No abstract available.
Biofeedback, Psychology*

No abstract available.
Cadaver* ; Fascia Lata* ; Fascia*

PURPOSE: The aim of the study was to evaluate the clinical outcome and complications of tension free vaginal tape (TVT) procedure for the surgical treatment of female stress urinary incontinence. MATERIALS AND METHODS: Between April 1999 and May 2000, 41 women with stress urinary incontinence underwent TVT procedure. Preoperative evaluation included questionnaires study, physical examination, one hour pad test and urodynamic study. Postoperative clinical outcome, patient's satisfaction and complications were checked after 3-months. RESULTS: The mean age of patients was 51.6 years (range 40-76) and mean hospital stay 2.1 days (range 1-10). The mean follow-up period was 9.9 months (range 3-15). Thirty six patients (87.8%) were cured, 2 patients (4.9%) were improved. Two of 3 patients with failed operation who developed postoperative urge incontinence had grade III cystocele. Five bladder perforations and 1 obturator nerve injury occurred. The abdominal leak point pressure (LPP) increased from 50.6cmH20 to 110.8cmH2O, detrusor pressure of maximal flow rate (Pdet.Qmax) increased from 15.8cmH2O to 28.6cmH2O and maximal flow rate (Qmax) decreased from 32.8ml/s to 22.5ml/s after operation. CONCLUSIONS: The TVT procedure is an effective and feasible surgical treatment for female stress urinary incontinence. However, in patients with grade III cystocele, postoperative urge incontinence may develop after the procedure. Since TVT procedure involves securing the mid-urethra, urinary obstruction may also occur, necessitating the need for continued follow-up as well as a careful comparison with other sling procedure.
Cystocele ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Obturator Nerve ; Physical Examination ; Surveys and Questionnaires ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence ; Urinary Incontinence, Urge ; Urodynamics

No abstract available.

No abstract available.
Biofeedback, Psychology* ; Electric Stimulation*

No abstract available.
Ischemia* ; Skin*

PURPOSE: We investigated the technical feasibility and clinical results of percutaneous bladder neck suspension(PBNS) using bone anchors(Vesica) which represents a minimally invasive surgical procedure for the treatment of stress urinary incontinence caused by hypermobility of the proximal urethra and bladder neck. MATERIALS AND METHODS: Among women who underwent PBNS using bone anchors for type I or type II stress urinary incontinence, 22 women were followed for at least postoperative 9 months. A miniature bone anchor was used. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ?Z-stitch?. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: Mean operation time was 32 minutes. Mean hospital stay was 0.9 days. Mean follow-up was 13 months(9 to 18 months). In the 22 patients, the procedure was successful in 18 cases(82%), with 11(50%) of the patients completely dry and 7(32%) significantly improved. Preoperative urgency was present in 10 patients(45%). Postoperative resolution rate of urgency was 60%(6 of 10 patients). In 4 cases(18%), de novo urgency was documented. Removal of the bone anchor and suture was necessary in only one patient, because of persistent vaginal infection. Other complications were transient urinary retention in 3 patients(14%), prolonged suprapubic discomfort in 1 patient(4.5%) and incidental bladder perforation in 1 patient(4.5%). Major complications such as chronic urinary retention, osteitis pubis were not noted. CONCLUSIONS: The use of this bone anchoring technique and preservation of the endopelvic fascia appears to enhance the success rate without increasing the risk to the patient and, as minimally invasive procedures, reduce the surgery time and the length of hospitalization. However, the suspension sutures of PBNS may pull through the paraurethral tissue because there is no paravesical scar formation as in open procedures. Therefore we conclude that modifications of the suspension technique should be required for the improvement of long-term results.
Cicatrix ; Fascia ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Length of Stay ; Neck* ; Osteitis ; Suture Anchors* ; Sutures ; Telephone ; Urethra ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Retention

The morbidity and mortality rates are believed to be much higher if the staghorn calculus is left unoperated, since complications resulting from infection and/or obstruction may become life-threating. So, surgical removal is essential element in the successful management of the majority of patients with staghorn calculous disease. To understand better the optimal management, we did a retrospective analysis of 41 patients treated during 12 year periods. Surgical managements were performed in 36 patients (41 kidneys) and no operation in 5. Methods of surgical managements were extended pyelolithotomy in 11 cases, extended pyelolithotomy and pyeloplasty in 1, extended pyelolithotomy with parenchymal extension in 4, ex- tended pyelolithotomy with parenchymal extension and partial nephrectomy in 1, anatrophic nephrolithotomy in 7, antrophic nephrolithotomy with partial nephrectomy in 3, partial nephrectomy in 3, partial nephrectomy in 3 and nephrectomy in 9. Complete removals of calculi were done in 32 kidneys(69.6%). Clinical complications occurred in 14 kidneys(30.4%) ; 5 were remnant stones(10.8%), massive bleeding in 2, renal artery injury in 1, urine leakage in 3, pneumothorax in 2 and hematuria and sepsis in 1. The managements of complications were reoperation in 8 cases, conservative treatment in 5 and no follow up in 1.
Calculi* ; Follow-Up Studies ; Hematuria ; Hemorrhage ; Humans ; Mortality ; Nephrectomy ; Pneumothorax ; Renal Artery ; Reoperation ; Retrospective Studies ; Sepsis

The purpose of this study was to determine the feasibility of treating female stress incontinence with a extraperitoneal laparoscopic Burch. We compared the operative data of laparoscopic Burch, open Burch and Raz`s suspension and we introduced our technique, hybrid of the laparoscopic Burch and Gittes` procedure which avoids traditional intracorporeal suturing entirely. Twenty patients underwent a laparoscopic Burch were compared with 15 open Burch and 21 Raz`s suspension during the same time period for anatomical stress incontinence. We did not use the application of balloon dissection and intracorporeal suturing but extracorporeal knot tying. The results showed that laparoscopic Burch operation could shorten the Foley catheter removal day and hospital day compared to other methods. There were no significant differences in operation time and the complications. Laparoscopic Burch operation offers a less invasive approach to surgical correction of stress urinary incontinence and a rapid return to normal activities. Further clinical assessment is necessary to evaluate the long-term feasibility.
Catheters ; Female* ; Humans ; Laparoscopy ; Urinary Incontinence*

Pressure transmission ratio (PTR; A urethral pressure/A bladder pressure x 100) is obtained during cough profile and has been extensively used in pre and postoperative evaluation of patients with genuine stress urinary incontinence. The purpose of this study is to evaluate which urodynamic parameters are most effective for the decision of success after Burch operation in patients with genuine stress urinary incontinence. Twenty-one women with genuine stress urinary incontinence were evaluated urodynamically both before and after Burch operations. The patients` age was 49.5+/-7.51 and parity, 3.1+/-1.5. Mean follow up period was 8.7 months after operations (range 3-36 months). Dynamic and static urethral pressure profilometry were measured with microtip transducer catheter pre and postoperatively. The preoperative and postoperative functional urethral length (2.76+/-0.48 vs 2.75+/-0.47cm, p>0.05) and maximal urethral closure pressure (71.9+/-15.7 vs 72.8+/-15.2cmH20, p>0.05) showed no significant changes after eighteen successful Burch procedures. The PTR at the points of MUCP (maximal urethral closure pressure) was significantly improved after eighteen successful surgeries (85.9+/- 10.9 vs 113.4+/-13.5%, p<0.001). Three women who remained incontinent, showed no improvement in PTR (76.3+/-4.16 vs 86.7+/-8.5%, p>0.05). The reasons for successful surgical treatment of stress urinary incontinence are not related to any changes in functional urethral length or maximal urethral closure pressure. However, the comparison of preoperative and postoperative PTR is helpful and objective in determining the adequacy of surgical correction of anatomical defect associated with genuine stress urinary incontinence.
Catheters ; Cough ; Female ; Follow-Up Studies ; Humans ; Parity ; Transducers ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics