PURPOSE: Although surgical options for a cystocele repair have changed diversely over the past twenty years, a 29% recurrence rate after an operation has been reported. We assessed the efficacy and safety of a cystocele repair using monofilament polypropylene mesh (MPM) to reinforce the weakened muscular pelvic floor. MATERIALS AND METHODS: 28 women underwent a cystocele repair using MPM. According to the International Continence Society (ICS) stage classification, 5, 20 and 3 women had stages II, III and IV cystocele, respectively. The operations were performed through the vaginal approach. An anterior colporrhaphy was performed, and mesh (15x5cm), with the lateral extensions, was then positioned into the retropubic space, without fixation, for tension free support of the bladder. The cure of cystocele was defined as stage 0, improvement as stage I, and failed treatment as stage II or greater. RESULTS: The mean follow-up, catheterization time and hospital stay were 20.4+/-3.2 months, 2.4+/-1.2 days and 6.6+/-3.4 days, respectively. The anatomical cure rate of cystocele was 89.3% (25/28). The cystocele repair improved 2 patients, but failed in 1. No significant intraoperative complications occurred. The postoperative complications included voiding difficulty (2 cases), vaginal bleeding around the suture site (1 case) and de novo urgency (2 cases). There were no mesh related complications. CONCLUSIONS: Cystocele repair using MPM showed a success rate of 89.3%, with no complications associated with the use of mesh. This procedure seems to be safe and efficient, but a prospective randomized trial and longer follow-up will be required to confirm these results.
Catheterization ; Catheters ; Classification ; Cystocele* ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Length of Stay ; Pelvic Floor ; Polypropylenes* ; Postoperative Complications ; Recurrence ; Surgical Mesh ; Sutures ; Urinary Bladder ; Urinary Bladder Diseases ; Uterine Hemorrhage

Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 223 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). Major underlying diseases were DM(115patients, 51.6%), hypertension(11 patients, 4.9%), spinal injury(three patients, 1.3%) and prior pelvic surgery(three patients, 1.3%). The volume of drug used ranged between 0.04 and 0.6ml(average:0.19ml). After a mean followup of 7.6 months(3-15 months), 141 patients(63.2%) left in the home injection program and among them, 125 patients(88.6%) had very high satisfaction. The drop-out rate was 36.8%(82 of 223) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism(six patients, 3.8%), pain(six patients, 3.8%) and granuloma on injection site(one patient, 0.6%) were noticeable complications, but coporal fibrosis and systemic side effect were not noticed. In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.
Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine

PURPOSE: To compare prospectively and randomly tension-free vaginal tape(TVT) with transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: One hundred twenty women with SUI were alternately assigned to either the TVT group(n=60) or TVT-O group(n=60). The preoperative evaluation included urodynamic study and a Korean version of the incontinence quality of life questionnaire(I-QoL). At 1-year after operation, surgical outcome, patient I-QoL parameters, long-term complications and uroflowmetry were evaluated in 2 groups. RESULTS: Preoperative patient characteristics including I-QoL and urodynamic study were comparable in the two groups. The rates of cure(86.8% for TVT vs. 86.8% for TVT-O), improvement(6.6% for TVT vs. 8.2% for TVT-O), and failure (6.6% for TVT vs. 5.0% for TVT-O) were similar for the two groups. The I-QoL parameters one year after surgery were improved significantly in both groups(p<0.001) and there was no difference between the two groups(p>0.05). The rates of the patient satisfaction with the procedure were 93.4% in the TVT group versus 95.0% in the TVT-O group(p>0.05). Mean operation time(11.5+/-1.4 min versus 15.2+/-1.8 min, p<0.05) was significantly shorter in the TVT-O than TVT. There were no long-term complications, such as vaginal erosion and prolonged voiding difficulty, in either group. CONCLUSION: TVT-O appears to be equally effective as TVT for the surgical treatment of stress urinary incontinence in women at a 1-year follow-up.
Female* ; Follow-Up Studies* ; Humans ; Patient Satisfaction ; Prospective Studies* ; Quality of Life ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: This study aims to compare the efficacy and safety of propiverine hydrochloride (propiverine) 40mg for the treatment of overactive bladder (OAB). MATERIAL AND METHODS: Total of 284 patients (male:86, female:198) with OAB were included in this study. The patients were treated with propiverine 20mg twice daily or 40mg once daily for 8 weeks. The initial evaluation included with history taking, physical examination, International Prostatic Symptom Score (IPSS), IPSS QoL and consecutive voiding diaries for 3 days. After a 8-week treatment, IPSS, IPSS QoL, patients perception of treatment benefit, global assessment of efficacy by physicain and safety were evaluated. RESULTS: Two hundred eighteen patients were treated with propiverine 20mg twice daily and 66 patients treated with 40mg once daily. The 59 patients had been treated previously with anticholinergics. After a 8-week treatment, IPSS score (total, voiding and storage subscore) and IPSS QoL were improved in all patients (p<0.05). After a 8-week with propiverine 40mg once daily, improvement of IPSS score was noted in the patients non-responsive to anticholinergics previously (p<0.05). The patients treated with propiverine 40mg once daily showed much more symptomatic improvements assessed by physicians than 20mg twice daily (p<0.05). The overall side effect was noted in the 13.4% patients and the most common side effect was dry mouth. CONCLUSION: Propiverine 40mg once daily is considered to reduce the symptom of OAB effectively and can be used safely in the patients with OAB. Treatment with propiverine 40mg is seemed to show more improvement in the unsatisfactory patients with previous anticholinergics.
Cholinergic Antagonists ; Humans ; Mouth ; Observational Study* ; Physical Examination ; Prospective Studies* ; Treatment Outcome ; Urinary Bladder, Overactive*

BACKGROUND: Bone marrow transplantation (BMT) has become a significant treatment modality for hematopoietic and solid organ malignancy. Recipients of BMTs lose immunity to measles-mumps-rubella (MMR) and hepatitis B infections which are preventable with vaccination. There is no consensus regarding a vaccination schedule after BMT and time of vaccination is variable according to each institution. We analyzed sequential changes in antibody titers of MMR and hepatitis B during the first year after BMT in an attempt to identify the time, dose, and needs for revaccination. METHODS: Total 20 patients with hematologic malignancies were studied. Serum levels of IgG antibodies of MMR and hepatitis B virus (HBV) were determined every three months post-BMT by enzyme immunoassay (EIA), chemical luminescence immunoassay (CLIA) and immunofluorescence assay (IFA). RESULTS: IgG antibody levels of measles, rubella, HBV were 1:746, 80 85 IU/mL, 214 343 IU/L before BMT, declined to 1:633, 18 11 IU/mL, 4 6 IU/L one year after BMT, respectively. All the antibody levels were still above cut-off value for positive immunity. Mumps antibody titers were 1:62 before BMT, declined to 1:25 significantly from 6 months after BMT, but the antibody level was still above cut-off value. CONCLUSION: Antibody titers of MMR and hepatitis B decline during the first year after BMT, but the levels are still above cut-off value. Thus, the timing of revaccination should be after the first year post-transplantation. Long-term studies are needed to determine the optimal time for revaccination.
Antibodies ; Appointments and Schedules ; Bone Marrow Transplantation* ; Bone Marrow* ; Consensus ; Fluorescent Antibody Technique ; Hematologic Neoplasms ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunization, Secondary ; Immunoassay ; Immunoenzyme Techniques ; Immunoglobulin G ; Korea* ; Luminescence ; Measles* ; Mumps* ; Rubella* ; Vaccination

Background and Objectives: Smoking is well-established as a risk factor for coronary artery disease. However, recent studies demonstrated favorable results, including reduced mortality, among smokers, which are referred to as the “smoker's paradox”. This study examined the impact of smoking on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: Patients with AMI undergoing PCI between 2004 and 2014 were enrolled and classified according to smoking status. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, stroke, and revascularization. Results: Among the 10,683 patients, 4,352 (40.7%) were current smokers. Smokers were 10.7 years younger and less likely to have comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, stroke, and prior PCI. Smokers had less MACE (hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.594–0.698; p<0.001) and cardiac death (HR, 0.494; 95% CI, 0.443–0.551; p<0.001) compared to nonsmokers during the 5 years in an unadjusted model. However, after propensity-score matching, smokers showed higher risk of MACE (HR, 1.125; 95% CI, 1.009–1.254; p=0.034) and cardiac death (HR, 1.190; 95% CI, 1.026–1.381; p=0.022). Smoking was a strong independent predictor of lung cancer (propensityscore matched HR, 2.749; 95% CI, 1.416–5.338; p=0.003). Conclusions In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.

Background and Objectives: Smoking is well-established as a risk factor for coronary artery disease. However, recent studies demonstrated favorable results, including reduced mortality, among smokers, which are referred to as the “smoker's paradox”. This study examined the impact of smoking on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: Patients with AMI undergoing PCI between 2004 and 2014 were enrolled and classified according to smoking status. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, stroke, and revascularization. Results: Among the 10,683 patients, 4,352 (40.7%) were current smokers. Smokers were 10.7 years younger and less likely to have comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, stroke, and prior PCI. Smokers had less MACE (hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.594–0.698; p<0.001) and cardiac death (HR, 0.494; 95% CI, 0.443–0.551; p<0.001) compared to nonsmokers during the 5 years in an unadjusted model. However, after propensity-score matching, smokers showed higher risk of MACE (HR, 1.125; 95% CI, 1.009–1.254; p=0.034) and cardiac death (HR, 1.190; 95% CI, 1.026–1.381; p=0.022). Smoking was a strong independent predictor of lung cancer (propensityscore matched HR, 2.749; 95% CI, 1.416–5.338; p=0.003). Conclusions In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.