Purpose: Urinary incontinence (UI) is a significant complication following surgery for pelvic organ prolapse (POP), including laparoscopic sacrocolpopexy (LSC). Although the incidence of postoperative UI is lower after LSC than after transvaginal mesh surgery, a subset of patients still experience UI. This study aimed to determine which factors, including mesh-related factors, contribute to UI impairing daily life following LSC. Methods: The study enrolled 96 patients who underwent LSC at our institution between June 2016 and September 2023. The Pearson chi-square test, multiple logistic regression analysis, and Cox proportional hazards model were used to determine the independent factors contributing to UI after LSC. Results: The Pearson chi-square test showed that body mass index, POP quantification (POP-Q) stage 4 and the presence of preoperative UI significantly correlated with the postoperative UI among preoperative and intraoperative factors (all P<0.05). POP-Q stage 4 and the presence of preoperative UI were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (all P<0.05). However, only preoperative UI remained an independent predictor for shorter time to UI onset in the multivariate Cox proportional hazards model (hazard ratio, 3.56; 95% confidence interval, 1.29–11.58; P=0.0158). Conclusions Patients with preoperative UI and stage 4 POP should receive close monitoring for postoperative UI.

Purpose: Urinary incontinence (UI) is a significant complication following surgery for pelvic organ prolapse (POP), including laparoscopic sacrocolpopexy (LSC). Although the incidence of postoperative UI is lower after LSC than after transvaginal mesh surgery, a subset of patients still experience UI. This study aimed to determine which factors, including mesh-related factors, contribute to UI impairing daily life following LSC. Methods: The study enrolled 96 patients who underwent LSC at our institution between June 2016 and September 2023. The Pearson chi-square test, multiple logistic regression analysis, and Cox proportional hazards model were used to determine the independent factors contributing to UI after LSC. Results: The Pearson chi-square test showed that body mass index, POP quantification (POP-Q) stage 4 and the presence of preoperative UI significantly correlated with the postoperative UI among preoperative and intraoperative factors (all P<0.05). POP-Q stage 4 and the presence of preoperative UI were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (all P<0.05). However, only preoperative UI remained an independent predictor for shorter time to UI onset in the multivariate Cox proportional hazards model (hazard ratio, 3.56; 95% confidence interval, 1.29–11.58; P=0.0158). Conclusions Patients with preoperative UI and stage 4 POP should receive close monitoring for postoperative UI.

Purpose: Urinary incontinence (UI) is a significant complication following surgery for pelvic organ prolapse (POP), including laparoscopic sacrocolpopexy (LSC). Although the incidence of postoperative UI is lower after LSC than after transvaginal mesh surgery, a subset of patients still experience UI. This study aimed to determine which factors, including mesh-related factors, contribute to UI impairing daily life following LSC. Methods: The study enrolled 96 patients who underwent LSC at our institution between June 2016 and September 2023. The Pearson chi-square test, multiple logistic regression analysis, and Cox proportional hazards model were used to determine the independent factors contributing to UI after LSC. Results: The Pearson chi-square test showed that body mass index, POP quantification (POP-Q) stage 4 and the presence of preoperative UI significantly correlated with the postoperative UI among preoperative and intraoperative factors (all P<0.05). POP-Q stage 4 and the presence of preoperative UI were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (all P<0.05). However, only preoperative UI remained an independent predictor for shorter time to UI onset in the multivariate Cox proportional hazards model (hazard ratio, 3.56; 95% confidence interval, 1.29–11.58; P=0.0158). Conclusions Patients with preoperative UI and stage 4 POP should receive close monitoring for postoperative UI.

Purpose: Stress urinary incontinence is a postoperative complication occurring in patients with pelvic organ prolapse (POP). Although the 1-hour pad test measures the degree of urinary incontinence qualitatively and quantitatively, some elderly women undergoing POP surgery do not have the daily activities of living to perform the pad test. Therefore, we examined whether the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) could be used as an alternative tool for pad tests. Methods: We retrospectively evaluated 132 patients with POP. In our hospital, 57 patients were treated by laparoscopic sacrocolpopexy (LSC), whereas 75 were treated by transvaginal mesh surgery (TVM). We measured the changes in symptoms preand postoperatively using the ICIQ-SF and 1-hour pad weight testing, and investigated the correlation between the total plus component question scores of the ICIQ-SF and 1-hour pad weight. Results: The preoperative ICIQ total scores in all patients decreased significantly as the amount of leakage on the 1-hour pad weight decreased. The component question scores also decreased significantly with decreasing levels of 1-hour pad weight. The LSC and TVM groups had decreased ICIQ-SF total and component question scores as pad weight decreased. At 12 months postoperatively, the ICIQ total scores in all patients significantly declined as the amount of leakage on the 1-hour pad weight decreased. In the LSC group, the ICIQ-SF total and component question scores also decreased with decreased pad weight, but the differences were not always significant between ICIQ scores and pad weight. In the TVM group, the ICIQ-SF total and component question scores also significantly decreased as the pad weight decreased. Conclusions The ICIQ-SF could be an appropriate substitute for the 1-hour pad weight testing in predicting the severity of urinary incontinence. In the future, we hope to predict the level of urine leakage based on the ICIQ-SF score.

A 77-year-old man was admitted to our hospital with sudden anterior chest pain followed by shock. An echocardiography showed enlargement of the sinus of Valsalva, severe aortic regurgitation and pericardial effusion. A chest CT scan showed a crescent sign in the ascending aorta. The preoperative diagnosis was a ruptured Stanford type A acute aortic dissection and an emergency operation was performed. In the operative findings, a bloody pericardial effusion, a hematoma around the ascending aorta and a tear (less than 2 cm) of the ascending aorta just distal area of the sinotubular junction were observed. In this case, since the enlargement of the sinus of Valsalva and the severe aortic regurgitation were observed, we performed a replacement of the ascending aorta including the aortic root with an artificial vascular graft (J graft 28 mm) and a biological valve (Magna EASE 25 mm). The pathologic examinations revealed a rupture of ascending aorta in all layers and a hematoma outside the adventitia. The pathologic diagnosis showed a spontaneous aortic rupture. The postoperative course was good and he was discharged 1 month after the surgery. A spontaneous aortic rupture is defined as an aortic rupture without a trauma, an aneurysm or a dissection. It is rare but fatal and it is said that surgical treatment is necessary. We report a successful surgical case of the spontaneous aortic rupture which was difficult to distinguish from a Stanford A type acute aortic dissection.

A 71-year old woman, who underwent direct closure of an atrial septal defect with mild tricuspid regurgitation (TR) 18 years previously, suffered terminal cardiac failure with extreme cardiomegaly, mitral regurgitation and severe TR. Medical treatment gradually became ineffectual and we decided to perform surgical therapy. Mitral annuloplasty with a prosthetic ring, tricuspid valve repair, plications of extended bilateral atrium walls and epicardial ventricular pacemaker implantation were performed. In tricuspid valve repair, anterior tricuspid leaflet was augmented by use of glutaraldehyde-preserved autologus pericardial patch and tricuspid annuloplasty with addition of a slightly larger prosthetic ring. Atrio-ventricular regurgitations disappeared and she was discharged 63 days after the operation. Valve extension is a very effective technique to treat severe secondary TR, and long term follow-up is necessary.

Pulmonary artery aneurysm (PAA) may be associated with congenital shunt disease such as patent ductus arteriosus, and its frequency and management are often controversial. We report successful surgical treatment of PAA following an operation for atrial septal defect (ASD). The patient was a 47-year-old woman who underwent closure of ASD at the age of 9. When she was investigated because of thyroid tumor, enlargement of her main pulmonary artery was pointed out and she was admitted to our hospital. Several examinations revealed a diagnosis of pulmonary valve insufficiency and 70mm PAA with dilatation extending to both proximal arteries. We performed replacements of pulmonary valve and pulmonary artery with a bioprosthetic valve and T-shaped graft. The patient is doing well 2 years after operation.

We evaluated long-term results of 126 consecutive bypass surgeries for chronic limb ischemia including 54 aorto-femoral (AF), 26 femoro-femoral crossover (FF), 7 axillo-femoral (AxF), and 39 femoro-above the knee popliteal (FP) bypasses. Patients who had undergone FF bypasses were significantly older than those who received AF bypasses (p<0.01). Preoperative ankle brachial pressure indices (ABI) of the AxF and FF patients were significantly lower than those of AF patients (p<0.05). Compared with AF patients, the AxF and FF groups included significantly higher percentages of Fontaine III and IV limbs treated by limb salvage surgery (p<0.05). The cumulative graft patency rates 5 years after AF, FF, and FP bypasses were 94.7%, 91.3%, and 64.3%, respectively. In the FP group, patients with intermittent claudication before surgery showed a 5-year graft patency rate of 82.5%, while that in patients who underwent surgery for limb salvage was 43.3%. The secondary graft patency rates 5 years after AF, FF, and FP bypasses were 94.6%, 91.3%, and 83.3%, respectively. All patients whose bypass grafts were occluded were male and were smokers. Poor run-off and insufficient anticoagulation therapies were also associated with graft occlusion. Two of the 12 patients who developed graft occlusion underwent limb amputation.

We investigated the effects of rewarming speed on cerebral circulation and oxygen metabolism during cardiopulmonary bypass (CPB). Twenty-four adult patients who had undergone open heart surgery with moderately hypothermic CPB were divided into two groups. In the slow rewarming group (group S), the rates of increase of blood temperature were under 0.1°C/min. In the rapid rewarming group (group R), they were more than 0.1°C/min. Mean blood flow velocity in the middle cerebral artery (mean MCAv) was measured by transcranial Doppler ultrasonography, and the index of cerebral oxygen consumption was evaluated by Doppler-estimated cerebral metabolic rate for oxygen (D-CMRO₂). The change of oxyhemoglobin level in the brain (Oxy Hb) was monitored by near-infrared spectroscopy. In group S, mean MCAv and D-CMRO₂ changed in a parallel manner following the changes of the rectal temperature throughout the periods, and mean MCAv was always higher than D-CMRO₂. In group R, however, the rate of increase of D-CMRO₂ was more rapid than that in group S from the beginning of rewarming, and D-CMRO₂ exceeded the level of mean MCAv just before termination of CPB. In addition, Oxy Hb in group R showed more rapid changes than that of group S. In conclusion, rapid rewarming during CPB may cause the disruption of cerebral flow-metabolism coupling.

We report a case of aneurysm localized to the noncoronary sinus of Valsalva with moderate aortic regurgitation (AR). The patient was a 49-year-old woman who had been suspected to have some kind of connective tissue disorders. She underwent an aortic root remodeling procedure to replace the isolated, unruptured and extracardiac aneurysm and the ascending aorta. Postoperative angiogram showed no aneurysm and improved AR. This procedure was able to preserve her own aortic valve and normal sinuses of Valsalva and enable her to obtain better quality of life, although progression of the enlargement of the aorta or AR requires careful follow-up.