방광류 환자에서 Monofilament Polypropylene Mesh를 이용한 방광류 교정술의 경험

이병기,강명범,백성현,노용수,전경규,김형곤 대한배뇨장애요실금학회 2009 International Neurourology Journal Vol.13 No.2

Purpose: The use of synthetic mesh to reinforce the anterior vaginal wall support for cystocele repair has been proposed to prevent recurrence. We evaluated the efficacy and safety of cystocele repair using monofilament polypropylene mesh (Gynemesh PSTM). Materials and Methods: This study was performed in 53 patents who underwent cystocele repair using monofilament polypropylene mesh between January 2006 and January 2009. According to the ICS (International Continence Society) stage classification, 33, 17 and 3 women had stage II, III and IV cystocele. The operation were performed through the vaginal approach. Patients were followed up for 9 to 36 months. We defined the cure of cystocele as stage 0, improvement as stage I, and failed as stage II or greater Results: The mean follow-up was 23.8 months. At follow-up, 41 women were anatomically cured (77.4%), 12 women were improved as stage I (22.6%) and no one was failed. Six cases were previously ICS stage II, 5 cases were stage III and 1 case was stage IV in improved group. No significant intraoperative complications occurred. The postoperative complications were de novo urgency (4 cases, 7.6%), erosion of mesh (2 cases, 3.8%) and anterior vaginal wall hematoma (1 case, 1.9%). Conclusion: The use of polypropylene mesh for correction of cystocele by transvaginal route with tension free technique seems to be a safe and effective procedure.

Ureteroscopic Surgery for a Large Upper Ureteral Stone in an Infant with Bilateral Vesicoureteral Reflux

백민기,백성현,이병기,강명범,노용수,김교순,김형곤 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.1

Pediatric urolithiasis is a relatively rare disease that can have lifelong consequences. The management of pediatric urolithiasis should be individualized with careful consideration of the patients’ small body sizes, delicate tissues, needs for general anesthesia with every procedure, and risks of long-term complications. Miniaturization of urological instruments has made the treatment of distal ureteral stones by ureteroscopy in children more common, but there are few reports of the ureteroscopic removal of large upper ureteral stones in infants. We present a case of a 10-month-old female who simultaneously underwent ureteroscopic surgery and endoscopic DefluxⓇ injection for treatment of a 22x10 mm unilateral upper ureteral stone and bilateral vesicoureteral reflux. We also review the current treatment options for pediatric urolithiasis.

80g 이상 크기 거대 전립선비대증에서 양극성 경요도전립선절제술의 유용성 및 절제량에 따른 수술 결과의 분석

백민기,백성현,이병기,강명범,노용수,정성일,김형곤 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.12

Purpose: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. Materials and Methods: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). Results: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. Conclusions: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result. Purpose: We evaluated the efficacy of bipolar transurethral resection of the prostate(TURP) in patients with large prostates(>80g) and determined the postoperative results based on the transitional zone resection ratio. Materials and Methods: Thirty patients with benign prostatic hyperplasia (BPH)>80g(group 1) and 76 patients with BPH between 30g and 80g (group 2) were evaluated. The evaluation before TURP included the International Prostate Symptom Score(IPSS), maximum urinary flow rate (Qmax), post-void residual urine(PVR), and transrectal ultrasonography. The operative time, weight of resected tissue, change in serum hemoglobin, and complications were noted. After TURP, patients were reassessed for the IPSS, Qmax, and PVR at 6 months. In group 1, subgroup analysis of the postoperative symptom scores was performed based on the ratio of the resection volume(RV) to the transitional zone volume(TZV). Results: In patients with large prostates, the operative times were prolonged, and the weights of resected tissues were higher. However, there were no statistically significant differences between the two groups with respect to hemoglobin changes, postoperative hospital stays, or complications. The postoperative clinical parameters were markedly improved in both groups. Severe bleeding necessitated blood transfusion, and the TURP syndrome did not occur in any patients. The symptom score improved more as the RV/TZV increased. Conclusions: Bipolar TURP is an effective and safe surgical treatment method, even in patients with large prostates. Considering that the complications associated with bipolar TURP are very rare, surgeons should aim to perform a complete resection of the enlarged transitional zone to ensure a good postoperative result.

Initial Experience with Concomitant ProliftTM System and Tension-Free Vaginal Tape Procedures in Patients with Stress Urinary Incontinence and Cystocele

박형근,백성현,이병기,강명범,전경규,김형곤 대한배뇨장애요실금학회 2010 International Neurourology Journal Vol.14 No.1

Purpose: The objective of this study is to report our initial experience about the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (ProliftTM) and concomitant tension-free vaginal tape (TVT) as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI). Materials and Methods: We reviewed the charts of patients who underwent ProliftTM and TVT between April 2009 and March 2010. All patients had a physical examination and staging of cystocele. According to the International Continence Society system 2, 5 and 3 women had stage grade II, III and IV respectively. All the patients underwent pelvic examination 1, 3, 6 month and 1 year after operation and anatomical and functional outcomes were recorded. An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher on the last physical examination. Results: The mean follow-up was 7.1 (1-11) months. Overall success rate of cystocele repair was 90%. The anatomical cure rate of cystocele was 50%. The cystocele repair improved 4 patients, but failed in 1. SUI was cured in all patients. No significant complications including bladder or vessel injury and mesh related erosion occurred. The postoperative complication was transient voiding difficulty (2 cases). Conclusions: These preliminary results suggest that ProliftTM and TVT offer a safe and effective treatment for female anterior vaginal wall prolapse and SUI. However, a long-term follow up is necessary in order to support the good result maintenance.