Spontaneous rupture of the renal pelvis or ureteropelvic juction area with extravasation of urine into the perinephric space is an uncommon pathologic condition (1). We report a case of 72-year-old woman who suffered 2 days of left loin pain. The patient has got residual urine sensation and weak urine stream since she has gone through a radical hysterectomy 17 years before. Because of these symptoms of voiding difficulty, the patient had abdominal straining during her urination. A CT scan exhibited renal pelvis rupture with perirenal extravasation of urine due to severe hydronephrosis, that was exacerbated by hidden neurogenic bladder disease. Moreover, the patient has detrusor underactivity and high intravesical pressure at voiding trial in the urodynamic study. One month after the percutaneous nephrostomy insertion into the left renal pelvis, the patient was successfully treated. The size of renal pelvis decreased. Moreover, urinoma disappeared in follow up CT scan image.
Aged ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Hysterectomy ; Kidney Pelvis ; Nephrostomy, Percutaneous ; Rivers ; Rupture ; Rupture, Spontaneous ; Sensation ; Tomography, X-Ray Computed ; Urinary Bladder, Neurogenic* ; Urination ; Urinoma* ; Urodynamics

PUROPOSE: To evaluate the effects of nocturia on health-related quality of life (HRQoL) and sleep. MATERIAL AND METHODS: From January 2007 to December 2007, 180 patients with lower urinary tract symptoms were prospectively selected for this study. Study was conducted among respondents with nocturia (void/night> or =1) (n=119) and age matched controls (no nocturia) (n=61), with participants completing a series of questionnaires on HRQoL (OAB-q short form) and Medical Outcomes Study (MOS) sleep scale and frequency voiding chart. RESULTS: The patients population had a mean age of 57.2 years. In the patients, the mean number of void per night was measured, 58 patients reported 2>void/night> or =1, 32 patients reported 3> voids/night> or =2 and 29 patients reported void/night> or =3. The number of nocturia episodes/night was significantly associated with the overactive bladder (OAB) symptom score (p=0.001), symptom bother (p=0.001) and the MOS sleep index (p=0.016). CONCLUSIONS: Increases in the number of voids/night have further negative effects on sleep, symptom bother and HRQoL.
Surveys and Questionnaires ; Female ; Humans ; Lower Urinary Tract Symptoms ; Nocturia* ; Prospective Studies ; Quality of Life* ; Surveys and Questionnaires ; Urinary Bladder, Overactive

PUROPOSE: The bladder outlet obstruction (BOO) causes a bladder hypertrophy and/or hyperplasia with time. Heparin binding epidermal growth factor like growth factor (HB-EGF) is a potent mitogen for bladder smooth muscle cell (BMSC), causing significant cellular hypertrophy. Few studies have evaluated the effect of HB-EGF on bladder hypertrophy or hyperplasia. We studied to evaluated the effect of HB-EGF on the hypertrophy or hyperplasia of human BSMC and fibroblast. MATERIAL AND METHODS: To evaluate the change of expression of HB-EGF mRNA of human BMSC under a constant stimuli of 40cm-H20 pressure during 0, 1, 3 and 5 hours, RT-PCR was perfromed. The human BMSC and bladder fibroblasts with the addition of the recombinant HB-EGF 25ng/ml were performed 3H-thymidine and 3H-leucine incorporation assay for DNA and protein production, respectively. RESULTS: The expression of HB-EGF mRNA in BMSC under a constant stimuli of 40cm-H20 pressure was up-regulated with time (p<0.05). The optimal concentration of HB-EGF was 25ng/ml. The 3H-Lecine and 3H-thymidine activity in both human BSMC and fibroblast were significantly increased in addition of 25ng/ml of HB-EGF (p<0.05 and p<0.05, respectively). CONCLUSIONS: Constant hydrostatic pressure induces the expression of HB-EGF in human BSMC. Subsequently HB-EGF induces hypertrophy and hyperplasia of human BSMC and fibroblast in vitro. Our data support that HB-EGF is one of relevant BOO-induced growth factors.
DNA ; Epidermal Growth Factor* ; Fibroblasts ; Heparin* ; Humans ; Hydrostatic Pressure ; Hyperplasia* ; Hypertrophy* ; Intercellular Signaling Peptides and Proteins ; Muscle, Smooth* ; Myocytes, Smooth Muscle ; RNA, Messenger ; Urinary Bladder Neck Obstruction ; Urinary Bladder*

PUROPOSE: Transobturator sling is a new minimally invasive treatment for female stress urinary incontinence. We compared the efficacy and safety of the two procedures, Monarc and TVT-O. MATERIAL AND METHODS: We included 110 patients with stress urinary incontinence who underwent the Monarc (n=52) or TVT-O (n=58) procedure and followed up at least for 1 year. Preoperative evaluations, the indices of voiding and postoperative complication were investigated. They were analyzed by Student's t-test, Paired t-test and chi-square test. RESULTS: There were no significant difference in the preoperative patients' characteristics, postoperative complication and success rate between the two groups. The preoperative and postoperative storage symptoms between two groups had no significant difference but the patients of both groups had significant improvement in storage symptoms such as frequency and urgency after surgery. CONCLUSIONS: The Monarc and TVT-O is equally effective and safe procedures as a treatment method of female stress urinary incontinence.
Female ; Humans ; Postoperative Complications ; Suburethral Slings ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Stress

PUROPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder to men and the syndrome is diagnosed only on the basis of symptoms, principally pain or discomfort in the pelvic region. However many patients have a urinary symptoms, especially storage symptoms such as frequency and urgency. The aim of this study was to evaluate the efficacy of anticholinergics in a prospective randomized, single-blind trial to young and middle aged patients to exclude the effect of benign prostatic hyperplasia as possible. MATERIAL AND METHODS: Forty six men with CP/CPPS (age of third to fifth decades) were randomized in a single-blind fashion to receive either group 1; gatifloxacin (200mg, bid) of 15 patients, or group 2; gatifloxacin (200mg, bid) and propiverine (20mg, once daily) of 31 patients for 2 months. The NIH chronic prostatitis symptom index (NIH-CPSI) and International Prostate Symptom Score (IPSS) were used to grade symptoms and the quality of life (QoL) impact at the start, 1 month and 2 months of the study. RESULTS: There was no significant difference between group 1 and group 2 in about age and duration of the disease. In addition, no significant difference was found between group 1 and 2 in the scores of sub-factors of IPSS and NIH-CPSI at the time of baseline. No statistically significant difference in the NIH-CPSI total score and each domain was seen after treatment. Statistically significant difference in the storage symptom of IPSS was seen after treatment. CONCLUSIONS: The efficacy of propiverine (combined to antibiotics) for CP/CPPS were improvements of the storage symptom of IPSS significantly.
Cholinergic Antagonists ; Humans ; Male ; Middle Aged ; Pelvic Pain* ; Pelvis ; Prospective Studies ; Prostate ; Prostatic Hyperplasia ; Prostatitis* ; Quality of Life

PUROPOSE: The efficacy of finasteride in the treatment of hematuria associated with benign prostatic hyperplasia (BPH) is well known. Recent studies have also shown that finasteride reduce angiogenesis and prostatic bleeding associated with BPH. We evaluated that pretreatment with finasteride could decrease perioperative bleeding associated with transurethral resectrion of prostate (TURP) in this way. MATERIAL AND METHODS: A total of 56 patients who underwent TURP due to BPH between January 2004 and August 2006 were evaluated. Of the patients, 30 recieved pretreatment with finasteride 5mg daily (group 1) while 26 did not undergo any pretreatment (control group). In the group 1, 17 had pretreatment period of 3months or more (group 2). In all patients we evaluated the degree of perioperative bleeding, intended as a reduction tendency in hemoglobin (Hb) and hematocrit (Hct) value in the 24 h following TURP. Also, we evaluated the correlation of the preoperative factor and postoperative change of Hb and Hct. RESULTS: Difference of reduction tendency in Hb and Hct between group 1 and control group was not significant (p=0.86, 0.95, respectively). Difference between group 2 and control was not significant (p=0.56, 0.29, respectively). The change of Hb and Hct correlated with prostate volume, significantly (p=0.006, 0.010). Also, operation time was correlated with the change of Hb and Hct (p=0.006, 0.011). CONCLUSIONS: There were no significant difference of the perioperative bleeding according to finasteride medication or medication duration.
Finasteride ; Hematocrit ; Hematuria ; Hemorrhage* ; Humans ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate*

PUROPOSE: We analyzed retrospectively the result of urodynamic studies of the female patients with overactive bladder to reveal the incidence of accompanying bladder outlet obstruction and compared the urodynamic charateristics according to the diagnostic criteria for bladder outlet obstruction to help make the appropriate diagnosis. MATERIAL AND METHODS: A total of 230 women who underwent urodynamic studies for evaluation of overactive bladder were retrospectively reviewed. The patients were classified as having obstruction based on two criteria, including one pressure flow cutoff point criteria (free Qmax < 12ml/sec and pdetQmax > or = 20cmH2O) (group I) and moderate or severe obstruction by the Blaivas- Groutz nomogram (group II). Urodynamic characteristics of the patients in Group 1 and 2 were compared with those of 42 patients having only overactive bladder without any voiding symptom (OAB group). RESULTS: Of the patients 31 (13.5%) were in group I, 42 (18.3%) in group II. Qmax of group I was the lowest among 3 groups. Detrusor pressure at maximum measurable flow and maximum detrusor pressure during voiding in group 1 and II were significantly higher than in OAB group. Detrusor overactivity was more observed in group I and II, and there was no signigicant difference in the presence of voiding symptoms between group I and II. Only 9 patients (4%) had obstruction by both of criteria. CONCLUSIONS: Considering the high incidence of bladder outlet obstruction in the patients of overactive bladder and non-specificity of the symptoms by bladder outlet obstruction, thorough urodynamic study may be helpful in detection and treatment of bladder outlet obstruction of the overactive bladder patients. The further study for the criteria of female bladder outlet obstruction should be necessary to make its accurate diagnosis.
Diagnosis ; Female ; Humans ; Incidence ; Nomograms ; Retrospective Studies ; Urinary Bladder Neck Obstruction* ; Urinary Bladder, Overactive* ; Urodynamics

PUROPOSE: This study was aimed at evaluating the clinical efficacy, satisfaction and complication of patients with transobturator tape (TOT) operation for the elderly women suffering with stress urinary incontinence (SUI). MATERIAL AND METHODS: 58 women with stress urinary incontinence who underwent TOT procedure between March 2004 and June 2006 were included in this study. To assess whether outcome was influenced by the patient's age, the patients were divided into two age groups: women aged 60 years and older (n=22) and women aged less than 60 years (n=36). Preoperatively, the patients were evaluated with history taking, a physical examination, a one-hour pad test, uroflowmetry and urodynamic study. The procedure was carried out using a previously established method under local anesthesia. The post-operative symptoms and patient satisfaction were assessed by questionnaire. RESULTS: There was no significant difference between the 2 groups in terms of the success rate: cure (71.4% vs. 78.2%, p=0.746), improved (19.1% vs. 9.3%, p=0.415), and same as preoperation (9.5% vs. 12.5%, p=1.000) for above 60 years old women and less than 60 years old women, respectively. In addition, the patient satisfaction rate was not different significantly between 2 groups. De novo urge symptoms were observed in 2 women aged 60 years and older. The intraoperative complications were not found. CONCLUSIONS: TOT procedure in elderly women with SUI offers high success rate and satisfaction for operation. TOT should play a significant role in treating them, due to its safety and availability. However, we do not know how long the improvement of voiding symptoms will last, and so additional longer term follow-up should be done.
Aged* ; Anesthesia, Local ; Female ; Humans ; Intraoperative Complications ; Patient Satisfaction ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinary Incontinence* ; Urodynamics

PUROPOSE: It is known that anticholinergics induces cognitive dysfunction and may aggravate the state of it. Tolterodine tartrate (detrusitol(R)) is a widely known selective anticholinergics to bladder, which does not cause a cognitive dysfunction. This study was designed to analyze the change of cognitive function of brain disease patients, whom are taking anticholinesterase inhibitor with tolterodine for overactive bladder (OAB). MATERIAL AND METHODS: From January 2001 to December 2004, with the patients whom have been followed for the brain disease in the department of neurology, we have analyzed 79 patients with tolterodine administered for OAB. We used K-MMSE (Korea minimental status examination) and SNSB (seoul neuropsychological screening battery) to analyze the state of cognition. Mean age of patients was 67.3+/-4.5 (yrs), mean administration period was 4.7+/-9.5 (mon). RESULTS: 7 patients made complaints for the decline of memory, 2 of them with Parkinsonism and 2 with cerebral infarction, 1 with progressive supranuclear palsy and, 2 dementia with lewy body (DLB). Patients with DLB was excluded in this study because the disease had fluctuation of cognitive function. CONCLUSIONS: The result of these studies demonstrates tolterodine tartrate caused the decline of cognitive function in only a few patients with brain disease. We concluded that prospective studies are needed to change the cognitive functions of the brain disease patients with OAB after administration of tolterodine tartrate.
Brain Diseases* ; Cerebral Infarction ; Cholinergic Antagonists ; Cognition ; Dementia ; Humans ; Lewy Bodies ; Mass Screening ; Memory ; Neurology ; Parkinsonian Disorders ; Supranuclear Palsy, Progressive ; Urinary Bladder ; Urinary Bladder, Overactive* ; Tolterodine Tartrate

PUROPOSE: To analyze lower urinary tract symptoms associated with prostate findings in occupational taxi drivers compared to office workers in Uijeongbu, Korea. MATERIAL AND METHODS: A population-based cross-sectional survey was conducted among drivers and office workers in Uijeongbu, Korea. All participants filled out the International Prostate Symptom Score (IPSS) questionnaire and the age, career, height and body weight were also recorded. They had uroflowmetry (UFM), transrectal ultrasound (TRUS) and prostatic cancer screening testing (PSA). We evaluated the parameters and compared them between the two groups. RESULTS: There was no significant difference in age, career and BMI between the two groups (p<0.01). For each group, the IPSS was closely related to the maximal flow rate (Qmax) (p<0.01). The mean value of the IPSS was 13.53+/-7.70 in the taxi drivers and 9.71+/-5.72 in office workers; therefore, the IPSSs showed a difference between the two groups (p=0.041). However, there were no significant differences among the other parameters between two groups. The value of Qmax was not significantly different in the comparisons between the two groups (p=0.973). CONCLUSIONS: Although the IPSS in taxi drivers was higher than in office workers, the objective parameters studied were not significantly different between the two groups. Therefore, there was no clinical evidence of higher morbidity associated with prostate abnormalities in taxi drivers compared to office workers.
Body Weight ; Cross-Sectional Studies ; Korea ; Lower Urinary Tract Symptoms* ; Mass Screening ; Prostate* ; Prostatic Neoplasms ; Surveys and Questionnaires ; Ultrasonography