Biomedical subjects

J M Choe

Publications and source records attributed to J M Choe.

9 recordsLinked to original sources

PubMed2000

Antibacterial mesh sling: a prospective outcome analysis.

OBJECTIVES: To prospectively assess the outcome results of the Gore-Tex antibacterial mesh sling in women with pelvic prolapse and stress incontinence. METHODS: Between July 1997 and November 1998, 30 women with stress incontinence and vaginal prolapse underwent vaginal reconstruction with the antibacterial mesh sling. All patients had documented stress incontinence by preoperative urodynamic evaluation. Postoperatively, we conducted an outcome analysis on the basis of the results from a self-reported satisfaction questionnaire, a detailed pelvic examination, a cough stress test, and the Q-tip test. Urodynamic studies were performed on patients with persistent stress incontinence or urge symptoms. Cystoscopy was performed on patients suspected of having urethral erosion. RESULTS: Complete follow-up was available for all 30 patients. Of the group, 12 (40.0%) of 30 underwent implantation of the antibacterial mesh sling alone and 18 (60.0%) underwent additional prolapse repair. The mean follow-up was 18 months (range 9 to 24); mean age was 58 years (range 29 to 87). Stress incontinence was cured in 28 (93.3%) of 30 patients. De novo urge incontinence developed in 1 (5.2%) of 18 patients; urge symptoms persisted in 5 (41.7%) of 12 patients. The postoperative mean Valsalva Q-tip angle was 15 degrees (range 0 degrees to 25 degrees ). The incidence of urethral obstruction and erosion was zero. The mean postoperative pain score was 3 of 10 (range 0 to 6), and the mean satisfaction score was 9 of 10 (range 7 to 10). The mean time to discharge was 21 hours (range 6 to 29). All 30 women (100%) were willing to undergo surgery again. CONCLUSIONS: The safety profile of the Gore-Tex antibacterial mesh is better than that of the conventional Gore-Tex sling. When meticulous surgical technique is used, excellent short-term results can be achieved in the correction of female stress incontinence.

Adult↗

PubMed1999

Gore-Tex patch sling: 7 years later.

OBJECTIVES: To assess the long-term results of a transvaginal endoscopic Gore-Tex patch sling in women with genuine stress urinary incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency, with or without coexistent urge incontinence. METHODS: Between December 1989 and June 1994, we performed a Gore-Tex patch sling procedure in 141 consecutive women. All patients had documented stress urinary incontinence on preoperative videourodynamic testing. We conducted outcomes analysis using the information from postoperative office visits, detailed chart reviews, patient questionnaires, and telephone surveys. RESULTS: A complete follow-up was available in 90 patients. The mean follow-up was 51 months (range 27 to 84). Their mean age was 54.2 years (range 32 to 86). Stress incontinence was completely cured in 80 (88.9%) of 90 patients. Pure stress incontinence persisted in 4 (4.4%) of 90 patients. Mixed incontinence occurred in 6 (6.7%) of 90 patients. Pure urge incontinence was experienced by 16 (17.8%) of 90 patients. Six patients required incision of the Gore-Tex patch for obstruction or retention; 3 remain continent. Five patients developed vaginal granulation tissue requiring Gore-Tex patch removal; 1 remains continent. There was no bladder or urethral erosion. CONCLUSIONS: The transvaginal Gore-Tex patch sling has provided durable efficacy with minimal morbidity for the treatment of stress urinary incontinence due to anatomic urethral hypermobility and/or intrinsic sphincter deficiency.

Adult↗

PubMed1999

A provocative maneuver to elicit cystometric instability: measuring instability at maximum infusion.

PURPOSE: We identify a provocative maneuver to enhance the sensitivity of cystometry in detecting detrusor instability when urge incontinence is suspected based on clinical history. MATERIALS AND METHODS: A total of 134 consecutive women with clinical urge incontinence underwent carbon dioxide cystometry between August 1995 and October 1996. The bladder was filled to maximal capacity with the patient supine. Six provocative maneuvers were performed consecutively to evoke detrusor instability, including lying supine, rising to a seated position, walking toward the bathroom, handwashing, coughing and sitting on the toilet with instructions not to void. Subjects were divided into 2 groups depending on the order of maneuvers. Sitting on the toilet was the last maneuver for group 1 (80 patients) and was in the middle of the sequence for group 2 (54). RESULTS: Sitting on the toilet evoked detrusor instability in 37.5% of group 1 and 53.8% of group 2. This maneuver with instructions not to void was the most provocative stimulus in eliciting detrusor instability with a detection rate of 68.4% for all subjects. CONCLUSIONS: Sitting on the toilet with the bladder at maximal capacity is the most provocative maneuver for detecting detrusor instability. The incidence of suspected detrusor instability is enhanced by using this test during routine cystometry.

Female↗

PubMed1997

The Gore-tex sling procedure for female sphincteric incontinence: indications, technique, and results.

We constructed a pubovaginal sling using the Gore-tex Soft Tissue Patch and 2-0 polytetrafluoroethylene (PTFE) suspension suture and placed it in 122 consecutive incontinent women with urethral hypermobility and/or intrinsic sphincter deficiency. We performed a retrospective outcome analysis using a questionnaire-based telephone survey. The mean follow-up period was 24.4 months. Stress incontinence was cured in 88% of patients (equally effective in type II and type III incontinence), de novo postoperative urinary frequency occurred in 32% of cases, and preoperative urinary frequency resolved postoperatively in 51% of patients. Significant urinary obstruction occurred in 5% of patients. Vaginal granulation tissue with exposed sling occurred in 4% of patients. There was no urethral or bladder erosion. The treatment of female stress incontinence with a PTFE sling is effective and durable with minimal complications. Furthermore, this technique addresses many of the presumed technical shortcomings of endoscopic needle suspensions.

Female↗

PubMed1997

Clinical usefulness of urinary control urethral insert devices.

Urinary control urethral insert devices have been introduced as a non-surgical remedy to treat female urinary incontinence. Several early clinical trials have demonstrated the degrees of safety and efficacy, and have defined the morbidity and complications of these urethral inserts. This is a descriptive review of urethral insert devices in clinical use or currently undergoing clinical investigation.

Female↗

PubMed1997

Artificial urinary sphincter: evolution and development.

The first hydraulic artificial urinary sphincter came into clinical use in 1972. The original prototype has undergone many modifications resulting from advances in mechanical design, applications of new technology, and clinical experience. This evolutionary process has culminated in the AS800, the most frequently used hydraulic artificial urinary sphincter in the U.S. today. Although the AS800 device most closely approximates the biological urinary sphincter, clinical demands for an ever more ideal urinary sphincter require the ongoing improvement of this device.

Equipment Design↗

PubMed1996

High-energy visual laser ablation of the prostate in men with urinary retention: pressure-flow analysis.

OBJECTIVES: To assess the efficacy of high-energy visual laser ablation of the prostate (VLAP) in men with urinary retention, using subjective and objective data. METHODS: Seventeen men in urinary retention underwent high-energy VLAP. The mean patient age was 69 years, and the mean follow-up was 12 months. All men were urodynamically obstructed by pressure-flow analysis with a functioning detrusor muscle. Interviews assessed retrograde ejaculation and patient satisfaction. RESULTS: The mean total energy applied was 71,088 J (range 27,556 to 110,294). The mean peak noninvasive urine flow rates increased from 2.1 to 18.1 cc/s, and the mean postvoid residual volumes decreased from 550.0 to 39.0 cc. The mean detrusor pressure at peak flow decreased from 66.4 to 41.9 cm H2O, and the mean maximal detrusor pressure decreased from 72.2 to 49.2 cm H2O. Ten men (59%) voided to completion within 1 week post-VLAP. The mean postoperative International Prostate Symptom Score was 6. Nine men (53%) reported new retrograde ejaculation, and 14 men (82%) were satisfied with their outcome. CONCLUSIONS: High-energy VLAP is an effective procedure for relief of bladder-outlet obstruction in men with urinary retention.

Aged↗

PubMed1996

Questionnaire-based outcomes study of nononcological post-vasectomy complications.

PURPOSE: We conducted an outcomes analysis to determine the incidence of post-vasectomy complications. MATERIALS AND METHODS: A questionnaire (154 questions) addressing post-vasectomy complications, incidence of post-vasectomy scrotal pain and quality of life issues was sent to 470 patients. Followup telephone surveys were made. RESULTS: A total of 182 patients (42.3%) responded. Mean follow-up was 4.8 years. The most common complication was post-vasectomy scrotal pain in 34 men (18.7%), which adversely affected the quality of life in 4 (2.2%). In retrospect, 71.4% of the men were satisfied with the decision for vasectomy, 19.3% had equivocal feelings and 9.3% were dissatisfied. CONCLUSIONS: Chronic scrotal pain is the most common post-vasectomy complication that may adversely affect quality of life in men undergoing vasectomy.

Adult↗

PubMed1995

Intravesical thiotepa-induced eosinophilic cystitis.

Eosinophilic cystitis is a rare form of an allergic cystitis. Factors such as food allergens, parasites, and drugs have been implicated in the genesis of eosinophilic cystitis. Associated risk factors include bronchial asthma, atopic diseases, and environmental allergens. Intravesical mitomycin is a reported causative agent. We report the first case of eosinophilic cystitis that developed after intravesical instillation of thiotepa for treatment of superficial bladder cancer.

Adult↗