A 54-year-old man presented to the emergency department with a chief complaint of suprapubic pain and inability to void for 1 day after self insertion of urethral foreign bodies. These foreign bodies were two beans self inserted compulsively into the urethra by the patient. On physical examination, two materials of oval shape in the bulbous urethra were palpable. Retrograde urethrogram showed a complete obstruction in the bulbous urethra. When possible, endoscopic removal should be used for urethral foreign bodies. However the beans of our case required surgical retrieval. We present a case of foreign bodies in the urethra with brief review of literature. To our knowledge, this is the first case of acute urinary retention due to beans in Korean literature.
Emergency Service, Hospital ; Fabaceae ; Foreign Bodies* ; Humans ; Middle Aged ; Physical Examination ; Urethra ; Urinary Retention*

PURPOSE: Midurethral sling procedure has become one of the most commonly performed procedures for the treatment of female stress urinary incontinence(SUI). Although complication rate is very low, some patients are required further treatment to correct unwanted problems after surgery as it continues to be more widely used. We evaluated the mesh-related complications in those who required further procedures after midurethral sling procedures. MATERIALS AND METHODS: From January 2000 to December 2005, female patients who underwent additional surgery because of complications after midurethral sling procedures for stress urinary incontinence were evaluated in this study. RESULTS: In 675 patients, 298 received a tension-free vaginal tape(TVT) and 377 received a Monarc(transobturator route, TOT) as a sling material at 3 different hospitals. 34(5.0%) out of 675 patients required additional surgery to correct complications including obstructive voiding symptoms, mesh extrusion, failed or recurred SUI, wound pain and mesh in the bladder. Mean age of 34 patients was 54.7, and TVT was used in 21(7.0%) out of 298 patients, Monarc was used in 12(3.4%) out of 377 as midurethral sling materials. In 19 patients who showed obstructive voiding symptoms, all were cured by mesh cutting and in 8 patients who complained of immediate recurrence of SUI, 7 showed complete dryness by shortening the loosen mesh. Mesh extrusion with vaginal erosion were observed in 3 and all were cured by segmental resection of mesh without recurrence of SUI. 2 patients who showed recurrence of SUI after 2 years of TVT received Monarc procedure. Mesh in the bladder which was found after 6 months of TVT was managed by endoscopic resection of mesh with Monarc procedure in 1, and suprapubic pain after TVT was improved by resection of TVT segment through suprapubic incision in 1. All reoperation procedures were performed by local anesthesia except 1(mesh in the bladder). CONCLUSION: These data demonstrate that midurethral sling is an excellent surgical procedure with low complication rate, high success rate in reoperation. However, care must be taken to reduce reoperation rate in applying tension of mesh on urethra because most patients(27 out of 34) who required reoperation have complained of obstructive voiding symptoms(19) and persistent incontinence(8).
Anesthesia, Local ; Female* ; Humans ; Recurrence ; Reoperation* ; Suburethral Slings* ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Wounds and Injuries

PURPOSE: Prostatitis is an extremely common syndrome that afflicts 2~10% of men and is now classified into NIH category. Of these, NIH category III(Chronic Prostatitis/Chronic Pelvic Pain Syndrome, CP/CPPS) varies widely in clinical presentation and response to treatment. We evaluated the characteristic symptoms of CP/CPPS based on NIH chronic prostatitis symptom index(NIH-CPSI), International Prostate Symptom Score(IPSS) and International Index of Erectile Function-5(IIEF-5) for the exploration of the future prospects of treatment. MATERIALS AND METHODS: 114 subjects agreed to participate in the study. The data from 99 patients were available for evaluation. The candidates with category IIIa and IIIb chronic pelvic pain syndrome were from 3rd decade to 6th decade for exclusion of effect of BPH. The NIH-CPSI, IPSS, IIEF-5 were used to grade symptoms and the quality of life impact at the start of the study. We investigated the correlation of the each domain of the scales categorized by age, location and multiplicity of the pain, and duration of the disease. Pearson's correlation method and ANOVA test were used for statistical analysis. RESULTS: Mean age of the patients was 41.1+/-8.5(3rd decade; 8 patients, 4th decade; 30, 5th decade 47, 6th decade 14). There were significant correlation between IPSS total score and urinary domain of NIH-CPSI (R=0.82), and irritative domain of IPSS and urinary domain of NIH-CPSI(R=0.76) with pearson's method. Analysis of the scores categorized by age revealed that there were no difference in 2nd, 3rd, 4th decade, but 6th decades had high IPSS total score. Analysis of the scores categorized by location and multiplicity of the pain revealed that the most common site of the pain was perineum(34.3%), and the patients who had 3 or more painful area had higher scores in all domains of CPSI and IPSS except pain domain of NIH-CPSI than the patients who had 1 painful area. Analysis of the scores categorized by duration of the disease revealed that the IPSS scores of the patients suffered during 1 year or more were higher than the patient suffered during 6months or less. There was no significant correlation between IIEF-5 and other scales. CONCLUSION: In our study there was significant correlation between urinary domain of NIH-CPSI and total score of IPSS. So, urinary domain of NIH-CPSI could be helpful index when alpha-blocker is used for the treatment of CP/CPPS. And alpha-blocker could be more effective in patients who are older and have longer duration of the disease and have multiple painful areas.
Humans ; Male ; Pelvic Pain* ; Prostate ; Prostatitis ; Quality of Life ; Weights and Measures

PURPOSE: To assess the efficacy and safety of a IRIS(innovative replacement of incontinence surgery) procedure for surgical treatment of stress urinary incontinence in women during the follow-up of 2 years. MATERIALS AND METHODS: From March 2003 to March 2004, 48 women with stress urinary incontinence underwent a IRIS procedure under local, spinal or general anesthesia. Post-operative evaluation was carried out after 1 month, 12 months and 24 months. The mean age was 51.1+/-11.0 years and mean follow-up period was 32.1+/-3.8 months. Operation time, success rate and patient's satisfaction, perioperative and postoperative complications were evaluated. RESULTS: The mean operation time was 24.46+/-1.95 minutes and mean hospital stay was 1.77+/-0.75 days. The success rates were 95.8%(cured 79.2%, improved 16.7%) and 93.8%(cured 75.0%, improved 18.8%), at the 1 and 2-year follow-up, respectively. The satisfaction rates were 91.7% at 1-year follow-up and persisted at 2-year follow-up. There were no serious or long-term complications related to the procedure, and no significant changes in the postoperative outcome over time. CONCLUSION: Our results demonstrate that the IRIS procedure is as safe and effective as TVT procedure for the treatment of female stress urinary incontinence, although longer follow-up is necessary to determine long-term effect.
Anesthesia, General ; Female* ; Follow-Up Studies* ; Humans ; Iris* ; Length of Stay ; Postoperative Complications ; Urinary Incontinence*

PURPOSE: In this study we demonstrate effect of selective nicotinic agonist, ABT-594 on voiding in spinal cord injury rat. MATERIALS AND METHODS: Spinal cord injury rat was made by complete resection of the spinal cord(T8~9) and checked cystometry three weeks after injury. In female Sprague-Dawley awake rats, an intravesical catheter was inserted through the bladder dome and intravenous catheter was inserted to right jugular vein. After the surgery, cystometry was performed by infusing saline into the bladder(0.08 ml/min). Cumulative doses of ABT-594 (0.01, 0.1, 1, 10 ug/kg) were injected intravenously in spinal cord injury rat at 1 hour intervals. RESULTS: All dose(0.01~10 ug/kg) of ABT-594 did not affect the intercontraction interval(ICI), maximal voiding pressure(MVP), and pressure threshold(PT), and from voiding contraction to non-voiding contraction(from VC to NVC), voiding volume(VV), residual volume(RV). But moderate dose(1 ug) of ABT-594 significantly decreased number of non-voiding contraction(55.6+/-13.7% of control)(p<0.05). CONCLUSION: These result suggest that the nicotinic agonist ABT-594 might in part affect voiding function through stimulation of serotonergic nerve to lumbosacral level in spinal cord injury rat.
Animals ; Catheters ; Female ; Humans ; Jugular Veins ; Nicotinic Agonists* ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder

PURPOSE: Tension free vaginal tape, which has become the common therapy for female stress urinary incontinence, has a complication associated with a blind passage. Transobturator vaginal tape inside-out (TVT-O) is a technique for the passage of the tape through the obturator foramens from inside to outside. We intend to evaluate the efficacy and safety of the TVT-O. MATERIALS AND METHODS: From September 2004 to December 2004, 35 patients underwent TVT-O under spinal anesthesia. Among them, 30 patients have been followed-up more than 12 months. The preoperative assessment included past history, physical examination, voiding diary, 1-hour pad test, urinalysis, voiding cystourethrography (VCUG), urodynamic study. Post-operatively a 16 Fr urethral Foley catheter was left for 24 hours. The procedural outcome, subjective satisfaction and complications were assessed retrospectively. RESULTS: The mean operative time was 15 minutes (range 12~20). Average hospital stay was 3.5 days (range 2~14). No intraoperative or postoperative complications were noted. One patient had immediate voiding difficulty, which was resolved after 2 weeks of clean intermittent catheterization. Three out of 10 patients (30%) with urge incontinence improved after the operation. The mean followed-up period was 13 months. Of 30 patients, 29 patients (96.6%) were cured and 1 patient (3.3%) improved. Subjective cure was present in 29 patients (96.6%). CONCLUSION: TVT-O is a simple, safe and effective surgical treatment for female stress urinary incontinence. However, a longer follow-up will be necessary to determine its long-term effect.
Anesthesia, Spinal ; Catheters ; Female* ; Follow-Up Studies ; Humans ; Intermittent Urethral Catheterization ; Length of Stay ; Operative Time ; Physical Examination ; Postoperative Complications ; Retrospective Studies ; Suburethral Slings ; Urinalysis ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: Benign prostatic hyperplasia(BPH) is known to be the most common cause of urination disturbance among the men over the age of 50. It is known that the prostate generally increases in size rises along with age. The growing number of the elderly of society requires more consistent care for the chronic diseases like BPH. The recent expansion of telecommunications infrastructure and mobile communications has made it possible for medical services to use mobile communication networks. Hence, we have researched the clinical patients' preference toward the distant management system for BPH patients using mobile communications. MATERIALS AND METHODS: The research proceeded with a questionnaire conducted by 40 BPH patients over the age of 50, who are undergoing out-patient clinic in the Urology Department at Chungbuk University Hospital and East West Neo Medical Center. The same interviewer gave an explanation to the patients through the questionnaire and the person-to-person talk so that the patients could understand for the personal BPH control program(PBCP). The research on patients' preference toward the PBCP as conducted under a few categories as follows: The contents of the questionnaire according to the patient's educational status: for under middle school graduates, under high school graduates, and for a college graduates. Patients were grouped into high, middle and low according to their financial status. International prostate symptom score(IPSS) were divided into mild, moderate and severe by Barry's classification. Patients' ages were grouped into 50s, 60s, and over 60s. Correlation of each categories was made by Pearson' SPSS version 12.0 and patient's preference toward the PBCP were compared with the variables. RESULTS: The higher the financial, educational status of the patient was, the more positive the reaction of the clinical patient was toward the PBCP(p=0.01, 0.038). However, it was irrelevant to the patient's IPSS and age(p=0.626, 0.087). CONCLUSION: It can be a bit hasty to draw conclusions from the evaluation on the PBCP for patients with a few simple elements, and we still need more comprehensive information. However, once it is successfully practiced, we expect to provide elderly or immobile patients with sufficient medical services in homes, which would offer them a great deal of convenience.
Aged ; Chronic Disease ; Chungcheongbuk-do ; Classification ; Educational Status ; Humans ; Male ; Outpatients ; Patient Preference ; Prostate ; Prostatic Hyperplasia* ; Surveys and Questionnaires ; Telecommunications ; Urination ; Urology

PURPOSE: We evaluated the efficacy and safety of the tension-free vaginal tape(TVT) procedure for the treatment of female stress urinary incontinence over a 6-year period. MATERIALS AND METHODS: We reviewed retrospectively our experience with 63 patients who underwent a TVT procedure for stress urinary incontinence, between March 1999 and March 2000. The preoperative evaluations included a comprehensive medical history, physical examination, urinalysis, urine culture, one hour pad test, urodynamic study including valsalva leak point pressure(VLPP) and maximal urethral closing pressure(MUCP). Long-term evaluations were performed by questionnaires on the durability of surgical outcome and the patients' satisfaction of the procedure. RESULTS: The TVT procedure remained successful in 95.2%(cured 81.0%, improved 14.3%) and 93.7%(cured 77.8%, improved 15.9%) at the 1 and 6-year follow-up, respectively. The satisfaction rates were 93.7% and 92.1%, at the 1 and 6-year follow-up, respectively. There were no serious or long-term complications related to the procedure. CONCLUSION: The TVT procedure seems to be a minimally invasive, safe and effective surgical procedure for the treatment of female stress urinary incontinence, with long-term durability of continence and minimal complications related to the surgery.
Female* ; Follow-Up Studies ; Humans ; Physical Examination ; Surveys and Questionnaires ; Retrospective Studies ; Suburethral Slings* ; Urinalysis ; Urinary Incontinence* ; Urodynamics

PURPOSE: To investigate the role of muscarinic receptors in bladder sensory mechanism. MATERIALS AND METHODS: Normal adult volunteers collected voided urine after taking five days of trospium(20 mg bid), tolterodine LA(4 mg qd) and oxybutynin XL(10 mg qd). The effect of intravesical administration of human urine on carbachol-induced bladder overactivity was studied in female Sprague-Dawley rats. Cystometric parameters during continuous infusion for over one hour each of saline, human urine, then mixture of carbachol and human urine were compared(n=6 in each group). Then 0.1 and 0.5microgram/ml of oxybutynin, trospium, tolerodine, and dimethindene were studied with the same methods. RESULTS: Human urine with or without intake of antimuscarinic agents had no effect on normal bladder function. Bladder capacity and intercontraction intervals were significantly decreased after an addition of carbachol to human urine containing vehicle, tolterodine or oxybutynin. Human urine after ingestion of trospium, however, prevented the carbachol-induced reduction in bladder capacity and intercontraction intervals. Maximum voiding pressure and pressure threshold were not changed in any case. 0.1 and 0.5microgram/ml of oxybutynin, trospium, tolerodine, and dimethindene prevented the decrease of intercontraction interval with intravesical carbachol(65+/-0.1% compared with baseline). CONCLUSION: The excreted urine after oral ingestion of 20 mg bid of trospium has a significant inhibitory effect in a rat model of detrusor overactivity. Intravesical instillation of antimuscarinic agents at clinically meaningful concentrations also suppressed carbachol-induced bladder overactivity. Antimuscarinic agents may be effective in treating bladder overactivity, not only by suppression of muscarinic receptor-mediated detrusor muscle contraction, but also by blocking muscarinic receptors in bladder-afferent pathways.
Administration, Intravesical ; Adult ; Carbachol ; Dimethindene ; Eating ; Female ; Humans ; Models, Animal ; Muscarinic Antagonists* ; Muscle Contraction ; Rats, Sprague-Dawley ; Receptors, Muscarinic* ; Urinary Bladder* ; Urinary Bladder, Overactive ; Volunteers ; Tolterodine Tartrate

PURPOSE: We evaluated predictive risk factors affecting the long-term efficacy of the tension-free vaginal tape(TVT) procedure for the treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: We included 138(mean age 52.4+/-9.3) women who underwent the TVT procedure and followed up for at least 5 years. We analyzed parameters including patient characteristics, history, physical examination, 1-hour pad test, and urodynamic studies using univariate and multivariate analyses with respect to the cure rates. The patients were regarded as cured in the absence of any episodes of involuntary urine leakage during stressful activities and stress cough test. RESULTS: The overall 5-year cure rate was 76.8%, with an 86.9% patient satisfaction rate. On univariate and multivariate analyses, there were no significant parameters affecting the cure rate. The urgency negatively impacted patients' satisfaction(p=0.017, OR=4.114). According to the subgroup analyses, cure rates were lower in patients with high body mass index(BMI=25 kg/m(2), 68.3% vs 83.3%, p=0.044), lower Valsalva leak point pressure(VLPP<60 cmH2O, 51.6% vs 82.8%, p=0.003), and high-grade incontinence(40.0% vs. 69.7%, 86.6%, p=0.012). CONCLUSION: the TVT procedure is an effective and safe surgery for SUI without any independent predictive factors affecting long-term cure execept urgency affecting satisfaction. However, higher BMI, low VLPP and high- grade incontinence may impair the efficacy of the TVT procedure.
Cough ; Female* ; Humans ; Multivariate Analysis ; Patient Satisfaction* ; Physical Examination ; Risk Factors ; Suburethral Slings* ; Urinary Incontinence* ; Urodynamics