Kuo-Hsuan Huang

Optimal Treatment for Distal Ureteral Calculi: Extracorporeal Shockwave Lithotripsy versus Ureteroscopy

BACKGROUND The optimal treatment for distal ureteral calculi remains controversial. We present data from our institution to compare the efficacy of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with different lithotripsy modalities (URSL). METHODS From January 1994 to September 1997, 954 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar) in 524 patients and ureteroscopy (Wolf 8.0F instrument and Swiss Lithoclast) in 430 patients. Stone sizes and patient ages were similar in these two groups. RESULTS In the SWL group, the 3-month stone-free rate was 87%, and the effectiveness quotient (EQ) was 68.7%. In the URSL group, there was a 96% stone-free rate with an EQ of 92.1%. The SWL treatment was more expensive than URSL. CONCLUSION At our institution, ureteroscopy is more efficacious than SWL for the treatment of distal ureteral calculi. In selected patients who had stones >10 mm with evidence of impaction and severe colic pain, we strongly suggest that URSL is the best choice.

Tuberculous Peritonitis as a Complication of Intravesical Bacille Calmette-Guérin Instillation for Superficial Bladder Cancer: Report of a Case

A 72-year-old man was treated with intravesical instillation of Bacille Calmette-Guerin for superficial bladder cancer. After six sessions of induction BCG therapy and three weekly maintenance treatments 3 months later, he developed abdominal pain and fullness, and low grade fever. Under laparoscopy, biopsy of the peritoneum revealed caseating granulomatous inflammation. Cultures for mycobacterium tuberculosis complex (MTBC) and direct detection of MTBC DNA from the peritoneal fluid were positive. Our patient appeared to have developed tuberculous peritonitis after intravesical BCG therapy. Antituberculous therapy with isoniazid, rifampicin, and ethambutal was given daily and the patient’s symptoms resolved. To our knowledge, such a complication has only been reported previously in a uremic patient, requiring dialysis.

Evaluation of Tension-Free Vaginal Tape (TVT) Procedure: Its Safety and Efficacy in the Treatment of Female Stress Urinary Incontience

Objectives: To assess the surgical results and the associated complications after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence. Methods: A total of 60 women with different types of stress urinary incontinence or mixed incontinence with urgency in the absence of pelvic prolapse were treated with TVT procedure between June 1999 and December 2001. Preoperative examinations included multi-channel urodynamics. Surgical procedure was performed according to the technique of Ulmsten et al under local, regional or general anesthesia. The surgical results were assessed objectively by urodynamics and subjectively by a three-degree subjective scale. Results: The average age was 57.6±10.9 (36-79) years and the mean parity was 4 ±1.2 (2-8). The mean operative time was 40.8±3.9 (25-55) minutes. All patients were followed up for at least 2 years after the procedure (mean 42.1±9.9, median 41.7, range 25.7-73.7). Objectively, 90% of the patients were cured of stress incontinence. Subjectively, 85% of patients were completely cured and 15% were improved. Nine patients (15%) had postoperative urine retention, three of them finally received section of tape. Bladder penetration occurred in four (6.7%) but there was no subsequent complication after removal of Foley catheter. Tape erosion from the vaginal wound was found in two patients (3.3%). There were no cases of tape rejection after TVT procedure. The amount of intra-operative blood loss was minimal. Totally, 10 patients (16.7%) had postoperative urgency including persistent urgency in six patients (6/23) and de novo urgency in four patients (4/37) at final follow-up. Seven patients (11.7%) felt mild suprapubic discomfort. Conclusions: Tension-free vaginal tape procedure seems to be an effective method for treating all types of stress incontinence with results comparable with those obtained by Burch colposuspension and fascial sling procedure. It can be performed under local, regional or general anesthesia with similar high success rates. However, the procedure also had many postoperative complications and the patients should be informed accordingly. Only well-trained surgeon and careful preoperative evaluation can decrease the postoperative complications and achieve satisfactory surgical results.

The Results of the Tension-Free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence

OBJECTIVE: To report our experiences in using tension-free vaginal tape (TVT) procedure as a primary treatment of type II or type III of female stress urinary incontinence. MATERIALS AND METHODS: Twenty women with urodynamically confirmed stress urinary incontinence underwent TVT procedure. A multichannel urodynamic study with Valsalva leak point pressure was used to classify the types of stress urinary incontinence. Of the 20 patients, 8 (40%) were diagnosed with type III incontinence, 8 (40%) with type II/III, and 4 (20%) with type II. Three patients had a past history of pelvic surgery; none had undergone anti-incontinence surgery. RESULTS: The mean age of the women was 61.0±10.4 years (range: 34-74). Seventeen (85%) were completely cured, 2 (10%) were improved, and 1 (5%) failed to improve. The average follow-up was 18.7±5.3 months (range: 10-28). The subjective success rate was 95% (cure and improvement). Intraoperative bladder penetration occurred in 2 patients (10%). One patient (5%) had post-operative urinary retention and continued clean intermittent self-catheterization. Two patients (10%) developed de novo urgency: 1 (5%) had persistent urgency and the other had a vaginal wound infection (5%). There was no tape rejection and blood loss was rare. CONCLUSIONS: The tension-free vaginal tape procedure is a minimally invasive surgery. It can be used as an effective and safe procedure for treatment of type II or type III female stress urinary incontinence. But further long-term studies are necessary for cases with intrinsic sphincter deficiency or those who had failed anti-incontinence surgery.