Yi-Hao Lin

Comparison between Elevate Anterior/Apical system and Perigee system in pelvic organ prolapse surgery: clinical and sonographic outcomes

ObjectiveThe aim of this study was to assess the incidence of de novo stress urinary incontinence (SUI) and sonographic features of implanted transvaginal mesh in continent women treated with Elevate™ anterior/apical [single-incision mesh (SIM-A)] or Perigee™ [transvaginal mesh with sacrospinous fixation (TVM + SSF)] in extensive pelvic organ reconstruction surgery.MethodsThis prospective observational study was done from May 2010 to January 2013. Patients were recruited from two tertiary centers, and the Elevate™ and Perigee™ systems were compared. Patients who had overt or occult SUI, previous prolapse or mesh insertion were excluded.ResultFifty-seven patients in the SIM-A group and sixty-one in the TVM + SSF group were analysed. All completed a minimum of 1-year follow-up. Groups were demographically and statistically similar. There was a significantly high incidence of de novo SUI postoperatively in the SIM-A group. The objective and subjective cure rate of pelvic organ prolapse (POP) were comparable between groups, with incidence of mesh erosion in the SIM-A group and three in the TVM + SSF group. Sonographic evaluation showed significant increase in mesh length in the SIM-A group.ConclusionElevate™ a offered lower incidence of mesh erosion and comparable results on anatomical POP correction; however, incidence of de novo SUI was high. There is an apparent lengthening of implanted Elevate® mesh sonographically.

Significance of bladder trabeculation in postmenopausal women with severe pelvic organ prolapse: clinical and urodynamic assessments.

Objective Bladder trabeculation (BT) is a secondary result of bladder outlet obstruction (BOO), which may result from severe pelvic organ prolapse (POP) and cause lower urinary tract symptoms (LUTS). This study was conducted to investigate the relationship among clinical manifestations, urodynamic findings, and BT in women with severe POP. Methods We reviewed the medical records of patients with stage 3 or stage 4 POP who underwent prolapse surgical operation in a tertiary hospital between 2005 and 2011. All patients received preoperative evaluations, including urodynamic studies, cystoscopy, and a structured urogynecological questionnaire. Demographics, LUTS, pelvic floor symptoms, and urodynamic findings were compared between women with BT and women without BT. Results Of the 308 women included, 54.9% had BT and 12.7% were diagnosed with BOO (maximal flow rate <12 mL/s; detrusor pressure at maximal flow >20 cm H2O). Mean age, prevalence of urgency, urge incontinence, voiding difficulty, detrusor overactivity, and postvoid residual greater than 100 mL were significantly higher in women with BT than in women without BT. In addition, severe BT had significantly higher prevalences of detrusor overactivity, BOO, lower maximal cystometric capacity, urge incontinence, and anterior vaginal prolapse. Logistic regression demonstrated that detrusor overactivity was the only variable associated with BT. Conclusions More than half of the women with severe POP have BT, which, when compared with women without BT, indicates higher incidences of LUTS, detrusor overactivity, and urinary retention. An objective evaluation of BT should become a prerequisite examination for women with severe POP who would undergo prolapse surgical operation.OBJECTIVE Bladder trabeculation (BT) is a secondary result of bladder outlet obstruction (BOO), which may result from severe pelvic organ prolapse (POP) and cause lower urinary tract symptoms (LUTS). This study was conducted to investigate the relationship among clinical manifestations, urodynamic findings, and BT in women with severe POP. METHODS We reviewed the medical records of patients with stage 3 or stage 4 POP who underwent prolapse surgical operation in a tertiary hospital between 2005 and 2011. All patients received preoperative evaluations, including urodynamic studies, cystoscopy, and a structured urogynecological questionnaire. Demographics, LUTS, pelvic floor symptoms, and urodynamic findings were compared between women with BT and women without BT. RESULTS Of the 308 women included, 54.9% had BT and 12.7% were diagnosed with BOO (maximal flow rate <12 mL/s; detrusor pressure at maximal flow >20 cm H2O). Mean age, prevalence of urgency, urge incontinence, voiding difficulty, detrusor overactivity, and postvoid residual greater than 100 mL were significantly higher in women with BT than in women without BT. In addition, severe BT had significantly higher prevalences of detrusor overactivity, BOO, lower maximal cystometric capacity, urge incontinence, and anterior vaginal prolapse. Logistic regression demonstrated that detrusor overactivity was the only variable associated with BT. CONCLUSIONS More than half of the women with severe POP have BT, which, when compared with women without BT, indicates higher incidences of LUTS, detrusor overactivity, and urinary retention. An objective evaluation of BT should become a prerequisite examination for women with severe POP who would undergo prolapse surgical operation.

Genome-based expression profiles study for the pathogenesis of pelvic organ prolapse: an array of 33 genes model

Introduction and hypothesisTo explore the potential molecular mechanisms contributing to the pathogenesis of pelvic organ prolapse (POP) with the aid of high-density oligonucleotide microarrays.MethodsWe compared microarray gene expression profiles in pelvic connective tissue from women with POP and nonprolapse controls. The round ligament and uterosacral ligament tissues were removed from each subject at the time of laparoscopic hysterectomy. RNA was then extracted, and all labeled samples were hybridized to ABI Human Genome Survey Microarray version 2.0 (Applied Biosystems, CA, USA).ResultsThe Mahalanobis distance in hierarchical cluster analysis revealed a model of 33 genes, which contained high expressions of round and uterosacral ligaments from women with POP. According to gene ontology, the expressions of mitochondrial genes encoding ribosomal protein were upregulated. Genes involved in potential interactions with mitochondrial electron transport, nucleosome assembly, cell cycle, and apoptosis were also upregulated. As a result, defective mitochondrial translation caused by ribosomal protein contributes to the potential molecular etiology of POP. Such changes, jointly termed “remodeling of pelvic connective tissue”, can constitute an important long-term consequence of POP.ConclusionsOur results support the use of genome-based expression profiling as a commonplace platform for diagnostic tests of POP.

Genome-based expression profiling study following spinal cord injury in the rat: An array of 48-gene model.

To explore the potential molecular mechanisms underlying experimental neurogenic bladder dysfunction.

Influence of anterior vaginal mesh with concomitant mid‐urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid‐urethral sling surgery (MUS) for stress urinary incontinence (SUI).

Factors Affecting Voiding Function in Urogynecology Patients

OBJECTIVE Our objective was to assess the impacts of menopause, age and parity on voiding function in urogynecology patients. MATERIALS AND METHODS The medical records of 4,470 patients with urodynamic studies were reviewed at our center between January 1999 and May 2003. Patients with conditions including a prior continence procedure, advanced pelvic prolapse, hysterectomy or neurologic deficits were excluded from our study. Comprehensive medical histories, physical examinations, bladder diaries and results of multi-channel urodynamic testing were analyzed. RESULTS The mean age of the 3,161 women enrolled was 50 years, and the mean parity was three. Four urodynamic variables served as voiding parameters: maximum flow rate (Qmax) and post-void residual (PVR) from uroflowmetry, and maximum flow rate (Qmax.p) and detrusor pressure at maximum flow (PdetQmax) from pressure-flow studies. Of the three factors studied (menopause, age, and parity), only parity had a significant impact on uroflowmetry and pressure-flow study results (Qmax, p=0.007; PVR, p<0.001; Qmax.p, p=0.002; PdetQmax, p<0.001). Twenty-five percent of the patients in our study were diagnosed with voiding dysfunction. CONCLUSION Our results indicated that parity had a significant impact on voiding function in urogynecology patients. Twenty-five percent of patients in our study were diagnosed with voiding dysfunction. The bladder behavior in women after childbirth may be more complex than previously thought, and special attention should be paid to women who suffer from bladder symptoms after childbirth.

Predictors of persistent detrusor overactivity in women with pelvic organ prolapse following transvaginal mesh repair

The aim of this study was to investigate the contributing factors of persistent detrusor overactivity (DO) in women with advanced pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair.

Monitoring bladder compliance using end filling detrusor pressure: Clinical results and related factors.

OBJECTIVE To assess the clinical significance of low compliance bladder (LCB) in women with lower urinary tract symptoms. MATERIALS AND METHODS Medical records of 1490 women undergoing videourodynamic studies (VUSs) were reviewed. Comprehensive medical histories, physical examinations, bladder diaries, and results of multichannel VUS were analyzed. This study adopted an end filling detrusor pressure (EFP) greater than 20 cmH2O to define LCB. RESULTS Among the study patients (n = 1490), 9.1% were diagnosed with LCB using a cutoff value of 17.5 cmH2O, which had a sensitivity and specificity of 89% and 92.7%, respectively. Results of multivariate analysis indicated that age (p = 0.005), maximum cystometric capacity (MCC; p = 0.002), detrusor overactivity (DO; p = 0.001), pelvic organ prolapse (POP; p = 0.018), recurrent urinary tract infection (p = 0.001), and radical abdominal hysterectomy (RAH; p < 0.001) as independent prognostic factors. Furthermore, our study results indicate that the MCC, urinary tract infection, and a history of RAH have a positive correlation with LCB, whereas, age, POP, and DO have a negative correlation with LCB. CONCLUSION Our idea using EFP (≥17.5 cmH2O) for screening women with LCB is feasible for clinical use.

Outcome after conservative management for mixed urinary incontinence

Recommended initial treatment for mixed urinary incontinence involves behavioral therapy, and drug and pelvic floor muscle exercises. Our objective is to evaluate the outcome of these conservative treatments in our patients with mixed urinary incontinence.

Rectus Sheath Hematoma During Pregnancy - A Severe but Easily Overlooked Condition: A Case Report

Summary Objective Rectus sheath hematoma (RSH) of the abdominal wall is a severe condition caused by a tear in the inferior epigastric artery. Due to its relative rarity compared with other obstetric complications, the early recognition of RSH challenges the diagnostic acumen of obstetricians. We report a case of RSH that was initially suspected to be placenta percreta with bleeding into an extrauterine compartment. The differential diagnosis and management of this clinical condition are also discussed. Case Report A 30-year-old woman, gravida 2 para 1, with a 31-week singleton pregnancy, complained of lower abdominal pain after a week of coughing. Abdominal ultrasonography identified a well-defined, hypoechoic mass with some internal echoes in the right lower quadrant of the abdomen. Doppler sonography detected vascularity with blood flowing around the mass but little within it. The patient underwent cesarean section and exploratory laparotomy because of unstable hemodynamics. After delivery of a 1,680 g male baby, surgical repair of the torn epigastric artery and ruptured rectus abdominis, and sufficient blood transfusion stabilized her condition. Conclusion RSH should be included in the differential diagnosis of patients with abdominal pain during pregnancy. The key to diagnosis is to suspect that the pain originates from the abdominal wall.