PURPOSE: The 1-hour pad-weighing test was compared with the cystourethrogram as a method for the preoperative diagnostic assessment of female stress urinary incontinence. MATERIALS AND METHODS: The records of 80 women, with stress urinary incontinence that had undergone anti-incontinence surgery, were reviewed. The 1-hour pad weighing test, proposed by the International Continence Society in 1988, was performed for the objective assessment of the degree of incontinence in all patients. History taking, physical examinations and cystourethrograms were also performed and the correlation between the 1-hour pad-weighing test and the results from the above procedures evaluated. RESULTS: The urinary leakage was examined in all patients during the 1-hour pad-weighing test, with an average urine loss of 50g (5-150). In 13 patients, no urinary leakage was demonstrated during straining on the cystourethrogram. Thus, compared with the 1-hour pad-weighing test, the cystourethrography was less sensitive in the diagnosis of incontinence, with a 16% false negative rate. The bladder neck position and degree of descent were measured on the cystourethrogram during resting and straining. The position of the bladder neck averaged 2.2 (0.5-6.0) and 4.2cm (1.0-8.0) from the upper margin of the symphysis pubis at rest, and during straining, respectively. The difference between these two parameters averaged 2.0cm (0.2-4.0). The number of type III stress urinary incontinence patients, based on the Blaivas classification, was 9. There were statistically significant correlations between the 1-hour pad-weighing test and the bladder neck positions during resting (r=0.296, p=0.008) and straining (r=0.356, p=0.001) on the cystourethrograms. There was a statistically significant difference between the 1-hour pad-weighing test and bladder neck opening during resting (p=0.001). CONCLUSIONS: It seems that the 1-hour pad-weighing test is an easy, inexpensive and non-invasive method for the preoperative diagnostic assessment of female stress urinary incontinence.
Classification ; Diagnosis ; Female* ; Humans ; Incontinence Pads ; Neck ; Physical Examination ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress

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: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
Cholinergic Antagonists ; Diagnosis ; Female* ; Humans ; Urinary Incontinence*

PURPOSE: Lateral cystourethrography is a radiological method used in the diagnosis and prediction of the degree of stress urinary incontinence. The aim of this study was to evaluate the efficiency of lateral cystourethrography in women with stress urinary incontinence. MATERIALS AND METHODS: In this retrospective study, a total of 76 women who underwent both cystourethrography and urodynamic study were included. The proximal urethral support was evaluated by lateral cystourethrography at rest and during voiding, with the images anatomically superimposed to measure the degree of bladder base descent and the posterior urethro-vesical angle (PUV angle). The urethral diameter was measured at 1cm below the bladder neck. Urodynamic assessments, included valsalva leak point pressure (VLPP), maximal urethral closing pressure (MUCP) and functional urethral length, were compared with the parameters of the cystourethrography. RESULTS: There was a significant correlation between the VLPP and the urethral diameter (p<0.05) only. Other parameters from the two methods showed no significant correlations. When the patients were divided into three subgroups, according to their VLPP (<60, 60-90, >90cmH2O), and into two subgroups, according to their MUCP (< or =25, >25cmH2O), the mean values of bladder base descent and PUV angle among the subgroups showed no significant correlation. CONCLUSIONS: In the current study, the lateral cystourethrography is suggested to not be appropriate for the diagnosis and prediction of stress urinary incontinence.
Diagnosis ; Female ; Humans ; Neck ; Retrospective Studies ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics* ; Urography

PURPOSE: This study was designed to determine the diagnostic availability of transperineal ultrasongraphy compared with chain cystourethrography for patients with stress urinary incontinence. MATERIALS AND METHOD: Twenty-seven outpatient women with stress urinary incontinence, who underwent both transperineal ultrasonography and chain cystourethrography for the last ten months, participated in this study. The mean age was 47 years(range 37 to 66 years). The posterior urethrovesical angle(PUVA) at lest and during strain, and both an increment of PUVA and bladder neck descent during strain were measured in the two methods, respectively. Wilcoxon Matched-Pairs Signed-Ranks test was used for the comparative analysis of the results. RESULTS: The mean of PUVAS at rest and during strain were 118.9 degrees and 142.3 degrees, respectively, and the mean of the increment of PUVAS during strain was 23.5 degreesin transperineal ultrasonography. The mean of PUVAS at rest and during strain were 130.7 degrees and 158,0 degrees, respectively, and the mean of the increment of PUVAS during strain was 27.3 in chain cystourethrography. There were statistically significant differences in PUVAS, but no significant differences in the increment of PUVAS during strain between the two methods. During strain condition, the mean descent of bladder neck was 11.8mm in transperineal ultrasonography and 13.7mm in chain cystourethrography, and there were no significant differences between the two methods. CONCLUSIONS: Compared with chain cystourethrography, the transperineal ultrasonography made no significant differences in the diagnosis of stress urinary incontinence using both the increment of PUVAS and the bladder neck descent caused by the increase of abdominal pressure during strain. In addition, the transperineal ultrasonography is considered to be replaceable for chain cystourethrography, as that is noninvasive, devoid of risks of irradiation, and removes the noticeable discomfort or embarrassment for the patient in the diagnosis of stress urinary incontinence.
Diagnosis ; Female ; Humans ; Neck ; Outpatients ; Ultrasonography* ; Urinary Bladder ; Urinary Incontinence

An ectopic ureteral orifice inserts at a point other than the trigone of the bladder. Ectopic ureteral orifices in a girl commonly are associated with complete ureteral duplication comprises only 10 to 12 per cent of such patients. Continuous incontinence in a girl with an otherwise normal voiding pattern after toilet training is the classic sign of an ectopic ureteral orifice. Here, we report a 3-years-old girl who was admitted to our hospital due to continuous urinary incontinence and managed with the diagnosis of bilateral ectopic ureteral orifices associated with bilateral complete ureteral duplication.
Diagnosis ; Female ; Humans ; Toilet Training ; Ureter* ; Urinary Bladder ; Urinary Incontinence

PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Diagnosis ; Exercise Test ; Female ; Humans ; Physical Examination ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics*

PURPOSE: The presence of urge incontinence may affect the results of stress urinary incontinence (SUI) treatment. In this study, women with SUI were divided according to their accompaniment with urge incontinence or not. The aim was to define a group in whom a urodynamic assessment was unnecessary prior to offering surgery. In other words, we wished to define a group where the treatment plan could be determined only with the clinical opinions based on the symptoms and physical examinations. MATERIALS AND METHODS: Two hundred and fifty five women with SUI between January 1997 and February 2001 were enrolled in this study. The women with SUI symptoms were divided into a group of patients who had symptoms of pure SUI, and those who had SUI as well as urge incontinence. The clinical and urodynamic variables were analyzed to identify the sub-groups of women where a urodynamic study was unnecessary before initiating treatment for SUI. RESULTS: Of the 101 women with symptoms of pure SUI, only 5 had a detrusor instability (DI). Of the 154 women with coexisting urge incontinence symptoms, only 33.8% (52/154) had DI, suggesting the poor predictability of urge incontinence symptoms for a diagnosis of DI based on the urodynamic study. An identification of SUI by the urodynamics were noted in 77.6% (198/255), which almost corresponding to the rate (76.9%) of positive urine leakage confirmed at the provocative stress test. CONCLUSIONS: If a patient has symptoms of pure SUI associated with a positive stress test, the SUI can be treated without a urodynamic study. For women with symptoms of mixed urinary incontinence, it may be better to undergo a urodynamic study before launching a definitive treatment.
Diagnosis ; Exercise Test ; Female ; Humans ; Physical Examination ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics*

PURPOSE: A finding of only subtle open bladder neck unaccompanied by leakage at resting state, without any other symptoms suggesting overt intrinsic sphincter incompetence, is commonly observed during cystographic evaluation for women with stress urinary incontinence (SUI). We tried to define whether this finding has any clinical significance in aspect of intrinsic sphincter deficiency. MATERIALS AND METHODS: A retrospective study was undertaken in a series of women whose diagnoses were SUI in our hospital. The appearance of contrast medium in the proximal urethra at resting state without overt leakage on cystogram was named as inverted tear-drop (ITD) sign. Quantification of ITD sign was made by measuring vertical and anterior-posterior (AP) distances of this area. Various clinical and urodynamic parameters were compared between the patients who had inverted tear-drop sign (ITD group) and those not (non-ITD group). RESULTS: A total of 453 women underwent fluoroscopic cystography and ITD sign was observed in 273 (60.2%). Analyses were performed in a total of 290 women (ITD group 186, non-ITD group 104). There was a significant difference in mean age between non-ITD (47.0+/-9.4 years) and ITD group (51.7+/-9.5 years). Several clinical factors such as frequency, urgency, urge incontinence, duration of symptoms, parity, previous pelvic surgery, previous anti-incontinence surgery, urine leakage volume by one hour pad test were not significantly different between two groups. However, a ITD sign was significantly more likely to be in groups of patients with menopause and those with a low valsalva leak point pressure (VLPP). VLPP was significantly lower in ITD group (87.1+/-2.7cmH2O) than in non-ITD group (99.0+/-4.1cmH2O). VLPP in ITD group has a negative correlation with vertical (p=0.0001. r=-0.498) and AP length (p=0.0014, r=-0.23) of tear-drop area. Maximal urethral closure pressure was significantly lower in ITD group (48.2+/-1.4cmH2O) than in non-ITD group (56.2+/-2.0cmH2O). ITD group has more advanced types by Blaivas classification than non-ITD group. CONCLUSIONS: Our results suggest that cystographic ITD sign at rest might reflect some loss of intrinsic sphincter function. When surgeons are planning to operate SUI patients, ITD sign could be considered as an additional parameter in choosing operation method.
Classification ; Diagnosis ; Female ; Humans ; Menopause ; Neck ; Parity ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics

From October 1990 through July 1991, 187 women who complained of urinary incontinence underwent investigation in the department of urology, especially urodynamically, compared with 42 women with female urethral syndrome as control group. The following results were obtained ; mean functional urethral length was 3.1+/-0.9cm and mean maximal urethral closure pressure was 80.2+/-2.4cmH2O in genuine stress incontinence patients. But each results of female urethral syndrome were 3.6+/-0.7cm and 121.1+/-3.8cmH2O, respectively, and were higher than those of genuine stress incontinence (p <0.05 ). The incidence of positive pressure equalization of genuine stress incontinence was higher than that of control group, as 85.6% and 14.3% (p<0.05). The findings of uroflowmetry and cystometry showed within normal limits in genuine stress incontinence and poor voiding pattern in female urethral syndrome. Conclusively. urodynamic study was important for diagnosis and follow up of genuine stress incontinence.
Diagnosis ; Female ; Humans ; Incidence ; Urinary Incontinence ; Urodynamics* ; Urology