No abstract available.
Echocardiography* ; Heart Failure* ; Heart*

Simple prostatectomy has been a mainstay of therapy for patients with benign prostate hyperplasia. In recent years, laparoscopic radical prostatectomy has emerged as a feasible treatment option for patients with localized prostate cancer. The advantages of laparoscopic procedures are minor surgical scars, shorter hospital stay, fewer analgesics utilization, and more rapid return to daily normal activities. We describe the use of laparoscopic resection of large hyperplastic prostate adenomas as an alternative to open prostatectomy.
Adenoma ; Analgesics ; Cicatrix ; Humans ; Hyperplasia ; Laparoscopy ; Length of Stay ; Prostate ; Prostatectomy* ; Prostatic Neoplasms

Purpose: Transurethral resection of the prostate (TURP) is the surgical treatment for symptomatic benign prostate hyperplasia with a good result, but some cases of postoperative delirium have been associated with this treatment. The purpose of this study is to develop and validate clinical prediction of postoperative delirium using the preoperative and postoperative data. Materials and Methods: We analyzed 417 patients who were admitted for TURP between January 1999 and December 2004. All patients underwent evaluations, including a medical history and laboratory tests, and we recorded the operative time, resection volume, complications, medications and length of stay from the medical records. Postoperative delirium was diagnosed using DMS-IV. Logistic regression test was used to assess the data of the patients and to determine the risk factor of postoperative delirium. Results: Postoperative delirium occurred in 33 patients (7.9%) of the 417 patients. The hospital stay of the patients with delirium was longer than that of the patients without delirium. Delirium was associated with an age>or=70 years, a postoperative Hb<10g/dl and decreased Hb>or=2.0g/dl (p<0.05). A postoperative Hb<10g/dl and a decreased Hb>or=2.0g/dl were associated with an increased risk of delirium on the multivariate analysis (odds ratio=4.6 and 5.7). Conclusions: The incidence of postoperaitve delirium in elderly patients with symptomatic benign prostate hyperplasia was 7.9%, and a postoperative Hb<10g/dl and a decreased Hb>or=2.0g/dl were identified as risk factors. Because delirium was associated with a variety of adverse outcomes, difficult treatment and high mortality, those patients with risk factor for delirium must be kept under close observation after TURP.
Aged ; Delirium* ; Humans ; Hyperplasia ; Incidence ; Length of Stay ; Logistic Models ; Medical Records ; Mortality ; Multivariate Analysis ; Operative Time ; Prostate* ; Prostatic Hyperplasia ; Risk Factors* ; Transurethral Resection of Prostate

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

The primary urethral calculi are rare and usually associated with urethral strictures or diverticulum. We report a case of primary giant urethral calculus in 79-year old man who has had no significant urinary and sexual symptom for 48 years.
Aged ; Calculi* ; Diverticulum ; Humans ; Urethra ; Urethral Stricture

A complicated urachal cyst requires surgical excision to prevent symptom recurrence and complications, most notably malignant degeneration. However, a traditional open excision is associated with significant morbidity and prolonged convalescence, especially in children. A seven year old male, with a complicated urachal cyst, underwent a laparoscopic excision of the urachal remnant. Through a transperitoneal approach, using three ports, the urachus was excised and separated from the bladder dome. We report our experience of a laparoscopic excision of an urachal cyst, with a review other reports, to find the efficacy and outcome of this approach as a minimally invasive alternative.
Child* ; Convalescence ; Humans ; Laparoscopy ; Male ; Recurrence ; Urachal Cyst* ; Urachus ; Urinary Bladder

PURPOSE: Cystourethroscopy provides information on the cause, size and severity of obstruction and the patency of the bladder neck, prostatic occlusion of the urethra and the estimated prostatic size. We evaluated the relationship between the prostatic morphology on the cystourethroscopic findings and the clinical findings and the outcomes of transurethral resection of the prostate (TURP). MATERIALS AND METHODS: We evaluated 291 patients who underwent TURP between January 1999 and June 2004. The prostate volume, the preoperative maximal flow rate (MFR), the postvoid residual urine volume (PVR) and the International Prostate Symptom Score (IPSS) were determined. The patients were divided into 4 groups by the cystourethroscopic findings before TURP: group I - isolated middle lobe enlargement, group II - isolated lateral lobe enlargement, group III - middle and lateral lobe enlargement, group IV - posterior commissural hyperplasia (median bar type). RESULTS: The analyses included 250 patients who had a mean age of 71.2 years, a mean prostate volume of 46.2g, a mean preoperative MFR of 7.8ml/s, a PVR of 73.1ml and an IPSS of 25.6. The prostate volume was larger in group II and III than in group l. The preoperative MFR and IPSS were not correlated with the prostatic morphology, but the storage symptom score was significantly higher in group IV. The postoperative parameters were not correlated with the prostatic morphology noted on cystourethroscopy. CONCLUSIONS: The cystourethroscopic findings are not prognostic factors for the expected surgical outcomes in TURP. TURP is a good surgical therapeutic tool for treating benign prostatic hyperplasia regardless of the prostatic morphology seen on cystourethroscopy. Cystourethroscopy might need to be performed only in limited cases.
Cystoscopy ; Humans ; Hyperplasia ; Neck ; Prostate* ; Prostatic Hyperplasia ; Transurethral Resection of Prostate ; Urethra ; Urinary Bladder

PURPOSE: Laparoscopic pyeloplasty is an alternative, minimally invasive approach for the repair of an ureteropelvic junction obstruction (UPJO). However, it has a technical difficulty, and various laparoscopic approaches are available. We present our initial experience of laparoscopic pyeloplasty using a transperitoneal approach in patients with an UPJO. MATERIALS AND METHODS: Between January 2002 and January 2004, 11 patients underwent laparoscopic pyeloplasty using a transperitoneal approach. Of these 11, 10 patients were followed up and enrolled in this study. They were comprised of 6 males and 4 females, with a mean age of 44 years (19-62). The chief complaints were flank pain in 8 patients, with a further 2 incidental detected. Three patients had had previous abdominal surgeries. The mean length of stricture was 1.1cm in the radiologic studies, and the degree of hydronephrosis was grade 3/4 in 6 patients and grade 4/4 in 4. An obstructive pattern in the 99mTc-MAG3 renal scan was present in 9 patients. RESULTS: Eight patients were treated with dismembered Anderson-Hynes pyeloplasty and 2 patients with Fenger pyeloplasty. The mean operating time and hospital stay were 225 minutes (120-450) and 7.4 days (5-10), respectively. During the operation, crossing vessels were found in 4 patients and an ureteral polyp in 1. One patient had an ascending colon injury, which was postoperatively detected and repaired. The mean follow- up period was 42.5 weeks (26-135). Follow-up excretory urography and a 99mTc-MAG3 renal scan showed improvements in 8 of the 10 patients (80%) at the 3 month follow-up. The flank pain disappeared in all the patients (100%) who had previously complained of this symptom. CONCLUSIONS: Laparoscopic pyeloplasty could be an alternative treatment for an ureteropelvic junction obstruction, especially using a transperitoneal approach, which seems to have a technical convenience over that of the retroperitoneal approach.
Colon, Ascending ; Constriction, Pathologic ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney Diseases ; Laparoscopy ; Length of Stay ; Male ; Polyps ; Technetium Tc 99m Mertiatide ; Ureter ; Ureteral Obstruction ; Urography

BACKGROUND: Limited information about the effects of stroke on sexual functioning is available. The purpose of this study was to assess the influences of ischemic stroke on sexual functioning and to evaluate the clinical and psychological factors related to poststroke sexual dysfunctions. METHODS:Sixty-six male post-ischemic stroke patients and fifty-one age-matched healthy controls completed a self-administered questionnaire on sexual functioning. The localization of ischemic stroke was determined by neuroimaging findings as well as focal neurological signs. The degree of disability and the degree of depression were also assessed. RESULTS: All domains of sexual functioning, including erectile functions, orgas-mic functions, sexual desire, intercourse satisfaction, and overall satisfaction were decreased in poststroke patients. Patients with occipital lesions had a lesser degree of sexual dysfunctions than those with lesions affecting other areas (p<0.05). Also, sexual dysfunctions in stroke patients were related to the degree of physical disability and the presence of depression (p<0.05). CONCLUSIONS Sexual dysfunctions are common in stroke patients. The reasons for sexual dysfunc-tions after stroke are multifaceted, which include stroke lesion site, physiological factors, and psychosocial factors. (J Korean Neurol Assoc 19(4):342~348, 2001)
Depression ; Humans ; Male ; Neuroimaging ; Psychology ; Surveys and Questionnaires ; Stroke*

BACKGROUND: The primitive reflexes such as palmomental, glabella, snout, nuchocephalic reflexes may appear in a variety of diseases of the central nervous system. In this study, we investigated the frequencies of these primitive reflexes in the healthy elderly Korean population that have never been studied before. METHODS: Randomly selected 103 vol-unteers aged older than 60 years were examined by neurologists with a systemic neurological examination which included primitive reflexes and by radiologists with neuroimaging. Seven subjects were excluded from the study due to abnormal findings in the MRI of one subject and unusual neurological signs in 6 subjects. RESULTS: The overall mean age of the subjects was 66.5 years. One or more of the primitive reflexes were seen in 26 (24.9%) subjects. Eighteen (17.2%) subjects showed the palmomental reflex; eleven (10.5%) subjects showed the glabella reflex; five (4.8%) sub-jects showed the snout reflex; and one (1.0%) subject showed the nuchocephalic reflex. One subject had palmomental, glabella as well as snout reflexes, and five subjects had two primitive reflexes at the same time. CONCLUSIONS: Despite the normal findings from the neurological examinations and neuroimaging, 24.9% of healthy aged people had one or more primitive reflexes. The presence of these primitive reflexes as an isolated phenomenon may not imply brain lesions. (J Korean Neurol Assoc 19(4):380~383, 2001)
Aged* ; Brain ; Central Nervous System ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Examination ; Reflex*