PURPOSE: The factors affecting the success and quality of life following a tension-free vaginal tape(TVT) procedure were investigated in patients with stress urinary incontinence. MATERIALS AND METHODS: We included 79 women with stress urinary incontinence that underwent the TVT procedure and were followed for at least 3 years. Preoperatively, the patients were evaluated by history, physical examination, a 1-hour pad test, and videourodynamics to determine the abdominal leak point pressure(ALPP). In addition, pre- and postoperative quality of life was evaluated by the incontinence quality of life questionnaire(I-QoL). We analyzed factors including patient characteristics, history, 1-hour pad test and ALPP with respect to the success and quality of life after the TVT. A success after the TVT was defined as the absence of any subjective complaint of leakage. RESULTS: The overall 3-year success rate of the TVT was 90%. There was a statistically significant increase in the I-QoL scores postoperatively. There were no significant preoperative factors affecting the success rate and the postoperative I-QoL scores. However, when the postoperative I-QoL scores were compared with the preoperative scores, the increase in the I-QoL scores was significantly higher in the patients with urge incontinence, low ALPP and high-grade incontinence. CONCLUSIONS: The results of this study suggest that the TVT procedure is effective for treating female stress incontinence and improving the quality of life without any independent risk factors. However, for improving the quality of life, the TVT was more effective in women with stress urinary incontinence with urge incontinence, low ALPP and high-grade symptoms.
Female ; Humans ; Physical Examination ; Quality of Life* ; Risk Factors ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

Studies of urinary incontinence have so far paid little attention with female urinary incontinence (FUI). The aims of this study are to define the nature and extent of psychological stress in women with FUI in the absence of other abnormality. Thirty women aged 24 to 51 were diagnosed as FUI and 30 women as control group without FUI. Diagnostic procedure included a history taking, physical examination, and urodynamic evaluation. Personality traits were assessed by means of the state-trait anxiety inventory (STAI) and the Beck depression inventory (BDI) in 30 FUI women. The results were compared with a control group of c,0ntinent women. The mean patient age were 39.6 years in FUI and 40.5 years in control group. Among the FUI patients, 23 (77%) were genuine stress incontinence (GSI), and 7 (23%) were GSI with urge incontinence (UI). State anxiety inventory was 44.78 +/-10.27 in FUI group and 39.97 +/- 4.49 in control group, there was a significant difference (p=0.025). Depression inventory were 8.67 +/- 7.91 in FUI and 4.47 + 2.09 in control group, with a significant difference also (p=0.007). However, trait-anxiety inventory was 44.70 +/-9.54, and 40.80 +/- 5.31, respectively without no significant difference (p>0.05). The results of this study were that FUI was `associated with state-anxiety and depression. Although FUI is not a severe physical disability, many psychological problems are associated with it.
Anxiety* ; Depression* ; Female* ; Humans ; Physical Examination ; Stress, Psychological ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: The transobturator Monarc procedure is a new minimally invasive treatment for female stress urinary incontinence (SUI), and this is known to be safe and convenient because serious complications such as bladder or bowel perforation and vascular injury, which can happen during a tension-free vaginal tape (TVT) procedure, can be avoided and cystoscopic examination is not necessary. We evaluated the 2 year clinical outcome of transobturator Monarc sling procedures for female SUI. MATERIALS AND METHODS: There were 114 women who underwent the transobturator Monarc procedure for SUI at 3 different hospitals of The Catholic University of Korea from December 2003 to February 2004. After 2 years following surgery, all the patients were asked about their voiding symptoms as well as any recurrence by conducting detailed telephone interviews. RESULTS: For the 114 patients, 86 patients (75.4%) stated that they had complete resolution of SUI, and 22 patients (19.3%) stated they were continent with only a small amount of leakage when coughing. The overall success rate of the Monarc procedure was 94.7% (108/114). 36 (64.3%) out of 56 patients who had urgency or urge incontinence before surgery indicated the improvement of their symptoms following surgery. For 62 patients who had frequency, the symptom was improved in 48 patients (77.4%), and for the 44 patients who had nocturia, the symptom was improved in 32 (72.7%). CONCLUSIONS: These data demonstrates that the transobturator Monarc procedure is a safe and effective treatment for women with SUI, which is comparable with TVT, and the patients' voiding symptoms can be expected to be improved after the transobturator Monarc procedure as well. However, we do not know how long the improvement of the voiding symptoms will last, and so additional longer term follow-up should be done.
Cough ; Female ; Follow-Up Studies* ; Humans ; Interviews as Topic ; Korea ; Nocturia ; Recurrence ; Suburethral Slings ; Surgical Mesh ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Vascular System Injuries

PURPOSE: A lot of patients with stress urinary incontinence(SUI) have lower urinary tract symptoms. So we evaluated the changes of voiding pattern following transobturator tape(TOT) operation, and investigated the factors for predicting persistent urinary frequency after operation. MATERIALS AND METHODS: The items of preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume chart and symptoms questionnaire. Patients with anticholinergics or any neurologic diseases that affect the voiding pattern were excluded. Between January to November 2006, 46 patients with TOT operation were enrolled, and were reevaluated with physical examination, 3 day frequency-volume chart and symptom questionnaires, postoperatively. RESULTS: The patients who voided 8 or more times per day had shorter symptom duration and higher body mass index(BMI) than those who voided under 8 times per day(each p<0.05). In 30 patients who void 8 or moretimes per day preoperatively, 17(56.7%) patients became void under 8 times, postoperatively. In each patient who had urgency or urge incontinence symptoms preoperatively, respective 72.7 and 82.8% resolved their symptoms, postoperatively. No one complained de novo urgency or urge incontinence, postoperatively. In a multivariate analysis, the patient with a history of previous pelvic surgery or moderate to severe urge incontinence was tightly associated with an increased likelihood of persistent urinary frequency after TOT operation (odd ratio[OR] 24.8, 95% confidence interval[CI] 2.044-301.284, p=0.012 and OR 31.9, 95% CI 1.662- 613.619, p=0.022, respectively). CONCLUSIONS: The TOT operation can improve the symptoms of urinary frequency, urgency and urge incontinence in patients with SUI. However, the patients who had previous pelvic surgeriesor moderate to severe urge incontinence should be fully advised for the risk of sustaining frequency, postoperatively
Cholinergic Antagonists ; Female ; Humans ; Lower Urinary Tract Symptoms ; Multivariate Analysis ; Physical Examination ; Suburethral Slings ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

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

PURPOSE: The anterior vaginal wall sling (AVWS) was introduced to be a simpler and less morbid procedure than the fascial or synthetic slings. However, the long-term outcome of the AVWS has not been fully assessed. In this study, the long-term outcomes of AVWS in female stress urinary incontinence were determined. MATERIALS AND METHODS: A total of 54 patients, followed-up postoperatively for at least five years, were surveyed. The surgical outcome was evaluated by pre- and post-operative SEAPI scores, subjective satisfaction and complications. The preoperative clinical parameters were analyzed using a multivariate analysis to determine the factors influencing the success. RESULTS: After a follow-up period of at least 60 months (mean 72.3 months), 63% were cured, 24% showed improvement and 13% had unsuccessful outcomes. The multivariate analysis demonstrated no preoperative factors for the prediction of the outcome of the AVWS. In a subjective satisfaction assessment, 40.8% were extremely satisfied, 40.8% were satisfied, 9.3% felt fair, and 9.3% were dissatisfied. The short-term complications were; UTI (1 case) and operation related transfusion (1 case). The long-term complications were; de novo urge incontinence (3 cases), removal of suture material due to extra-vaginal protrusion (3 cases) and chronic pelvic pain (1 case), but there was no chronic retention. CONCLUSIONS: An AVWS has many benefits, such as low morbidity, easiness of familiarization and can be performed on patients with anatomical incontinence and internal sphincter deficiency. Nevertheless, the complete dry rate of AVWS is 63% for a follow-up of over 5-years. With regard to its long-term durability, this procedure is considered a less effective treatment modality for female stress urinary incontinence.
Female* ; Follow-Up Studies* ; Humans ; Multivariate Analysis ; Pelvic Pain ; Surgical Procedures, Operative ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.
Acidosis, Respiratory ; Catheterization ; Catheters ; Cystoscopy ; Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: To evaluate the long-term efficacy of laparoscopic Burch colposuspension, we reviewed the success rate and subjective satisfaction rate of this operation for female patients with stress incontinence. Materials and Methods: Between Sep. 1995 and Aug. 1999, 126 patients underwent laparoscopic Burch colposuspension. We reviewed 88 patients who had been followed up for more than 3 years. The mean patient age was 51.1 years and 26 of the 88 patients complained of urge incontinence. All were preoperatively assessed with voiding cystourethrography (VCUG), urodynamic study, cystoscopy and stress, emptying, anatomic, protection, and instability (SEAPI) score. Colposuspension was performed with 2 non- absorbable sutures (n=70) or polyprophylene mesh and Tacker (n=18) by the retroperitoneal approach. RESULTS: At the mean follow-up of 56 months, 58 patients (66%) were cured, and 19 patients (22%) showed significant improvements. Sixty one (94.4%) out of 66 patients who had previously required pad protection attained a pad-free status. Urge incontinence disappeared in 15 out of 26 patients, but 8 (9.1%) patients complained of de novo urge incontinence. The pre- operative factors (age, symptom periods, symptom score, abdominal leak point pressure (ALPP) and VCUG findings) made no difference for the success rate. The subjective satisfaction rate was 93%. The mean operation time was 88 minutes and it decreased to 67 minutes after 50 cases. The mean hospital stay was 3.5 days and mean duration of catheterization was 3.7 days. We had 5 (5.68%) cases of complications: two port site bleeding, one peritoneal injury, one respiratory acidosis and one obturator venous bleeding. However, all of them eventually recovered. CONCLUSIONS: Laparoscopic colposuspension revealed good results on the long-term follow-up, as well the operation as being a minimally invasive procedure. There was a 88% success rate, a 93% subjective satisfaction rate and 94% of the patients became pad free.
Acidosis, Respiratory ; Catheterization ; Catheters ; Cystoscopy ; Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Sutures ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: To determine the efficacy and safety of the in situ anterior vaginal wall sling procedure for the treatment of anatomical incontinence (AI) and intrinsic sphincter dysfunction (ISD). MATERIALS AND METHODS: A total of 53 women (31 with AI and 22 with ISD), having undergone in situ anterior vaginal wall sling procedures, were reviewed. The preoperative evaluation included a detailed history taking, physical examination and urodynamic study, including Valsalva leak point pressure (VLPP) and incontinence staging, with Stamey grade. The efficacy and clinical outcome of this procedure were accessed by telephone interviews. RESULTS: With a mean follow up of 30.8 months (24-52), 49 (92.5%) of the 53 patients were completely continent or improved. The success rate of AI and ISD patients were 93.5 and 90.9% respectively. One patient (1.9%) required a prolonged Foley catheter drainage of up to 2 weeks. Sixteen (84.2%) out of the 19 patients with preoperative urge incontinence improved postoperatively, and de novo urge incontinence developed in 1 patient (1.9%). Postoperative wound infections developed in 3 patients (5.7%). CONCLUSIONS: The in situ anterior vaginal wall sling procedure can be an effective and safe surgical treatment option in both AI and ISD patients.
Catheters ; Drainage ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Physical Examination ; Surgical Wound Infection ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge ; Urodynamics

PURPOSE: The results of pubovaginal sling operation using mersilene mesh fixed to Cooper's ligament(Cooper's ligament sling;CLS) were evaluated and compared with the results of anterior vaginal wall sling(AVWS). MATERIALS AND METHODS: One hundred forty patients who had undergone sling operation and had been followed up for more than one year were enrolled in the study. Sixty patients underwent CLS and 80 AVWS. Therapeutic efficacy and complications were evaluated by reviewing medical records and by telephone interview. RESULTS: Mean operating times were 93 and 87 minutes, mean urethral Foley catheter indwelling times were 1.5 and 1.8 days and mean postoperative hospital stays were 5.1 and 5.2 days, respectively, in the CLS and AVWS groups(p>0.05). Recurrence of incontinence was reported by 6 patients in the CLS group and 7 in the AVWS group(p>005). The incidence of significant complication and postoperative urge incontinence did not show a statistically significant difference between the two groups. Suprapubic pain of more than 1-month duration after surgery was found in patients in the AVWS group only, which had disappeared at 6 months after operation. The postoperative satisfaction state was statistically similar in both groups. CONCLUSIONS: Pubovaginal sling operation using mersilene mesh fixed to Cooper's ligament compares favorably with AVWS in terms of incontinence rate and complication. It has the clear advantages of being relatively cheap and devoid of the transvesical suprapubic pain that is seen with AVWS, and, furthermore, has the theoretical advantage of increased durability due to fixation to a fixed portion. Follow up for a longer period of time should be done.
Catheters ; Follow-Up Studies ; Humans ; Incidence ; Interviews as Topic ; Length of Stay ; Ligaments* ; Medical Records ; Recurrence ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge