treated. After then, most urologists and gynecologist favored the anti-incontinence surgery in spite of the effectiveness of pelvic floor exercise. However, pelvic floor muscle exercise is regarded as ""something good to do"" before considering surgery, nowadays. This study evaluated the efficacy of the pelvic floor muscle exercise for the treatment of genuine stress incontinence patients with mild symptoms and pelvic relaxation. We treated 31 patients with pelvic floor muscle exercise with perineometer and followed up all of the patients for 3 months. Twenty seven out of thirty one cases improved incontinence symptom. Sixty five percent of cases showed less than 2 gm urine leak after one hour pad test and 48% of cases showed the increase of vaginal tone (mean 13.2mmHg) with perineometer. This study shows the improvement of genuine stress incontinence symptom is mainly due to perineal blockage just before the increase of intraabdominal pressure.

The prevalence of female urinary incontience ; preliminary study / 대한산부인과학회잡지

No abstract available.

A study on the occurrence of circulating antisperm antibodies in patients with testicular rupture / 대한비뇨기과학회지

Immunologic factors including antisperm antibodies play a significant role in pathogenesis of 10-20% of unexplained infertility cases. and any event or circumstance that would breach the blood-testis barrier may result in the formation of antisperm antibodies. Using an immunobead test we studied the occurrence of circulating antisperm antibodies in twelve patients who had undergone surgical treatment for testicular rupture due to blunt scrotal trauma. On the follow-up ranging from 6 to 14 months after surgical treatment only one patient was found to have circulating antisperm antibodies but his semen remained normal in spite of the presence of circulating antisperm antibodies.

GNRH test in Male Hypogonadism / 대한비뇨기과학회지

GnRH test was performed in male hypogonadism which included hypogonadotrophic hypogonadism, Kallmann's syndrome, oligospermia and azoospermia, total 24 cases. The results were as follows: 1. GnRH test is most useful in the evaluation of patients with suspected gonadotropins deficiency. 2. GnRH test is helpful in the differentiation of hypothalamic from pituitary disorder, but single GnRH test does not reliably differentiate. 3. GnRH test facilitate the differentiation between delayed puberty and isolated gonadotropins deficiency. 4. GnRH test is useful in the evaluation of patients with oligospermia or azoospermia, especially with normal basal hormone level, to diagnose the primary lesion. 5. GnRH test is valuable in the determination of treatment modality in hypogonadotrophic hypogonadism and infertile men.

GNRH test in Male Hypogonadism / 대한비뇨기과학회지

GnRH test was performed in male hypogonadism which included hypogonadotrophic hypogonadism, Kallmann's syndrome, oligospermia and azoospermia, total 24 cases. The results were as follows: 1. GnRH test is most useful in the evaluation of patients with suspected gonadotropins deficiency. 2. GnRH test is helpful in the differentiation of hypothalamic from pituitary disorder, but single GnRH test does not reliably differentiate. 3. GnRH test facilitate the differentiation between delayed puberty and isolated gonadotropins deficiency. 4. GnRH test is useful in the evaluation of patients with oligospermia or azoospermia, especially with normal basal hormone level, to diagnose the primary lesion. 5. GnRH test is valuable in the determination of treatment modality in hypogonadotrophic hypogonadism and infertile men.

The Effects of Simple Hydrodistention of Bladder in Interstitial Cystitis / 대한비뇨기과학회지

PURPOSE: We reviewed 19 patients with interstitial cystitis from March 1992 to August 1996. All patients were treated with simple hydrodistention of bladder, and we followed the results of their effect. MATERIALS AND METHODS: Most of the patients were middle aged women(mean age: 50.4 years). On cystoscopy, glomerulations were noted in all patients. Major symptoms were frequency(100%), dysuria(74%), urgency(74%) and suprapubic discomforts(47%). Simple hydrodistention was used in all patients. Mean bladder capacity was 150m1(50-280) in 1 month after procedure compared with 114m1(50-190) before procedure. Hematuria was noted during postoperative period in all patients. RESULTS: As the result of the postoperative urodynamic study, 5 out of 19 patients(26.3%) had no more symptoms, 9 patients(47.4%) was improved, but 5 patients(26.3%) showed no improvement. Sixteen of 19 patient were followed up 1.5-14(mean: 71) months, previous symptoms were recurred in 12 patients 3-4 months after the treatment. CONCLUSIONS: Even though the results show short-term effects, simple bladder hydrodistention would be one of the effective treatment modalities of interstitial cystitis.

Clinical Investigation of Male Hypogonadism / 대한비뇨기과학회지

Male hypogonadism refers to decrease in Leydig cell function, diminished or absent spermatogenesis, or both in tandem. The results of clinical investigation on 29 patients with male hypogonadism seen in urology department of Severance hospital from May, 1980 to August, 1982 are reported. The results were as follows; 1. Physical findings varied according to whether onset occurred before or after puberty. 2. The major physical finding was delay in sexual maturation. In addition, gynecomastia was found in 7 cases, hyposmia or anosmia in 4 cases, secondary bilateral anorchia in 4 cases, cryptorchidism in 3 cases and mental retardation in 1 case. 3. In patients with hypergonadotrophic hypogonadism (eunuch group), testicular volume was 2.5 +/- 0.8 ml. In patients with hypogonadotrophic hypogonadism (eunuchoid group), testicular volume was 2.4 +/- 1.8ml. 4. In patients with hypergonadotrophic hypogonadism, penile length was 4.4 +/- 1.2cm. In patients with hypogonadotrophic hypogonadism, penile length was 2.8 +/- 1.4cm. 5. In patients with hypergonadotrophic hypogonadism, serum FSH was 62.4 +/- 20.5mlU/ml, serum LH 65.0 +/- 23.6mlU/ml, serum testosterone 1.6 +/- 1.4ng/ml and serum prolactin 10.2 +/- 4.2ng/ml. In patients with hypogonadotrophic hypogonadism, serum FSH was 3.5 +/- l.9mlU/ml, serum LH 5.3 +/- 2.8mlU/ml and serum testosterone 0.9 +/- 0.6ng/ml. 6. The cause of hypergonadotrophic hypogonadism was Klinefelter's syndrome in 5 cases, prepubertal traumatic bilateral anorchisms in 2 cases, postpubertal bilateral anorchisms for seminoma or torsion in 2 cases. Testicular atrophy was found in 3 cases, 2 cases having past history of mumps orchitis and 1 case having past history of trauma. In 3 cases, no etiology could be identified. 7. The causes of hypogonadotrophic hypogonadism was a kallmann's syndrome in 4 cases. In two other cases, a pituitary lesion was suspected but could not be confirmed due to absence of pituitary hormone reserve function test. Two cases were identified as gonadotropin deficiency with growth hormone deficiency. 8. In patients with hypergonadotrophic hypogonadism, androgen replacement therapy with a testosterone preparation was performed. After the treatment, improvement of male secondary sex characteristics such as hair growth, voice change, enlargement of penis size and scrotum size was noted. Promotion and maintenance of sexual potency was also noted. 9. The patients with hypogonadotrophic hypogonadism were treated with androgen, HCG or HCG and HMG. However, due to the short period of therapy and follow-up, no firm conclusions about treatment efficacy in this group can be drawn. However, the best therapy to promote fertility should have been human chorionic gonadotropin combined with human menopausal gonadotropin. In conclusion, it appears that long-term treatment with androgen preparation promotes sexual potency and improves male secondary sex characteristics in hypergonadotrophic hypogonadism. In addition, long-term treatment with human chorionic gonadotropin combined with human menopausal gonadotropin may provide an efficient means of treating patients with hypogonadotrophic hypogonadism to obtain potency and fertility.

The Comparison on Postoperative Outcomes of Burch, Stamey and Raz's Operation

No abstract available.

Sling Operation for the Genuine Stress Incontinence Patients with Intrinsic Sphincter Dysfunction / 대한비뇨기과학회지

The sling operation is especially indicated in patients with intrinsic sphincter dysfunction (ISD). We evaluated of the effectiveness of the sling operation for the treatment of genuine stress incontinence patients with ISD. We operated 7 patients and followed up all of the patients for 214 (mean 8) months. Preoperative maximal urethral closure pressure was ranged from 23 to 74 (mean 38.4) cmH2O and valsalva leak point pressure (VLPP) was ranged from 41 to 78 (mean 59.5) cmH2O. We applied rectus fascia or GoreTex mesh as sling material. As a results, genuine stress incontinence (GSI) had completely cured in all of 7 cases. However, postoperative urinary retention was developed in two cases. In one of these, we released suspension suture, and in another case, urethrolysis and Raz operation was underwent in other hospital. All of these two cases showed improvement of voiding and any recurrence of incontinence was not noted. In conclusion, GSI due to ISD can be cured by the technique of the sling operation, so we suggest that the sling operation is one of the treatment for GSI patient with ISD.