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Purpose: We compared the recovery periods in zoster-associated voiding dysfunction according to the treatment modality to establish the best treatment policy. Materials and Methods: From January 2004 to August 2006, medical records of 250 patients admitted for zoster infection were reviewed. Of 250 patients, patients complaining of lower urinary tract symptoms (LUTS) were selected. The clinical and urodynamic features, and treatment outcomes were analyzed. Results: Thirty eight (15.2%) of 250 patients had zoster-associated LUTS. Urinary retention was the most common symptom. Urodynamically, detrusor underactivity was the most common finding (71.8%). Twenty were followed, of which 5 received oral medication, 10 received clean intermittent catheterization (CIC), 4 received indwelling catheterization (IC) and remained 1 was observed without treatment. All patients regained normal voiding function. Mean recovery period was 12 days. According to the treatment modality, mean recovery period was 21 days in medication group, 10 days in CIC group, and 6 days in IC group. The mean recovery period was significantly shorter in CIC or IC group than medication group (p=0.013, 0.005). Conclusion: Zoster-associated voiding dysfunction is a reversible condition. Thus, patients with mild symptoms can be observed. However, if symptoms are severe or retention develops, catheterization is recommended rather than medication alone. (J. Korean Continence Society 2007;11:36-40)
Purpose: Tension-free vaginal tape (TVT) procedure is widely used as an initial operative method in stress urinary incontinence because of high success rate and low morbidity. However, some patients have complained of voiding difficulties after TVT. We evaluated 14 patients who underwent mesh cutting because of obstructive symptoms after TVT. Materials and Methods: 14 patients who underwent mesh cutting because of prolonged obstructive symptoms after TVT were included for the study. Their voiding symptoms were evaluated by Qmax, voiding time and postvoid residual urine. These parameters which were done before TVT, post-TVT and post-mesh cutting were compared. Results: 4 out of 14 patients were intrinsic sphincter deficiency (valsalva leak point pressure <60 cmH2O) and no patient had detrusor overactivity before TVT. After TVT, Qmax was decreased from 25.4±3.5 ml/sec to 9.4±2.4 ml/sec, and voiding time was prolonged from 26.7±6.6 sec to 65.5±24.8 sec. However, the volume of postvoid residual urine was unchanged. After mesh cutting, Qmax was increased to 21.7±7.7 ml/sec and voiding time was decreased to 27.2±7.6 sec. Subjective voiding symptoms were improved immediately in 13 out of 14 patients (92.9%), although 1 patient showed small amount of urine leakage when coughing. And also, in 1 out of 2 patients, detrusor overactivity which was shown after TVT was disappeared. Conclusion: We believe that we do not need to hesitate to cut the mesh in patients who are suffering from severe obstructive symptoms after TVT. (J. Korean Continence Society 2005;9:13-16)
Purpose: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. Materials and Methods: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients (30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization (CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. Results: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. Conclusion: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed. (J. Korean Continence Society 2005;9:40-45)
The tension-free vaginal tape procedure (TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation. (J. Korean Continence Society 2005;9:46-48)
Purpose: The aim of this study was to analyze the influence on voiding symptoms when performing sling operation on patients with stress urinary incontinence with detrusor underactivity. Materials and Methods: We analyzed medical records of 100 patients who received the sling operation. Based on their preoperative urodynamic study, we defined "stress urinary incontinence with detrusor underactivity (SUI with DU)" group as these findings; peak flow less than 11 ml/s or void with abdominal pressure instead of detrusor contraction or residual urine volume more than 100 ml. And the others were defined as the "stress urinary incontinence only (SUI)"group. We compared two groups and analyzed the changes of pre- and postoperative uroflowmetry. Results: The number of patients with the "SUI with DU" group was 30 and that with the "SUI" group was 70. In the "SUI with DU" group, there were no changes in peak flow rate and residual urine volume between postoperative uroflowmetry and preoperative urodynamic study (15.1 ± 7.9 vs. 14.7 ± 7.1 ml/s, 123.1 ± 79.2 vs. 127.3 ± 91.9 ml) (p>0.05). Twenty four patients underwent urinary drainage with nelatone catheter either on postoperative first or second day. However, 22 patients did not need to continue self catheterization. Conclusion: Sling operation could be performed on patients who are diagnosed as stress urinary incontinence with detrusor underactivity without aggravating their voiding symptoms. (J Korean Continence Soc 2009;13:73-79)
Purpose: Detrusor hyperactivity with impaired contractility (DHIC) can be found in many elderly patients with benign prostatic hyperplasia (BPH). It is hard to expect the efficacy of transurethral resection of prostate (TURP) on such patients. Therefore, we retrospectively estimated the effect of TURP on BPH patients with DHIC. Materials and Methods: Eighteen male patients with BPH and DHIC were underwent TURP. Through urodynamic studies, DHIC was identified. Findings of bladder outlet obstruction were evaluated with TRUS and/or diagnostic cystoscopy in all patients. They were requested to go through uroflowmetry and international prostate symptom score (IPSS), before and after TURP. The subjective satisfaction scale was measured after TURP. Results: Total IPSS (from 20.6 to 12.5), obstructive symptom score (from 11.5 to 6.0), and maximal flow rate (from 6.0 ml/sec to 14.6 ml/sec) of the patients were improved significantly (p<0.05) after TURP. Storage symptom score (from 9.0 to 6.3) got better, but the improvement was not statistically significant (p>0.05). Only 2 (12%) of the patients were unsatisfied with the outcomes of TURP. Conclusion: We suggest that TURP can be used as a good therapeutic option for selected patients with BPH accompanied with DHIC. (J. Korean Continence Society 2005;9:135-138)
Purpose: To compare IRIS procedure with TVT and SPARC in the treatment of female stress urinary incontinence (SUI). Materials and Methods: Among 96 patients with SUI who underwent sling procedure, we retrospectively compared IRIS procedure (n=34) to TVT (n=32) and SPARC (n=30). All patients were evaluated preoperatively with a detailed history, pelvic examination, voiding cystourethrography, urodynamic study and incontinence staging with SEAPI classification. Parameters of comparison included presence of stress incontinence, length of hospital stay, duration of catheterization, operation time, complication, success rate and satisfaction rate. Results: The success rates were 97%, 96.9% and 96.7% in the IRIS, TVT and SPARC group, respectively. The satisfaction rates were 94.1%, 96.9% and 96.6% in the IRIS, TVT and SPARC group. The complication rates were 23.5%, 21.8% and 23.3% in the IRIS, TVT and SPARC group. There was no statistically significant difference among the 3 groups in terms of success rates, satisfaction rates, complication rates, and postoperative subjective SEAPI scores. Conclusion: IRIS procedure was equally effective compared to conventional mid urethral sling procedure such as TVT and SPARC in the management of female SUI with high cure rates and acceptably low complication rates. (J. Korean Continence Society 2006;10:126-131)