Cheng-Min Liu

Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence

Purpose of review The aim of this review was to assess the recent evidence on the effectiveness and complications of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for female stress urinary incontinence between January 2008 and March 2009. Recent findings A meta-analysis of recent studies revealed that the short-term objective cure rate was borderline worse in the TOT group compared with TVT [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.37–1.00; P = 0.05]. Bladder perforation (OR 12.23; 95% CI 2.86–52.34) was significantly more common, whereas groin/thigh pain was significantly less in the TVT group (OR 0.32; 95% CI 0.11–0.92; P = 0.022). Postoperative urinary retention was slightly more in women undergoing TVT than those undergoing TOT (OR 1.6; 95% CI 0.90–3.12; P = 0.06). The rates of vaginal erosion (OR 0.34; 95% CI 0.09–1.33), de-novo urgency (OR 1.21; 95% CI 0.52–2.79) and urinary tract infection (OR 0.88; 95% CI 0.56–1.38) were comparable in both procedures. In addition, TVT appeared to be more obstructive than TOT, as evidenced by ultrasonographic and urodynamic findings. Changes in sexual function need further investigation because this issue has not been well studied for either sling procedure. Summary TOT has the advantages over TVT with shorter operative time and a relatively lower complication rate. For women with intrinsic sphincter deficiency, however, TVT appears to be a better option because it is more obstructive.

Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction.

OBJECTIVE: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure. METHODS: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision. RESULTS: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24–39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days. CONCLUSION: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation. LEVEL OF EVIDENCE: III

Ultrasonographic assessment of tape location following tension-free vaginal tape and transobturator tape procedure

Background. The purpose of this study was to perform an ultrasonographic comparison of tension‐free vaginal tape (TVT) and the TVT‐obturator (TVT‐O) procedure in women with stress urinary incontinence (SUI). Methods. We retrospectively reviewed 159 women with SUI undergoing either TVT (n = 91) or TVT‐O (n = 68). All subjects underwent perineal ultrasonographies, pelvic examination, urinalyses, 1‐h pad tests, multichannel urodynamic studies and a personal interview using the Bristol Female Lower Urinary Tract Symptoms Questionnaire before and 1 year after surgery. Results. At rest or during Valsalva, the middle of the TVT‐O tape localised more distally than the TVT on ultrasound (p<0.01). A higher rate of urethral kinking during straining was observed in the TVT group compared with the TVT‐O group after surgery (86.9 versus 23.9%, p<0.01). Mean operative time was significantly shorter in the TVT‐O group (16.2 versus 28.6 min, p<0.01). The rate of objective cure was comparable for the TVT and TVT‐O groups (94.5 versus 88.2%, p<0.05). However, subjective cure rate was significantly lower for the TVT‐O than the TVT group (82.4 versus 93.4%, p = 0.042). There was no statistical difference between the 2 groups regarding patient characteristics and complication rates. Conclusions. TVT‐O tape results in a less acute angle and localises to a more distal part of the urethra, resulting in less urethral compression and a lower rate of urethral dynamic kinking.

Three-year outcome of transvaginal mesh repair for the treatment of pelvic organ prolapse

OBJECTIVE To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP). STUDY DESIGN One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire. RESULTS We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P<0.001) except for total vaginal length (P=0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P<0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P<0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low. CONCLUSION TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.

Clinical and Ultrasonographic Comparison of Tension-Free Vaginal Tape and Transobturator Tape Procedure for the Treatment of Stress Urinary Incontinence

STUDY OBJECTIVE The purpose of this study was to compare tension-free vaginal tape (TVT) and the TVT-obturator (TVTO) procedures. DESIGN Multicenter retrospective cohort study (Canadian Task Force classification II-2). SETTING Tertiary teaching hospitals. PATIENTS We reviewed 82 women with urodynamically proven stress incontinence undergoing either TVT (n = 53) or TVTO (n = 29) without concomitant surgery. INTERVENTION TVT and TVTO procedure. MEASUREMENTS AND MAIN RESULTS All subjects underwent urinalyses, 1-hour pad testing, perineal ultrasonography, and urodynamic studies, as well as validated questionnaires before and 1 year after surgery. Mean operative time was significantly shorter in the TVTO group (16.8 +/- 10.7 minutes vs 28.6 +/- 6.9min, p <.01; unpaired t-test). The subjective and objective cure rates were comparable for the TVT and TVTO groups (p = .085 vs .19, respectively; Fishers exact test). At rest or during Valsalva, the middle of the TVTO tape localized more distally than that of TVT on ultrasound scanning (p <.01; unpaired t-test). A higher rate of urethral kinking during straining was noted in the TVT group compared with the TVTO group after surgery (87% vs 25%, p <.01; chi2 test). After TVT, maximum urethral closure pressure increased significantly (83.6 +/- 24.6 cm H2O vs 69.2 +/- 25.9 cm H2O, p <.05), but this was not the case in the TVTO group (67.8 +/- 15.0 cm H2O vs 63.2 +/- 12.3 cm H2O, p >.05; paired t test). CONCLUSION With comparable subjective and objective cure rates, TVTO has the advantages over TVT with shorter operative time. However, the TVTO tape is at a less acute angle and localizes to a more distal part of the urethra, resulting in a lower rate of urethral kinking and less urethral compression.

Modulation of tumorigenesis and oestrogen receptor‐α expression by cell culture conditions in a stem cell‐derived breast epithelial cell line

Background information. The common phenotypes of cancer and stem cells suggest that cancers arise from stem cells. Oestrogen is one of the few most important determinants of breast cancer, as shown by several lines of convincing evidence. We have previously reported a human breast epithelial cell type (Type 1 HBEC) with stem cell characteristics and ERα (oestrogen receptor α) expression. A tumorigenic cell line, M13SV1R2, was developed from this cell type after SV40 (simian virus 40) large T‐antigen transfection and X‐ray irradiation. The cell line, however, was not responsive to oestrogen for cell growth or tumour development. In the present study, we tested the hypothesis that deprivation of growth factors and hormones may change the tumorigenicity and oestrogen response of this cell line.

Comparison of the Changes in Sexual Function of Premenopausal and Postmenopausal Women Following Transvaginal Mesh Surgery

INTRODUCTION The effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial. AIM To compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair. METHODS One hundred and fifty-two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty-eight women were included because they were sexually active and had complete follow-up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). MAIN OUTCOME MEASURES The FSFI, UDI-6, and IIQ-7 questionnaires. RESULTS The mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P < 0.05) compared with the premenopausal group. As for the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) in both groups except for total vaginal length (P > 0.05). Similarly, the UDI-6 and IIQ-7 scores significantly decreased postoperatively (P < 0.01). After POP surgery, the score of the dyspareunia domain decreased significantly in the premenopausal group (P < 0.01) but was not the case for the postmenopausal group (P > 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033). CONCLUSION TVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women.

Effect of ovariectomy on the gene expression of detrusor muscarinic receptors in female rats.

Eight rats served as control subjects with sham surgeries and eight rats underwent ovariectomy. Two months later, the expression of muscarinic receptors, neuronal nitric oxide synthase (nNOS), and estrogen receptor (R) at the mRNA level were assessed by reverse-transcription polymerase chain reaction. The results showed that performing an ovariectomy in a virgin rat appears to have little effect on the gene expression of detrusor muscarinic receptors and urethral nNOS despite the menopausal events that occurred.

Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function.

To evaluate the short‐term impact of surgical repair with total transvaginal mesh (TVM) on sexual function among women with pelvic organ prolapse (POP).

Changes in Female Sexual Function following Anterior with and without Posterior Vaginal Mesh Surgery for the Treatment of Pelvic Organ Prolapse

INTRODUCTION Comparison of female sexual function following anterior and total transvaginal mesh (TVM) surgery has never been reported. AIM To compare the sexual function after anterior and total TVM repair for the treatment of pelvic organ prolapse (POP). MAIN OUTCOME MEASURES The short forms of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and the Female Sexual Function Index (FSFI). METHODS One hundred and sixty-five women with symptomatic POP stages II to IV defined by the POP quantification (POP-Q) staging system underwent TVM procedures at our hospitals. Seventy women were included because they were sexually active and had complete follow-up. All subjects were divided into the anterior group (anterior TVM; N=39) and total group (anterior and posterior TVM; N=31). Preoperative and postoperative assessments included pelvic examination using the POP-Q system, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with the short forms of UDI-6 and IIQ-7, and the FSFI. RESULTS There was no difference between the two groups as for age, parity, diabetes, hypertension, concomitant procedures, and success rates for TVM and mid-urethral sling in this study (P>0.05). Regarding the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P<0.05) in both groups except for total vaginal length (P>0.05). The preoperative scores of UDI-6 and IIQ-7 were significantly higher in the total group (P<0.01), and the UDI-6 and IIQ-7 scores showed significant decreases in both groups postoperatively (P<0.01). After TVM surgery, the score of the dyspareunia domain worsened significantly in both groups (P<0.05), and the deteriorated lubrication domain was noted only in the total group (P=0.042). CONCLUSIONS TVM procedure creates an effective anatomical restoration of POP, but individual domains of FSFI may worsen. Compared with the anterior group, women of the total group had worse quality of life in term of urinary symptoms preoperatively, and experienced a greater sexual impairment on lubrication following surgery.