PURPOSE: To compare the estimated degree of urine leakage during straining on standing cystourethrography(CUG) under fluoroscopy with subjective degree and Valsalva leak point pressure(VLPP), and to determine it's clinical significance. MATERIALS AND METHODS: 157 consecutive women who presented with stress urinary incontinence with a mean age of 47 years were included in this study. Standing CUG was performed in the state of urethral catheter insertion and removal. Degree of urine leakage was determined on the fluoroscopy during standing CUG by one urologist, and VLPP was determined by another observer. Each of subjective degree, leakage amount and VLPP was classified into 3 grade and compared it's results to each other. RESULTS: High correlation was present between the leakage amount and VLPP(p<0.05), and the subjective degree and VLPP(p<0.001), but subjective degree was not highly correlated with leakage amount. Among the clinical parameters, urge syndrome and urge incontinence only had the positive effect to urine leakage. CONCLUSIONS: Estimation of leakage amount during standing CUG on fluoroscopy seems to be a simple and useful method in the objective evaluation of urine leakage, but it should be considered to be the possibility of over-estimation in the cases of associated urge syndrome and urge incontinence.
Female ; Fluoroscopy ; Humans ; Urinary Catheters ; Urinary Incontinence* ; Urinary Incontinence, Urge

Detrusor instability is defined as involuntary detrusor contraction above 15 cmH2O during normal bladder filling without neuralgic disorder. Recently clinical evaluation of the patients with detrusor instability was being made more commonly by urodynamic study. We analysed urodynamic study (filling and voiding cystometry) on 26 patients diagnosed as BPH with detrusor instability (Group A) on the Department of Urology, Korea University Haehwa Hospital during the period from September. 1988 to July, 1989. The results were compared with the 22 patients who were diagnosed as BPH without detrusor instability (Group B). The results was followed : 1. In Group A, bladder volume of urge to void (148.81 +- 87.61 ml) and maximum cystometric capacity (231.80 +- 116.49ml) were lower than the results of Group B (232.41 +- 101.69ml and 429.82 +- 121.16ml) in filling cystometry. 2. In Group A, the compliance was low in 21 (<20ml/cm H20) and mean compliance was 10.38 +- 10.29ml/cm H20. It was much lower than that of the Group B (28.66 +- 17.19ml/cm H20) (p <0.005). 3. In voiding cystometry, typical obstructive pattern was 32 cases and 11 cases were failed due to urge incontinence during filling cystometry. 4. Among 26 cases of BPH with detrusor instability, Oxybutynin were given on 12 cases in which postoperative incontinence were persisted in spite of UTI control. 5. 10 (83.3%) in 12 cases of BPH group treated with Oxybutynin showed subjective improvement of irritative voiding symptoms. 6. Detrusor pressure at maximum cystometric capacity were 74.2 +- 29.7 cmH20 in Group A and 45.2 +- 25.7 cmH20 in Group B. (p<0.005).
Compliance ; Humans ; Korea ; Urinary Bladder ; Urinary Incontinence, Urge ; Urodynamics* ; Urology

PURPOSE: Bladder irritative symptoms such as urinary urgency or urge incontinence could be worse even after proper treatments, if accompanying the unstable bladder with lower urinary tract obstruction or female urinary incontinence was not found before treatments. We performed walking cystometrography to detect unstable bladder which could be masked by cystometrography in sitting position. MATERIALS AND METHODS: We evaluated 133 patients who complained of urinary urgency or urge incontinence. Walking cystometrography (Group 2) was done for pa tients who did not show unstable bladder at cystometrography in sitting position (Group 1). Bladder volume at first desire to void, cystometric maximal bladder capacity, and occurrence of unstable bladder of both groups were compared. RESULTS: In cystometrography performed in sitting position (Group 1), unstable bladder was found in 48 (36.1%) out of 133 patients. Among the rest 85 patients, 23 patients (27.1%) showed unstable bladder in walking cystometrography (Group 2). Conse quently, 71 (53.4%) out of 133 patients showed unstable bladder in both groups. Com paring the bladder capacity of these two measuring methods, we could observe that bladder volume at first desire to void and maximal bladder capacity of walking state were smaller than those of sitting position from 187.4 +/- 36.9ml (Group 1) to 138.5 +/- 31.6ml (Group 2), 413.6 +/- 42.5ml (Group 1) to 342.8 +/- 43.2ml (Group 2), respectively (p <0.05). CONCLUSIONS: We expect that the diagnosis of unstable bladder through walking cysto metrography is meaningful when the method is applied to the patients who have urinary urgency or urge incontinence but seem to be normal by conventional cystometrography.
Diagnosis* ; Female ; Humans ; Masks ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge* ; Urinary Tract ; Walking*

PURPOSE: The purpose of this study is to evaluate the efficacy of biofeedback 1 treatment and functional electrical stimulation in stress incontinence patients as a physiotherapy and to know which factors affect on the outcome. MATERIALS AND METHOD: A group of 65 patients with stress incontinence were treated with combined alternating biofeedback and intravaginal electrical stimulation during 12 sessions, each 21 minutes in length, during 6 weeks. All patients had type l or ll stress incontinence. RESULTS: At immediate post treatment, subjective cure(complete dryness) rate was 15% and improvement(recovery to avoid other forms of treatment) rate was 60% and failure rate was 25%. Thus, the overall success rate for this treatment was 75%. In 49 patients who had all scheduled sessions and good compliance, subjective cure rate was 14% and improvement rate was 71%, but in 16 patients not to have good compliance, cure rate was 19%, improvement rate was 25%. In compliant patients, the result of 3 months after treatment showed cure rate was 11%, improvement rate was 54%. Compliance with reatment was the most significant parameter predictive of a good outcome(p<0.01) and the degree of stress incontinence was also significant in compliant patients(p<0.05). No clinical correlation with outcome was found in age, type, severity of cystocele, pelvic muscle strength, initial degree of vaginal contraction. Intravaginal pressure increased by an average of 10cmH20. Increased vaginal pressure was found in 93% of the patients and at least 50%improvement was 61%. Urge incontinence and urgency were present in 10(15%) and 19(29%) of the patients and improvement including cure was found 90% in urge incontinence and 89% in urgency. CONCLUSIONS: Biofeedback treatment and functional electrical stimulation is more effective for the patients who have good compliance, low degree stress incontinence and combined bladder irritation symptoms. In order to attain and maintain good results, a well structured biofeedback and functional electrical stimulation program that teaches specific muscle exercise should be used and the patients should be followed by a maintenance program and reinforcement.
Biofeedback, Psychology* ; Compliance ; Cystocele ; Electric Stimulation* ; Humans ; Muscle Strength ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: We evaluated the changes of storage symptoms after tension-free vaginal tape(TVT) procedures in stress urinary incontinence(SUI) patients, and we investigated the factors predicting the changes of storage symptoms. MATERIALS AND METHODS: From January 2000 to August 2003, 713 patients with SUI were operated on with using suburethral sling procedures(TVT). A follow-up study was conducted for over a one year period with 495 patients. We analyzed the one year outcomes of TVT surgeries and the changes of storage symptoms after TVT. RESULTS: The rates of cure and improvements at one year after TVT were 80.8% and 12.3%, respectively. At one month after TVT, 59 of 180(33%) patients with urgency before TVT were improved, and 60 of 72(83.6%) patients with urgency incontinence before TVT were improved. In 86 of 180(47.8%) patients, the urgency is improved, and in 65 of 72(90.1%) patients, the urgency incontinence disappeared at one year after TVT procedure. Urgency developed in 65 of the 243(26.9%) patients who had no urgency before TVT, but after 1 year, only 28(10.2%, 25/243) these 243 patients had urgency. 102(31.6%) of the patients with frequency before TVT were improved after TVT. Of the 92 patients with nocturia, 22 (23.4%) patients were improved. There were no statically significant factors predicting the changes of the storage symptoms. CONCLUSIONS: The total improvement rate (cure+improvements) of stress urinary incontinence was 93.1% at one year. We can expect the improvement of urgency(47.1%) and urgency incontinence(90.1%) after TVT procedures, but not improvement of the frequency and nocturia.
Follow-Up Studies ; Humans ; Nocturia ; Suburethral Slings* ; Urinary Bladder, Overactive ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: We reviewed surgical results in a group of women after Raz bladder neck suspension using questionnaire based outcomes analysis. MATERIALS AND METHOD: Of 71 patients who underwent Raz bladder neck suspension 55 had completed the questionnaire. Interviewees mean age was 54 years(range: 41-72 years) and mean observation time was 26.2 months(range: 3-77 months). RESULTS: According to outcomes analysis 39 patients(70.9%) were cured, 4(7.2%) improved, 11(20%) same and 1(1.8%) became worse. Overall improvement was found to be 43 patients(78.2%). 40(72.7%) patients replied 'satisfactory' for the Raz bladder neck suspension. Overall 'success rate' was estimated as 74.5%. No significant statistical correlation was found between success rate of Raz bladder neck suspension and various factors such as patients age, urge incontinence or follow up length. Of the 55 patients 7(12.7%) reported daily pad use. CONCLUSIONS: With these questionnaire based outcome analysis there was an overall success rate of 74.5%. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontience surgery.
Female ; Follow-Up Studies ; Humans ; Neck* ; Surveys and Questionnaires* ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: The purpose of this study is to compare changes in voiding pattern after midurethral sling surgery (MUS) between the stress urinary incontinence (SUI) group and the overactive bladder (OAB)+SUI group. MATERIALS AND METHODS: From January 2008 to February 2011, a retrospective survey was conducted of 225 female patients who had been diagnosed with SUI and undergone MUS. The subjects were divided into the SUI group and the OAB+SUI group. Changes in the overactive bladder symptom score (OABSS) and American Urological Association-Symptom Index (AUA-SI) before and three months after the MUS were compared. RESULTS: Of the 225 patients, 165 patients (73.3%) were classified as SUI group, and 60 patients (26.7%) were classified as OAB+SUI group. The mean age of the subjects was 54.7 years (range, 31-80 years), and the mean age of patients was 53.9 years (range, 34-80 years), and 56.8 years (range, 31-78 years) in the SUI group and OAB+SUI group. In SUI group, voiding symptom and storage symptom among the AUA-SI were significantly increased (p<0.05). OABSS were slight increased, but was statistically insignificant (p=0.847). In OAB+SUI group, voiding symptom score and OABSS showed a significant increase (p<0.05), but storage symptom score showed an insignificant increase (p=0.790). CONCLUSIONS: OAB may occur in approximately 18% of SUI patients who undergo MUS surgery, and voiding dysfunctions with deteriorated voiding symptom and storage symptom may also occur. The deteriorated OAB was shown in 45% of SUI patients with OAB after the surgery.
Animals ; Female ; Humans ; Mice ; Retrospective Studies ; Suburethral Slings* ; Urinary Bladder, Overactive* ; Urinary Incontinence* ; Urinary Incontinence, Urge

PURPOSE: This study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence (SUI). For this purpose, we recruited women with symptoms of mixed as well as pure SUI and compared the clinical characteristics of each subgroup. MATERIALS AND METHODS: A total of 241 female patients who were diagnosed with SUI and mixed urinary incontinence (MUI) were analyzed retrospectively. Patients with only SUI were categorized as group 1. Patients with MUI were categorized as group 2. Clinical and urodynamic differences between the 2 groups were compared. RESULTS: The proportion of Stamey grade was significantly different between the 2 groups: grade 1 SUI was higher in group 1, but grades 2 and 3 SUI were higher in group 2. The incidence of urgency was proportional to the degree of Stamey grade (23.5% in grade 1, 36.9% in grade II, and 60.0% in grade III). In the urodynamic study, the presence of detrusor overactivity was significantly higher in group 2 than in group 1 (25.9% vs. 49.4%). Other clinical parameters were also significantly different between the 2 clinical groups: Q-tip angle (group 1: 42.1degrees, group 2: 28.6degrees, p<0.05), maximal urethral closure pressure (group 1: 54.7 cmH2O, group 2: 44.1 cmH2O, p<0.05), maximal bladder capacity (group 1: 356.3 ml, group 2: 282.0 ml, p<0.05), and bladder volume at first desire (group 1: 144.6 ml, group 2: 123.2 ml, p<0.05). CONCLUSIONS: According to this analysis, the more serious the symptoms of SUI, the higher the incidence of urinary urgency.
Female ; Humans ; Incidence ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: Detrusor instability is common in men with benign prostatic hypertroplasia(B.P.H.) and known to be reversed in about two thirds of patients after operation. We evaluated the fate of detrusor instability in B.P.H patients after operation. MATERIALS AND METHODS: In 11 patients with urgency or urge incontinence combined with B.P.H., cystometries were performed at baseline and 3 months after operation. RESULTS: Detrusor instability associated with B.P.H was reversed postoperatively in 7 patients (63.6%). CONCLUSIONS: Detrusor instability with urgency or urge incontinence can be managed by operation for B.P.H. This will improve the quality of life for B.P.H. patients.
Humans ; Male ; Prostatectomy* ; Prostatic Hyperplasia* ; Quality of Life ; Urinary Incontinence, Urge

Burch and Stamey operations are reliable techniques for correcting genuine stress urinary - incontinence. The purpose of this study is to evaluate which operation brings better success and which factors affect the postoperative outcome. We reviewed 103 patients who underwent Burch (53 patients) and Stamey (50 patients) operations between January 1992 and June 1994 for stress urinary incontinence. The followup period of all patients was over 2 years and mean followup was 37 months. A standardized questionnaire using telephone was used to evaluate postoperative outcome. Cure (complete dryness) rate was 72% in Burch and 48% in Stamey group. Overall, a successful outcome (cure or rare stress incontinence not requiring protection) was 92% of patients in Burch and 76% in Stamey group. In Stamey group, the only significant predictor of outcome was the degree of preoperative stress urinary incontinence (mild, moderate, severe) but not in Burch group. No statistical correlation in success was found with patients age, number of parity, prior hysterectomy, combined operation (hysterectomy, anterior and posterior colporraphy), preoperative urgency and urge incontinence. Preoperative urgency was present in 23% of Burch, and 30% of Stamey group patients. Postoperative resolution of urgency was 58% in Burch, and 60% in Stamey group. De novo urgency occurred in 20% of Burch group patients, and in 14% of Stamey group patients. Persistent or de novo urgency was more common among failure group than success group (75% vs 20% in Burch group, 42% vs 16% in Stamey group). The success rate of Burch operation was higher than Stamey operation. So we think Burch operation is better management for stress urinary incontinence. In Stamey group, the only factor affecting on outcome was the degree of preoperative stress urinary incontinence.
Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Parity ; Surveys and Questionnaires ; Telephone ; Urinary Incontinence* ; Urinary Incontinence, Urge