Ting-Chen Chang

Risk Factors Affecting Cure After Mid-urethral Tape Procedure for Female Urodynamic Stress Incontinence: Comparison of Retropubic and Transobturator Routes

OBJECTIVES To identify the risk factors affecting cure after the tension-free vaginal tape procedure (TVT) or transobturator tape procedure (TOT). METHODS A total of 121 women with urodynamically proved stress incontinence underwent TVT (n = 61) or TOT (n = 60). We analyzed all data with univariate and multivariate logistic regression analyses. RESULTS Univariate analysis revealed that a larger postvoid residual urine volume, greater pad weight test, and lower maximal flow rate were associated with a greater risk of failure to be cured after TVT. A lower maximal urethral closure pressure (MUCP) was associated with a greater risk of failure after the TOT procedure. With additional analysis, we found that a MUCP of <or=40 cm H(2)O (odds ratio [OR] 9.21, P = .004) was associated with a significantly greater risk of failure to be cured after the TOT procedure but not a MUCP of <o=50 cm H(2)O (OR 2.24, P = .21). Multivariate analysis revealed that preoperative detrusor overactivity was an independent risk factor affecting cure after TVT (OR 113.1, 95% confidence interval 1.84-6592.77, P = .02) or TOT (OR 23.7, 95% confidence interval 1.63-344.53, P = .02), and MUCP <o=40 cm H(2)O (OR 8.34, 95% confidence interval 1.52-45.65, P = .01) was another risk factor for TOT. CONCLUSIONS The risk factors affecting cure after mid-urethral tape procedures were preoperative detrusor overactivity for TVT and TOT and MUCP <o=40 cm H(2)O for TOT.

Comparisons of urodynamic effects, therapeutic efficacy and safety of solifenacin versus tolterodine for female overactive bladder syndrome

Aim:  To evaluate the urodynamic effects, therapeutic efficacy and safety of solifenacin versus tolterodine treatment for women with overactive bladder syndrome.

Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function Index

INTRODUCTION Childbirth impacts sexual function in women, but few reports have addressed sexual function shortly after childbirth. AIM Using the Taiwan version of the Female Sexual Function Index (FSFIT), this study aimed to describe womens sexual function and to examine differences between groups in sexual function shortly after delivery. METHODS A prospective longitudinal investigation was performed in women who completed the FSFIT, a numeric analog scale, the Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D), and a demographic questionnaire in a Taiwanese medical center at 3 days and 6 weeks postpartum. MAIN OUTCOME MEASURES Using a general linear model, differences were tested between groups, including those defined by delivery mode, type of feeding, depression score, pain score, and birth history. RESULTS After adjusting for covariates, (i) significant differences in sexual function and desire were found between the vaginal delivery and Cesarean section groups at day 3 and week 6 postpartum (P = 0.0419 and <0.0001, respectively); (ii) differences in desire and satisfaction between the tubal ligation and not groups were significant at both time points (P = 0.0346 and 0.0338); (iii) differences in sexual function and sexual activity or intercourse between low and high CES-D scores were significant at 6 weeks postpartum (P = 0.0040 and 0.0043, respectively); and (iv) differences between pain level groups in sexual activity or intercourse and desire were significant at 6 weeks (P = 0.0493 and 0.0004). At 3 days postpartum, significant differences between educational level and ethnic groups were observed (P = 0.0002 and 0.0414). CONCLUSIONS The results showed significant differences in sexual function shortly after delivery between groups based on delivery method, tubal ligation, depression, pain, ethnicity, and educational level. This information may help health professionals to be more aware of womens perception of sexuality and may foster sensitivity in assessing their sexual function after childbirth.

Solifenacin and Tolterodine are Equally Effective in the Treatment of Overactive Bladder Symptoms

BACKGROUND/PURPOSE Various antimuscarinic agents have been developed for the treatment of overactive bladder (OAB). More data comparing these agents are still required. This study evaluated the efficacy and safety of solifenacin and tolterodine in Taiwanese patients with OAB symptoms. METHODS This was a prospective, randomized, open-label study. A total of 75 patients (25 men and 50 women) with OAB symptoms were randomized to treatment with solifenacin (n = 39) or tolterodine (n = 36). Efficacy and safety variables were assessed and compared with the baseline and between the two groups. RESULTS At week 12, solifenacin and tolterodine demonstrated equal efficacy in reducing the number of micturition (-2.56 ±3.31 vs. -2.44 ± 4.56, p = 0.58), urgency (-1.70 ± 3.07 vs. -1.15 ± 2.68, p =0.37) and incontinence (-2.79 ± 2.82 vs. -4.67 ± 9.29, p =0.28) episodes per 24 hours. There was no difference in improvement of the quality of life. The patient and physician assessments of treatment benefit were not statistically different for solifenacin and tolterodine (p = 0.23 and p = 0.52, respectively), with the majority showing benefits in both groups. The incidence of major adverse events, including dry mouth (18.0%vs. 8.3%, p = 0.31) and constipation (12.8%vs. 2.8%, p = 0.20) was not significantly different. Compared with baseline, the severity of dry mouth did not increase in either group. CONCLUSION Both solifenacin and tolterodine are effective in treating key OAB symptoms, including urinary frequency, urgency and incontinence in the Taiwanese population. Both medications are comparably effective and safe, with the most common adverse effects being dry mouth and constipation.

Evaluation of Bladder Diary Parameters Based on Correlation with the Volume at Strong Desire to Void in Filling Cystometry

Accurate assessment of patient bladder capacity is important in determining the proper initial treatment for lower urinary tract dysfunctions and as well as for monitoring therapeutic outcomes. However, urodynamic study is an invasive procedure. Thus, it is important to find a surrogate for invasive urodynamic study, and the aim of this study is to identify the parameter from patient-recorded bladder diary that is best correlated to the volume at strong desire to void (VSD) derived from urodynamic studies. A total of 900 women who underwent urodynamic studies at a university hospital between January 2009 and December 2011. Correlation between bladder diary parameters and VSD was investigated by Spearman rank-correlation coefficient. Days 1 to 3 average maximum daytime voided volumes excluding the first morning void (DVVmaxavg) (mean 263 ml) had the highest correlation with VSD (mean 261 ml; ρ = 0.51, p<0.001). The predictive value of VSD was 146+0.44 × DVVmaxavg. The days 1, 2, and 3 daytime maximum voided volumes excluding the first morning void (DVVmax) were all significantly associated with VSD and had similar mean volumes (ρ = 0.43–0.46, all p<0.001). DVVmaxavg had the highest area under the receiver operating characteristic curve (0.75; 95% confidence interval = 0.72–0.78) for predicting bladder oversensitivity. The threshold of DVVmaxavg <250 ml had good predictive value for detecting bladder oversensitivity (sensitivity 70.9%; specificity 65.8%), and day 1 DVVmax <250 ml had similar sensitivity (70.6%) and specificity (59.1%). Besides, the correlation coefficients (ρ) between day 1, day 2 and day 3 DVVmax and DVVmaxavg were good with a range of 0.70–0.89. In conclusion, DVVmaxavg was the bladder diary parameter best correlated with VSD. DVVmaxavg and day 1 DVVmax may be useful in screening for bladder oversensitivity.

Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

OBJECTIVES To investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment. STUDY DESIGN Women with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires. MAIN OUTCOME MEASURES The differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women. RESULTS Eighty-five women with OAB (tolterodine, n=42; solifenacin, n=43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P<0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient=0.21), obsessive-compulsive symptoms (0.69 vs. 0.44, coefficient=0.25), anxiety symptoms (0.42 vs. 0.27, coefficient=0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient=0.14), neuroticism (9.23 vs. 5.17, coefficient=3.73), and extroversion-introversion (13.64 vs. 15.25, coefficient=-1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P<0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient=-0.39), low hostility score (coefficient=2.11), and high additional symptoms score (coefficient=-1.46) were associated with good therapeutic effect (all P<0.05). CONCLUSIONS OAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.

Clinical and urodynamic effects of baclofen in women with functional bladder outlet obstruction: Preliminary report

To investigate the efficacy and urodynamic effects of baclofen in women with functional bladder outlet obstruction.

Transvaginal Cystocele Repair Using Pursestring Technique Reinforced With Custom-tailored Two-armed Mesh

OBJECTIVE To evaluate the efficacy and safety of vaginal cystocele repair using a pursestring suture technique reinforced with custom-tailored 2-armed mesh. METHODS The records of patients who underwent isolated cystocele repair by a single surgeon were retrospectively reviewed. All women were assessed by clinical examination and lower urinary tract symptoms preoperatively and at 3 and 6 months and every year postoperatively. The principal outcome measure was anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification system. RESULTS From May 2005 to June 2009, 50 consecutive patients with minimum stage 2 (Aa or Ba 0) cystocele were treated using the procedure. The mean follow-up was 24 months (range 12-54), and the success rate was 96% (48 of 50). No intraoperative complications occurred. Two developed vaginal erosion (4%) and underwent excision of the extruded mesh smoothly. The final 21 consecutive patients underwent urodynamic assessment pre- and postoperatively. Compared with the baseline urodynamic findings, surgery resulted in decreased maximal urethral pressure and maximal urethral closure pressures. However, neither increased de novo incontinence nor reduced cystometric bladder capacity developed. CONCLUSION The use of the pursestring suture technique reinforced with custom-tailored 2-armed mesh for vaginal cystocele repair is safe, effective, and economic.

Utilizing preoperative 20-minute pad testing with vaginal gauze packing for indicating concomitant midurethral sling during cystocele repair

OBJECTIVE To investigate the feasibility of using preoperative 20-minute pad testing with vaginal gauze packing for cystocele reduction to indicate a concomitant midurethral sling during cystocele repair. STUDY DESIGN Retrospective review of the records of consecutive women with pelvic organ prolapse quantification≥stage II symptomatic cystocele who visited the urogynecologic outpatient clinics and underwent cystocele repair between July 2005 and December 2010. Only patients who underwent preoperative urodynamic studies and 20-minute pad testing with vaginal gauze packing for cystocele reduction were enrolled. RESULTS Twenty-one patients did not demonstrate any stress urinary incontinence. For evident stress urinary incontinence (>1g pad weight before reduction), the criterion of ≥8g pad weight before reduction was chosen for concomitant midurethral sling. For patients with occult stress urinary incontinence (≤1g pad weight before reduction), the criterion of ≥8g pad weight after reduction was chosen as an indication for concomitant midurethral sling. Among 22 patients with evident stress urinary incontinence (<8g) without concomitant midurethral sling, only one patient (4.5%) received a midurethral sling during the follow-up period (median follow-up interval: 30.5 months). Among 21 patients with occult stress incontinence but <8g after reduction without concomitant midurethral sling, only one patient (4.8%) received midurethral sling during the follow-up period (median follow-up interval: 38 months). CONCLUSIONS A preoperative 20-minute pad test with vaginal gauze packing for cystocele reduction is a feasible and practical method to decide for a concomitant midurethral sling.

Changes in urodynamic parameters after tolterodine treatment for female overactive bladder syndrome with or without voiding dysfunction

Aim:  To investigate changes in urodynamic parameters after tolterodine treatment for female overactive bladder syndrome, especially in patients with voiding dysfunction.