Khalil Mosley posted an update 4 months, 1 week ago
The adverse effects and perioperative complications of TUI-BN for the women in this study were acceptable. Only eight patients experienced mild urinary incontinence that developed during abdominal straining or sleeping, and the incontinence was self-limited and resolved within 6 months after surgery. Preventing the guarding reflex could lead to urinary overflow incontinence during sleep because patients usually have a higher Pves at Cy3.5 maleimide capacity and a lower urethral resistance during sleep. Only one patient developed a vesicovaginal fistula, and she recovered well after fistula repair surgery. The patient had a history of cervical cancer and received radiotherapy 15 years earlier. Unhealthy tissue in the vaginal endopelvic fascia could increase the risk of development of a vesicovaginal fistula in the deep incision of the bladder neck.The main limitation of this study is its retrospective design, small sample size, and single-center experience. The follow-up course was not well scheduled and not comprehensive. A prospective, randomized, controlled study with a large cohort is necessary to confirm the effectiveness of TUI-BN in women with DU. The conclusion of the current study is that TUI-BN is an effective procedure to improve VE for women with DU in the long term. A higher baseline Pves predicts a satisfactory surgical outcome.AcknowledgmentsA 23-year-old female presented to our institution for refractory epilepsy. Her seizures started when she was 22 years old and they were classified as complex partial seizure (CPS) with secondary generalization. The seizure semiology included typical symptoms of CPS of temporal lobe origin including aura without postural drop at the seizure onset. Then there would be automatism, such as flipping the book pages and lip smacking. The CPS occurred 5–10 times monthly. Routine electroencephalogram was unremarkable. Brain magnetic resonance imaging (MRI) at the time of presentation, with only T1- and T2-weighted axial images, was reported to be normal. She had tried various anticonvulsants without achievement of a seizure-free state including valproate, lamotrigine, oxcarbazepine, topiramate, levetiracetam, and perampanel. Her usual daily activities were considerably affected. At age 29, epilepsy surgery was considered. Brain MRI was repeated with dedicated epilepsy protocol. A tumor of 1.6 cm × 1.5 cm × 1.3 cm was found over the right temporal lobe (C). Retrospectively, subtle abnormal signals with obscuration of gray-white differentiation were already present in the initial MRI scan (A and 1B). The patient then received partial right temporal lobectomy with preservation of the hippocampal complex. Intraoperative electrocorticogram demonstrated epileptiform discharges over tumor margins prior to resection. Postresection intraoperative electrocorticogram over the resection margin showed marked reduction in epileptiform discharges. Histology confirmed World Health Organization Grade I pilocytic astrocytoma. After the surgery, she has become seizure-free with monotherapy of levetiracetam.MRI is the most ideal modality in detecting structural lesions in epilepsy. However, the proper use of this modality with dedicated protocol affects its effectiveness. The 3-T MRI is superior to the 1.5-T MRI for better resolution. Axial slices should be planned along the long hippocampal axis. Axial scan in commissura anterior–commissura posterior angulation in particular for fluid-attenuated inversion recovery (FLAIR) sequence is advocated for more effective results in detection of subtle cortical dysplasia. Coronal slices should be oriented perpendicular to the long hippocampal axis. Three dimensional T1-weighted gradient echo sequence with 1-mm slices and 1-mm voxel can provide optimal gray–white matter differentiation and facilitate assessment of cortical thickness. Coronal slices of 2-mm or 3-mm thickness in FLAIR sequence is useful in detecting abnormalities in the hippocampal complex and also cortical and subcortical signal abnormalities related to focal cortical dysplasia. T2*-weighted gradient-recalled echo or susceptibility weighted imaging should also be included, aiming to detect calcifications, hemorrhage, and occult vascular malformations. Intravenous contrast is usually not necessary, unless tumor or neurocutaneous syndrome lesions are suspected. The images should be interpreted by experienced radiologists or epileptologists.