No abstract available.
Muscle, Smooth*

No abstract available.
Muscle, Smooth*

PURPOSE: Benign prostatic hyperplasia (BPH) frequently combines other geriatric diseases, which affect voiding in complicated manner. However, differential diagnosis of BPH attributable to voiding dysfunction in such complicated cases has been difficult. Videourodynamic study, allowing the better correlation of structure and function, have had an important position in the diagnosis of various kind of voiding dysfunction. We compared diagnostic values between traditional pressure-flow study and videourodynamic study in the evaluation of the BPH. MATERIAL AND METHODS: Forty-seven men were subjected to this study, who showed lower urinary tract symptoms (LUTS) secondary to BPH combined with other underlying diseases (cerebrovascular disease, spinal cord injury, diabetes mellitus, Parkinson's disease) which could affect the voiding pattern. Included was patients older than 50 years, with a total International Prostate Symptom Score (IPSS) of 8 points or more. All patients were evaluated with detailed history, physical examination including digital rectal examination, prostate specific antigen (PSA), transrectal ultrasonography (TRUS), and videourodynamic study. Pressure-flow study was additionally performed in 27 patients who had been diagnosed as equivocal or obstructed or unobstructed on videourodynamic findings. RESULTS: The sensitivity of videourodynamic study and pressure-flow procedures was 87% and 55%, respectively, as complete pressure-flow data are not available in 12 patients due to difficult urination by catheterization. The specificity of videourodynamic study and pressure-flow study was 76% and 100%, respectively. Videourodynamic study additionally showed uninhibited bladder contraction and/or detrusor sphincter dyssynergia (internal or external) in 65.1% of the patients, which are not available from pressure-flow study. CONCLUSIONS: To diagnose voiding dysfunction from BPH in complicated case, videourodynamic study showed advantages over pressure-flow study in terms of diagnostic sensitivity, both functional and anatomical informations on lower urinary tract. It is likely that the videourodynamic study is the method of choice for the assessment of voiding dysfunction in BPH combined with other diseases.
Ataxia ; Catheterization ; Catheters ; Diabetes Mellitus ; Diagnosis* ; Diagnosis, Differential ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Spinal Diseases ; Ultrasonography ; Urinary Bladder ; Urinary Tract ; Urination

PURPOSE: The Aim of this study was to find the value of intravesical permeability of potassium as a diagnostic measure of the interstitial cystitis and to find importance of intravesical mucosal layer by intravesical instillation of potassium chloride solution. MATERIALS AND METHODS: 20 patients with interstitial cystitis and 20 normal subjects without UTI, frequency and urgency underwent intravesical challenge with 40ml water and 40ml of 400meq/L potassium chloride solution. After 5 minutes, patients were asked about increase or decrease of urgency or suprapubic pain and subjective response of urgency or suprapubic pain were recorded on a scale of 0 to 5. RESULTS: Neither normal subjects nor patients with interstitial cystitis reacted to water administered intravesically. There was marked sensitivity to intravesical potassium in 85% of patients with interstitial cystitis versus 10% of normal controls (p<0.05). CONCLUSIONS: Diffusion of urinary potassium ion into the bladder interstitium may induce sensory symptoms, damage the tissue and be a major toxic factor in the pathogenesis of interstitial cystitis. Intravesical potassium sensitivity can be a reliable method for detecting abnormal epithelial permeability and useful diagnostic test for interstitial cystitis.
Administration, Intravesical ; Cystitis, Interstitial* ; Diagnosis* ; Diagnostic Tests, Routine ; Diffusion ; Humans ; Permeability* ; Potassium Chloride ; Potassium* ; Urinary Bladder ; Water

PURPOSE: To determine whether specific clinical and urodynamic characteristics can be used to identify women with stress urinary incontinence(SUI) due to intrinsic sphincteric deficiency, we assessed correlation between Valsalva leak point pressure(VLPP) and other clinical and urodynamic parameters. MATERIALS AND METHODS: A prospective analysis was performed of 108 patients who underwent urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincteric deficiency (ISD) was defined as a VLPP of 60cmH2O or less at 150-250ml filling of the bladder. Anatomic incontinence(AI) was defined as a VLPP of 90cmH2O or high. Patients with VLPP between 60 and 90cmH2O were excluded in this study. All patients were evaluated with symptom grade(Stamey), duration of symptom, age, body weight, parity, functional urethral length(FUL) and maximum urethral closure pressure(MUCP). Correlation of VLPP and these parameters were computed. RESULTS: Of the 108 patients, 50 had ISD and 58 had AI. In ISD group, SUI was grade I in 14%, II in 48% and III in 38%. There were significant differences in the incidence between grade I and grade II or III. In AI group, SUI was grade I in 43%, II in 45% and III in 12%. There were significant differences between grade III and grade I or II. The two groups were similar in all other preoperative clinical and urodynamic characteristics. CONCLUSIONS: The only preoperative clinical index that can predict the presence of intrinsic urethral sphincter dysfunction, as defined by VLPP, was severity of symptom. Higher grades of stress urinary incontinence have a higher likelihood of a low VLPP.
Body Weight ; Female ; Humans ; Incidence ; Parity ; Prospective Studies ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics*

PURPOSE: Prostate volume(PV) has been known to be poorly correlated with other clinical parameters used to assess benign prostate hyperplasia (BPH), including international prostate symptom score(IPSS), peak flow rate(Qmax) and amount of postvoid residuals(PVR). The purpose of this study was to determine if the parameters of prostate volume including PV, transition volume, transitional zone index (TZI) and residual prostatic volume ratio(RPVR) correlated well with other clinical parameters before and after transurethral resection of prostate(TURP). MATERIALS AND METHODS: 31 men with symptomatic BPH were evaluated using IPSS, Qmax before and after TURP and the parameters of prostate volume were determined by transrectal ultrasonography(TRUS). The clinical outcome was evaluated by the difference(Delta) in IPSS, Qmean and Qmax before and 3 months after TURP. RESULTS: PV was not correlated with DeltaIPSS and DeltaQmax, but transition volume(r=0.394, p=0.034) and TZI(r=0.368, p=0.049) were significantly correlated with DeltaQmax. There were negative correlations between the RPVR and DeltaIPSS and DeltaQmax(r=-0.449, -0.385, p=0.011, 0.033). CONCLUSIONS: TRUS is a useful tool for estimating prostate weight before surgery of BPH. Transition volume, TZI and RPVR could be useful parameters to predict the IPSS and Qmax after TURP based with IPSS and Qmax before TURP. The smaller the RPVR after TURP, the better the clinical outcome.
Humans ; Hyperplasia ; Male ; Prostate* ; Transurethral Resection of Prostate*

PURPOSE: Sling operation has been known the best treatment of woman with anatomical urinary incontinence(AI) and intrinsic sphincteric deficiency(ISD). We evaluated the clinical outcome of anterior vaginal wall sling as a treatment for stress urinary incontinence. MATERIALS AND METHODS: Thirty three patients with stress urinary incontinence who treated with anterior vaginal wall sling from October 1995 to March 2000 were analyzed. Patients were evaluated preoperatively with history, physical examination, voiding cystourethrography, evaluation with SEAPI classification and urodynamic study including of Valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). All patients were assessed for the outcome of the procedure and subjective satisfaction by questionnaires. Surgical outcomes were then analyzed in relation to VLPP , MUCP and subjective SEAPI score. Of the total 33 patients, 26(78.8%) had AI and 7(21.2%) had ISD. According to the Stamey grades, 6(18.2%) were grade I, 23(69.7%) were grade II and 4(12.1%) were grade III. RESULTS: With a mean follow-up of 42.4 months (range 14 to 66). Urinary incontinence completely disappeared in 20 patients(60.6%), significantly improved in 8 patients(24.2%), failed in 5 patients(15.2%). Complication included urinary retention in two patients, suprapubic pain in two patients, and urge incontinence in two patients. Pre- and postoperative urge incontinence was major factor for failure rate. CONCLUSIONS: Anterior vaginal sling operation is a simple, safe and effective procedure for treatment of both AI and ISD. The urge incontinence is closely related to success rate.
Classification ; Female ; Follow-Up Studies* ; Humans ; Physical Examination ; Surveys and Questionnaires ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urinary Retention ; Urodynamics

PURPOSE: The purpose of this study is to investigate in vitro the effects of serotonin on the rat detrusor. In particular, this study examines what drugs inhibit the serotonin-induced detrusor contractions. MATERIALS AND METHODS: Isometric tension changes of isolated rat bladder muscle strips were recorded in an organ bath using a force transducer. Acute effects of serotonin (0.0001-0.01mM) were assessed on resting tension. Electrical field stimulation (EFS), bethanechol (0.0001-0.01mM), ATP (1-3mM) or KCl(63.5-254mM)-induced contractions using application in organ bath were compared with serotonin-induced contractions. In order to examine the action mechanism of serotonin-induced stimulation, EFS, bethanechol, ATP or KCl-induced contraction under serotonin (0.001mM) was assessed and serotonin (0.001 to 0.1mM) was cumulatively added to the organ bath following pre-incubation with propranolol, ketanserine, tropisetron, propiverine, sodium nitroprusside or doxazocin. RESULTS: There are two phases to the serotonin-induced responsean initial transient contraction and a prolonged tonic phase. Serotonin produced a reversible and dose-dependent contraction of the detrusor strips. Responses to bethanechol significantly increased with a concentration of 0.001mM serotonin (p<0.05). There was no effect on the responses to ATP, KCl, or EFS under 0.001mM serotonin. The 5-HT2 receptor is mainly responsible for serotonin-induced contractions of the detrusor (p<0.05), while the 5-HT1 receptor is partially responsible. Doxazocin and propiverine each significantly suppressed the responses to serotonin, while sodium nitroprusside and tropisetron each had no effect (p<0.05). CONCLUSIONS: Because the 5-HT2 antagonist blocked the effect of serotonin-induced bladder contractions and the stimulation of the adrenoreceptors, the 5-HT2 antagonist seems to improve lower urinary tract symptoms.
Adenosine Triphosphate ; Animals ; Baths ; Bethanechol ; Ketanserin ; Lower Urinary Tract Symptoms ; Nitroprusside ; Propranolol ; Rats ; Receptors, Serotonin, 5-HT1 ; Serotonin ; Serotonin 5-HT2 Receptor Antagonists ; Transducers ; Urinary Bladder ; Urinary Bladder, Overactive*

PURPOSE: This study was designed to investigate the prevalence of female urinary incontinence, and factors affecting the quality of life. It was also to provide the basic data for the primary urinary incontinence management program through the community-based cross sectional study. MATERIALS AND METHODS: Questionnaires were taken from 2,183 women, aged over 30 up to 89, residing in Seoul, Kyongki . Kangwon, Chungchong, YongNam, HoNam, Jeju provinces. Those who understood and responded to the questionnaires were collected from church meetings, teaching facilities, corporations, public offices, the voluntary organizations, and old people's homes. The data were analyzed by Student t-test, chi2-test, and multiple logistic regression with using SAS program. RESULTS: The results were as follows ; 1. The overall reported prevalence of urinary incontinence was 55.7% with urinary leakage more than one time a month for the past one year. By age, the highest prevalence was 71.0% in the fifties. The stress urinary incontinence was 60.8%, the mixed urinary incontinence 38.2%, the urge urinary incontinence 1.0 %. In case of severity, a slight case was 64.3%, a moderate case 21.8% and a severe case 13.6%. 2. Urinary incontinence was associated with the radiation therapy on lower abdomen (OR=3.05, 95% CI=1.47, 6.33), hysterectomy (OR=2.42, 95% CI=1.05, 5.62), alcohol intake(OR=1.43,95% CI=1.08, 1.89), high economic status(OR=1.37, 95% CI=1.04, 1.81), lower urinary tract symptoms(OR=1.16, 95% CI=1.12, 1.21), high body mass index(OR=1.09, 95% CI=1.02, 1.15) and old age(OR=1.06, 95% CI=1.04, 1.08). CONCLUSIONS: The above findings indicate that the prevention and management programs of the urinary incontinence should be developed and operated for the female in Korea and for those who had risk factors associated with the urinary incontinence.
Abdomen ; Epidemiologic Studies* ; Female ; Gangwon-do ; Gyeonggi-do ; Humans ; Hysterectomy ; Korea ; Logistic Models ; Prevalence ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; Seoul ; Urinary Incontinence* ; Urinary Tract

No abstract available.
Capsaicin ; Nerve Growth Factor ; Receptors, Nicotinic ; Urinary Bladder Neck Obstruction ; Urinary Bladder* ; Urothelium*