Fei-Chi Chuang

Polypropylene mesh as an alternative option for uterine preservation in pelvic reconstruction in patients with uterine prolapse.

Aim:  The aim of this study was to evaluate the efficacy and safety of polypropylene mesh for uterine preservation during pelvic reconstruction in patients with severe uterine prolapse.

Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction

Introduction and hypothesis Voiding dysfunction has gained interest due to its high prevalence in the elderly. This study characterized bladder dysfunction in women with voiding dysfunction using video urodynamic studies (VUDS) focused on detrusor underactivity (DU). Methods We studied 1914 women in which first-line medical treatment failed. Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. Results VUDS were normal in 2.9% (n = 56) of patients and showed DU in 23.1% (n = 443), detrusor hyperactivity and impaired contractility (DHIC) in 12.0% (n = 231), hypersensitive bladder in 17.0% (n = 325), detrusor overactivity (DO) in 2.6% (n = 49) and bladder outlet obstruction in 42.3% (n = 810). The mean age of patients in the DU and DHIC groups was significantly older than in women with normal VUDS and those with hypersensitive bladders (p<0.01). Decreased bladder sensation and larger cystometric bladder capacity were noted in the DU group compared to the DHIC, HSB, and DO groups. Bladder sensation was negatively associated with the bladder contractility. Bladder contractility index and voiding efficiency were lower in the DU and DHIC groups compared to the normal group. Conclusions The bladder conditions of women with voiding dysfunction included DU, DHIC, HSB and DO. Bladder contractility index and voiding efficiency were significantly lowest in DU and DHIC groups and lower in HSB and DO groups than normal tracing group. Reduced bladder sensation was noted in DU and negatively associated with detrusor contractility.

Comparing the midterm outcome of single incision vaginal mesh and transobturator vaginal mesh in treating severe pelvic organ prolapse

OBJECTIVE The aim of this study is to compare perioperative parameters and midterm clinical outcomes using two different mesh kits: transobturator vaginal mesh (TVM) (both Perigee and Apogee), versus single incision vaginal mesh (SIM) (combined Elevate anterior/apical system and Elevate posterior/apical system) in treating severe pelvic organ prolapse (POP). MATERIALS AND METHODS This is a retrospective cohort study. During 2008 and 2013, those women with severe POP [POP quantification system (POP-Q), Stage III and Stage IV], who received either TVM or SIM operation, were enrolled for cohort comparison. There were 111 patients in the TVM group, and 136 in the SIM group. Those with an incomplete POP-Q record, or who did not complete postoperative urodynamic study were excluded. Perioperative characteristics and outcomes, postoperative urinary symptoms, urodynamic parameters, prolapse recurrence (defined as the leading edge > 0 using the POP-Q system), and mesh extrusion rate were compared. RESULTS There were no differences in the operation time, blood loss, hospital stay, and the postoperative visual analog scale for pain. Urodynamic studies showed improvement in bladder outlet obstruction in both groups. The postoperative stress urinary incontinence was significantly higher in the SIM group. The recurrence of prolapse was comparable between the two groups at a median follow-up of 2 years. The mesh extrusion rate was significantly lower in the SIM group. CONCLUSION At an average of 2 years of follow-up, the mesh extrusion rate was lower in the SIM group than in the TVM group, but there was no difference in postoperative visual analog scale for pain. The postoperative stress urinary incontinence was higher in the SIM group.

Videourodynamic evaluation of urge syndrome following pubovaginal sling procedure for stress urinary incontinence in women

Introduction and hypothesisThe purpose of this study is to evaluate women with urge syndrome following pubovaginal sling procedure for stress urinary incontinence using a polypropylene mesh.MethodsA total of 292 cases were available to compare preoperative and postoperative videourodynamic parameters.ResultsThere were 142 women (48.6%) with urge syndrome before operation and 92 (31.5%) with urge syndrome after pubovaginal sling procedure. Urge syndrome was persistent in 79 women, resolved in 63, and de novo urge syndrome was noted in 13. Urodynamic detrusor overactivity (DO) was present in 67 (22.9%) women before operation and in 47 (16.1%) after operation. DO was persistent in 29, resolved in 38, and de novo DO in 18 after operation. Among the 18 women with de novo DO, 15 (83.3%) had preoperative urge syndrome.ConclusionsOf patients with urge syndrome after pubovaginal sling procedure, 85.9% had a chronic condition, and 83.3% of patients with de novo DO had preoperative urge syndrome.

Lower Urinary Tract Symptoms and Video-Urodynamic Characteristics of Women with Clinically Unsuspected Bladder Outlet Obstruction

Objective: To analyze the lower urinary tract symptoms (LUTS) and video‐urodynamic characteristics of women with clinically unsuspected bladder outlet obstruction (BOO).