No abstract available.
Female* ; Humans ; Urinary Incontinence*

No abstract available.
Female* ; Humans ; Urinary Incontinence*

PURPOSE: A varicocele is the most common correctable cause of infertility in men. Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, varicoele persistence and recurrence. The inguinal approach with classic Palomo technique was used to be simplified the procedure and to get the same good results with the Palomo technique. MATERIALS AND METHODS: From March 1990 to March 1997, we experienced surgical corrections of 54 patients with varicocele(A mean age 20.3 years) The most of patients were left-sided(96.3%). Until March 1996, surgical correction with Palomo(6 patients) and modified Palomo(13 patients) technique by retroperitoneal approach and Ivanissevich techrique(20 patients) by inguinal approach have been performed, and since April 1996, Palomo technique(15 patients) with inguinal approach has been performed, in which the entire vascular pedicle is ligated superior to the entrance of the was deferens through the inguinal incision. RESULTS: The postoperative recurrences in the modified Palomo technique occurred In two of the 13 patients(15%) and in the Ivanissevich technique in three of the 20 patients(15%). But there were no recurrences In the retroperitoneal Palomo and modified inguinal Palomo techniques. The modified inguinal Palomo technique was completed within 45.3minutes in mean duration, but the standard retroperitoneal Palomo technique within 55.2minutes, modified Palomo technique within 57.2minutes and Ivanissevich technique within 51.4minutes. There was no varicocele recurrence, hydrocele and atrophy of testis in modified inguinal Palomo techniques. CONCLUSIONS: The modified inguinal Palomo technique was easily approachable and relatively fast in our experience and had no recurrence.
Atrophy ; Humans ; Infertility ; Male ; Recurrence ; Testis ; Varicocele*

Adenocarcinoma of the rete testis arising in the mediastinum testis is a rare, highly malignant neoplasm. Wedescribe one such case in a 25-year-old male who presented with a palpable right scrotal mass which metasta-sizedto the right inguinal lymph node eight months later. Ultrasonography of this tumor showed a complex cystic andsolid mass in the swollen right scrotum, which was separate from the right testis. Ultrasonographic and clinicalfindings suggested that the mass was, indeed, paratesticular. Surgical pathology following right radicalorchiectomy and hemiscrotectomy, however, confirmed the presence of an exophytic adenocarcinoma of the retetestis. A pelvic CT performed to evaluate a right inguinal mass, which was palpated eight months later, revealed amainly cystic mass in the right inguinal area. Metastasis was confirmed by biopsy.
Adenocarcinoma* ; Adult ; Biopsy ; Humans ; Lymph Nodes ; Male ; Mediastinum ; Neoplasm Metastasis ; Pathology, Surgical ; Rete Testis* ; Scrotum ; Testis ; Ultrasonography

PURPOSE: A variety of retropubic and transobturator surgical techniques have been developed to restore support of the urethral sphincteric apparatus, but there is no consensus on the best procedure. The safety and efficacy of the SPARC (SPARC sling system, suprapubic arc, American Medical System) and the MONARC (MONARC subfascial hammock, American Medical System) sling systems for the treatment of female stress incontinence were evaluated in a prospective randomized trial. MATERIALS AND METHODS: Forty three women with stress incontinence were randomly assigned to the SPARC (n=22), or MONARC sling (n=21) procedures, between December 2003 and July 2004. The operative techniques complied with the manufacturers instructions. The patient characteristics and urodynamic evaluations were similar in both groups. The preoperative evaluation included a careful history taking, physical examination, voiding diary, stress & pad test and a comprehensive urodynamic examination. The postoperative evaluation included a questionnaire, stress & pad test and uroflowmetry with postvoid residuals. RESULTS: The mean operative time was shorter in the MONARC group, but this difference was not significant (23 min vs. 26 min). No bladder injury occurred in the MONARC group, versus 4.5% (n=1) in the SPARC group. The rate of postoperative urethral obstruction, including retention, was 27.2% (n=6) in the SPARC group, versus 28.5% (n=6) in the MONARC group, but this was improved by conservative therapy. The rates of cure (81.8% vs. 80.9%), improvement (18.2% vs. 19.1%) and failure (0% vs. 0%) were similar in the SPARC and MONARC groups, respectively. CONCLUSIONS: The MONARC procedure appears to be equally efficient as the SPARC procedure for the surgical treatment of stress urinary incontinence in women over a short-term follow-up. Although further studies are needed to establish its long-term efficacy and safety, the SPARC and MONARC procedures might be attractive alternative tools for the treatment of female stress urinary incontinence.
Consensus ; Female* ; Follow-Up Studies ; Humans ; Operative Time ; Physical Examination ; Prospective Studies* ; Surveys and Questionnaires ; Surgical Mesh ; Urethra ; Urethral Obstruction ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

PURPOSE: The transobturator adjustable tape (TOA) allows adjustment of tension after surgical intervention, thus permitting correction of postoperative incontinence or obstruction. The aim of this study was to compare the efficacy and safety of TOA versus transobturator tape (TOT) for the treatment of stress urinary incontinence with intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: Patients underwent TOA (n=33 with ISD) or TOT (n=47 with ISD) insertion by one experienced surgeon. The patients were considered to have ISD on the basis of a Valsalva leak point pressure <60 cmH2O or a maximum urethral closure pressure <20 cmH2O. The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1-hour pad tests, and a comprehensive urodynamic examination. Postoperative evaluation included a stress test, 1-hour pad test, questionnaire, and uroflowmetry with postvoid residuals. RESULTS: After 6 months of follow-up, the rate of cure (TOA, 75.6% vs. TOT, 72.3%) was similar between the two groups. The rate of satisfaction was not significantly higher in the TOA group than in the TOT group (84.8% vs. 78.7%; p=0.05). Four patients in the TOA group (12.1%) needed a reduction in tension because of urinary obstruction (flow <10 ml/sec and/or residual urine >50 ml). The tension of the mesh was tightened in 5 patients (15.2%) because of the persistence of a certain degree of incontinence. The residual urine volume at postoperative 7 days was significantly lower in the TOA group than in the TOT group (19.5 ml vs. 41 ml; p=0.016, repeated-measures analysis of variance test). CONCLUSIONS: The TOA allows postoperative readjustment of the suburethral sling pressure for a number of days after surgical intervention, which allows for the achievement of good short-term results. These data suggest that better lower obstructive voiding symptoms than those achieved with the traditional nonadjustable mesh can be obtained with the TOA.
Achievement ; Analysis of Variance ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Physical Examination ; Suburethral Slings ; Treatment Outcome ; Urinary Incontinence ; Urodynamics

Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.
Adult ; Estrogens, Conjugated (USP) ; Female ; Humans ; Iliac Vein ; Korea ; Leiomyoma* ; Leiomyomatosis ; Mitosis ; Necrosis ; Phenobarbital* ; Uterus*

PURPOSE: The transobturator adjustable tape (TOA) sling operation is a new procedure that allows for the adjustment of tension after surgical intervention, thus permitting correction of postoperative incontinence or obstruction. The aim of this study was to compare the efficacy and safety of TOA with that of the transobturator tape (TOT) procedure. MATERIALS AND METHODS: Between 2008 and 2009, women with stress urinary incontinence (SUI) underwent TOT (n=63) or TOA (n=40). The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1-hour pad tests, and a comprehensive urodynamic examination. Postoperative evaluation was performed at the 1-week and 3-month postoperative follow-up visits. RESULTS: The overall cure rate was 90.0% for the TOA group and 85.7% for the TOT group. The rate of satisfaction was higher in the TOA group than in the TOT group (95.0% vs. 85.6%). Four patients in the TOA group needed reduced tension as the result of urinary obstruction. The tension of the mesh was tightened in 1 patient because of a certain degree of continuing incontinence. The residual urine volume was significantly lower in the TOA group than in the TOT group (7.8 ml vs. 43 ml, p=0.01). CONCLUSIONS: TOA allowed postoperative readjustment for a number of days after surgical intervention, which allowed for good short-term treatment outcomes. These data suggest that better subjective and objective results and residual urine volume can be obtained in the TOA group than those achieved with the traditional non-adjustable mesh and without significant postoperative complications.
Female ; Follow-Up Studies ; Humans ; Physical Examination ; Postoperative Complications ; Suburethral Slings ; Treatment Outcome ; Urinary Incontinence ; Urodynamics

PURPOSE: The present study was designed to evaluate the incidence and characteristics of acquired cystic kidney disease (ACKD) in patients with end-stage renal disease who were treated by chronic hemodialysis, using renal ultrasonography. MATERIALS AND METHODS: We performed renal ultrasonography as a screening modality in 112 patients treated with long-term hemodialysis due to end-stage renal disease. We classified the patients years from one to six years. RESULTS: In our study, cystic lesions were noted in 41 patients (36.6%) and there was no sexual predilection of ACKD. Also, a prolonged period of hemodialysis increased the incidence of ACKD, especially for those treated more than 49 months. We encountered a case of renal cell cancer, evaluated it with CT, and then treated it by radical nephrectomy. CONCLUSIONS: With these results, renal ultrasonography can be used as a screening modality in patients treated with long-term hemodialysis more than 49 months due to end-stage renal disease. As complications occur, further evaluation will be needed.
Carcinoma, Renal Cell ; Humans ; Incidence ; Kidney Diseases, Cystic* ; Kidney Failure, Chronic ; Mass Screening ; Nephrectomy ; Renal Dialysis* ; Ultrasonography

PURPOSE: We report results of long-term follow-up (more than 2 years) for the pubovaginal fascial sling procedure in the treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS: A retrospective analysis of 51 women with SUI, consecutively having undergone a pubovaginal fascial sling procedure, was undertaken. Patients were evaluated preoperatively, by physical examination, voiding cystourethrography, Q-tip test, and urodynamic study including; valsalva leak point pressure (VLPP), and their incontinence ranked according to the Stamey grades. Of the 51 patients, 19 cases (37%) were anatomically incontinent, 24 cases (47%) were intrinsically sphincter deficient (ISD) and 8 cases (16%) were of the equivocal type, according to VLPP. The patients were assessed by questionnaire and SEAPI (stress-related leakage, emptying ability, anatomy, protection, inhibition) scores, postoperatively. RESULTS: The pubovaginal fascial sling procedure was effective in 96.1% (cured 84.3%, improved 11.8%) of SUIs, with more than 2 years follow up (mean follow up 34.1 months; 24 to 49 months). There was no significant relationship between VLPP and success rate, and no significant changes in the postoperative outcome over time. The main complications were de novo urge incontinence (3 cases; 5.8%) and permanent urinary retention (3 cases; 5.8%), with transvaginal urethrolysis being performed in the latter cases. CONCLUSIONS: We would conclude that the pubovaginal fascial sling procedure is an effective treatment modality for the female SUI.
Female* ; Follow-Up Studies* ; Humans ; Physical Examination ; Surveys and Questionnaires ; Retrospective Studies ; Urinary Incontinence* ; Urinary Incontinence, Urge ; Urinary Retention ; Urodynamics