Zhu L

Estrogen levels and estrogen receptors in patients with stress urinary incontinence and pelvic organ prolapse

Objectives: To investigate the histologic characteristics of tissues presumed to be the cause of urinary stress incontinence and pelvic organ prolapse. Methods: Cardinal ligament and uterosacral ligament samples were obtained from 73 women undergoing hysterectomy. The evaluation of estrogen receptors (ERs) by immunohistochemical staining was semi‐quantitative. Serum estrogen was determined by ELISA. Statistical analyses were performed by the independent‐sample t‐test and one‐way ANOVA. Results: Serum estradiol levels and ER values in the premenopausal women with pelvic organ prolapse were significantly lower than in the control group (P<0.01). A positive correlation was found between ERs and the number of postmenopausal years (P<0.01). ER values were similar in the cardinal and uterosacral ligaments. Conclusions: Serum estrogen levels and ER values are significantly lower in the uterine ligaments of premenopausal women with pelvic organ prolapse, and there was a positive correlation between ER values in the uterine ligaments and the duration of postmenopausal years. Serum estrogen levels and ER values were similar in the cardinal ligament and the uterosacral ligament.

Manometric comparison of anorectal function after posterior vaginal compartment repair with and without mesh.

Background:Although repair augmented with mesh has been proved its priority in anatomical and functional recovery after anterior compartment reconstruction, the data about posterior compartment are scarce. The aim of this study was to compare bowel functional outcome of posterior vaginal compartment repair with and without mesh in patients with pelvic organ prolapse (POP). Methods:This was a prospective, double-blind, clinical pilot study of 22 postmenopausal women with symptomatic POP (overall POP-quantification [POP-Q] Stage III-IV) who underwent total pelvic floor reconstruction. Patients were grouped according to the use of mesh for posterior vaginal compartment repair: A mesh group and a nonmesh group. POP-Q stage, the pelvic floor impact questionnaire short form-7 (PFIQ-7) and anorectal manometry were evaluated before and 3 months after surgery. Anatomical success was defined as POP-Q Stage II or less. A t-test was used to compare preoperative with postoperative data in the two groups. Results:Totally, 17 (71%) were available for the follow-up. POP-Q measurements improved significantly compared to baseline (P < 0.05) in both groups. No recurrence was observed. Subjects in both groups reported improvement in pelvic floor symptoms, and there was no significant difference in the PFIQ-7 score between groups at follow-up (P > 0.05). Compared with baseline, the nonmesh group exhibited a statistically significant decrease in anal residual pressure, a significant increase in the anorectal pressure difference during bowel movement, and a reduced rate of dyssynergia defecation pattern (P < 0.05). Conclusions:Provided there is sufficient support for the anterior wall and apex of vagina with mesh, posterior compartment repair without mesh may be as effective as repair with mesh for anatomical recovery while providing better anorectal motor function.

Proteomic Analysis of the Uterosacral Ligament in Postmenopausal Women with and without Pelvic Organ Prolapse

Background:Pelvic organ prolapse (POP) is a major health problem in adult women that involves many factors. No proteomic analysis has been conducted exclusively in POP patients. This study aimed to identify the differential expression of proteins that may be involved in POP by proteomic analysis. Methods:Samples of the uterosacral ligament (USL) were collected from five POP patients and five non-POP patients matched according to age, parity, and menopausal status and analyzed using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to verify the mRNA expression of proteins that showed differential expression in the proteomic analyses. Results:Proteins differentially expressed between POP and non-POP patients were detected. Eight proteins that were down-regulated in the POP group were identified by MALDI-TOF-MS. These proteins included electron transfer flavoprotein, apolipoprotein A-I, actin, transgelin, cofilin-1, cyclophilin A, myosin, and galectin-1, and their expression was verified by qRT-PCR. Conclusion:Using comparative proteomics, we identified eight differentially expressed proteins (including four cytoskeleton proteins and three proteins related to apoptosis) in the USL that may be involved in apoptosis associated with the tissue effects in POP pathophysiology.

Efficacy and Safety of Solifenacin Succinate Tablets Versus Solifenacin Succinate Tablets With Local Oestrogen for Overactive Bladder in Post-Menopausal Women – A Multi-Centre, Randomised, Open, Controlled Comparison Study

Withdrawn

Postoperative evaluation of tension-free vaginal tape procedure in China

The tension-free vaginal tape (TVT) procedure was first performed in China in 2001. Forty-two patients with cystocele and stress urinary incontinence confirmed by urodynamic studies underwent the TVT procedure as described by Ulmsten w1x under local anesthesia and intravenous sedation. Prolapse repair was simultaneously performed. Follow-up evaluation was carried out after 2, 6, 12 and 24 months, after operation in the outpatient clinic. The criteria for cure were no leakage on the cough stress test and patient-determined continence. Improved status meant a small leakage on the cough stress test and urine leakage less than 50% of pre-intervention measurement on the 1-h pad test. Mean TVT operation time was 26.29 min; mean blood loss was 29.85 ml; 88% of the women were able to urinate spontaneously within 12 h; residual urine was less than 100 ml; and an in-dwelling catheter had to be used temporarily in 12% of the women. The average hospital stay was 2.91 days and 88% of the women were discharged within 2 days. There were no major intra-operative