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: 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

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

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.

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: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.