Duloxetine versus Placebo for Treatment of Korean Women with Stress Predominant Urinary Incontinence

Purpose: To compare duloxetine with placebo for the treatment of Korean women with stress urinary incontinence (SUI). Materials and Methods: This was a phase 3, double-blind, stratified, randomized, parallel, placebo-controlled, multi-center study investigating efficacy and safety of a of duloxetine compared with placebo in the treatment of SUI. After a 2-week no-drug screening period, women ages 29-69 were randomly assigned to placebo (n=60) or duloxetine (n=61) as 40mg twice daily for 8 weeks followed by a 2 week no-drug period. Women were seen at 4-week intervals. The primary efficacy variable was percent change in incontinence episodes frequency (IEF)/week. Secondary variables included percent change in, changes in Incontinence Quality of Life (I-QoL) total and 3 sub-scale scores, and Patient Global Impression of Improvement (PGI-I) ratings. Safety was evaluated by treatment emergent adverse events (TEAE), discontinuations due to adverse events, vital signs measurements, and clinical laboratory tests. Results: There were statistically significant improvements with duloxetine compared with placebo in IEF (duloxetine baseline 16.4IEF/wk, endpoint 7.7IEF/wk, median percent reduction=50.0% vs placebo baseline 13.3IEF/wk, endpoint 8.8IEF/wk, median percent reduction=37.1%, p=0.033), and avoidance and limiting behavior subscale (p=0.006) in I-QoL. TEAEs were reported significantly more often in the duloxetine group compared with the placebo group (82.0% vs 31.7%; p<0.001); common AEs (≥5% in duloxetine-treated subjects and p<0.05) were nausea, dizziness, anorexia, fatigue, lethargy, abdominal discomfort, and constipation. Discontinuation rates because of AEs were 34.4% for duloxetine and 8.3% for placebo. Conclusions: These data provide evidence for the safety and efficacy of duloxetine for the treatment for Korean women with SUI.ope

Twenty Years of Experience with Artificial Urinary Sphincter Implantation

PURPOSE: The efficacy of the artificial urinary sphincter(AUS) in treating sphincteric incontinence has been clearly demonstrated. We report on 20 years of experience using artificial sphincter implantation at a single institute. MATERIALS AND METHODS: The follow-up data for 37 patients who received AUS(AMS 800(TM)) implantation between 1987 and 2006 at Yonsei University were available for this study. We investigated various components of the medical records, such as the number of pads used per day, results of pre-operative urodynamic studies, operative and post-operative complications, and revision rate. RESULTS: Mean patient age was 35.6 years(range 15-64 years), and mean follow-up duration was 12.4 years(range 1.4-19.8 years). Of the 37 patients, 21 had neurogenic bladder, and 9 had traumatic injury. Other causes of incontinence included post-operative complications(4 patients) and congenital anomalies(3 patients). The cuffs were placed were in the bladder necks of 21 patients and in the bulbous urethrae of 16 patients. The average number of pads used daily decreased significantly from 6.2 to 1.2 after the operation, and 27 patients(72.9%) were able to maintain 'dry-up status' (number of pads used< or=1). A total of 32 artificial sphincters remained in place(86.4% survival rate), with 8 revisions(21.6%) required secondary to infection, mechanical failure, or urethral stone. CONCLUSIONS: AUS implantation is a safe and durable treatment for urinary incontinence in patients with intrinsic sphincter deficiency from various underlying diseases.ope

Long-term Follow up of Augmentation Ileocystoplasty with Goodwin's Ileal Cup Patched Bladder.

PURPOSE: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin(')s ileal cup patched bladder. MATERIALS AND METHODS: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. RESULTS: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. CONCLUSIONS: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladdersope

The Difference in Mode of Administration of International Prostate Symptom Score(IPSS) in Patients with Lower Urinary Tract Symptoms

Purpose The International Prostate Symptom Score (IPSS) is generally self-administrated; however, it is doubtful that the self-administrated IPSS score correctly reflects patients' symptoms; therefore, the difference in the IPSS self-administrated score and physician-interviewed patients was studied. Materials and Methods A total of 202 patients completed two IPSS questionnaires during the same office visit, one by self-administration and the other by physician-interview, at two medical centers, one located in an urban area and the other in a rural area. The mean total symptom score and the score for each question, and the quality of life score were compared between the two modes of administration. A multi-logistical regression analysis was performed to identify differences due to the effects of age, the order of administration, location and educational level. Results The mean total symptom score and quality of life score were higher in the self-administrated than physician-interviewed group (14.16 vs. 13.07, p=0.001, 3.27 vs. 3.2, p=0.090). The residual sense (2.03 vs. 1.97, p=0.20), frequency (2.07 vs. 1.97, p=0.026), interruption (1.83 vs. 1.61, p=0.002), urgency (1.89 vs. 1.55, p=0.001), weak stream (2.74 vs. 2.60, p=0.042), hesitancy (1.77 vs. 1.59, p=0.005) and nocturia (1.82 vs. 1.77, p=0.12) were also higher in the self-administrated group. The multilogistical regression analysis revealed statistically significant differences in relation to age and location. Conclusions The self-administrated IPSS score was higher than the physician-interview score, especially in relation to an older age and an urban location. Therefore, active intervention should be considered during the administration of the IPSS, especially for old aged patients living in urban areas.ope

Effects of α-blocker 'add on' treatment on blood pressure in symptomatic BPH with or without concomitant hypertension

We investigated the effects of 'add on' treatment of α-blocker (AB) on blood pressure (BP) and the safety of ABs in men with symptomatic BPH with or without hypertension. We retrospectively reviewed 2,924 BPH outpatients who took ABs at our institution between 2005 and 2009. BPH symptom severity, prostate volume and BP were determined for 953 patients with their baseline data. BP level and International Prostate Symptom Score were measured within 2 months after AB treatment. Patients were assigned to four groups: group 1 had 272 normotensive patients on concomitant hypertensive medication; group 2 had 293 normotensive patients not on the medication; group 3 had 216 hypertensive patients on concomitant medication; and group 4 had 172 hypertensive patients not on the medication. The addition of AB lowered the mean systolic BP by 16.6 mm Hg for group 3 and by 8.6 mm Hg for group 4, and diastolic BP by 18.0 mm Hg for group 3 (P<0.05). However, normotensive groups on entry, irrespective of antihypertensive medication, showed no significant BP changes from baseline after AB medication. In the hypertensive groups on entry, the doxazosin gastrointestinal therapeutic system (GITS) resulted in significant reductions in systolic BP from 142.2 to 134.9 mm Hg and in diastolic BP from 97.6 to 84.6 mm Hg. When analyzed by AB regimen, the incidence of BP-related adverse events was comparable. AB therapy for BPH can have an appropriate and beneficial effect on BP, especially in baseline hypertensive patients. Doxazosin GITS treatment resulted in optimal management of BP within the normal range, especially in pharmacologically or physiologically hypertensive patients.ope

Desire to Void in Patients with Complete Spinal Cord Injury

Objective: To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group Method: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. Results: There were 37 patients (31.6%) with the preserva-tion of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p＜0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. Conclusion: The presence of desire to void was noted in 31.6% of complete SCI patients observed.ope

Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage

PURPOSE: Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment. MATERIALS AND METHODS: Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone. RESULTS: Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM. CONCLUSION: Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatmentope

Significance of Repeat Prostate Biopsy for Detection of Prostate Cancer

Purpose: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen(PSA) levels, where the initial biopsies were negative for cancer. Materials and Methods: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218(29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104(19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26(4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. Results: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result(12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients(p＜0.05). Conclusions: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patientsope

The Transvaginal Bladder Neck Suspension by Raz for Stress Urinary Incontinemce: A Review of 106 Cases

From January, 1990 to December, 1995, 106 patients received transvaginal bladder neck suspension by Raz. Followup periods ranged from 3 monhths to 5 years, and mean age of patientss was 52.2 years.s Severity of incontinence were grade I in 22, grade II in 83, and grade III in I patient. Afte rminimum of 3 months followup, 87 (82.1%) patients were completely cured and 14 (13.2%) patients reported minimal leaking, the final success rate being 95.3% (101/106). Degree of posterior urethral angle kand grades of incontinence (classified either by Blaivas or Green) were n9ot significant factors in predicting outcome. Grade of incontinence, preoperative irritative voiding ksymptoms, previous incontinence surgery, age, and menopause were not correlated with success. However the history of hystrectomy and overweight were related with lower success rate. Mean hospital stay was 6.1 days, and 50 (47.2%) patients performed intermittent atheterization at discharge but later all resumed normal voiding. Among 34 paktients with urgency preoperatively 25 (73.5) improved after operation, and de novo urgency was found in 11 (16.2%). Complications including urinary tract infection, blood perforation, and wound perforation was seen. Success rate of Raz operation is more than 90%, which was higher than other types of bladder suspension. Raz colposuspension can place bladder neck traction sutures accurately without causing obstruction or significant morbidity, therefore should be recommended as a premier mode of surgical treamtment in patients with stress urinary incontinence.ope

Intrauterine Insemination Using Eletroejaculation in Anejaculatory Male

A total of 41 anejaculatory men participated in the electroejaculation study. Mean patient age was 33.2 years (range 22 to 54 years). Greater than one million motile sperm were obtained in 26 patients(63.4%). We attempted intrauterine insemination on 25 occasions in 14 subjects` spouses. Four of them(28.6%) becamepregnant ;two aborted and the other two delivered fullterm healthy babies.ope