Purpose: Overactive bladder (OAB) symptoms may improve following surgical correction of cystocele. This study aimed to evaluate changes in urgency, the primary symptom of OAB, and identify factors associated with improvement in urgency after surgical treatment for cystocele. Methods: We conducted a retrospective analysis of medical records for patients who underwent surgical treatment for cystocele and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Patients were categorized into 2 groups based on their urgency status 3 months postsurgery: those with improved urgency and those without improvement. Improvement was defined as a reduction of 2 or more points on the scale following surgery. We compared preoperative clinical and urodynamic factors between the 2 groups. Results: A total of 137 patients were included in the study, with 98 (71.5%) showing improvement in urgency symptoms after surgery. The improved group had a significantly higher prevalence of preoperative urgency urinary incontinence (UUI) (62.2% vs. 30.8%, P=0.001) and bladder outlet obstruction (43.9% vs. 20.5%, P=0.011) compared to the nonimproved group. Urodynamic evaluations indicated that the detrusor pressure at maximum flow rate (PdetQmax) was significantly higher in the improved group than in the nonimproved group (P=0.004). Multivariate logistic regression analysis identified preoperative UUI, higher PdetQmax, and lower vaginal parity as independent predictors of improvement in urgency postoperatively. Conclusions Preoperative UUI, higher PdetQmax, and lower vaginal parity were significant predictors of postoperative improvement in urgency. Both clinical and urodynamic factors may help identify patients with cystocele and preoperative urgency who are most likely to benefit from anatomical correction.

Background: The management of sexually transmitted infections (STIs) at the national level is necessary for the health and well-being of individuals in society. The purpose of this study was to propose a redesign of the STI surveillance system by collecting opinions from experts. Methods: After the major STIs were reviewed, 1) gonorrhea, 2) chancroid, 3) Mycoplasma genitalium infection, and 4) trichomoniasis were selected as diseases requiring a redesign of the surveillance system through the Delphi method, a technique for solving problems by collecting opinions from experts. The expert panel was selected from experts on STIs (n = 17) and included members of the Korean Association of Urogenital Tract Infection and Inflammation, the Korean Society of Infectious Diseases, and the 3rd advisory committee on STIs. Results: The experts agreed upon the exclusion of surveillance for chancroid on the basis of the low incidence, with an agreement rate of 83%. The experts agreed upon the inclusion of M. genitalium in the surveillance system, with a high agreement rate of 88%. However, there was disagreement among the experts on whether to include trichomoniasis in the surveillance system and whether to switch to a mandatory surveillance system for gonorrhea. Conclusion Although a consensus was not reached in some of the surveys in this study, it involved the collection of various expert opinions. Therefore, policies should be promoted with a prioritized focus on items with high agreement, but items for which no consensus was reached need to be reviewed in greater depth through additional research and investigation.

Objective: Spinal stenosis is a prevalent condition; however, the optimal surgical treatment for central lumbar stenosis remains controversial. This study compared the clinical outcomes and radiological parameters of 3 surgical methods: unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (ULBD-UBE), conventional subtotal laminectomy (STL), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: This retrospective study included 86 patients, divided into ULBD-UBE (n=34), STL (n=24), and MIS-TLIF (n=28) groups. We evaluated demographics and perioperative factors and assessed clinical outcomes using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and neurogenic intermittent claudication (NIC). Radiological parameters assessed included lumbar lordosis, L4S1 Cobb angle (L4S1), T12S1 Cobb angle (T12S1), increased cross-sectional dural area (CSA), dynamic angulation (DA), dynamic slip (DS), and development of postoperative instability. Results: The ULBD-UBE group showed a significantly shorter hospital stay duration and operation time and reduced blood loss than the other groups (p<0.001). ULBD-UBE group showed a trend towards greater VAS and ODI improvement at 1 month and postoperative NIC symptom relief. Radiologically, MIS-TLIF group exhibited lower postoperative DA and DS (p<0.001), indicating higher postoperative stability. Postoperative instability was lower in the ULBD-UBE group (2.9%) than in the STL group (16.7%) and similar to the MIS-TLIF group (0.0%) (p=0.028). The CSA was highest in the MIS-TLIF group (295.5%) compared to that in the other groups (ULBD-UBE, 216.3%; STL, 245.2%) (p<0.001). Conclusion Compared to other procedures, ULBD-UBE is a safe, effective, and viable surgical procedure for treating lumbar central stenosis.

Objective: We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs). Methods: We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters. Results: While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36. Conclusion Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.

Isolated spinal artery aneurysms are rare vascular lesions of the spinal cord. Due to their rarity, the natural disease course and treatment guidelines have not been clearly defined. Here, we report a case of an angiography-negative isolated spinal aneurysm in the thoracic spine surgically that was treated without neurological compromise using indocyanine green (ICG) and intraoperative neurophysiological monitoring (IONM). A 52-year-old man without any prior medical history presented to the emergency room with acute lower back and bilateral leg pain accompanied by worsening voiding and difficulty defecating. Magnetic resonance imaging (MRI) of the lumbar spine showed a diffuse subarachnoid hemorrhage in the lumbar spine. The patient was initially treated conservatively with painkillers, but experienced a rapid recurrence of symptoms. A follow-up MRI scan showed subacute transformation and expansion of the subarachnoid hematoma, as well as a non-enhancing, intradural, extramedullary lesion at the T12/L1 level. Angiography did not show any remarkable findings, and surgical exploration revealed a thrombosed aneurysmal lesion. The lesion did not show ICG uptake, and temporary clipping of the caudal end of the lesion did not lead to changes in motor-evoked potential signals. A pathological examination revealed a capillary vascular structure in granulation tissue with organizing thrombi, favoring a thrombosed, granulated lesion over a vascular neoplasm. Ruptured, isolated spinal aneurysms can be especially difficult to diagnose and treat when angiography findings are negative. We report that a spinal artery aneurysm can be safely excised using intraoperative ICG and IONM.

Objective: Multilevel posterior cervical fusion (PCF) and decompression surgery is a viable treatment option for multilevel ossification of posterior longitudinal ligament (OPLL) and spondylotic myelopathy. Since OPLL is known to affect bone formation, this study aimed to examine the effect of OPLL on the incidence of pseudarthrosis following PCF in a cohort study. Methods: We conducted a retrospective cohort study of patients with PCF and laminectomy at our institution. This study included patients who underwent C3 to C6 posterior fusion surgery involving lateral mass screw fixation without anterior surgery for OPLL or spondylotic myelopathy. Fusion status was evaluated 1 year postoperatively with computed tomography. Bone mineral density (BMD) and sagittal parameters were also evaluated as potential contributing factors to the fusion rate. Results: Eighty patients were included. Pseudarthrosis was observed in 22.5% (n=18) of patients. Pseudarthrosis incidence was lower in patients with OPLL (spondylosis vs. OPLL, 33.3% vs. 12.2%; p=0.003), and a higher BMD T-score (pseudarthrosis vs. fusion, -1.9 ± 0.7 vs. -0.6 ± 1.3; p<0.01), a larger preoperative range of motion (ROM) (26.7 ± 13.3 vs. 17.6 ± 10.9; p=0.01), and a greater preoperative-to-postoperative decrease in cervical lordosis (-8.1 ± 7.9 vs. -2.7 ± 7.9; p<0.01). Pseudarthrosis was associated with worsening neck pain after surgery. Conclusion The absence of OPLL, lower BMD, larger preoperative ROM, and a greater decrease in postoperative cervical lordosis were identified as risk factors for pseudarthrosis after multiple PCF.

Objective: White matter hyperintensities (WMH) are common among the elderly. Although WMH play a key role in lowering the threshold for the clinical expression of dementia in Alzheimer’s disease (AD)-related pathology, the clinical significance of their location is not fully understood. This study aimed to investigate the association between WMH and cognitive function according to the location of WMH in AD. Methods: Subjects underwent clinical evaluations including volumetric brain magnetic resonance imaging study and neuropsychological tests using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet. WMH were calculated using automated quantification method. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3–13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH), and deep WMH (DWMH), respectively. Results: Total WMH volume was associated with poor performance in categorical verbal fluency test (β=-0.197, p=0.035). JVWMH volume was associated with poor performances on categorical verbal fluency test (β=-0.201, p=0.032) and forward digit span test (β= -0.250, p=0.012). PVWMH volume was associated with poor performances on categorical verbal fluency test (β=-0.185, p=0.042) and word list memory test (β=-0.165, p=0.042), whereas DWMH volume showed no association with cognitive tests. PVWMH volume were also related to Clinical Dementia Rating Scale Sum of Boxes score (β=0.180, p=0.026). Conclusion WMH appear to exhibit different associations with the severity of dementia and cognitive impairment according to the distance from ventricle surface in AD.

Objective: This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Methods: Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Results: Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35–4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Conclusion Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Purpose: Bilateral axillo-breast approach robotic parathyroidectomy (BABA-RP) aims to remove overactive or enlarged parathyroid glands with no visible neck collar incision. In this study, we compared the safety and surgical outcomes of BABA-RP vs. those of an open surgery group to ascertain whether BABA-RP is a safe and feasible surgical approach for patients with primary hyperparathyroidism (pHPT). Methods: This single-institution retrospective cohort study included 74 patients with primary HPT who underwent open parathyroidectomy (n = 37) or BABA-RP (n = 37) at our institution between November 2014 and March 2023. Patient demographics, biochemical cure rates, operative time, blood loss rates, and complication rates were examined and compared. Results: The patients in the BABA-RP group were younger and had a longer mean operative time. Regarding complication events, 2 patients in the open surgery group and 1 patient in the BABA-RP group had transient hypoparathyroidism. All 74 patients achieved biochemical cure at <6 months, regardless of the approach used. Two patients in the BABA-RP group and 1 patient in the open surgery group had carcinoma on surgical pathology. All 3 patients with parathyroid carcinoma remained recurrence-free at 1-year follow-up. Conclusion Compared with the open procedure, BABA-RP is a safe and feasible procedure that provides an excellent biochemical cure rate for patients with pHPT and has superior cosmetic benefits with equivalent surgical outcomes.

Purpose: We investigated the current practices and perceptions of colorectal surgeons in South Korea regarding intracorporeal ileocolic anastomosis (IIA) in minimally invasive right hemicolectomy (RHC). Methods: Members of the Korean Society of Coloproctology (KSCP) participated in an online survey encompassing demographic information, surgical experiences, methods for IIA, and advantages, barriers, and perceptions of IIA. We performed a statistical analysis of survey results. Results: Among the 1,074 KSCP members contacted, 178 responded to the survey. Most respondents were males aged 40–49 years with >10 years of experience who were affiliated with a tertiary healthcare facility. One hundred fifty-six respondents had performed <100 colorectal cancer surgeries annually. Fifty-nine respondents reported experiences of the IIA technique in minimally invasive RHC. Most respondents favored the isoperistaltic side-to-side (S-S) anastomosis and stapled S-S anastomosis, hand-sewn closure for the common channel, and the periumbilical area for primary specimen extraction. Respondents with IIA experience emphasized the reduction in postoperative complications as the primary reason for performing IIA, whereas respondents without IIA experience cited the lack of benefits as the main deterrent. Respondents commonly cited concerns regarding anastomotic leakage and intraabdominal contamination as the primary reasons for not performing IIA. Respondents with IIA experience demonstrated a more positive response towards attempting or transitioning to IIA than those without. Respondents with IIA experience prioritized self-sufficiency, whereas respondents without IIA experience prioritized proctorship and discussions of the initial cases. Conclusion Measures to standardize the IIA technique and appropriate training programs must be implemented to enhance its use in minimally invasive RHC.