The overactive bladder, according to the original definition by International Continence Society refers to the storage phase of the bladder and is diagnosed by urodynamics. The overactive bladder is a medical condition referring to the symptoms of frequency and urgency, with or without urge incontinence, in the absence of local pathology or metabolic factors that would account for these symptoms. The definition of overactive bladder needs clarification, which would help to overcome the current confusion. Possible neurological, muscular, and metabolic causes have been proposed but in many cases the exact causes remain unclear. The diagnosis depends greatly on a detailed history, clinical examination, and urinalysis. Urodynamic evaluation is indicated when neuropathy is suspected, and the treatment may be unsuccessful without exact knowledge of patients' state. It can be treated conservatively by bladder training, physiotherapy, and drugs alone or with combination. For refractory cases neuromodulation, denervation techniques, and bladder augmentation or substitution can be used with good results.
Behavior Therapy ; Denervation ; Diagnosis ; Pathology ; Urinalysis ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics

No abstract available.
Apoptosis* ; Hyperplasia*

From August 1991 to July 1992, 262 patients of benign prostatic hyperplasia (BPH) were treated with transurethral microwave thermotherapy (TUMT). Among those, 64 patients were followed up more than I year and 26 patients were followed up more than 4 years without other treatment. The patient`s age ranged from 49 to 80 years with a mean of 64.3 years. Prostate volume determined by transrectal ultrasonography ranged from 27.0cm3 to 73.6cm3, the mean 40.8cm3. After I year, maximum flow rate increased from 8.1+/-2.3ml/sec to 11.5+/-3.6ml/sec, Madsen symptom score decreased from 12.6 +/-3.8 to 6.6+/-4.7, and residual urine volume decreased from 75.6+/-33.5ml to 43.4+/-35.3ml. Complete response of maximum flow rate and Madsen symptom score observed in 17.2% in each group, partial response in 50.0% and 40.6%, and non-response in 32.8% and 42.2%. Improvement of subjective symptoms were evaluated by patients themselves and divided into 3 groups: ""satisfactory"" was 28.1%, ""acceptable"" 34.4%, and ""not effective"" 37.5%. Complications were i case of erectile dysfunction and 4 cases of dry ejaculation. Among the 64 patients who were followed up more than 1 year, 26 patients (40.6%) were remained without other treatment, 20 (31.3%) patients were medicated additionally, 11 (17.2%) patients required TUR-P during the follow-up period due to persistent symptoms, and 7 (10.9%) patients were performed re-TUMT. In conclusion, TUMT could be useful, safe and inexpensive treatment for BPH when it is applied selectively and should be advanced in mechanism to be more effective in treatment of BPH.
Ejaculation ; Erectile Dysfunction ; Follow-Up Studies* ; Humans ; Male ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate* ; Ultrasonography

Foreign bodies in genitourinary tract are not rare and most of them are present in the bladder. Various kinds of object are introduced into bladder through urethra by both male and female patients. Traditionally, they were introduced mainly for the purpose of sexual behavior. But recently like in our cases, many of them are inserted iatrogenically with development of endourologic procedure. We report 14 cases of bladder foreign bodies. Some of them are surprising and beyond common sense in kind of object and aim of insertion. Six cases were inserted by iatrogenic, 5 cases for masturbation, 2 cases by independently of patient`s intention by other person(s). One patient who had history of mental retardation did not remember when, how, why and by whom the foreign body had been introduced. All the foreign bodies could be diagnosed by history, symptom, X-ray and cystoscopy and removed by cystoscopic manipulation or cystostomy with ease and without complication.
Cystoscopy ; Cystostomy ; Female ; Foreign Bodies* ; Humans ; Intellectual Disability ; Intention ; Male ; Masturbation ; Sexual Behavior ; Urethra ; Urinary Bladder*

Foreign bodies in genitourinary tract are not rare and most of them are present in the bladder. Various kinds of object are introduced into bladder through urethra by both male and female patients. Traditionally, they were introduced mainly for the purpose of sexual behavior. But recently like in our cases, many of them are inserted iatrogenically with development of endourologic procedure. We report 14 cases of bladder foreign bodies. Some of them are surprising and beyond common sense in kind of object and aim of insertion. Six cases were inserted by iatrogenic, 5 cases for masturbation, 2 cases by independently of patient`s intention by other person(s). One patient who had history of mental retardation did not remember when, how, why and by whom the foreign body had been introduced. All the foreign bodies could be diagnosed by history, symptom, X-ray and cystoscopy and removed by cystoscopic manipulation or cystostomy with ease and without complication.
Cystoscopy ; Cystostomy ; Female ; Foreign Bodies* ; Humans ; Intellectual Disability ; Intention ; Male ; Masturbation ; Sexual Behavior ; Urethra ; Urinary Bladder*

A diagnostic accuracy was evaluated in total of 65 patients with acute painful scrotal swelling who underwent ultasonography and/or radionuclide scrotal imaging as an initial diagnostic modality. An accuracy with radionuclide scrotal imaging was 77.8% (7/9) in patients with testicular torsion. 92.0% (23,25) in those with epididymoorchitis. Ultasonography showed the diagnostic accuracy of 100% (15,15) in patients with epididymoorchitis. 66.7% (2/3) in those with testicular torsion and 87.5% (14,16) in those with scrotal trauma. One patient with the torsion of appendix testis was not diagnosed by radionuclide scrotal imaging preoperatively. Two of 8 patients (25%) with testis rupture were misdiagnosed by ultrasonography. Scrotal ultrasonography and nuclear medicine scan are useful adjuncts in diagnosis of torsion of appendix testis and testicular abscess. A possibility of misleading for diagnosis should not be overlooked. Scrotal exploration is mandatory in patients whose clinical pictures are not correlated with radiographic findings.
Abscess ; Acute Pain ; Appendix ; Diagnosis* ; Humans ; Nuclear Medicine ; Rupture ; Spermatic Cord Torsion ; Testis ; Ultrasonography*

Transurethral microwave thermotherapy(TUMT) is a new treatment modality for benign prostatic hyperplasia(BPH). Among those BPH patients who are treated by TUMT, 32 patients who are followed up appropriately are selected to analyze the effectiveness of TUMT. Patients were treated one time, for 1 hour. without sedation on an outpatient basis. All patients tolerated the treatment well without secondary effect Toxicity was mild. consisting of bladder spasm, urinary retention, dysuria, hematuria and urethral pain. Significant increase in urine flow rate(from 6.71 ml/sec to 11.2 ml/sec), decrease in post-void residual urine volume (from 82.2 ml to 28.6 ml) and decrease in frequency of nocturia (from 3.1 to 1.7) were observed. TUMT represents a safe and promising out-patient approach to treatment of BPH, particularly for patients who are not candidates for conventional surgical approaches because of medical or personal reasons.
Dysuria ; Hematuria ; Humans ; Microwaves* ; Nocturia ; Outpatients ; Prostatic Hyperplasia* ; Spasm ; Urinary Bladder ; Urinary Retention

We noticed the treatment results of each of them after having treated the seventy-nine cases of benign prostatic hyperplasia with TUMT (N=32, Term ; 92.6-93.3), TUR-P (N=31, Term; 91.4-93.3), open prostatectomy (N=16, Term; 91.4-93.3). However, there was a difficulty to get to statistical reliability, for there was a little gap between the term of survey and the period of treatment of three groups. The results are following. In the TUMT, the maximal flow rate was improved from 8.2ml/s to 13.3ml/s and Madsen score dropped from 13.6 to 5.3, in the TUR-P they were 8.4ml/s to 16.5ml /s and 14.5 to 5.3 respectively, and in the open prostatectomy 6.8ml/s to 20.0ml/s and 15.8 to 5. 3 respectively. The degree of satisfaction of the patients themselves with each prescription was 46.9% in the TUMT. 67.7% in the TUR-P and 81.2% in the open prostatectomy. But 18.8% and l6.l% of the patients thought TUMT and TUR-P respectively ineffective. The conclusion is that open prostatectomy presented the better results than TUMT or TUR-P in the degree of satisfaction of patients and uroflowmetry during the survey period. And even though TUMT have presented lesser degree of satisfaction then TUR-P up to now, if the exact indications for the use of TUMT are found and the mechanical improvements undergo, then a number of benign prostatic hyperplasia cases seem to be treated in more safety and with lesser cost and time by TUMT instead of TUR-P.
Humans ; Hyperthermia, Induced ; Microwaves* ; Prescriptions ; Prostatectomy* ; Prostatic Hyperplasia*

PURPOSE: To evaluate the usefullness of high energy transurethral microwave thermotherapy (TUMT) for the treatment of BPH in young or sexually active men, this study was performed. MATERIALS AND METHODS: The changes of sexual behaviors and sexual functions after TURP and high energy TUMT in 36 patients treated with TURP and 27 patients treated with high energy TUMT from January 1997 to December 2000 were analysed retrospectively. Assessment parameters were International Prostate Symptom Score (IPSS), uroflowmetry, residual urine and sexual functions such as morning erection, number of coitus, state of ejaculation and sexual satisfaction at 12 months from treatment. RESULTS: In both groups, the voiding function improved significantly after treatment, but TURP was much superior to TUMT in effectiveness. After 12 months of treatment, morning erection maintained 96.3% in TUMT group and 88.9% in TURP group. The number of coitus per month increased to 3.4 from 3.1 in TUMT group, and decreased to 2.2 from 2.8 in TURP group. Ejaculation preserved in 92.6% in TUMT group and 27.8% in TURP group. In sexual satisfaction, "Satisfied" increased to 51.9% from 40.7% in TUMT group, and decreased to 27.8% from 38.9% in TURP group. "Unsatisfied" changed little in TUMT group but changed from 22.2% to 47.2% in TURP group. In 28 patients with anejaculation, 78.6% considered no ejaculation had adverse effect and 21.4% considered it had no adverse effect on sexual satisfaction. CONCLUSIONS: Although both TURP and high energy TUMT significantly improved clinical outcome, the former was far superior to the latter in improving voiding symptoms caused by BPH. However, high energy TUMT was a better therapeutic option than TURP for patients who want to preserve sexual function. In particular, erection and ejaculation were preserved well with high energy TUMT while there was significant deterioration of these functions following TURP.
Coitus ; Ejaculation ; Humans ; Hyperplasia* ; Hyperthermia, Induced ; Male ; Microwaves ; Prostate* ; Prostatic Hyperplasia ; Retrospective Studies ; Sexual Behavior ; Transurethral Resection of Prostate*

PURPOSE: The urodynamic findings and subjective symptoms, in patients complaining of persistent lower urinary tract symptoms (LUTS) after a transurethral resection of the prostate (TURP) were evaluated. On the basis of these evaluations, the correlation, if any, between the urodynamic findings and the subjective symptoms was investigated. MATERIALS AND METHODS: A total of 47 men, with persistent voiding dysfunction more than a year following TURP, were evaluated using the international prostate symptom score (IPSS) and multichannel urodynamics. The patients were classified into three groups: obstructed (<10ml/sec), equivocal (10-15ml/sec) and unobstructed (>15ml/sec), according to their Abrams-Griffiths nomogram. RESULTS: From the urodynamic study, after the TURP, 6, 7 and 34 patients were placed into the obstructed, equivocal and unobstructed groups, respectively. There were no significant differences in the IPSS, and irritative and obstructive voiding symptom scores, between the obstructed, equivocal and unobstructed groups. The average IPSS in LUTS, with, and without, detrusor instability were 17.2+/-8.4 and 16.3+/-2.6 (p>0.05). The Qmax, detrusor pressure and residual urine volume, of the unobstructed group was significantly higher than those of the other two groups. CONCLUSIONS: Detrusor instability was the most frequent urodynamic finding in the patients complaining of persistent LUTS after TURP, but it is necessary to perform the urodynamics to decide on the appropriate treatment; either medical treatment, for the detrusor instability without a bladder outlet obstruction, or surgical removal of a bladder outlet obstruction. The symptoms were not reliable in predicting the urodynamic findings in regard to an obstruction and detrusor instability.
Humans ; Lower Urinary Tract Symptoms* ; Male ; Nomograms ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate* ; Urinary Bladder Neck Obstruction ; Urination Disorders ; Urodynamics