No abstract available.

PURPOSE: An autologous dermal fat graft has several advantages, over other viable or synthetic sling materials, in expenditure, postoperative complication and biocompatibility of the host. We investigated the success rate and risk factors of a pubovaginal sling, using an autologous dermal fat graft, in female stress urinary incontinence. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 30 women that underwent a pubovaginal sling, using a dermal fat graft. The preoperative evaluations included: age, Stamey grade, Blaivas type, urodynamic study and previous pelvic operation history. We observed the postoperative results using questionnaire research during the follow-up (cured: no urine leakage and satisfactory, improved: urine leak< or =4 times/week and satisfactory, failed: urine leakage>4 times/week or unsatisfactory). The risk factors affecting the postoperative outcomes and complications were also analyzed. RESULTS: The success rate was 90.0% (success rate was calculated by cured rate plus improved rate, cured rate: 53.3%, improved rate: 36.7%), with the follow-up periods ranging from 6 to 24 months. A wound infection, requiring hospitalization, developed in one patient, but no other significant complications related to dermal graft were noted. Within the preoperative evaluations, the Blaivas type and a previous pelvic operation history were statistically related to the success rate (p<0.05). CONCLUSIONS: The Blaivas type and previous pelvic operation history are meaningful factors for predicting the success rate. The use of a dermal fat graft might be beneficial in the treatment of stress urinary incontinence in terms of its cost and success rate. However, a lower abdominal scar, of more than 5cm in length, and postoperative infections remain in some patients. Therefore it might be necessary to find another useful material for to treat female stress urinary incontinence.
Cicatrix ; Female* ; Follow-Up Studies ; Health Expenditures ; Hospitalization ; Humans ; Medical Records ; Postoperative Complications ; Surveys and Questionnaires ; Retrospective Studies ; Risk Factors ; Transplants* ; Urinary Incontinence* ; Urodynamics ; Wound Infection

PURPOSE: Although percutaneous aspiration and sclerotherapy is a simple, noninvasive and cost-effective therapy for symptomatic renal cysts, the recurrence rate is high. Recently, a laparoscopy has been attempted on symptomatic renal cysts. To assess the clinical efficacy and safety of the laparoscopic cyst marsupialization, the clinical characteristics and operative parameters were evaluated, and compared with the results of sclerotherapy. MATERIALS AND METHODS: Between November 1993 and February 2003, 71 patients with symptomatic simple renal cysts were treated with either laparoscopic marsupialization or sclerotherapy. Respectively, 26 of 31 laparoscopy patients and 27 of 40 sclerotherapy patients were followed-up over a 2 months period and included in this study. The laparoscopic marsupialization was accomplished with either transperitoneal (15 patients) or retroperitoneal approaches (11). The sclerotherapy was composed of percutaneous aspiration followed by an injection of 99% ethanol. RESULTS: The clinical characteristics, including cyst size, location and laterality, were no different in either group. The mean follow-up durations were 19.7 and 18.1 months in laparoscopy and sclerotherapy groups, respectively. Comparing the laparoscopy with the sclerotherapy group, the operation time (106.2 vs. 15.3 min.), hospital stay (7.8 vs. 4.6 days) and complication rate (23.1 vs. 3.7%) were significantly decreased in the sclerotherapy group. However, the success rate (96.2 vs. 77.8%) was significantly increased in the laparoscopy group. With either the transperitoneal or retroperitoneal approaches in the laparoscopy group, there was no statistical difference in the operative time, hospital stay and complication and success rates. CONCLUSIONS: For a symptomatic renal cyst, laparoscopic marsupialization is an effective therapy, with a high success rate on the long-term follow-up. The clinical results, according to the approach method, were not different for the transperitoneal and retroperitoneal approaches.
Ethanol ; Follow-Up Studies* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Recurrence ; Sclerotherapy*

PURPOSE: During transrectal ultrasound guided prostate biopsy, 65% to 90% of patients reportedly have discomfort. We compared the anesthetic effects of a periprostatic injection of lidocaine under ultrasound guidance with the effects of a rectal instillation of lidocaine gel before the transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: A prospective randomized double-blind study was performed in 72 patients requiring a systematic biopsy of the prostate. Patients were randomized into two groups according to the method of anesthetic delivery that was used. Group 1 consisted of 37 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before biopsy, and 5 ml of normal saline was injected into the periprostatic nerve plexus just before biopsy under ultrasound guidance using an 18 gauge 16 cm needle on each side. Group 2 consisted of 35 patients who received 10 ml of sterile gel without lidocaine and a 5 ml 1% lidocaine injection using the same method as group 1. The pain score was assessed using a visual analogue scale immediately after biopsy. RESULTS: There was a statistical difference in the mean pain score between the two groups (5.1+/-1.7 in group 1 versus 3.3+/-1.5 in group 2) (p<0.001), but The complication rates were not significantly different. CONCLUSIONS: We believe that performing the transrectal ultrasound guided prostatic nerve blockade before biopsy significantly diminishes the discomfort associated with the procedure, which, in turn, improves patient tolerance more so than rectal instillation of lidocaine gel. In addition, this procedure is a safe, simple, and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.
Administration, Rectal* ; Anesthetics ; Biopsy* ; Double-Blind Method ; Humans ; Lidocaine* ; Needles ; Nerve Block ; Prospective Studies ; Prostate* ; Ultrasonography*

A testicular Sertoli cell tumor is a very rare, usually benign, testicular neoplasm. Of the total number of reported Sertoli cell tumors, only 30 cases were malignant. Usually, these patients have a history of a slowly growing scrotal mass and gynecomastia. These neoplasms vary greatly in size and in their microscopic appearances. A radical inguinal orchiectomy is the initial treatment, with the efficacy of chemotherapy or radiotherapy being controversial. They have an aggressive metastatic behavior and a poor prognosis. Herein, the case of 67-year-old man with a malignant Sertoli cell tumor is reported.
Aged ; Drug Therapy ; Gynecomastia ; Humans ; Male ; Orchiectomy ; Prognosis ; Radiotherapy ; Sertoli Cell Tumor* ; Testicular Neoplasms ; Testis*

PURPOSE: The ability of preoperative findings, to identify patients where an overactive bladder syndrome failed to resolve postoperatively, was assessed. The clinical outcome of a pubovaginal sling was also evaluated to determine the correlation between the postoperative success rate (subjective, objective) and satisfaction in overactive bladder syndrome. MATERIALS AND METHODS: Thirty three women, with stress urinary incontinence, received a pubovaginal sling procedure using polypropylene mesh. All the preoperative factors that affect the presence of preoperative overactive bladder syndrome, and the postoperative changes in overactive bladder syndrome, were analyzed and evaluated. The correlation between the changes in overactive bladder syndrome and the success rate (subjective, objective) and satisfaction were also analyzed. RESULTS: The presence of preoperative overactive bladder syndrome was significantly related to a decrease in the Valsalva leak point pressure (p=0.05) and an increase of the Stamey grade (p<0.05), and was closely related to the Valsalva type (p=0.07) and the open bladder neck at rest, with the patient erect (p=0.07). The differences in the Blaivas type, Q tip angle, posterior urethrovesical angle and bladder neck descending in the strain lateral view of a cystourethrogram, between the resolved and persistent patients of overactive bladder syndrome postoperatively, were statistically significant (p<0.05). Preoperative urgency, urge incontinence and persistence of postoperative overactive bladder syndrome, are significant factors contributing to decreases in the subjective success rate and patient satisfaction (p<0.05). CONCLUSIONS: Preoperative overactive bladder syndrome was closely associated with the variables related to incompetence of the urethra, and the postoperative persistence of overactive bladder syndrome was associated with the variables related not only to incompetence of the urethra, but also to the urethral hypermobility.
Female* ; Humans ; Neck ; Patient Satisfaction ; Polypropylenes ; Urethra ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: Sling procedures have been used successfully for the treatment of all type of female stress urinary incontinence. Polypropylene mesh has more biocompatibility with less erosion rate over other synthetic sling materials. We investigated the objective, subjective success rate, satisfaction on pubovaginal sling operation using polypropylene mesh in stress urinary incontinence women. MATERIALS AND METHODS: Between November 2001 and July 2002, thirty three women with stress urinary incontinence underwent polypropylene mesh sling procedure were analyzed. Preoperative evaluations included the patient's history, a physical examination, urinalysis, a urodynamic test, incontinence staging with Stamey grade, Balivas type, and so forth. A 1.5x20cm polypropylene mesh was placed under the bladder neck to proximal urethra. Postoperatively, the patients were evaluated with a symptom questionnaire, physical examination, uroflowmetry, and postvoid residual volume at 3 day, 3 months. RESULTS: The average follow-up period was 164.6 days (minimum; 2 months). The average operation time was 83.6 minutes (including the anesthesia). No major intra-operative, post-operative complication occurred. No patient has permanent retention, erosion, or repeated surgery. The 22 patients (66.7%) were completely continent, 11 (33.3%) had an improvement, subjectively. The 27 patients (81.8%) were completely continent, 6 (18.2%) had an improvement, objectively. The treatment result was showed satisfactory by all patients (very satisfaction; 20 (60.6%), satisfaction; 13 (30.4%)). The follow-up period, valsalva leak point pressure, Pdetmax, opened bladder neck at rest, preop. urgency, preop. and postop. urge incontinence, total score of preop. and postop. Urge syndrome were related to subjective success rate, satisfaction statistically (p<0.05). CONCLUSION: Placement of a polypropylene mesh under the bladder neck to proximal urethra provides a simple, safe, inexpensive and effective method to correct stress urinary incontinence.
Female ; Follow-Up Studies ; Humans ; Neck ; Physical Examination ; Polypropylenes* ; Surveys and Questionnaires ; Residual Volume ; Risk Factors* ; Urethra ; Urinalysis ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics

Multilocular cystic renal cell carcinoma is a rare subtype of renal cell carcinoma with multiple variable sized, non-communicating fluid-filled cystic spaces. It is often very difficult to differentiate multilocular cystic renal cell carcinoma from non-neoplastic, and other malignant neoplastic mass clinically and radiologically. The tumor is usually shown in low grade and low stage. Surgical treatment results in good prognosis. We report a case of multilocular cystic renal cell carcinoma which was presumptively diagnosed preoperatively, confirmed intraoperatively by frozen section examination of tissue, and treated with wedge resection in a 43-year-old man.
Adult ; Carcinoma, Renal Cell* ; Frozen Sections ; Humans ; Kidney ; Prognosis

A 31-year-old man presented with painless gross hematuria. His serum-creatinine level was within the normal range. Abdominopelvic CT showed an infrahepatic calcified fibrous cord, which was suggestive of inferior vena cava (IVC) remnant. Extensive venous collateralization around both kidneys and venous drainage of the extremities via the inferior epigastric and internal thoracic veins were shown. We report a case of chronic post-thrombotic obstruction of the IVC, involving both renal veins, which was believed to be the cause of painless gross hematuria from mucosal varices of the pelviureteral system in normal functioning kidney.
Adult ; Hematuria/etiology ; Human ; Kidney/physiopathology ; Male ; Mucous Membrane/blood supply ; Pelvis/blood supply ; Renal Veins ; Thrombosis/*complications ; Ureter/blood supply ; Varicose Veins/complications ; Vascular Diseases/*etiology ; *Vena Cava, Inferior

A 31-year-old man presented with painless gross hematuria. His serum-creatinine level was within the normal range. Abdominopelvic CT showed an infrahepatic calcified fibrous cord, which was suggestive of inferior vena cava (IVC) remnant. Extensive venous collateralization around both kidneys and venous drainage of the extremities via the inferior epigastric and internal thoracic veins were shown. We report a case of chronic post-thrombotic obstruction of the IVC, involving both renal veins, which was believed to be the cause of painless gross hematuria from mucosal varices of the pelviureteral system in normal functioning kidney.
Adult ; Hematuria/etiology ; Human ; Kidney/physiopathology ; Male ; Mucous Membrane/blood supply ; Pelvis/blood supply ; Renal Veins ; Thrombosis/*complications ; Ureter/blood supply ; Varicose Veins/complications ; Vascular Diseases/*etiology ; *Vena Cava, Inferior