Urinary incontinence is a relatively common and potentially disabling disease affecting the life quality of a patient. Many successful series in the treatment of incontinence by medical or surgical therapy using autologous materials have been reported. However, those who have structural abnormalities, injury around the urethra, and derangements in the nervous system could not be benefited by such treatments. In other countries, the artificial urethral sphincter, introduced in 1972, have achieved satisfactory results and then increased in use; but in Korea, it was not widely used because of many limitations and obstacles. Based on our ten-year experience with 10 cases of implantation of artificial urethral sphincter from 1987 to 1996, we tried to elucidate the present status, problems, and the possible ways of improvements of its use within this country. A total of ten male patients underwent implantations of the AMS Model 800 artificial urethral sphincter. Mean age was 34.5 (17-43) years. Mean follow-up was 4.2 (0.5-10) years. Two patients were spinal cord injury patients, 2 meningomyeloceles, and 6 posterior urethral injuries. Two patients had the prosthesis removed due to infection and cuff erosion. In the other 8 patients, 6 were dry (75.0 %) and 1 was improved (12.5 %) and 1 was wet (12.5 %). The revision rate was 20% (2/10) and overall improvement of incontinence was observed in 7 (87%) patients. The reasons for the low incidence of the implantation of artificial urinary sphincter in this country are as follows. According to the other reports, the most common application of artificial urinary sphincter in the west is in the post-prostatectomy incontinence accounting for about 60% of artificial urinary sphincter implantation whereas in this country, the majority of cases are patients who had trauma. Since radical prostatectomy has not been established well in the country (in the recent 4 years, totally only 53 cases were performed) and also the excellent performance of the transurethral surgery making the incidence of incontinence low, could be one of the reasons. In addition, the high price of the prosthesis over 4 million won and operation fee of 3 to 6 million won is a formidable burden to most patients. In the view of mechanical problem, the cuff size of the urethra in the oriental people is observed smaller than the western, and we must let the company prepare the cuff set of smaller size. In conclusion, if we solve those problems in our country, the artificial urethral sphincter is an effective device for treatment of urinary incontinence in patients who have failed more conservative modes of therapy.
Fees and Charges ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Linear Energy Transfer ; Male ; Meningomyelocele ; Nervous System ; Prostatectomy ; Prostheses and Implants ; Quality of Life ; Spinal Cord Injuries ; Urethra* ; Urinary Incontinence ; Urinary Sphincter, Artificial

An objective finding for the diagnosis of interstitial cystitis (IC) is the so called `glomerulation`, petechial hemorrhages that occur after distention of the bladder. Glomerulation occurs in most IC patients and although there are some reports that it occurs in the normal bladder as well, there has been no actual study carried out to confirm this and further study into this matter is needed. Therefore, we induced glomerulations in non-IC patients and compared its frequency and severity with IC patients in order to elucidate the importance of glomerulation in IC. 25 (10 males, 15 females; mean age 44.3 years) IC patients received hydrodistention between Jan 1992 to Sep 1996 at the Department of Urology at Yongdong Severance Hospital. 12 (8 males, 4 females; mean age 47.5 years) non-IC patients who were to receive urological surgery under spinal or general anesthesia were selected for hydrodistention; there were 6 ureter stone, 4 BPH, and 2 stress urinary incontinence patients. 92.0% (23/25) of IC patients and 83.3% (10/12) of non-IC patients showed glomerulation and there was no statistical significance between the two groups. 76.0% (6 grade 2, 13 grade 3 glomerulation) of IC patients and 50.0% (3 grade 2, 3 grade 3) of non-IC patients showed glomerulation of grade 2 or higher. The frequency and severity of glomerulation was in an inverse relationship with trabeculation of the bladder. The sensitivity of glomerulation in the diagnosis of IC was 92.0% whereas the specificity was low with 16.7%. These findings suggest that glomerulation is nonspecific in IC and warrants further investigation.
Anesthesia, General ; Cystitis, Interstitial* ; Diagnosis* ; Female ; Hemorrhage ; Humans ; Male ; Sensitivity and Specificity ; Ureter ; Urinary Bladder ; Urinary Incontinence ; Urology

Twenty vesicoureteral reflux patients with 31 reflux renal units were treated with endoscopic Teflon injection. Twenty one reflux renal units were cured and the success rate after first injection was 67.7 %. In 5 more renal units the second injection was done and the refluxes were subsided in all cases. The overall success rate was 83.9 %. Teflon injection was also effective in vesicoureteral reflux with neurogenic bladder. There are many benefits of endoscopic Teflon injection in the treatment of vesicoureteral reflux but long term follow-up is needed and we must consider the possibility or complication especially in child.
Child ; Follow-Up Studies ; Humans ; Polytetrafluoroethylene* ; Urinary Bladder, Neurogenic ; Vesico-Ureteral Reflux*

No abstract available.
Erectile Dysfunction* ; Evoked Potentials, Somatosensory* ; Male

From January, 1990 to December, 1995, 106 patients received transvaginal bladder neck suspension by Raz. Follow up periods ranged from 3 months to 5 years, and mean age of patients was 52.2 years. Severity of incontinence were grade 1 in 22, grade II in 83, and grade III in 1 patient. After minimum of 3 months follow up, 87 (82.1%) patients were completely cured and 14 (13.2%) patients reported minimal leaking, the final success rate being 95.3% (101/106). Degree of posterior urethral angle and grades of incontinence(classified either by Blaivas or Green) were not significant factors in predicting outcome. Grade of incontinence, preoperative irritative voiding symptoms, previous incontinence surgery, age, and menopause were not correlated with success. However the history of hysterectomy and overweight were related with lower success rate. Mean hospital stay was 6.1 days, and 50 (47.2%) patients performed intermittent catheterization at discharge but later all resumed normal voiding. Among 34 patients with urgency preoperatively 25 (73.5%) improved after operation, and de novo urgency was found in 11 (16.2%). Complications including urinary tract infection blood loss requiring transfusion were seen in one patient respectively, but no case of peritonitis, bladder perforation, and wound perforation was seen. Success rate of Raz operation is more than 90%, which was higher than other types of bladder suspension. Raz colpo-suspension can place bladder neck traction sutures accurately without causing obstruction or significant morbidity, therefore should be recommended as a premier mode of surgical treatment in patients with stress urinary incontinence.
Catheterization ; Catheters ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Length of Stay ; Menopause ; Neck* ; Overweight ; Peritonitis ; Sutures ; Traction ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Tract Infections ; Wounds and Injuries

A total of 41 anejaculatory men participated in the electroejaculation study. Mean patient age was 33.2 years (range 22 to 54 years). Greater than one million motile sperm were obtained in 26 patients(63.4%). We attempted intrauterine insemination on 25 occasions in 14 subjects' spouses. Four of them(28.6%) became pregnant ;two aborted and the other two delivered fullterm healthy babies.
Humans ; Insemination* ; Male* ; Pregnancy ; Spermatozoa ; Spouses

Twenty one ratients diagnosed with diabetic cystopathy in Yongdong Severance Hospital for 6 years were analysed for the clinical and urodynamic features. The mean age was 65.4 years (33-83) and females were twice in number when compared to males. The mean duration of diabetes was 9.7 years. The symptoms were urinary retention, residual urine sensation, abdominal straining, hesitancy, interruption, impaired voiding desire, dysuria in order of frequency. Significant bacteriuria was found in 62% of patients and was more frequent in females, In cases with confirmed bacteriuria, 62% of the identified bacteria was E. coli. Diabetic neuropathy was present in 100% and nephropathy in 77%, nephropathy in 43%. In the presence of one complication, there was a tendency for other concurrent complications. In urodynamic study, the residual urine volume, volume at first sensation, maximum intravesical pressure. compliance were larger than in normal persons and loss of reflex detrusor contraction was more frequent which means impaired bladder sensation and detrusor contractility in diabetic cystopathic patients. The age of patients, duration of diabetes, treatment mode of diabetes, level of blood sugar do not influence the severity of diabetic cystopathy Administration of cholinergics and intermittent catheterization showed a high cure rate and was throughout to be a good treatment mode.
Bacteria ; Bacteriuria ; Blood Glucose ; Catheterization ; Catheters ; Cholinergic Agents ; Compliance ; Diabetic Neuropathies ; Dysuria ; Female ; Humans ; Male ; Reflex ; Sensation ; Urinary Bladder ; Urinary Retention ; Urodynamics*

We analyzed one hundred and thirty nine cases of urodynamic findings of male patients who had voiding problems without organic or neurologic lesions. There were 45 patients (32.4%) with normal urodynamic findings and 94 patients (67.6%) with abnormal finding. The most frequent finding in the latter was high maximum urethral closure pressure in 41 cases (29.5%). The popular voiding symptoms were residual urine sensation (75.5%), frequency (67.6%), hesitancy (63.3%) and so on. There was no correlation between urodynamic findings and symptoms. Although many patients were lost to follow up, the results of the management were good. So we expect that it would be better to manage such patients according to the results of urodynamic findings than to manage only by the symptoms.
Humans ; Lost to Follow-Up ; Male* ; Sensation ; Urodynamics*

Since June 1978, 40 patients who had been taken renal arteriographies were analysed and following results were obtained. 1. Male to female ratio was approximately 1:1 and peak incidence was in the fifth decade. 2. The symptoms and signs as indications for renal arteriography were flank pain, gross hematuria, renal trauma, flank and abdominal mass, in decreasing order of frequency. 3. Renal arteriographies were performed in 8 patients who showed gross hematuria but normal excretory urography. In 6 patients arteriography showed clearly the absence of abnormal vasculature within the kidney. In the other two, the kidney were identified as having inflammatory change and arteriovenous malformation, respectively. 4. Arteriographically detected extravasation of urine which were not identified on excretory urography was noted in one case. 5. The over-all accuracy of the angiographic diagnosis of simple benign cyst and renal tumor was 100%.
Angiography* ; Arteriovenous Malformations ; Diagnosis ; Female ; Flank Pain ; Hematuria ; Humans ; Incidence ; Kidney ; Male ; Urography

We studied 33 patients with acute urinary retention due to benign prostatic hyperplasia for evaluating the recovery of the detrusor muscle function and its affecting factors through the serial urodynamic studies prospectively. And ninety nine patients were studied for risk factors of acute urinary retention retrospectively. Among the 33 patients studied prospectively, detrusor contraction at immediate decompression was observed in 20 cases(60.7%) and was not observed in 13 cases (39.3%), and there was statistically significant difference in the retained volume and duration of retention between two groups. In 10 cases of non-contraction group at immediate decompression, serial urodynamic studies showed that detrusor contraction recovered within 2 days in 4 cases, but in 6 cases no detrusor contraction was found upto 5 days. Overall, detrusor function recovered in 80% or patients within 2 days. Among the patients studied for risk factors, hesitancy and interruption were the most common symptoms whereas urgency and urge incontinence were the least common. In conclusion, it is thought that acute urinary retention due to benign prostatic hyperplasia is resulted from temporary or permanent loss of detrusor muscle function due to overdistension, and the degree of retention duration and retained volume expressly affect the severity of loss of detrusor muscle function. The risk of acute urinary retention is higher in benign prostatic hyperplasia patients with obstructive symptoms rather than irritative symptoms.
Decompression ; Humans ; Prospective Studies ; Prostatic Hyperplasia* ; Retrospective Studies ; Risk Factors ; Urinary Incontinence, Urge ; Urinary Retention* ; Urodynamics