Yeo Jung Moon

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

Purpose The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). Materials and Methods This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. Results The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse ≥ stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. Conclusions ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

MicroRNA‐30d and microRNA‐181a regulate HOXA11 expression in the uterosacral ligaments and are overexpressed in pelvic organ prolapse

The balanced turnover of collagen is necessary to maintain the mechanical strength of pelvic supportive connective tissues. Homeobox (HOX) A11 is a key transcriptional factor that controls collagen metabolism and homoeostasis in the uterosacral ligaments (USLs), and the deficient HOXA11 signalling may contribute to alterations in the biochemical strength of the USLs, leading to pelvic organ prolapse (POP). However, it is unknown how HOXA11 transcripts are regulated in the USLs. In this study, we found that microRNA (miRNA)‐30d and 181a were overexpressed in women with POP, and their expression was inversely correlated with HOXA11 mRNA levels. The overexpression of miR‐30d or 181a suppressed HOXA11 mRNA and protein levels in 293T cells, whereas the knockdown of these miRNAs enhanced HOXA11 levels and collagen production. Cotransfection of a luciferase reporter plasmid containing the 3′‐untranslated region of HOXA11 with miR‐30d or 181a mimic resulted in decreased relative luciferase activity. Conversely, cotransfection with anti‐miR‐30d or 181a increased luciferase activity. Taken together, these results indicate that both miR‐30d and 181a are important posttranscriptional regulators of HOXA11 in the USLs and could be a potential therapeutic target for POP.

Estrogen-related genome-based expression profiling study of uterosacral ligaments in women with pelvic organ prolapse

Introduction and hypothesisThe aim of the study was to identify the differential expression of estrogen-related genes that may be involved in the menopause and pelvic organ prolapse (POP) using microarray analysis.MethodsAn age, parity, and menopausal status-matched case–control study with 12 POP patients and 5 non-POP patients was carried out. The study was conducted from January to December 2010 at Yonsei University, Severance Hospital. We examined microarray gene expression profiles in uterosacral ligaments (USLs) from POP and non-POP patients. Total RNA was extracted from USL samples to generate labeled cDNA, which was hybridized to microarrays and analyzed for the expression of 44,049 genes. We identified differentially expressed genes and performed functional clustering. After clustering, we focused on transcriptional response and signal transduction gene clusters, which are associated with estrogen, and then validated the changes of gene expression levels observed with the microarray analysis using quantitative polymerase chain reaction (qPCR).ResultsThe data from the microarray analysis using more than a 1.5-fold change with p value <0.05 resulted in 143 upregulated genes and 87 downregulated genes. Of 59 genes identified to be associated with signal transduction and transcription, 4 genes were chosen for qPCR that have been classified to be associated with estrogen. We found that estrogen receptor-related receptor-α (ERRα) was downregulated and that the expression of death-associated protein kinase 2 (DAPK 2), signal-transducing adaptor protein-2 (STAP-2), and interleukin (IL)-15 were upregulated.ConclusionsWe found four differentially expressed genes by microarray analysis that may account for the way in which changes in estrogen level affect POP pathophysiology.

Changes in Sexual Function and Comparison of Questionnaires Following Surgery for Pelvic Organ Prolapse

Purpose The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. Materials and Methods From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. Results Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99±0.18 vs. 7.56±1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width. Conclusion In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function.

NGF and HB-EGF: Potential Biomarkers that Reflect the Effects of Fesoterodine in Patients with Overactive Bladder Syndrome

Purpose To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. Materials and Methods This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. Results Urinary levels of NGF/Cr (OAB: 1.13±0.9 pg/mg; control: 0.5±0.29 pg/mg) and HB-EGF/Cr (OAB: 8.73±6.55 pg/mg; control: 4.45±2.93 pg/mg) were significantly higher in subjects with OAB than in controls (p<0.001). After 16 weeks of fixed-dose fesoterodine treatment, urinary NGF/Cr levels (baseline: 1.13±0.08 pg/mg; 16 weeks: 0.60±0.4 pg/mg; p=0.02) and HB-EGF/Cr levels significantly decreased (baseline: 8.73±6.55 pg/mg; 16 weeks: 4.72±2.69 pg/mg; p=0.03, respectively). Both the OABSS and OAB q scores improved (p<0.001). However, there were no a statistically significant correlations between these urinary markers and symptomatic scores. Conclusion Urinary levels of NGF and HB-EGF may be potential biomarkers for evaluating outcome of OAB treatment. Fixed-dose fesoterodine improved OAB symptoms. Future studies are needed to further examine the significance of urinary NGF and HB-EGF levels as therapeutic markers for OAB.

Prenatally detected congenital orbital teratoma

1. Snyder HM III. Genitourinary tumors, adrenal, sympathetic chain and retroperitoneal tumors. In Pediatric Urology, vol. 2, Kellalis PP, King LR, Belman AB (eds). W. B. Saunders: Philadelphia, PA, 1992; 1379–1414. 2. Massad M, Slim SM, Mansour A, Dabboun I, Frizli S, Issa P. Neuroblastoma: report on a 21-year experience. J Pediatr Surg 1986; 21: 388–391. 3. Hoffman BB, Lefkomitz RT. Catecholamines and sympathomimetic drugs. In The pharmacological basis of therapeutics, Goodman-Gilman A, Rall TW, Nies AS, Taylor P (eds). Pergamon Press: New York, 1990; 187–220. 4. Sendo D, Katsuura M, Akiba K, Yokoyama S, Tanabe S, Wakabayashi T, Sato S, Otaki S, Obata K, Yamagiwa I, Hayasaka K. Severe hypertension and cardiac failure associated with neuroblastoma: a case report. J Pediatr Surg 1996; 31: 1688–1690. 5. Imperato-McGinley J, Gautier T, Ehlers K, Zullo MA, Goldstein DS, Vaughan ED Jr. Reversibility of catecholamine-induced dilated cardiomyopathy in a child with pheochromocytoma. N Engl J Med 1987; 316: 793–797. 6. Rosti L, Festa P, Corbetta C. Rapid reversal of dilated cardiomyopathy following removal of neuroblastoma. Cardiol Young 1999; 9: 519–521. 7. Joseph T, Olivier B, Magnier S, Brugières L, Casasoprana A. Cardiomyopathy induced by catecholamines in neuroblastoma. Arch Pediatr 1997; 4: 32–35. 8. Lee YH, Lee HD, Lee YA, Lee YS, Jung JA, Hwang GG, Jung GW, Kim DW, Roh MS. Ganglioneuroblastoma presenting as dilated cardiomyopathy. Arch Dis Child 2003; 88: 162–164. 9. Kato M, Hirata S, Kikuchi A, Ogawa K, Kishimoto H, Hanada R. Neuroblastoma presenting with dilated cardiomyopathy. Pediatr Blood Cancer 2006; 25; Epub ahead of print.

Association between the poly(ADP-ribose) polymerase-1 gene polymorphism and advanced pelvic organ prolapse.

ObjectiveApoptotic cell death, probably induced by oxidative stress, contributes to the development of pelvic organ prolapse. Because poly(ADP-ribose) polymerase-1 is an important mediator of cellular response to oxidative stress, genetic variations in the poly(ADP-ribose) polymerase-1 gene may play a role in the pathogenesis of pelvic organ prolapse. This study aimed to determine the association between advanced pelvic organ prolapse and Val762Ala polymorphism in the poly(ADP-ribose) polymerase-1 gene. MethodsA total of 340 women were enrolled in the study. The pelvic organ prolapse group consisted of 185 women with stage III or IV pelvic organ prolapse, whereas the control group consisted of 155 postmenopausal women with stage 0 or I pelvic organ prolapse who visited the hospital for treatment of benign gynecologic disease or routine gynecologic checkup. Genotyping of the poly(ADP-ribose) polymerase-1 Val762Ala polymorphism was performed by real-time polymerase chain reaction analysis using a TaqMan assay. ResultsGenotype distribution in the pelvic organ prolapse group was different from that in the control group (P = 0.024). Furthermore, C-allele frequency was lower in the pelvic organ prolapse group than in the control group (P = 0.029). Women with the CC genotype had a 0.461-fold lower risk of developing advanced pelvic organ prolapse than women with the TT genotype (95% CI, 0.245-0.870; P = 0.017), and women with the C-allele had a 0.716-fold lower risk of developing advanced pelvic organ prolapse than women with the T-allele (95% CI, 0.527-0.973; P = 0.033). ConclusionsThese findings suggest that the poly(ADP-ribose) polymerase-1 Val762Ala polymorphism is associated with a decreased risk of advanced pelvic organ prolapse.

Predicting risk factors of postoperative voiding dysfunction after abdominal sacrocolpopexy in the treatment of pelvic organ prolapse

목적: 본 연구는 골반장기 탈출증의 수술적 치료인 복식 천골질고정술(abdominal sacrocolpopexy) 수술 후 발생하는 배뇨장애(voiding dysfunction)를 예측할 수 있는 인자를 알아보고자 한다. 연구방법 2007년 1월부터 2009년 12월까지 본원 산부인과에서 골반장기 탈출증으로 복식 천골질고정술을 시행받은 총 89명의 환자를 대상으로 후향적 연구를 시행하였다. 환자들의 POP-Q system에 따른 병기를 포함한 임상적 특징, 산과력, 수술력, 수술 후 도뇨관 제거일을 조사하였으며, 수술 전 시행한 요역동학 검사들의 결과를 검토하였다. 수술 후 배뇨장애가 발생한 환자들을 조사하여 배뇨장애가 발생하지 않은 환자들과 비교분석하였다. SPSS 프로그램을 이용하여 분석하였으며, χ2 test와 t-test를 이용하여 두 군의 차이를 비교하였고 다중회귀 분석을 이용하여 수술 후 배뇨장애의 발생에 영향을 미치는 요인들을 알아보았다. 결과: 복식 천골질고정술을 받은 89명 중 17명(19.1%)이 배뇨장애를 호소하였다. 배뇨장애가 발생한 환자군과 발생하지 않은 환자군의 임상적 특징 중 당뇨가 있거나(29.4% vs. 9.7%, odds rations [OR]: 3.87, 95% confidence intervals [CI]: 1.05-14.23), 도뇨관 제거일이 늦은 경우 (수술 후 4일: 47.1% vs. 13.9%, OR 5.51, 95% CI 1.72-17.64) 유의한 차이를 보였고 요역동학 검사결과 비교에서는 detrusor pressure at maximal flow rate (Pdet at Qmax)가 (13±8 vs. 23±15, per 10 cm H20, OR 0.54, 95% CI 0.31-0.95) 유의한 차이를 보였다. 다중회귀 분석을 통해 이들 중 Pdet at Qmax (OR 0.94, 95% CI 0.89-0.99)만이 통계적으로 유의한 차이를 보였다. 결론: 골반장기 탈출증 치료로 복식 천골질고정술을 시행하는 경우, 수술 전 시행한 요역동학 검사상 Pdet at Qmax가 낮을수록 수술 후 배뇨장애가 발생할 가능성이 증가한다.

Effective parameters of urodynamic study before pelvic organ prolapse surgery and validation of concomitant surgery on urinary outcomes: Retrospective cohort study

Worldwide, over 200 million people are living with urinary incontinence (UI). Estimated 19% of women under the age of 45 experience UI and 29% of women over the age of 80 also experience this condition. Stress urinary incontinence (SUI) is commonly found in healthy adult women‐approximately 30% of the women under 30 years old and 14% to 41% of the women between the ages of 30 to 60. The prevalence of daily UI increases with age, ranging from 12.2% in all women from 60 to 64 years of age to 20.9% in those 85 years of age and over [1]. Pelvic organ prolapse (POP) has been estimated that over the next EFFECTIVE PARAMETERS OF URODYNAMIC STUDY BEFORE PELVIC ORGAN PROLAPSE SURGERY AND VALIDATION OF CONCOMITANT SURGERY ON URINARY OUTCOMES: RETROSPECTIVE COHORT STUDY Ju Hyun Cho, MD, Soo Rim Kim, MD, Yeo Jung Moon, MD, Sei Kwang Kim, MD, Sang Wook Bai, MD Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine; Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea

Erratum: Correlation analysis about effect of cardiovascular risk factors and disease in women on overactive bladder and stress urinary incontinence

Results The two groups had no difference with cardiovascular disease, history of cardiovascular disease, age, obesity, smoking, alcohol, hypertension, dyslipidemia, excluding diabetes. In the univariate logistic regression analysis, diabetes was associated with prevalence of overactive bladder than stress urinary incontinence. In the multiple logistic regression analysis, there was no factor which had influence on the status of urinary incontinence.