Journal of Yeungnam Medical Science

Original articles

Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study: Yeong Uk Kim; J Yeungnam Med Sci. 2023;40(3):252-258. Published online July 21, 2022; DOI: https://doi.org/10.12701/jyms.2022.00311

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Background
The purpose of this study was to investigate whether postoperative cystography findings can predict early and long-term recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters.
Methods
I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed.
Results
The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis.
Conclusion
This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

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A single‐center retrospective comparative analysis of urinary continence in robotic prostatectomy with a combination of umbilical ligament preservation and Hood technique
Hiroaki Shimmura, Taro Banno, Kazutaka Nakamura, Anju Murayama, Haruki Shigeta, Toyoaki Sawano, Yukiko Kouchi, Akihiko Ozaki, Fumito Yamabe, Junpei Iizuka, Toshio Takagi
International Journal of Urology.2023; 30(10): 889. CrossRef

Association between cystographic anastomotic urinary leakage following retropubic radical prostatectomy and early urinary incontinence: Se Yun Kwon; Yeungnam Univ J Med. 2021;38(2):142-147. Published online November 19, 2020; DOI: https://doi.org/10.12701/yujm.2020.00682

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Abstract PDF

Background
This study was performed to investigate the association between cystographic anastomotic urinary leakage (UL) after radical retropubic prostatectomy (RRP) and early urinary incontinence (UI).
Methods
The medical records of 53 patients who had undergone cystography after RRP at our institution between January 2015 and December 2018 were retrospectively analyzed. Cystography was performed 7 to 10 days after surgery. The duration of catheterization depended on the degree of UL, which was classified as mild, moderate, or severe. The study subjects were divided into the non-UL group and the UL group. Continence was defined as the use of no pads. The prostate was dissected in an antegrade fashion, and urethrovesical anastomosis was performed with a continuous suture.
Results
Incontinence rates at 1 and 3 months postoperatively were significantly higher in the UL group than the non-UL group (83.3% vs. 52.2%, p=0.014 and 76.7% vs. 47.8%, p=0.030, respectively); however, those at 6 and 12 months were not significantly different (23.3% vs. 17.4%, p=0.597 and 4.3% vs. 10.0%, p=0.440, respectively). The presence of cystographic anastomotic UL was found to be predictive of UI during the first 3 postoperative months (odds ratio, 3.3; p=0.045). The continence rates during the first 3 postoperative month continence rate showed significant difference with non-UL group regardless of the degree of UL.
Conclusion
The presence of anastomotic UL on cystography was associated with higher rates of UI in the early postoperative period, however the grade of UL was not related to the late recovery of UI. Incontinence rates in patients with or without anastomotic UL immediately after RRP equalized at 6 months.

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Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome
I-Hung Shao, Hung-Cheng Kan, Hung-Yi Chen, Ying-Hsu Chang, Liang-Kang Huang, Yuan-Cheng Chu, Po-Hung Lin, Kai-Jie Yu, Cheng-Keng Chuang, See-Tong Pang, Chun-Te Wu
Journal of Personalized Medicine.2023; 13(1): 126. CrossRef

Pelvic floor muscle exercise with biofeedback helps regain urinary continence after robot-assisted radical prostatectomy: Yeong Uk Kim, Dong Gyu Lee, Young Hwii Ko; Yeungnam Univ J Med. 2021;38(1):39-46. Published online June 22, 2020; DOI: https://doi.org/10.12701/yujm.2020.00276

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Abstract PDF

Background
To determine the benefit of pelvic floor muscle exercise with visual biofeedback on promoting patient recovery from incontinence, we investigated variables associated with the early restoration of continence for patients who underwent robot-assisted radical prostatectomy.
Methods
Of the 83 patients enrolled, 41 consecutive patients completed pelvic floor muscle exercise (the exercise group), and the other 42 consecutive patients just before the pelvic floor muscle exercise program commenced (the control group). The primary outcome was whether pelvic floor muscle exercise engagement was associated with zero pad continence restoration within 3 months of surgery.
Results
Continence restoration percentages (defined as zero pads used per day) at 1, 3, and 6 months after surgery were 49.4%, 77.1%, and 94.0%, respectively. The exercise group achieved significantly higher recovery rates at 1 month (p=0.037), 3 months (p<0.001), and 6 months (p=0.023). Cox regression analysis demonstrated that a lower Gleason score (<8; hazard ratio, 2.167), lower prostate specific antigen (<20 ng/dL; hazard ratio, 2.909), and engagement in pelvic floor muscle exercise (hazard ratio, 3.731) were independent predictors of early recovery from postprostatectomy incontinence. Stratification by age showed that those younger than 65 years did not benefit significantly from exercise (log-rank test, p=0.08), but that their elderly counterparts, aged 65–70 years (p=0.007) and >70 years old (p=0.002) benefited significantly.
Conclusion
This study suggests that postoperative engagement in pelvic floor muscle exercise with biofeedback speeds up the recovery of continence in elderly patients (≥65 years old) that undergo robot-assisted radical prostatectomy.

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Urinary incontinence rehabilitation of after radical prostatectomy: a systematic review and network meta-analysis
Kai Yu, Fan Bu, Tengteng Jian, Zejun Liu, Rui Hu, Sunmeng Chen, Ji Lu
Frontiers in Oncology.2024;[Epub] CrossRef
Effect of Kegel exercises on the prevention of urinary and fecal incontinence in patients with prostate cancer undergoing radiotherapy
A.E. Urvaylıoğlu, S. Kutlutürkan, D. Kılıç
European Journal of Oncology Nursing.2021; 51: 101913. CrossRef

Original Articles

Oncological and functional outcomes following robot-assisted laparoscopic radical prostatectomy at a single institution: a minimum 5-year follow-up: Jun-Koo Kang, Jae-Wook Chung, So Young Chun, Yun-Sok Ha, Seock Hwan Choi, Jun Nyung Lee, Bum Soo Kim, Ghil Suk Yoon, Hyun Tae Kim, Tae-Hwan Kim, Tae Gyun Kwon; Yeungnam Univ J Med. 2018;35(2):171-178. Published online December 31, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.171

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Abstract PDF

Background
To evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution.
Methods
We retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated.
Results
Based on the D’Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediaterisk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (≥T3a) and 26.6% (34/128) had high grade disease (Gleason score ≥8). During a median follow-up period of 71 months (range, 66-78 months), the frequency of BCR was 33.6% (43/128) and the median BCR-free survival was 65.9 (0.4-88.0) months. Multivariate Cox regression analysis revealed that high grade disease (Gleason score ≥8) was an independent predictor for BCR (hazard ratio=4.180, 95% confidence interval=1.02-17.12, p=0.047). In addition, a majority of patients remained continent following the RALP procedure, without the need for additional intervention for post-prostatectomy incontinence.
Conclusion
Our study demonstrated acceptable outcomes following an initial RALP procedure, despite 50% of the patients investigated demonstrating high-risk features associated with non-organ confined disease.

Citations

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Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy
Ching-Wei Yang, Hsiao-Hsien Wang, Mohamed Fayez Hassouna, Manish Chand, William J. S. Huang, Hsiao-Jen Chung
Scientific Reports.2021;[Epub] CrossRef

The Effects of Electrical Stimulation Therapy with Microchip for the Treatment of Bladder Irritability Symptoms in Stress Urinary Incontinent Women.: Hee Chang Jung, Yeun Ho Chung, Hyoun Jin Shin; Yeungnam Univ J Med. 2004;21(2):207-214. Published online December 31, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.2.207

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Abstract PDF

PURPOSE: This study was carried out to evaluate the efficacy of intravaginal pelvic floor electrical stimulation (FES) therapy on bladder irritability symptoms in stress urinary incontinent women. MATERIALS AND METHODS: The evaluation before and after treatment included the Blaivas's female Bladder Questionnaire, the quality of life questionnaires and the overall satisfaction with present voiding state using visual analogue test (VAT). All patient were treated for 20 minutes, twice a week for 6 weeks, using a new intravaginal electrical stimulator with microchip (PIC16C74). RESULTS: After the FES therapy, the overall success rate of the SUI was 50.4.% at 9 months. The bladder irritability symptoms such as frequency, nocturia, urgency, residual urine sensation and lower abdominal discomfort were improved. In particular, the symptoms of frequency, urge incontinence, dysuria were significantly improved after the FES therapy at 9 months. The VAT score of the overall satisfaction with the present voiding state was significantly lower after the FES therapy. 73.7% of patients were satisfied with the FES therapy and complications such as hemorrhage, vaginitis, urinary tract infection and pain were not encountered. CONCLUSION: These results suggest that FES therapy with microchip improves some bladder irritability in SUI women. Therefore, electrical stimulation therapy should be considered as a first line therapy in SUI women with bladder irritability symptoms.

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Effect of Spiritual Well-being on Mental Health in Nursing Students
Nae-Young Lee, Ji-Young Han
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2014; 23(1): 21. CrossRef

The Prevalence of Urinary Incontinence of The Women in Daegu.: Sung Chul Park, Min Whan Koh, Tae Hyung Lee, Hyeon Sook Youn; Yeungnam Univ J Med. 2004;21(1):60-66. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.60

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Abstract PDF

BACKGROUND
The aim of this study was to estimate the prevalence of urinary incontinence and its correlation to the underlying diseases of women in Daegu. MATERIALS AND METHODS: Urinary incontinence questionnaire regarding age, body weight, height, body mass index (BMI), parity, delivery mode, menopausal status, history of hormonal replacement therapy, abortion history, and any underlying diseases were administered from May to November, 2001 to 412 women over 20 who had been randomly selected from the Outpatient Department of Obstetrics and Gynecology of Yeungnam University. The clinical characteristics of women who experience, and those who do not experience urinary incontinence were compared by means of the Student's t-test for continuous variables and by the Pearson's Chi-square test or Fisher's exact test for categorical variables. A p value of < 0.05 was considered statistically significant. RESULTS: The mean age of the urinary incontinent group (N=193) was 44.2 years. There was a significant increase in the prevalence of incontinence with the increase of age (p=0.000). The prevalence of urinary incontinence was significantly related to the number of deliveries and the mode of delivery (p=0.007, p=0.001) No significant relationship was demonstrated between urinary incontinence and BMI (body mass index) ; the number of abortions; hormonal status; or any underlying diseases such as thyroid disease, diabetes mellitus, and chronic respiratory disease. Also, most of the urinary incontinent women didn't recognize their incontinence as pathological and consequently, didn't consult a physician. CONCLUSION: Our study indicates that the prevalence of urinary incontinence is significantly correlated to age, parity, and the mode of delivery. Most of the middle-aged women who suffered from urinary incontinence didn't recognize their incontinence a pathological. Those results suggest that women in this age group need more information and more education about urinary incontinence.

Citations

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Knowledge and Attitudes About Urinary Incontinence Among Community-Dwelling Korean American Women
Youngmi Kang
Journal of Wound, Ostomy & Continence Nursing.2009; 36(2): 194. CrossRef
Prevalence Rate and Associated Factors of Urinary Incontinence among Nursing Home Residents
Moon-Sil Kim, Seung-Hee Lee
Journal of Korean Academy of Nursing.2008; 38(1): 92. CrossRef
Social and Cultural Construction of Urinary Incontinence among Korean American Elderly Women
Youngmi Kang, Neva L. Crogan
Geriatric Nursing.2008; 29(2): 105. CrossRef

The Efficacy of Biofeedback and Electrical Stimulation by Kontinence HMT2000 in the Treatment of Stress Urinary Incontinence Patients.: Yeun Kyoung Bae, Dae Hyung Lee, Sung Chul Park, Sung Hee Jin, Min Whan Koh, Tae Hyung Lee; Yeungnam Univ J Med. 2003;20(1):36-44. Published online June 30, 2003; DOI: https://doi.org/10.12701/yujm.2003.20.1.36

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Abstract PDF

BACKGROUND
To evaluate the efficacy of EMG biofeedback and pelvic floor electrical stimulation in the stress urinary incontinence patients by Kontinence HMT2000. MATERIALS AND METHODS: A group of 14 patients with stress urinary incontinence were treated with combined biofeedback and intravaginal electrical stimulation during 12 sessions from 2 weeks to 6 weeks. RESULTS: At immediate post treatment, subjective cure rate was 28% and improvement rate was 57% and failure rate was 15%. Thus the overall success rate for this treatment was 85%. The result of 3 months after treatment showed cure rate 14% and improvement rate was 43%. Intravaginal pressure increased by an average of 11.9 cmH2O. Increased vaginal pressure was found in 93% of the patients and more than 50% increment of intravaginal pressure was 71%. CONCLUSIONS: Combined biofeedback and pelvic floor electrical stimulation by use of Kontinence HMT2000 is effective for the patients who have good compliance, relative low degree stress urinary incontinence. In order to attain good results, a well structured program that teaches specific muscle exercise and the patients should be followed by regular interval reinforcement treatment.

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Effects of Electric Stimulation and Biofeedback for Pelvic Floor Muscle Exercise in Women with Vaginal Rejuvenation Women
Jung Bok Lee, So Young Choi
Journal of Korean Academy of Nursing.2015; 45(5): 713. CrossRef

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence.: Hong Seok Shin, Jin Wook Yoo, Hee Chang Jung, Tong Choon Park; Yeungnam Univ J Med. 2001;18(1):59-66. Published online June 30, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.1.59

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Abstract PDF: BACKGROUND
The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.

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