Jinghe Lang

The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China.

Objective:The aim of this study was to evaluate the prevalence and associated risk factors of urinary incontinence (UI) in Chinese women. Methods:In the cross-sectional survey, 20,000 Chinese women 20 years or older were randomly selected and interviewed with modified Bristol Female Lower Urinary Tract Symptoms questionnaires to estimate population prevalence rates and identify potential risk factors. Results:A total of 19,024 women were included in the analysis and 976 excluded; qualified rate is 95% (19,024/20,000). Of the Chinese women aged from 20 to 99 years (mean ± SD, 45 ± 16 y), the overall prevalence rate of UI was 30.9%. Estimates of stress urinary incontinence (SUI), urge urinary incontinence, and mixed urinary incontinence prevalence were 18.9%, 2.6%, and 9.4%, with a corresponding proportional distribution of 61%, 8%, and 31%, respectively. The prevalence of mixed urinary incontinence increased with aging, whereas the prevalence of SUI peaked in the group of women aged 50 years and that of urge urinary incontinence in the group of women aged 70 years. Only 25% of women have consulted doctors on this issue. Through multivariable logistic regression analysis, we identified age, vaginal delivery, multiparity, alcohol consumption, central obesity (womens waist circumference, ≥80 cm), constipation, chronic pelvic pain, history of respiratory disease, gynecological events, pelvic surgery, and perimenopause and postmenopause status as potential risk factors for SUI, among which age, vaginal delivery, and multiparity are three major risk factors. Conclusions:Our findings suggest that the prevalence of UI is high in China, with SUI as the most common subtype. Age, vaginal delivery, and others are risk factors for SUI.

Expression of vascular endothelial growth factor and thrombospondin-1 mRNA in patients with endometriosis

OBJECTIVE To investigate the expression of vascular endothelial growth factor (VEGF) mRNA and thrombospondin-1 (TSP-1) mRNA in endometriosis. DESIGN Molecular studies in human tissue. SETTING Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China. PATIENT(S) Patients undergoing laparoscopy for infertility or other benign gynecologic conditions. INTERVENTION(S) Biopsies were taken from endometriotic lesions (red peritoneal lesion, ovarian endometrioma, and unterosacral ligament nudule) and eutopic endometrium during laparoscopy. MAIN OUTCOME MEASURE(S) mRNA expression from endometriotic lesion and eutopic endometrium was analyzed by reverse transcriptase polymerase chain reaction (PCR) and Northern blotting. RESULT(S) Among the endometriotic lesions, red peritoneal lesions expressed higher levels of VEGF mRNA and lower levels of TSP-1 mRNA, whereas ovarian endometrioma expressed lower levels of VEGF mRNA and higher levels of TSP-1 mRNA. Eutopic endometrium of women with endometriosis had higher expression levels of VEGF mRNA and lower expression levels of TSP-1 mRNA than that of women without endometriosis. CONCLUSION(S) The expression of VEGF and TSP-1 in endometriotic lesions appears to be associated with the extent of their neovascularization. The imbalance in expression of VEGF and TSP-1 in the endometrium may play a role in the development of endometriosis.

Abdominal wall endometriomas.

Objective: To investigate the clinical characteristics, treatment, and factors of recurrence of abdominal wall endometriomas (AWE). Method: Sixty‐four cases of AWE diagnosed at Peking Union Medical College Hospital (PUMCH) from 1983 to 2003 were reviewed retrospectively. Result: There was an AWE incidence of 0.044% among the parturients undergoing cesarean section at PUMCH, of whom 87.5% had the typical complaint of an enlarging mass and pain during menstruation. Among these women, 62 underwent low abdominal surgery for endometrioma (2 for primary umbilicus endometrioma); 2 women with small endometriomas opted for a temporary medical solution and had relief after menopause. The latent period of AWE positively correlated to the womens age at onset of symptoms (P < 0.001). Of the 62 women who underwent local excision, 19 had an unsatisfactory experience with medical management. There were 5 recurrences and 1 evolution to malignancy during a mean follow‐up of 83.7 months. Recurrence was closely related to the size and depth of lesions. Conclusion: Because of its typical clinical manifestations, abdominal wall endometriomas could be diagnosed before pregnancy. Surgical excision is the only effective treatment and wide local excision with clear margins is the key point to prevent recurrence.

Estrogen levels and estrogen receptors in patients with stress urinary incontinence and pelvic organ prolapse

Objectives: To investigate the histologic characteristics of tissues presumed to be the cause of urinary stress incontinence and pelvic organ prolapse. Methods: Cardinal ligament and uterosacral ligament samples were obtained from 73 women undergoing hysterectomy. The evaluation of estrogen receptors (ERs) by immunohistochemical staining was semi‐quantitative. Serum estrogen was determined by ELISA. Statistical analyses were performed by the independent‐sample t‐test and one‐way ANOVA. Results: Serum estradiol levels and ER values in the premenopausal women with pelvic organ prolapse were significantly lower than in the control group (P<0.01). A positive correlation was found between ERs and the number of postmenopausal years (P<0.01). ER values were similar in the cardinal and uterosacral ligaments. Conclusions: Serum estrogen levels and ER values are significantly lower in the uterine ligaments of premenopausal women with pelvic organ prolapse, and there was a positive correlation between ER values in the uterine ligaments and the duration of postmenopausal years. Serum estrogen levels and ER values were similar in the cardinal ligament and the uterosacral ligament.

The prevalence of and potential risk factors for female urinary incontinence in Beijing, China.

Objectives: To survey and evaluate the prevalence and potential risk factors of female urinary incontinence (UI) in Beijing, China. Design: A population-based cross-sectional study was performed from April to July 2005. We randomly sampled 1.0% of female residents aged 20 years and older from year 2000 national census data, totaling 5,300 women. All of the women were interviewed face to face using a modified questionnaire based on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms. Data were collected and analyzed. Results: The overall prevalence of female UI was 38.5%. Prevalence rates of female stress urinary incontinence (SUI), female urge urinary incontinence, and female mixed urinary incontinence were 22.9%, 2.8%, and 12.4%, respectively. The prevalence rate of female UI was more than 50% in postmenopausal women. In multiple logistic models, multiple vaginal deliveries (odds ratio [OR] = 2.1; 95% CI: 1.443-3.179), age (OR = 1.7; 95% CI: 1.039-2.742), postmenopausal status (OR = 1.5; 95% CI: 1.182-1.983), chronic pelvic pain (OR = 1.4; 95% CI: 1.134-1.814), obesity (OR = 1.4; 95% CI: 1.205-1.721), lack of exercise (OR = 1.3; 95% CI: 1.105-1.509), constipation (OR = 1.3; 95% CI: 1.109-1.586), and hypertension (OR = 1.2; 95% CI: 1.053-1.474) were identified as potential risk factors of female SUI. No association between female SUI and offspring birth weight, occupation, or chronic diseases was observed in this study. Only 12.8% of women with UI and 7.4% of women with SUI seek medical help. Conclusions: UI is a major disorder that affects female quality of life. The prevalence of female UI is high (38.5%) in Beijing. Among the different types of UI, SUI was the most prevalent (22.9%). Potential risk factors identified for female SUI were multiple vaginal deliveries, age, postmenopausal status, chronic pelvic pain, obesity, lack of exercise, constipation, and hypertension.

Transobturator tape procedure versus tension-free vaginal tape for treatment of stress urinary incontinence

To compare the efficacy and safety of the tension‐free vaginal tape (TVT) and inside‐out transobturator tape (TVT‐O) procedures for the treatment of stress urinary incontinence (SUI).

Comparisons of vaginal and abdominal radical trachelectomy for early-stage cervical cancer: preliminary results of a multi-center research in China

Background:There are limited data comparing the prognosis and fertility outcomes of the patients with early cervical cancer treated by trans-vaginal radical trachelectomy (VRT) or abdominal radical trachelectomy (ART).The objective of this study was to compare the surgical and pathologic characteristics, the prognosis and fertility outcomes of the patients treated by VRT or ART.Methods:Matched-case study based on a prospectively maintained database of patients underwent radical trachelectomy in 10 centres of China was designed to compare the prognosis and fertility outcomes of the patients treated by VRT or ART.Results:Totally 150 cases, 77 in the VRT and 73 in the ART group, were included. VRT and ART provide similar surgical and pathological outcomes except larger specimens obtained by ART. In the ART group, no patient developed recurrent diseases, but, in the VRT group, 7 (9.8%) patients developed recurrent diseases and 2 (1.6%) patients died of the tumours (P=0.035). The rate of pregnancy in the VRT group was significantly higher than those of ART (39.5% vs 8.8%; P=0.003). The patients with tumour size >2 cm showed significant higher recurrent rate (11.6% vs 2.4%, P<0.05) and lower pregnant rate (12.5% vs 32.1%, P=0.094) compared with the patients with tumour size <2 cm.Conclusion:Patients treated by ART obtained better oncology results, but their fertility outcomes were unfavourable compared with VRT. Tumour size <2 cm should be emphasised as an indication for radical trachelectomy for improving the outcome of fertility and prognosis.

Clinical characteristics of 70 patients with Herlyn-Werner-Wunderlich syndrome

To analyze the clinical characteristics of patients with Herlyn–Werner–Wunderlich (HWW) syndrome.

Fertility-preserving treatment in young women with well-differentiated endometrial carcinoma and severe atypical hyperplasia of endometrium

A retrospective study on 25 women (8 with endometrial carcinoma, 17 with severe endometrial atypical hyperplasia) under 35 years treated with progestin showed that six cases (75%) in the endometrial carcinoma (EC) group and 17 (100%) in the atypical hyperplasia (AH) group responded to the treatment, and among the 14 complete responders, 4 (40%) patients with AH had 7 pregnancies and 3 healthy deliveries. Given accurate pretreatment assessment, progestin therapy is a feasible management option to preserve fertility for young women with well-differentiated endometrial carcinoma or severe atypical hyperplasia of endometrium.

Comparing vaginal tape and transobturator tape for the treatment of mild and moderate stress incontinence.

Objective: To compare the efficacy and safety of the tension‐free vaginal tape (TVT) and transobturator suburethral tape (TVT‐O) procedures for the treatment of mild and moderate stress urinary incontinence (SUI). Methods: A total of 56 women were randomly selected to undergo the TVT‐O or the TVT procedure. In some patients, vaginal repair or vaginal hysterectomy was done simultaneously for associated indications. Results: Mean blood loss and hospital stay duration were the same for the 2 groups, but mean ± SD operative time was significantly shorter in the TVT‐O than in the TVT group (16 ± 4 min vs 27 ± 6 min; P < 0.001). On the second day following surgery a residual urine volume less than 100 mL was noted in 86% and 89% of the patients in the TVT‐O and TVT groups, respectively; cure was achieved in 92.9% and 92.6% of the patients. No serious complications occurred in either group. Outcome was subjectively assessed, with the patients followed‐up for a mean of 27.6 months. Conclusion: No significant differences in rates of cure, postoperative urine retention, or operative complications were found following the TVT‐O or the TVT procedure.