Soo-Cheen Ng

Changes in the extracellular matrix in the anterior vagina of women with or without prolapse

To investigate the changes in the connective tissues located in the upper portion of the anterior vaginal wall, which are associated with anterior vaginal wall prolapse, 23 women with anterior vaginal wall prolapse were included in the study group and 15 women with normal genital support served as control group. The anterior vaginal wall tissue samples were obtained for immunohistochemical staining of collagen (type I, III, IV, V, VI), elastin, and glycoproteins from the extracellular matrix (fibronectin, vitronectin, laminin). The number of capillaries per arteriole and mitochondria numbers per smooth muscle cell were evaluated for demonstrating whether the anatomical prolapse affect on blood supply to these tissues. Collagen III was significantly less in the anterior vaginal wall of patients with anterior vaginal wall prolapse. Quantitative immunoreactivity of collagen I and III had significant positive correlations with ageing.

Anorectal dysfunction in women with urinary incontinence or lower urinary tract symptoms.

Objectives: (1) To evaluate the prevalence of anorectal dysfunction among women with urinary storage or voiding symptoms; and (2) to investigate the risk factors associated with anorectal symptoms. Methods: A sample of 320 women who attended the urogynecology outpatient clinic for urodynamic evaluation were requested to complete a structured questionnaire. The information collected included the medical, surgical, gynecological, and obstetric histories of the patients. Anal incontinence was defined as involuntary leakage of solid or liquid feces or gas. Constipation was defined as less than three bowel movements per week. Prevalence was estimated for anal incontinence and for constipation. A chi‐square test was used to compare risk factors between women with and without anal incontinence or constipation. We used a multi‐variable logistic regression analysis to estimate the association between other variables. Result: Forty‐nine (15.9%) women reported having anal incontinence according to the above definition. Of those 49 women, 11 (3.6%) experienced leakage of liquid and/or solid feces and 38 (12.3%) had flatus incontinence. Constipation was reported by 100 (31.5%) of the women. A multiple logistic regression analysis revealed that the main risk factor associated with anal incontinence and constipation was the presence of uterovaginal prolapse (odds ratio=5.02; 95% CI=2.19–11.5 for anal incontinence; odds ratio=1.78; 95% CI=1.03–3.09 for constipation). Conclusion: Our results demonstrate a relatively high prevalence of anal incontinence or constipation among women suffering from urinary dysfunction. Uterovaginal prolapse is the main risk factor associated with anorectal dysfunction.

Herlyn-Werner-Wunderlich Syndrome Consisting of Uterine Didelphys, Obstructed Hemivagina and Ipsilateral Renal Agenesis in a Newborn

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Müllerian duct anomalies consisting of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome are usually asymptomatic until menarche, when they present with acute lower abdominal pain. Here we report a case of a female newborn with right renal agenesis diagnosed during the pregnancy. The patient presented with a protruding mass over the vaginal introitus that was associated with an obstructed hemivagina and uterine didelphys.

Complications of synthetic graft materials used in suburethral sling procedures

Problems relating to the erosion of sling material, through either the vagina or the urethra, have been encountered with almost all kinds of synthetic sling materials. We present four unusual cases of women using different synthetic materials and the complications that occurred. The biopsies were examined histologically and analyzed for collagen and inflammatory reactions. Four patients who underwent suburethral slingplasty previously with different sling materials required surgical management for complications, including one intravesical Ethibond migration, vaginal mucosal mesh erosion in two patients, and one proximal urethral overcorrection with intravesical erosion. We reviewed the literature regarding the amount of mesh erosion and connective tissue reaction with synthetic materials. The efficiency of mesh removal was assessed. The four patients maintained urinary continence after urethrolysis and removal of the mesh. Fibrosis and severe inflammatory reactions were found in the connective tissue adjacent to the mesh as well as the Prolene mesh. Technically, it would be easier to remove the graft of patch sling if rejection or erosion occurs.

Prevalence of and risk factors for pelvic organ prolapse and lower urinary tract symptoms among women in rural Nepal

To evaluate the prevalence and associated risk factors of pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) among women seeking healthcare services in 3 discrete rural areas in Nepal.

Overactive bladder in Taiwanese women: Re-analysis of epidemiological database of community from 1999 to 2001†‡

To update our previous computerized epidemiological data according to the new taxonomy, we re‐evaluated and re‐analyzed the data using the current definitions of lower urinary tract symptoms (LUTS) which were approved and published by the ICS in 2002 and 2010 according to patient perception. Further, we divided overactive bladder (OAB) symptoms into OAB dry and OAB wet to assess their prevalence percentages by using the current definitions.

Outcomes of autologous fascial slingplasty procedure for treating female urinary incontinence

The aims of this study were to compare the pre- and postoperative urodynamic findings of the suburethral autologous rectus fascial sling procedure and to determine patient satisfaction with the procedure by telephone interviews. Eight-four female patients with urodynamic stress incontinence completed a multi-channel urodynamic study and pad test before and after the operation. Subjective and objective satisfaction were also recorded. Significant changes were noted in the stress maximal urethral closure pressure, pad test, voided volume, and peak flow rate (P < 0.05). The success rate was about 94%, and subjective satisfaction was about 72%. The most common complication was transient urinary tract infections. The suburethral sling resolved 50% of detrusor overactivity (DO), but de novo DO was 24%. The procedure combined with anterior colporrhaphy corrected or improved 97% of anterior vaginal wall prolapses (≥stage II). This retrospective study demonstrates that suburethral autologous facial slingplasty has a high cure rate, high patient satisfaction, and is a less complicated procedure. It can also correct and prevent a recurrence of anterior vaginal wall prolapse when combined with anterior colporrhaphy.

Lymph node metastases, not human telomerase reverse transcriptase or p53 proteins, as the strongest prognostic factor for survival in early stage cervical cancer

Aim:  Human telomerase reverse transcriptase (hTERT) is known to be significantly activated during immortalization, and p53 is thought to be a guardian of that apoptosis pathway in most cancer cells. The aim of this study was to assess the relationships among hTERT, p53 and various clinicopathological parameters of cervical cancer patients and overall survival.

Obliterative LeFort colpocleisis for pelvic organ prolapse in elderly women aged 70 years and over

OBJECTIVE Treatment of genital prolapse in elderly women is challenging. The aim of this study was to evaluate the long-term postoperative patient satisfaction and objective improvement in women aged 70 years and over with high stages of pelvic organ prolapse treated with obliterative LeFort colpocleisis. MATERIALS AND METHODS From January 2003 to December 2013, female patients aged 70 years and over who underwent colpocleisis surgery were included in this study. We reviewed the charts for preoperative and postoperative medical history, severity of prolapse, urodynamic studies, and early postoperative complications related to this procedure in these patients. Subjective outcomes were assessed by a nursing coordinator who interviewed patients by telephone in June 2014. RESULTS Colpocleisis was performed in 22 elderly patients and 59% patients were of advanced age (≥ 80 years). The mean postoperative follow-up duration was 48.1 months (range, 7-118) months. Six patients (27.3%) had died of medical problems at the time of the telephone interview. Fourteen patients (87.5%) reported a successful outcome after the operation and two patients (12.5%) reported improvement. For present satisfaction, 93.8% of patients reported that they were satisfied. CONCLUSION Colpocleisis should be considered as one of the surgical options for treating advanced pelvic organ prolapse in elderly patients who do not wish to preserve vaginal function for sexual intercourse.

ARE THERE ANY PREDICTORS FOR FAILED BURCH COLPOSUSPENSION

OBJECTIVE To investigate early postoperative complications of Burch colposuspension and the risk factors that may be associated with failure. METHODS We retrospectively reviewed the chart records of all patients who underwent Burch colposuspension from October 1997 to September 2002. Indications for colposuspension included urodynamic stress incontinence with bladder neck hypermobility and adequate vaginal capacity. The occurrence of early postoperative complications related to the operation was documented. Subjective failure of the operation was defined as patient dissatisfaction and/or persistent urinary leakage. Chi-square test or Fishers exact test was used to determine the association among risk factors, early postoperative complications, and the failure rate of Burch colposuspension. RESULTS A total of 258 patients (92.5%) reported satisfaction with the surgical outcome. The age, parity, menopausal status, use of hormone replacement therapy, previous hysterectomy, and occurrence of early postoperative complications did not significantly influence the failure rate. CONCLUSION Our results demonstrate that Burch colposuspension is an effective and, according to our patients, highly satisfactory procedure for the treatment of urodynamic stress incontinence.