Kun-g Lin

Three‐dimensional ultrasonographic assessment of compression effect on urethra following tension‐free vaginal tape and transobturator tape procedures

To compare the anatomical difference using three‐dimensional (3D) ultrasound between the urethra at rest and during straining, in women who have undergone a tension‐free vaginal tape (TVT) or TVT‐obturator tape (TVT‐O) procedure for stress urinary incontinence (SUI).

Comparison of Low Urinary Tract Symptoms during Pregnancy between Primiparous and Multiparous Women

Background and Purpose. Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. Methods. A chart review of consecutive pregnant women who attended our antenatal clinic from March 2002 to January 2006 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. Results. Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P < 0.001) and urgency incontinence (P = 0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. Conclusions. Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during pregnancy.

Comparison of Clinical Outcomes Using “Elevate Anterior” versus “Perigee” System Devices for the Treatment of Pelvic Organ Prolapse

Objective. This study aims to compare clinical outcomes using the Perigee versus Elevate anterior devices for the treatment of pelvic organ prolapse (POP). Study Design. One hundred and forty-one women with POP stages II to IV were scheduled for either Perigee (n = 91) or Elevate anterior device (n = 50). Preoperative and postoperative assessments included pelvic examination, urodynamic study, and a personal interview about quality of life and urinary symptoms. Results. Despite postoperative point C of Elevate group being significantly deeper than the Perigee group (median: −7.5 versus −6; P < 0.01), the 1-year success rates for two groups were comparable (P > 0.05). Apart from urgency incontinence, women with advanced POP experienced significant resolution of irritating and obstructive symptoms after both procedures (P < 0.05), generating the improvement in postoperative scores of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) (P < 0.01). On urodynamics, only the residual urine decreased significantly following these two procedures (P < 0.05). Women undergoing Perigee mesh experienced significantly higher visual analogue scale (VAS) scores and vaginal extrusion rates compared with the Elevate anterior procedure (P < 0.05). Conclusions. With comparable success rates, the Elevate procedure has advantages over the Perigee surgery with lower extrusion rate and postoperative day 1 VAS scores.

Clinical and urodynamic effects of tolterodine in women with an overactive bladder

OBJECTIVE The aim of this study was to compare the changes in urinary symptoms and urodynamic parameters after administration of tolterodine in women with an overactive bladder (OAB). MATERIALS AND METHODS Thirty-eight women diagnosed with OAB and treated with tolterodine were reviewed. Urinalysis, pelvic examination, 3-day bladder diary, urodynamic study, and a personal interview to identify urinary symptoms prior to and 3 months after treatment were recorded and interpreted. RESULTS Most of our patients were menopausal (76.3%; mean age 55.7 years) and multiparous (mean parity 3.3) women. Urinary symptoms such as urinary frequency, urgency, urge incontinence, and nocturia were decreased significantly (p < 0.05). All urodynamic parameters did not change significantly except for the maximum cystometric capacity (p < 0.05), showing a significant increase after 3 months of medication. CONCLUSIONS Tolterodine, at a recommended dose, improves the symptoms of OAB syndrome without causing urine retention, as proved by the changes of urodynamic parameters.

Factors Associated with Types and Intensity of Postoperative Pain following Gynecological Laparoscopic Surgery: A Cross-Sectional Study

Objective To evaluate influences of various factors on the types and intensity of postoperative pain following gynecologic laparoscopic surgery. Study Design Cross-sectional questionnaire and chart review. Results A total of 84 questionnaires were distributed and returned. The types of postlaparoscopic pain are different in multiparous women and nulliparous ones (71.43% surgical wound pain versus 63.64% nonsurgical wound pain, p = 0.0033) and those with striae gravidarum and without striae gravidarum (93.94% surgical wound pain versus 52.94% nonsurgical wound pain, p < 0.0001). On postoperative day 1, the average VAS score is higher in nonsurgical wound pain than in surgical wound pain (5.62 ± 1.50 versus 3.51 ± 1.68, p < 0.0001). The CO2 removal procedure has a significant negative correlation with the VAS of nonsurgical wound pain (coefficient: −0.4339, p = 0.0187). Conclusion Our study suggests that women with abdominal rigidity (nulliparous, no striae gravidarum) experience mainly nonsurgical wound pain, while women with abdominal wall laxity mostly experience surgical wound pain. The VAS score of nonsurgical wound pain is greater than surgical wound pain on postoperative day 1. The CO2 removal procedure has negative correlation to the VAS score of nonsurgical wound pain on postoperative day 1.

Clinical effects of transobturator tape procedure with porcine small intestine submucosa for female stress urinary incontinence

The aim of this study was to evaluate the efficacy of the transobturator tape (TOT) procedure using porcine small intestine submucosa (SIS) for the treatment of female stress urinary incontinence (SUI). Forty‐two consecutive patients with SUI who underwent the TOT procedure with porcine SIS were enrolled. The surgical outcomes, and data of urodynamic study and a questionnaire prior to and after surgery were collected and analyzed retrospectively. SUI was reported subjectively cured in 34 of the 42 patients (81.0%) 1 year after surgery, and declined to the rate of 66.7% at 5 years postoperatively. The subjective symptoms of frequency and nocturia also improved significantly (p < 0.01). Graft‐versus‐host disease (GVHD) developed in four patients, but without major complications. Despite the bladder volume at first desire to void increased significantly after surgery (p < 0.01), the remaining urodynamic parameters did not differ in a significant manner. In conclusion, the long‐term cure rate of the TOT procedure with SIS is lower than with synthetic materials, but with relatively lower morbidity.

A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Comment

Dear Editor, We read with great interest the article by Freeman et al. [1] and commend the authors for further investigating the efficacy of abdominal versus laparoscopic sacrocolpopexy. The study design was good and obtained important evidence of the discrepancy between two different routes. However, we feel that the text of “Patients and methods” is flawed in its description of the pelvic organ prolapse quantification (POP-Q) system [2]. The authors state: “Patients referred with symptomatic grade 2 or more post-hysterectomy vaginal vault prolapse (i.e. vaginal angles/“dimples” seen at least 1 cm above or beyond the hymeneal remnants)”. It is apparent that this statement is contradictory. It is well known that grade classification belongs to the Baden– Walker half-way system. Women with grade 2 or more vault prolapse means that their leading portions of prolapse are over the mid-plane of the vagina, while the latter sentence showing “at least 1 cm above or beyond the hymeneal remnants” should equate to stage 3 or more of the POP-Q system. Moreover, the “Inclusion criteria” showed “patients with symptomatic and bothersome vault prolapse of greater than or equal to grade 2 on the POP-Q”. I wonder about the real extent of POP in all the participants in this study. Over the last decades, the POP-Q system has gained international recognition as the “gold standard” for classifying pelvic support and a number of reports in the literature document excellent intraand inter-examiner reliability [3]. The Baden–Walker half-way system remains commonly employed in clinical practice because of its ease of use. However, it should not continue to replace the POP-Q system in scientific studies [3]. Although this is simple knowledge in POP, a number of clinical surgeons ignore it. We hope that this letter might remind reviewers or authors to take a look at the discrepancies between the two classification systems.

Laparoscopic Organopexy with Non-mesh Genital (LONG) Suspension: A Novel Uterine Preservation Procedure for the Treatment of Apical Prolapse

To assess whether our novel uterus-sparing procedure- laparoscopic organopexy with non-mesh genital(LONG) suspension is an effective, safe, and timesaving surgery for the treatment of apical prolapse. Forty consecutive women with main uterine prolapse stage II or greater defined by the POP quantification(POP-Q) staging system were referred for LONG procedures at our hospitals. Clinical evaluations before and 6 months after surgery included pelvic examination, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with overactive bladder symptom score(OABSS), the short forms of Urogenital Distress Inventory(UDI-6) and Incontinence Impact Questionnaire(IIQ-7), and the Female Sexual Function Index(FSFI). After follow-up time of 12 to 30 months, anatomical cure rate was 85%(34/40), and the success rates for apical, anterior, and posterior vaginal prolapse were 95%(38/40), 85%(34/40), and 97.5%(39/40), respectively. Six recurrences of anterior vaginal wall all suffered from significant cystocele (stage3; Ba>+1) preoperatively. The average operative time was 73.1 ± 30.8 minutes. One bladder injury occurred and was recognized during surgery. The dyspareunia domain and total FSFI scores of the twelve sexually-active premenopausal women improved postoperatively in a significant manner (P < 0.05). The results of our study suggest that LONG suspension is an effective and safe uterus-sparing surgery for the treatment of apical prolapse.

Epigallocatechin-3-gallate alleviates bladder overactivity in a rat model with metabolic syndrome and ovarian hormone deficiency through mitochondria apoptosis pathways

Metabolic syndrome (MetS) and ovarian hormone deficiency could affect bladder storage dysfunction. Epigallocatechin-3-gallate (EGCG), a polyphenolic compound in green tea, has been shown to protect against ovarian hormone deficiency induced overactive bladder (OAB). The present study investigated oxidative stress induced by MetS and bilateral ovariectomy (OVX), and elucidated the mechanism underlying the protective effect of EGCG (10 umol/kg/day) on bladder overactivity. Rats were fed with high fat high sugar (HFHS) diet to induce MetS and received ovariectomy surgery to deprive ovarian hormone. By dieting with HFHS for 6 months, rats developed MetS and OAB. MetS + OVX deteriorated bladder storage dysfunction more profound than MetS alone. MetS and MetS + OVX rats showed over-expression of inflammatory and fibrosis markers (1.7~3.8-fold of control). EGCG pretreatment alleviated storage dysfunction, and protected the bladders from MetS and OVX - induced interstitial fibrosis changes. Moreover, OVX exacerbated MetS related bladder apoptosis (2.3~4.5-fold of control; 1.8~2.6-fold of Mets group), enhances oxidative stress markers (3.6~4.3-fold of control; 1.8~2.2-fold of Mets group) and mitochondrial enzyme complexes subunits (1.8~3.7-fold of control; 1.5~3.4-fold of Mets group). EGCG pretreatment alleviated bladder apoptosis, attenuated oxidative stress, and reduced the mitochondrial and endoplasmic reticulum apoptotic signals. In conclusions, HFHS feeding and ovarian hormone deficiency enhances the generation of oxidative stress mediated through mitochondrial pathway. EGCG reduced the generation of oxidative stress and lessened bladder overactivity.

Comparison of Uphold TM Vaginal Mesh Procedure with Hysterectomy or Uterine Preservation for the Treatment of Pelvic Organ Prolapse

Hysterectomy is the empirical treatment for female pelvic organ prolapse (POP) without robust evidence to prove its efficacy. Uphold transvaginal mesh (TVM) system is an innovated device with smaller area, superior anterior/apical support with single incision to treat POP. The prospective cohort study aims to evaluate Uphold TVM’s performance with or without concomitant hysterectomy. Inclusion criteria specify patients suffering from stage 2 or more anterior/apical prolapse without previous hysterectomy. Exclusion criteria specify those with contraindications to uterine preservation, such as leiomyomas, adenomyosis, endometrial hyperplasia, abnormal uterine bleeding, postmenopausal bleeding, cervical dysplasia, receiving tamoxifen treatment, family history of gynecology cancer, or colon cancer and incapability to be routinely followed. Thirty patients are recruited in the hysterectomy group and 66 patients in the hysteropexy group. The results demonstrate that patients with Uphold mesh only experience longer vaginal length, shorter operation duration, less blood loss and less post-operation pain. The performance in anatomical correction, lower urinary tract symptoms improvement, de novo dyspareunia, urodynamic study parameters and mesh extrusion rates are comparable with or without uterus preservation. The information is useful in pre-operation counseling, when the patient can make an educated choice whether or not to receive concomitant hysterectomy.