The tension-free vaginal tape procedure(TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation.
Female* ; Humans ; Incidence ; Operating Rooms ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Retention

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
Cholinergic Antagonists ; Diagnosis ; Female* ; Humans ; Urinary Incontinence*

PURPOSE: The frontal lobe is the highest center of importance in the control of micturition. Patients with frontal lobe lesion have detrusor hyperreflexia, detrusor areflexia or uninhibitory urethral relaxation. However, the precise regions controlling the detrusor activity have not been established. Therefore, we analogize the regions of the frontal lobe controlling micturition by means of analyzing the detrusor change of patient with frontal lobe lesion. MATERIALS AND METHODS: The cystometric findings of twenty-two patients, who had frontal lobe lesions bun don't any other causes of a neurogenic bladder, were analyzed. And the frontal lobe lesions were classified by magnetic resonance imaging into seven lesions(the olfactory frontal center, gyrus recti, cingulate gyrus, inferior frontal gyrus, medial frontal gyrus, superior frontal gyrus, and precentral gyrus). RESULTS: In the urodynamic study, 11 patients showed detrusor overactivity(40.0%), 2 normal findings(14.7%) and 8 detrusor areflexia(36.3%). In the detrusor hyperreflexia group, high involvement of the medial frontal gyrus 63.6%, superior frontal gyrus(54.5%) and precentral gyrus(54.5%) were observed. In the detrusor areflexia group, the medial frontal gyrus 62.5%, superior frontal gyrus 37.5%, and precentral gyrus 62.5% were also more involved. CONCLUSION: The patients with detrusor hyperreflexia and detrusor areflexia have high incidences of precentral gyrus and medial frontal gyrus involvement. This implies that the superior surface of the frontal lobe(precentral gyrus and medial frontal gyrus) might be associated with the inhibitory reflex of micturition and detrusor contractibility.
Frontal Lobe* ; Gyrus Cinguli ; Humans ; Incidence ; Magnetic Resonance Imaging ; Reflex ; Reflex, Abnormal ; Relaxation ; Urinary Bladder, Neurogenic ; Urination ; Urodynamics

PURPOSE: The aim of this study is to determine whether the outcome of the mid-urethral sling procedures may be influenced by the body-mass index in Korean women with stress urinary incontinence(SUI). MATERIALS AND METHODS: A total of 285 women 28 to 80 years old with a minimum follow-up of 6 months were included in the study. Patients were stratified as follows: normal weight, 18.5~23 kg/m2; overweight, 23~27.5 kg/m2; obesity, 27.5 kg/m2 or higher. RESULTS: There was no significant complication. Bladder perforations were noted in 11 cases(4.9%, 3.8% and 2.2% in the normal weight, overweight and obesity group, p=0.449). There was no significant difference between the three groups for cure rate(p=0.173). The rates of postoperative urinary retention were 9.9%, 10.1% and 15.6% in the normal weight, overweight and obesity group(p=0.396). No significant difference was found between the three groups in the persistence of urgency(p=0.312). Seventy-nine patients(27.7%) had symptoms suggestive of voiding disorder, postoperatively. The incidence of these symptoms was not significant difference in the three groups(p=0.106). CONCLUSION: Our results demonstrate the feasibility and safety of the mid-urethral sling procedures for obese Korean women with SUI. Additional studies, including prospective randomized trials with longer follow-up, are needed to verify these findings.
Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Incidence ; Obesity ; Overweight ; Polypropylenes ; Suburethral Slings* ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Urinary Retention

PURPOSE: It seems that nocturia is not improved even after various forms of treatment in benign prostatic hyperplasia(BPH) patients. We studied the relationship of nocturia with other components of the International Prostate Symptom Score(IPSS) in BPH patients and also evaluated the changes of nocturia score following medical or surgical treatments to determine whether the nocturia score behaves differently. MATERIALS AND METHODS: Between March 2002 and March 2004, a total of 198 men with BPH were enrolled in this study. Baseline symptom scores and the change after treatment were analyzed particularly focused on nocturia score. RESULTS: On baseline score analysis, the nocturia score correlated with frequency and urgency scores(p=0.01). Total IPSS score was changed from 21.8+/-6.5 to 10.1+/-6.7 after treatment(p<0.001). The changes of nocturia score were 2.4+/-1.2 to 1.8+/-1.1 in the younger group and 3.1+/-1.3 to 2.2+/-1.2 in the older group, 2.9+/-1.3 to 2.1+/-1.1 in the surgical treatment group and 2.3+/-1.2 to 1.7+/-1.1 in the medical treatment group. The improvement of nocturia score was minimal after treatment. CONCLUSION: It seems that nocturia score behaves differently in the symptom complex of BPH. These facts should be considered when we consult patients with BPH complaining of nocturia.
Humans ; Male ; Nocturia* ; Prostate ; Prostatic Hyperplasia*

PURPOSE: To characterize autonomic dysfunction in patients with benign prostatic hyperplasia(BPH), we measured heart rate variability(HRV) and analyzed them compared with those of normal population. MATERIALS AND METHODS: ECG signals were obtained from 11 male patients(mean age, 63.1 years) and 23 healthy male controls(mean age, 57.0 years) in resting state. We analyzed their parameters of HRV and compared them between groups. RESULTS: Time domain analysis including standard deviation of NN interval(SDNN), square root of mean of sum of squares of differences between adjacent NN intervals(RMSSD) in patients with BPH were not significantly different with those of controls. There were suggested evidence of decreased total power(TP), high frequency (HF) in patients with BPH(p<0.05) while no significant difference in other frequency domain such as very low frequency(VLF), low frequency(LF) and LF/HF ratio. CONCLUSION: This preliminary study shows that patients with BPH have different results on HRV study comparing to controls. With the exception of LF and LF/HF ratio, all parameters of HRV in patients with BPH lower than normal controls. TP, HF in patients with BPH significantly lower than that of normal controls. The decreased values of HRV study means that they may have some kinds of disease or imbalance in autonomic nervous system(ANS). So we suggest that HRV study may be a tool to describe the possibility of altered ANS activity in patients with BPH.
Autonomic Nervous System ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Male

PURPOSE: Tension-free vaginal tape(TVT) procedure is widely used as an initial operative method in stress urinary incontinence because of high success rate and low morbidity. However, some patients have complained of voiding difficulties after TVT. We evaluated 14 patients who underwent mesh cutting because of obstructive symptoms after TVT. MATERIALS AND METHODS: 14 patients who underwent mesh cutting because of prolonged obstructive symptoms after TVT were included for the study. Their voiding symptoms were evaluated by Qmax, voiding time and postvoid residual urine. These parameters which were done before TVT, post-TVT and post-mesh cutting were compared. RESULTS: 4 out of 14 patients were intrinsic sphincter deficiency(valsalva leak point pressure <60 cmH2O) and no patient had detrusor overactivity before TVT. After TVT, Qmax was decreased from 25.4+/-3.5 ml/sec to 9.4+/-2.4 ml/sec, and voiding time was prolonged from 26.7+/-6.6 sec to 65.5+/-24.8 sec. However, the volume of postvoid residual urine was unchanged. After mesh cutting, Qmax was increased to 21.7+/-7.7 ml/sec and voiding time was decreased to 27.2+/-7.6 sec. Subjective voiding symptoms were improved immediately in 13 out of 14 patients(92.9%), although 1 patient showed small amount of urine leakage when coughing. And also, in 1 out of 2 patients, detrusor overactivity which was shown after TVT was disappeared. CONCLUSION: We believe that we do not need to hesitate to cut the mesh in patients who are suffering from severe obstructive symptoms after TVT.
Cough ; Humans ; Suburethral Slings* ; Urinary Incontinence

PURPOSE: The purpose of this study was to show the effects of aspirin and arginine on hyperactive bladder of hypercholesterol diet rats. MATERIALS AND METHODS: We used 40, 3-month-old Sprague-Dawley rats. Ten of them received the 2% cholesterol diet for 8 weeks and 10 received cholesterol diet and aspirin treatment and 10 received cholesterol diet, aspirin and arginine treatment. The remaining 10 served as control and were fed a normal diet. Cystometry and bladder muscle strips study were evaluated in each group. RESULTS: Compared with normal control, mean serum cholesterol and body weight significantly elevated in the cholesterol group. Aspirin +/- arginine treatment lessened the increase of body weight and serum cholesterol level. Compared to control, the cholesterol group showed a shorter voiding interval and smaller functional bladder capacity in cystometrogram, however, aspirin +/- arginine treatment group showed no difference in voiding interval and functional bladder capacity. In detrusor muscle strip study, the increase in the proportion of purinergic components and the decrease in the proportion of cholinergic components were observed in the cholesterol group, however, not in aspirin +/- arginine treatment group. Overall, additional effect of arginine on aspirin treatment was negligible. CONCLUSION: Treatments of aspirin +/- arginine showed significant protective effect on the bladder overactivity induced by hypercholesterol diet in rats. In patients with heart diseases and overactive bladder, aspirin could be a useful treatment for protection and treatment.
Animals ; Arginine* ; Aspirin* ; Body Weight ; Cholesterol ; Diet* ; Heart Diseases ; Humans ; Infant ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urination Disorders ; Urodynamics

No abstract available.
Diagnosis-Related Groups* ; Inflammation* ; Reflex* ; Spinal Cord* ; Urinary Bladder* ; Urination*

Urethral prolapse is rarely diagnosed. We have reported a case of urethral prolapse that was successfully managed by a simple ligation of prolapsed urethra over a Foley catheter in a postmenopausal woman who was suffering from advanced lung cancer.
Catheters* ; Female* ; Humans ; Ligation* ; Lung Neoplasms ; Prolapse* ; Urethra