PURPOSE: Laparoscopic bladder neck suspension is an effective treatment for genuine stress urinary incontinence. To decrease the operating time, associated morbidity and hospital stay, we introduced laparoscopic bladder neck suspension using extracorporeal needle. We assessed the feasibility of this new technique, and compared with simple laparoscopic bladder neck suspension and transvaginal Raz procedure. MATERIALS AND METHODS: Eleven patients underwent a laparoscopic bladder neck suspension using extracorporeal needle were compared with 16 patients underwent simple laparoscopic bladder neck suspension and 66 patients treated with transvaginal Raz procedure for genuine stress urinary incontinence. All patients were assessed for their age, duration of symptom, operative time, length of hospital stay, postoperative residual urine volume, complications, and success rate. RESULTS: The result of present method was cure in 82% and improvement in 18% of patients. The overall success rate of three methods were similar. Average duration of postoperative admission was 3.4 days and average residual urine volume at discharge was 12.1 ml (simple laparoscopic Burch procedure: 5.1 days and 22.1 ml; Raz procedure: 7.7 days and 37.5 ml). Operative time of laparoscopic bladder neck suspension using extracorporeal needle was shorter than the simple laparoscopic bladder neck suspension and transvaginal Raz procedure (55 vs. 125 and 102 minutes). CONCLUSION: Laparoscopic bladder neck suspension using extracorporeal needle is a good technique for treatment of genuine stress urinary incontinence. However, additional long term follow-up study will be required.
Follow-Up Studies ; Humans ; Length of Stay ; Neck* ; Needles* ; Operative Time ; Urinary Bladder* ; Urinary Incontinence*

No abstract available.
Prognosis*

For the treatment of genuine stress urinary incontinence(GSUI), various surgical approaches have been developed since early in this century. Laparoscopic bladder neck suspension has recently been described as an alternative method to the open surgical correction of GSUI. We had treated 16 patients of GSUI with laparoscopic Burch procedure from May to November 1995. Mean age of the patients was 42.5 years(range:28-77years) and mean parity was 3.7. There was no serious operative complications such as bladder rupture or bleeding needed transfusion. The duration of follow up was 6.2 months(range:3-9 months) in average. Incontinence was completely disappeared in 11 patients(68.7%) and significantly improved in 5 patients (31.3%), and no patient was recurred during follow up periods. Postoperatively, there was no significant complication, except two cases of urinary tract infection. Early results of the small number of women studied suggest that this new technique can provide successful outcomes in properly selected patients.
Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Neck* ; Parity ; Rupture ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Tract Infections

PURPOSE: This study was designed to identify the possible mechanism of insensitivity of DU145 prostate cancer cells to the transforming growth factor (TGF)-beta1-mediated growth inhibition. MATERIALS AND METHODS: DU145 cells were treated with 4, 40, 100 pM TGF-beta1 for 3, 6, 9 days. Initially we performed the growth assay. After that, we analysed the change of cell cycle using fluorescence flow cytometry. At each time point, Western blot analysis with cell pellets was performed to investigate the change of expressions of epidermal growth factor(EGF), TGF-alpha, EGF receptor(EGFR) and TGF receptorII(TbetaR-II) proteins. RESULTS: The growth rate of TGF-beta1-treated cells was initially suppressed, but over time returned to control level. Flow cytometric analysis revealed that TGF-beta1-treated cells showed an increase in apoptotic/G1 phases, and concurrent decrease in S, G2/M phases until 6days. On day 9, however, TGF-beta1-treated cells showed a persistent increase of apoptotic unclei in spite of recovery of apoptotic/G1, S and G2/M phases. Western blot analysis showed that the intensity of EGF or TGF-alpha band decreased in dose-sependent manner on day 6. However, the intensity of each band increased up to the control level on day 9. the expression of EGFR or TbetaR-II protein did not change after treatment of TGF-beta1. CONCLUSIONS: these results suggest that EGF and TGF-alpha sould mediate in part the escape fron the inhibitory effect of TGF-beta1 in DU145 cells.
Blotting, Western ; Cell Cycle ; Epidermal Growth Factor* ; Flow Cytometry ; Fluorescence ; Prostate* ; Prostatic Neoplasms* ; Transforming Growth Factor alpha ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; United Nations

Forty two patients (ages 55 to 88 years) who had bladder outlet obstruction due to benign Prostatic hyperplasia were treated with TULIP procedure from October 1993 to Apri1 1994. Preoperatively, the patients underwent digital rectal examinations, determination of prostate specific antigen levels and transrectal ultrasound guided biopsies when necessary to rule out the presence of prostatic cancer. The overall preoperatively estimated weight of prostate gland was 37.3+/-5.0g by transrectal ultrasonography, and all types of prostatic enlargement, including median lobe obstruction, were treated. The TULIP device incorporates ultrasound visualization with 90 degree angle, side-firing Nd: YAG laser to induce coagulation necrosis of prostatic tissue. Treatment was performed primarily under epidural anesthesia, and the mean irradiated laser energy was 20,315 joules. There were no intraoperative complications such as hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. The patients were evaluated at three months following treatment. The subjective symptom scores were significantly decreased from 23.7+/-4.3 to 3.2+/-1.9 for a 87% improvement(P<0.001). Maximum flow rate increased from 8.2+/-3.2ml/sec to 13.7+/-3.4ml/sec, for a 67% improvement (P<0.001). For three months follow-up period epididymitis was developed in 2 cases, but these were easily handled with antibiotics. There were no patients of incontinence or impotence, as a complication, after TULIP procedure With these results we can conclude that TULIP is a reliable and effective procedure of little morbidity, especially for the aged patients with various medical problems.
Anesthesia, Epidural ; Anti-Bacterial Agents ; Biopsy ; Blood Transfusion ; Digital Rectal Examination ; Epididymitis ; Erectile Dysfunction ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Lasers, Solid-State ; Male ; Necrosis ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Tulipa ; Ultrasonography ; Urinary Bladder Neck Obstruction

Various surgical approaches have been used for the treatment of genuine stress urinary incontinence. We had treated 30 patients of GSUI (genuine stress urinary incontinence) with modified Pereyra methods, so called Raz procedure. Mean age of the patients was 48.5 years (range; 32- 79 years). The duration of the incontinence was 10.4 years in average (range ; 0.5-26 years) In the degree of severity, Grade 1 was 3.3% (1), Grade II was 86.7% (26) and Grade III was 10% (3). Mean parity was 3.6 and six patients (20% ) had been undergone hysterectomy. The duration of follow up was 17.3 months in average. Incontinence was completely disappeared in 20 patients( 66.7%) and significantly improved in 7 patients ( 23.3% ), but three patients(10%) were recurred. There was no serious operative complication such as bleeding needed transfusion. But temporary urinary retention(8), suprapubic pain(7), vaginitis(2) and urinary tract infection(1) were complained. Raz procedure is a reliable technique among various surgical techniques with little morbidity.
Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Neck* ; Parity ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Tract

Visual internal urethrotomy (VIU) is a valuable initial management methods of the patient with incomplete urethral stricture. VIU is not widely used in the management of the patient with complete urethral stricture, due to the risk of complication. We performed VIU in 10 male-patients had suffered from complete urethral stricture after trauma. We used a flexible Chole-nephroscoper connected with Xenon light source as a guide for the VIU. The length of the urethral stricture was 1.2 +/-0.8 cm. The operation time was 62 +/-26.4 min. The urethral catheter had indwelled for 20.3 +/-17.19 days. All the 10 complete urethral stricture patients became to void successfully. There was no specific serious complication. In conclusion, this method needs only short operative time, had little complication and did not require fluoroscopic guidance. We suggest that this alternative method may be useful and safe for the management of the complete urethral stricture.
Humans ; Operative Time ; Urethral Stricture* ; Urinary Catheters ; Xenon

To evaluate the preoperative high risk factors in the management of benign prostatic hyperplasia. a score system has been devised which includes associated medical diseases and urologic complications such as urinary retention. urinary tract infection and uremia. A score of one to three was given for each high risk factor. The patients with a total score of one to three of each risk factor were regarded as grade I, four to six as grade II and more than seven as grade III. According to this score and grade system, the high grade group showed the high incidence of postoperative complications and morbidity. So. the more careful preoperative evaluations and postoperative cares might be needed in the high risk patients. On the base of this analysis, if more further studies will be performed. we may expect that we have achieved low mortality and morbidity rates even in high operative risk patients.
Humans ; Incidence ; Mortality ; Postoperative Complications ; Prostatic Hyperplasia* ; Risk Factors* ; Uremia ; Urinary Retention ; Urinary Tract Infections

Recently the percutaneous aspiration and instillation with 95% ethanol, for the sclerosing therapy of the renal simple cyst, was widely used because of high recurrence rate in simple needle aspiration. Ten patients were instillated with ethanol after aspiration. Ages of patients were between 37 to 77 years old. Chief complaints were flank pain, gross hematuria, indigestion, epigastric discomfort and hypertension. After local anesthesia, the cysts were punctured with a trocar needle and inserted 8.3 Fr. single J-catheter with guide wire in turn, under ultrasonic guidance. After complete aspiration of the fluid, 95% ethanol was instillated as much as 20-30% of the cystic volume, and kept for 20-30 minutes. The pigtail catheter was removed after one day. The aspirated volume was 166 ml in average and nearly identical to transudate. There was no bacteria or malignant cells. Follow-up period was 7+/-2 months in average. Five cases were completely cured, four cases recurred but the cyst was smaller(< 50% of the original size) and one recurred as its original size. The complications were transient flank pain and facial flushing. In conclusion, aspiration and instillation with ethanol was very easy, safe, fast and effective treatment for the simple renal cyst.
Aged ; Anesthesia, Local ; Bacteria ; Catheters ; Dyspepsia ; Ethanol* ; Exudates and Transudates ; Flank Pain ; Flushing ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Needles ; Recurrence ; Surgical Instruments ; Ultrasonics

Of 105 patients who underwent percutaneous nephrolithotomy (PNL) for 10 years, 22.9% had complications. Major complications were severe hemorrhage (6cases), renal pelvis perforation (2cases), ureteral perforation (1case) and pyonephrosis (1case). The patients with severe hemorrhage were treated with nephrectomy (1case), transarterial embolization (1case) and transfusion (4cases, 5pints or more). All the cases with pelvis perforation were treated with primary repair. And the patient with postoperative pyonephrosis required nephrectomy Minor complications included hemorrhage (4cases), urinary tract infection (5cases), paralytic ileus (2cases) and fever (3cases), which were treated with conservative managements. We compared the success and complication rates between early and late 5-year periods. The success rates in the early and late periods were 82.0% and 92.7%, respectively. On the other hand, the complication rates in the early and late periods were 30.0% and 16.4%, respectively Thus we conclude that PNL must be included in the effective treatment of upper urinary tract stone disease if experiences and operation technique for PNL were accumulated and appropriate therapy for the complications were taken.
Fever ; Hand ; Hemorrhage ; Humans ; Intestinal Pseudo-Obstruction ; Kidney Pelvis ; Nephrectomy ; Nephrostomy, Percutaneous* ; Pelvis ; Pyonephrosis ; Ureter ; Urinary Calculi ; Urinary Tract Infections