Chronic bacterial seminal vesiculitis as a potential disease entity in men with chronic prostatitis.

OBJECTIVES: To investigate bacterial infection in the seminal vesicles by bacteriological examination and radionuclide imaging in men with chronic prostatitis. METHODS: The study included 50 patients with chronic prostatitis who showed hot uptake in seminal vesicles on Tc-99m ciprofloxacin imaging and eight patients who did not show hot uptake. The evaluation included the National Institutes of Health Chronic Prostatitis Symptom Index and four-glass test. In all participants, transperineal aspiration of seminal vesicle fluid under the guidance of transrectal ultrasonography and bacteriological examination was carried out. RESULTS: Of the 50 patients who showed hot uptake in the seminal vesicles on the isotope study, microorganisms were isolated from the seminal vesicle fluid in 17 patients (positive predictive value, 34%). The most common causative organisms were Escherichia coli in 13 patients (26%), followed by coagulase-negative Staphylococcus species in two patients (4%), Enterococcus faecalis in one patient (2%) and Chlamydia trachomatis in one patient (2%). No microorganisms were isolated in the eight patients who did not show hot uptake in the seminal vesicles (negative predictive value, 100%). However, there were no significant differences in National Institutes of Health Chronic Prostatitis Symptom Index total scores and subscores between the study groups. CONCLUSIONS: Chronic bacterial seminal vesiculitis might simultaneously affect a considerable portion of patients with chronic prostatitis, although the clinical implication of the disease remains to be further investigated.

Clinical value of acute pyelonephritis grade based on computed tomography in predicting severity and course of acute pyelonephritis.

PURPOSE: This study aimed to evaluate the efficacy of computed tomography (CT)-based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. MATERIALS AND METHODS: This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). RESULTS: A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. CONCLUSIONS: This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Lack of effect of concomitant stage II cystocele repair on lower urinary tract symptoms and surgical outcome after tension-free vaginal tape procedure: randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the lower urinary tract symptom changes and surgical outcome between the tension-free vaginal tape (TVT) procedure with and without concomitant stage II pelvic organ prolapse (cystocele) repair in a randomized clinical trial setting. METHODS: Patients with urodynamically proven stress urinary incontinence (SUI) and asymptomatic stage II cystocele were randomly and equally allocated to either a TVT and concomitant cystocele repair group or TVT only group. SUI was corrected with TVT in all cases. The cystocele repair procedure was performed with Gynemesh. Lower urinary tract symptoms and surgical outcome were assessed at postoperative year 1. Lower urinary tract symptoms were assessed with the American Urological Association Symptom Score (AUASS) questionnaire, uroflowmetry, and postvoid residual (PVR). RESULTS: The cure rate of TVT only and the concomitant repair group was 87 and 91%, respectively (p > 0.05). Cystocele was cured in all patients in the concomitant repair group. After the operation, the total AUASS were 6.4 and 8.4 in the TVT only group and concomitant repair group, respectively, with no statistical difference. There was no difference in the change in peak flow rate (Qmax) and PVR between the two groups. The prevalence of postoperative mixed incontinence was not different between the two groups. CONCLUSIONS: In patients with stage II cystocele and SUI, there was no difference in the surgical outcome and lower urinary tract symptoms between the TVT sling only group and concomitant repair group. Cystocele repair can be safely omitted in patients with stage II cystocele.

Nonselective blocking of the sympathetic nervous system decreases detrusor overactivity in spontaneously hypertensive rats.

The involuntary dual control systems of the autonomic nervous system (ANS) in the bladder of awake spontaneously hypertensive rats (SHRs) were investigated through simultaneous registrations of intravesical and intraabdominal pressures to observe detrusor overactivity (DO) objectively as a core symptom of an overactive bladder. SHRs (n = 6) showed the features of overactive bladder syndrome during urodynamic study, especially DO during the filling phase. After injection of the nonselective sympathetic blocking agent labetalol, DO disappeared in 3 of 6 SHRs (50%). DO frequency decreased from 0.98 ± 0.22 min(-1) to 0.28 ± 0.19 min(-1) (p < 0.01), and DO pressure decreased from 3.82 ± 0.57 cm H(2)O to 1.90 ± 0.86 cm H(2)O (p < 0.05). This suggests that the DO originating from the overactive parasympathetic nervous system is attenuated by the nonselective blocking of the sympathetic nervous system. The detailed mechanism behind this result is still not known, but parasympathetic overactivity seems to require overactive sympathetic nervous system activity in a kind of balance between these two systems. These findings are consistent with recent clinical findings suggesting that patients with idiopathic overactive bladder may have ANS dysfunction, particularly a sympathetic dysfunction. The search for newer and better drugs than the current anticholinergic drugs as the mainstay for overactive bladder will be fueled by our research on these sympathetic mechanisms. Further studies of this principle are required.

Effect of Intravesical Prostatic Protrusion on the Characteristics of Lower Urinary Tract Symptom Change after 12-Week Drug Medication: A Prospective Analysis.

OBJECTIVES: The aim of this study was to identify whether intravesical prostatic protrusion (IPP) is related to the characteristics of voiding symptoms improvement after drug treatment in benign prostatic hyperplasia patients. METHODS: Ninety male patients with more than 30 g prostate volume were prospectively enrolled. All patients were evaluated with International Prostate Symptoms Score (IPSS), uroflowmetry, postvoid residual urine (PVR), prostate volume and IPP measurement by transrectal ultrasound. Treatment response was evaluated again by IPSS after 12 weeks of medication. We evaluated the correlation of IPP and IPSS, quality of life (QoL) score, maximum urinary flow rate (Qmax) and PVR, and compared IPPS and IPSS subscale score change between the IPP and non-IPP groups. RESULTS: IPP was significantly correlated with total IPSS, voiding/storage symptom subscore and PVR. IPP was inversely correlated with Qmax. IPP showed a significant correlation with storage symptoms after an adjustment of prostate volume. After 12 weeks of medication, the IPP group showed persistently high storage symptoms than the non-IPP group. CONCLUSION: BPH patients with IPP showed less improvement of storage symptoms after 12 weeks of medication. This study suggests that IPP may be a possible cause of intractable storage symptoms in early treatment.

Transvaginal cystocele repair by purse-string technique reinforced with three simple sutures: surgical technique and results.

PURPOSE: Different techniques for cystocele repair including the conventional anterior colporrhaphy and mesh technique are known. Our goal was to evaluate the anatomical success and safety of our method of transvaginal anterior vaginal wall repair by the purse-string technique reinforced with three simple additional sutures in the repair of cystocele over a 4-year follow-up period. METHODS: This was a retrospective review of 69 consecutive patients (grades 2 to 4) who underwent the above operations between 2001 and 2011, including their success rates as assessed by use of the Baden-Walker halfway classification system. RESULTS: Of the patients, 62 patients (98%) were completely cured of cystocele and 1 patient showed grade 2 cystocele recurrence that required no further treatment. Two patients with grade 4 cystocele were completely cured. There was no vaginal erosion related to the cystocele repair. CONCLUSIONS: Transvaginal anterior colporrhaphy by a purse-string technique reinforced with simple additive sutures appears to be a simple, safe, and easily performed approach in cystocele repair. There is no need for other material for reinforcement, even in high-grade cystocele, which is an advantage of our technique.

Effect of anti-siglec-f antibody and reactive oxygen species blocking on histamine release in urinary bladder of ovalbumin-treated mice.

PURPOSE: Sialic acid-binding Ig-like lectin (Siglec) is an immune inhibitory receptor that plays a role in the negative regulation of the activation of immune cells. This study aimed to evaluate the effects of anti-Siglec-F on plasma and urinary histamine levels in ovalbumin (OVA)-challenged urinary bladder in mice. METHODS: Thirty BALB/c mice were used. In group I (control group, n=5), mice were sensitized with OVA and challenged with saline. In group II (OVA challenge group, n=5), OVA was used for intraperitoneal sensitization and intravesical challenge. The challenged mice in group III (control immunoglobulin G [IgG] group, n=5) and those in group IV (anti-Siglec-F group, n=5) were intraperitoneally pretreated with rabbit control IgG or anti-Siglec-F antibody, respectively. In groups V (N-acetylcysteine [NAC] in OVA challenge group, n=5) and VI (control NAC only, n=5), mice were pretreated with NAC. RESULTS: Urinary histamine concentrations were significantly higher 7 days after intravesical OVA challenge (P<0.01), whereas plasma histamine levels were not. Pretreatment with anti-Siglec-F antibody significantly prevented the increase in urinary histamine release (P<0.05), whereas pretreatment with the IgG antibody control did not. Also, pretreatment of the OVA challenge group with NAC did not affect the histamine concentration in either urine or plasma. CONCLUSIONS: Systemic anti-Siglec-F treatment showed anti-allergic effects at least on local histamine release, particularly in the lower urinary bladder.

Long-term clinical outcomes of the tension-free vaginal tape procedure for the treatment of stress urinary incontinence in elderly women over 65.

PURPOSE: The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases. MATERIALS AND METHODS: Women with SUI who underwent a TVT procedure were studied. "Cure" was defined as no urine leakage at all in any circumstances and "improvement" was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, ≥65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure. RESULTS: A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5±5.9 and 72.0±5.0 years and the mean follow-up times were 50.5±9.4 and 48.8±9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7% and 4.7% vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8±1.1 vs. 3.3±1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6±3.3 kg/m(2) and 26.6±1.0 kg/m², and body mass index was the only factor that differed significantly between the two subgroups (p=0.028). CONCLUSIONS: Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate.

Long-term Outcomes of Tension-free Vaginal Tape Procedure for Treatment of Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency.

PURPOSE: To assess the long-term outcomes of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and to identify influencing factors for failure in these cases. METHODS: A total of 136 women who underwent TVT procedures with minimum follow-up duration of 3 years were included in the study. Patients were divided into two groups (non-ISD and ISD groups) based on preoperative urodynamic studies. Patient outcomes were assessed from retrospective chart review and telephone research. Cure was defined as the subjective resolution of SUI in any circumstances. Improvement was defined as the subjective improvement of SUI without complete resolution. Failure was defined as the subjective lack of improvement of SUI. Patients in ISD group were subdivided into two subgroups (cure and non-cure groups) and were compared to identify influencing factors for TVT procedure failure. RESULTS: Eighty-nine patients were in non-ISD group, and 47 in ISD group. The mean follow-up durations were 50.3±9.2 and 49.7±9.7 months, respectively. Subjective cure rate was 75.3% for non-ISD group, and 76.7% for ISD group (P>0.05). Improvement rate was 6.7% for non-ISD group, and 2.1% for ISD group (P>0.05). Satisfaction scores was 3.8±1.2 points in the non-ISD group, and 3.5±1.2 points in ISD group (P>0.05). In ISD subgroups, VLPP was 41.9±12.0 cmH(2)O for non-cure group, and 50.5±8.6 cmH(2)O for cure group, and was the only factor that showed significant statistical difference between the two subgroups (P=0.011). CONCLUSIONS: With our long-term results, TVT is an effective treatment even in women with ISD. However, ISD patients with low VLPP should be counseled carefully about TVT outcome.