Hee Chang Jung

The 7-year outcome of the tension-free vaginal tape procedure for treating female stress urinary incontinence.

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

Efficacy and safety of solifenacin succinate in Korean patients with overactive bladder: a randomised, prospective, double-blind, multicentre study.

Purpose:  We assessed the efficacy and safety of solifenacin compared with tolterodine for treatment of overactive bladder (OAB) in Korean patients.

Generic and disease-specific health-related quality of life in women with coital incontinence: a prospective, multicenter study.

Objective: This study was carried out to evaluate the impact of coital incontinence on health-related quality of life (HRQOL) in women with lower urinary tract symptoms. Methods: A total of 180 women with sexual activity were evaluated. To obtain HRQOL assessments, patients were asked to fill out the Bristol Female Lower Urinary Tract Symptoms and the Medical Outcomes Study Short Form (SF-36) questionnaires. Results: The coital incontinence group had more frequently symptoms including urgency, urge incontinence, bladder pain, stress incontinence, unpredictable incontinence, nocturnal incontinence, reduced stream, and stopping flow than the no coital incontinence group. The frequency of incontinence and volume of leakage were also higher in the coital incontinence group than the no coital incontinence group. All symptom questions regarding sexual matters and quality of life except cutting down on fluid were more frequent in patients with coital incontinence than those without coital incontinence. Of the eight domains in the SF-36 questionnaire, five domains, namely, Physical functioning, Role-physical functioning, Social functioning, Role-emotional functioning, and Mental health were significantly different between the two groups. When comparing the Bristol Female Lower Urinary Tract Symptoms scores in the two groups, the scores in all domains except Voiding symptoms in the coital incontinence group were significantly higher than those in the no coital incontinence group. Patients with coital incontinence had more HRQOL impairment than those without coital incontinence. Conclusions: Our study reveals that more emphasis should be placed on coital incontinence in the terminology of urinary incontinence.

A Prospective Multi-center Trial of Escherichia coli Extract for the Prophylactic Treatment of Patients with Chronically Recurrent Cystitis

We have assessed the efficacy and safety of Escherichia coli extract (ECE; Uro-Vaxom®) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2±5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging (MRI) on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI. A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6 days. The accuracy of the MRI for simplified tumor location (right, left, bilateral and none) was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ‘MRI predicted a unilateral lesion, but pathology revealed bilateral lesions’ (58.3%), followed by ‘MRI predicted no lesion, but pathology revealed the presence of a lesion’ (32.0%). Multivariable analysis showed that the discordant group had a shorter interval (25.0 ± 14.3 vs 38.1 ± 20.6 days, P < 0.01) preceding the MRI and a higher rate of hemorrhage as observed by MRI (80.4% vs 54.8%, P < 0.01) in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 (P < 0.001). At the MRI intervals cutoff of 28.5 days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28 days, the accumulated accuracy was only 26.1% (23/88); however, when it was performed after 28 days, the reversely accumulated accuracy was 61.5% (59/96). These data support a waiting period of at least 4 weeks after a biopsy before performing an MRI for the purposes of surgical refinement.

A Long-Term Study of the Effects of the Tension-Free Vaginal Tape Procedure for Female Stress Urinary Incontinence on Voiding, Storage, and Patient Satisfaction: A Post-Hoc Analysis

Purpose We assessed the long-term effects of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) on voiding, storage, and patient satisfaction. Materials and Methods This retrospective study examined the records of 134 patients who had undergone the TVT procedure for SUI and were followed up for more than 5 years. Voiding function was evaluated by measuring maximum urinary flow rate (MFR), post-void residual urine volume (PVR), and storage function by using a voiding diary. Patients were asked to describe their satisfaction with the operation. Results MFR was lower at 1 month compared with the preoperative level, but had recovered to preoperative levels by 5 years postoperatively. However, some patients with >50%, 25-50%, and <25% decreases in the MFR at 1 month postoperatively showed a decrease in the MFR of >50% at 5 years. PVR increased over the 5 postoperative years. Of the patients with urgency and urgency incontinence, 43.8% and 48.1% showed improvement, respectively, whereas new patients developed postoperatively. Thus, the total number of patients with urgency or urgency incontinence remained similar over the 5 years. In those with a changed voiding pattern, patient satisfaction was negatively affected by de novo urgency and urgency incontinence and decreased MFR. Conclusions Any obstructive effect of the TVT procedure diminished over time in most patients, although a decrease in the MFR was sustained in some patients. With regard to overactive bladder symptoms, some patients were cured and some patients complained of de novo symptoms. The most major factor affecting patient satisfaction was de novo urgency.

Impact of the Midurethral Sling Procedure on Quality of Life in Women with Urinary Incontinence

Purpose This study was designed to objectively assess the impediment of incontinence to quality of life (QoL) in females and its improvement by the midurethral sling (MUS) procedure. Materials and Methods From June 2006 to June 2007, 93 female patients underwent the MUS procedure at our institute because of urinary incontinence. The incontinence quality of life (I-QoL) questionnaire was administered to measure the QoL of the incontinent patients before and 1 and 12 months after the MUS procedure. Preoperative data and urodynamic factors were analyzed retrospectively by I-QoL scores to identify factors that may affect the QoL of incontinent patients. Results The average preoperative I-QoL score of the 93 patients was 61.1±21.0 points. At 1 year after surgery, the average I-QoL score was found to have improved to 98.4±20.7 points. There were no significant differences between stress and mixed urinary incontinence in terms of cure and satisfaction (p>0.05). I-QoL scores of the cured and improved patients increased at 1 year after surgery (p<0.01). There were no statistically significant differences in the increment of I-QoL between cured and improved patients (p>0.05). Although urinary urgency and large urine leak amounts significantly reduced preoperative QoL in incontinent patients, the MUS procedure effectively improved the QoL regardless of these factors. Conclusions Preoperative I-QoL assessment revealed a significant impairment of QoL in incontinent women, but the MUS procedure effectively improved these womens QoL.

Effect on Sexual Function of Patients and Patients' Spouses After Midurethral Sling Procedure for Stress Urinary Incontinence: A Prospective Single Center Study

To evaluate the effect on sexual function of patients and their spouses after transobturator tape (TOT) procedure, prospectively. Midurethral sling procedure has been widely performed for treatment of urinary incontinence; however, little has been reported regarding sexual function after surgery.

Bicycle riding: impact on lower urinary tract symptoms and erectile function in healthy men.

Purpose Recently, reports in the mass media have implicated that bicycle riding increases the risk of erectile dysfunction and prostatic diseases. So, we evaluate the impact of bicycle riding on erectile function and lower urinary tract symptoms (LUTS) in healthy general men. Methods From 26 June 2010 to 20 July 2010, we investigate degree of LUTS (voiding and storage symptoms), using International Continence Society-male Questionnaire (ICS-mQ) and erectile function using International Index of Erectile Function-5 Questionnaire (IIEF-5) in 5 work places (personnel of public office, hospital, university, etc.) of which bicycle riding club members were doing active club activities. Respondents, who participated in club activities for 6 months and longer, were classified as the bicycle club (142 men; age, 44.02±8.56). Ones who do not ride bicycles were classified as the control group (83 men; age, 42.13±7.85). People who were having the history of urological and other chronic diseases (diabetes, vascular disease, heart disease, etc) were excluded from both groups. Results Bicycle club is not significantly associated with increased prevalence of LUTS (bicycle club, 2.1 to 57.7% control, 4.8 to 73.5%) and erectile dysfunction (bicycle club, 46.1% control, 55.4%). The total mean score (storage/voiding/erectile function) of bicycle club (13.93±1.95/11.14±3.49/20.46±5.30) were not significantly different from control (14.35±2.49/11.52±3.38/20.40±4.07) (P=0.190 to 0.968). Conclusions These results suggested that bicycle riding as exercise or hobby has no negative effect on LUTS and erectile function in healthy general men, although this research data were limited to the questionnaire analysis.

The Long-Term Outcomes of the Tension-free Vaginal Tape Procedure for Treatment of Female Stress Urinary Incontinence: Data from Minimum 13 Years of Follow-Up

To evaluate the long‐term outcomes from the tension‐free vaginal tape (TVT) procedure, we investigated the data from a minimum 13‐year follow‐up and predictive risk factors affecting efficacy for treatment of female stress urinary incontinence (SUI).