PURPOSE: The Valsalva leak point pressure (VLPP) has been suggested to be an objective tool for diagnosing female stress urinary incontinence (SUI) accompanied by intrinsic sphincter dysfunction (ISD). However, measuring the VLPP is difficult, complex and expensive. A new clinical test, supine stress test to measure the VLPP, was compared. MATERIALS AND METHODS: Fifty-one patients with SUI were evaluated prospectively with a urodynamic study. A supine stress test using cough and Valsalva's maneuvers was performed after bladder filling to 200ml with sterile normal saline by gravity. A urodynamic study, including measuring the VLPP and the maximum urethral closure pressure, was performed. ISD was diagnosed as Blaivas type III and Stamey grade III, and the sensitivity, specificity, positive and negative predictive values of the supine stress test and the VLPP were calculated. RESULTS: Forty-two patients with SUI were enrolled this study and were evaluated with the VLPP and supine stress test. When the radiological findings were divided into Blaivas type III, and type I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 95.0%/90.0%, 86.4%/73.9%, 86.4%/78.3%, 95.0%/89.5%, respectively. When the symptom severity was diagnosed as being Stamey classification grade III, and grade I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 94.7%/89.5%, 82.6%/73.9%, 81.8%/73.9%, 95.0%/80.9%, respectively. CONCLUSIONS: The supine stress test is easy, quick and inexpensive, and is a positive test to reliably predict ISD as precise as the VLPP. This simple, non-invasive supine stress test is recommended as a screening test to detect ISD, especially at an outpatient department.
Classification ; Cough ; Exercise Test* ; Female ; Gravitation ; Humans ; Mass Screening ; Outpatients ; Prospective Studies ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

PURPOSE: We evaluated the clinical outcome of a tension free vaginal tape(TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: One hundred-nine women(94 with genuine stress urinary incontine : and 15 with mixed urinary incontinence) underwent a TVT procedure under spinal, general anesthesia. Mean age was 48.6+/-9.3 years. The mean follow-up period was 13.5+/-2.0 months. Two women had experienced failed antiincontinence surgery and seven women had experienced pelvic surgery. RESULTS: The mean operation time was 35.6+/-1.6 minutes and mean hospital stay was 2.03+/-0.4 day. Mean duration of postoperative indwelling catheter was 10.4+/-2.5 hours. Sixteen patients(14.6%) had immediate postoperative voiding difficulties necessitating an extra procedure(soundation with Hegar dilator). Nine patients(8.3%) with de novo detrusor instability were improved by anticholinergics medication. Nine(66.7%) of 15 women with urge incontinence were significantly improved or cured after surgery. Success rate was 96.3% and 95.4% in postoperative 3 and 6 months, respectively. The patients satisfied with this procedure were 103(94.5%) in postoperative 3 months and 102(93.6.%) in postoperative 6 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.
Anesthesia, General ; Catheters, Indwelling ; Cholinergic Antagonists ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. This complication is treacherous, since symptoms of urinary tract disease are mostly absent. Inflammatory ureteral engagement should always be suspected in patients with Crohn's disease, particularly when located in the terminal ileum. The treatment for this condition is still controversial. We report a case of a 25 year-old man who presented with intermittent diarrhea, weight loss, and RLQ pain. Diagnostic studies confirmed Crohn's disease, and revealed an abdominal mass obstructing the right ureter with hydroureteronephrosis. The patient was successfully treated with corticosteroid and mesalamine, without resection of the ileocecal lesion, drainage of the iliopsoas abscess and ureterolysis. We discuss a ureteral obstruction as a complication of Crohn's disease, with emphasis on conservative treatment.
Adult ; Crohn Disease* ; Diarrhea ; Drainage ; Humans ; Hydronephrosis ; Ileum ; Mesalamine ; Psoas Abscess ; Ureter* ; Ureteral Obstruction* ; Urologic Diseases ; Weight Loss

PURPOSE: Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. MATERIALS AND METHODS: We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were evaluated preoperatively with detailed history, physical examination, urodynamic study and incontinence staging. Postoperative outcome measures and complications were checked. RESULTS: Preoperative parameters, such as clinical and urodynamic data were comparable for both groups. With a mean follow-up of 5.4 months(range 1-14) for group I, 27(90%) were cured. In group II, with a mean follow-up of 6.7 months(range 1-11), 28(93%) were cured. Postoperative de novo urge incontinence was present in 6(20%) patients in group I. The hospital stays, periods of residual urine below 50ml and postoperative lower abdominal pain of group II were significantly lower than those of group I. Each group(97%) was either very satisfied or somewhat satisfied with their outcome. CONCLUSION: Modified pubovaginal fascial sling operation including the use of small piece of rectus fascia and fixation of sling to the Cooper's ligament is an effective treatment for stress incontinence with high cure and low complication rate. However, larger followup is needed to confirm our results.
Abdominal Pain ; Abdominal Wall* ; Fascia* ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Ligaments* ; Outcome Assessment (Health Care) ; Physical Examination ; Retrospective Studies ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urinary Retention ; Urodynamics

Renal hemorrhage is a most distressing complication of percutaneous renal surgery. Two cases of renal pseudoaneurysm that occurred as a complication of percutaneous nephrolithotomy (PNL) for staghorn calculi are presented. Two male patients were admitted to our hospital for treatment of staghorn calculi. Laboratory data on admission revealed no significant abnormality. They underwent PNL, and most of the calculi were removed. Two nephrostomys were placed in the middle and lower calyces, and were removed at two and three days postoperatively, respectively. Significant bleeding, uncontrolled by the usual measures, developed for six and eight days following the removal of the nephrostomy tubes. Renal angiography was performed and demonstrated pseudoaneurysms. At the same time the pseudoaneurysms were treated by superselective embolization with a coil. We keep in mind the late hemorrhage after PNL, even when there was no hemorrhage from nephrostomy removal.
Aneurysm, False* ; Angiography ; Calculi ; Hemorrhage ; Humans ; Male ; Nephrostomy, Percutaneous*

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.
Adult ; Cognition Disorders ; Cross-Sectional Studies ; Deglutition Disorders ; Female ; Humans ; Mass Screening ; Pain Management ; Polypharmacy ; Prevalence ; Urinary Bladder ; Urinary Incontinence

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults. METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA. RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age. CONCLUSION The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Adult ; Aged ; Fabry Disease/blood/*diagnosis ; Female ; Humans ; Kidney Failure, Chronic/blood/*therapy ; Male ; Middle Aged ; *Renal Dialysis ; Trihexosylceramides/*blood ; alpha-Galactosidase/genetics/metabolism