Publications by authors named "Ching-Chung Liang"

82 Publications

Prenatal transplantation of human amniotic fluid stem cell could improve clinical outcome of type III spinal muscular atrophy in mice.

Sci Rep 2021 Apr 28;11(1):9158. Epub 2021 Apr 28.

Prenatal Cell and Gene Therapy Group, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, WC1E 6HU, UK.

Spinal muscular atrophy (SMA) is a single gene disorder affecting motor function in uterus. Amniotic fluid is an alternative source of stem cell to ameliorate SMA. Therefore, this study aims to examine the therapeutic potential of Human amniotic fluid stem cell (hAFSC) for SMA. Our SMA model mice were generated by deletion of exon 7 of Smn gene and knock-in of human SMN2. A total of 16 SMA model mice were injected with 1 × 10 hAFSC in uterus, and the other 16 mice served as the negative control. Motor function was analyzed by three behavioral tests. Engraftment of hAFSC in organs were assessed by flow cytometry and RNA scope. Frequency of myocytes, neurons and innervated receptors were estimated by staining. With hAFSC transplantation, 15 fetuses survived (93.75% survival) and showed better performance in all motor function tests. Higher engraftment frequency were observed in muscle and liver. Besides, the muscle with hAFSC transplantation expressed much laminin α and PAX-7. Significantly higher frequency of myocytes, neurons and innervated receptors were observed. In our study, hAFSC engrafted on neuromuscular organs and improved cellular and behavioral outcomes of SMA model mice. This fetal therapy could preserve the time window and treat in the uterus.
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http://dx.doi.org/10.1038/s41598-021-88559-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080644PMC
April 2021

Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study.

Arch Gynecol Obstet 2021 Mar 4. Epub 2021 Mar 4.

Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.

Purpose: We aimed to examine the effect of gestational weight gain (GWG) on perinatal outcomes, quality of life (QoL) during pregnancy, and medical costs of childbirth.

Methods: The observational cohort comprised 2210 pregnant women who were classified into three groups based on their pre-pregnancy body mass index (BMI) and GWG in relation to the 2020 Institute of Medicine (IOM) recommendations. The data were collected on perinatal outcomes, urinary incontinence (UI) during pregnancy, changes in sexual function, and medical costs of hospitalization for delivery. Univariate and multivariable logistic regression models were employed to explore those associations.

Results: Only 42.1% of women met the 2020 IOM guidelines. After adjustments for potential confounding factors, women with above-normal GWG had adverse pregnancy outcomes, including a large fetal head circumference and macrosomia, and women with below-normal GWG were more likely to deliver low-birthweight fetuses preterm than women with normal GWG. Only 16.8% of women reported sexual activity during pregnancy. There were not significant differences in sexual activity and satisfaction, or QoL among the three GWG groups. Child-bearing expenses were higher for women with above-normal GWG than for women with normal GWG. Although the child-bearing expenses were higher for the above-normal GWG, the proportion of women with expenses above the median increased according to pre-pregnancy BMI.

Conclusion: Our results show that inappropriate GWG is associated with a greater risk of adverse perinatal outcomes and increased medical expenses for delivery. Healthcare providers are advised to counsel women to maintain their GWG following the 2020 IOM recommendations throughout pregnancy.
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http://dx.doi.org/10.1007/s00404-021-05983-2DOI Listing
March 2021

Beneficial effect of Bletilla striata extract solution on zymosan-induced interstitial cystitis in rat.

Neurourol Urodyn 2021 03 19;40(3):763-770. Epub 2021 Feb 19.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Aims: Interstitial cystitis (IC) is a chronic pain syndrome that is characterized by suprapubic pain upon bladder filling. Bletilla striata, a well-known traditional Chinese herb with established efficacy in wound healing and anti-inflammation, was hypothesized to improve the symptoms of IC possibly though forming a physical barrier that could isolate the bladder tissue from irritants. This study was conducted to evaluate the beneficial effects of intravesical treatment with B. striata extract solution (BSES) on visceral pain and bladder function of rats with zymosan-induced IC.

Methods: Thirty female rats were randomly divided into control group, zymosan-induced cystitis rats treated with normal saline (Z + NS), and zymosan-induced cystitis rats treated with BSES (Z + BSES). All rats underwent evaluation for abdominal withdrawal reflex (AWR) scores to assess visceral hypersensitivity, cystometrography, and electromyogram (EMG) of both external urethral sphincter and bladder detrusor. Data were analyzed by one way analysis of variance.

Results: The Z + NS group had an increased visceral hypersensitivity as compared to control group. Rats treated with BSES (Z + BSES group) had decreased AWR scores and amplitude of bladder detrusor-EMG. Besides, BSES treatment improved overactive bladder with significant effects on the extend of micturition interval and increase of storage of urine.

Conclusions: Intravesical instillation of BSES can significantly alleviate zymosan-induced visceral hypersensitivity and bladder overactivity associated with IC. This study suggested that intravesical instillation with BSES might be a promising treatment for IC.
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http://dx.doi.org/10.1002/nau.24630DOI Listing
March 2021

Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study.

Biomed J 2020 12 24;43(6):476-483. Epub 2020 Nov 24.

Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, Taoyuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address:

Background: To evaluate the effects of prepregnancy body mass index (BMI) on pregnancy outcomes, prevalence of urinary incontinence, and quality of life.

Methods: The observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), and obese (≥30). Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12) and changes in sexual function.

Results: Compared with normal weight, overweight and obesity were associated with advanced maternal age, low education level, multiparity, preterm delivery, cesarean section, gestational weight gain above the Institute of Medicine (IOM) guidelines, preeclampsia, gestational diabetes, macrosomia and large fetal head circumference. After adjusting for confounding factors, women with overweight and obesity were more likely to have adverse maternal outcomes (gestational weight gain above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the 4 BMI groups, but more than 90% of pregnant women had reduced or no sexual activities regardless of BMI.

Conclusions: Maternal prepregnancy overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia and urinary incontinence. Health care providers should inform women to start their pregnancy at a BMI in the normal weight category.
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http://dx.doi.org/10.1016/j.bj.2019.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804172PMC
December 2020

The effect of intravesical hyaluronic acid therapy on urodynamic and clinical outcomes among women with interstitial cystitis/bladder pain syndrome.

Taiwan J Obstet Gynecol 2020 Nov;59(6):922-926

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Objective: Treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) is often delayed because of a lack of objective data during diagnosis. This study was conducted to determine the clinical validity of using urodynamic studies to investigate the effect of intravesical hyaluronic acid (HA) treatment among women with IC/BPS.

Materials And Methods: Thirty patients with IC/BPS undergoing 6-month intravesical instillation of HA were recruited. Pretreatment evaluation involved a urinalysis and urinary culture, urinary cytology, a 3-day voiding diary, and cystoscopy with hydrodistention of the bladder. Urodynamic study was performed before and after HA treatment. Symptomatic changes were assessed using a questionnaire covering lower urinary tract symptoms, the O'Leary-Sant symptom index and problem indexes (ICSI and ICPI), and the visual analog scale for pain and urgency. Patient demographics, urinary symptoms, ICSI/ICPI scores, pain and urgency scores, and urodynamic results before and after HA treatment were compared.

Results: Urinary frequency, nocturia, urgency, pelvic pain, bladder capacity, ICSI, and ICPI were significantly improved after HA treatment. Comparing urodynamic parameters, the volumes at first desire to void (FDV) and maximum cystometric capacity were significantly increased after HA treatment. Before HA treatment, a negative correlation existed between the ICSI and ICPI and urodynamic parameters, including maximum flow rate and bladder capacity, but there were no significant correlations after treatment. Before HA treatment, a negative correlation was discovered between nocturia and FDV. However, after HA treatment, there were no significant correlations between urinary symptoms and urodynamic parameters.

Conclusions: Our results indicate that the improvement of urinary symptoms of IC/BPS after HA treatment is associated with increased FDV and maximum cystometric capacity. The value of FDV and the frequency of nocturia after treatment may become useful objective indicators for prognosis of IC/BPS.
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http://dx.doi.org/10.1016/j.tjog.2020.09.021DOI Listing
November 2020

Effect of amniotic fluid stem cell transplantation on the recovery of bladder dysfunction in spinal cord-injured rats.

Sci Rep 2020 06 22;10(1):10030. Epub 2020 Jun 22.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

The effects of human amniotic fluid stem cell (hAFSC) transplantation on bladder function and molecular changes in spinal cord-injured (SCI) rats were investigated. Four groups were studied: sham and SCI plus phosphate-buffered saline (SCI + PBS), human embryonic kidney 293 (HEK293) cells, and hAFSCs transplantation. In SCI + PBS rat bladders, cystometry showed increased peak voiding pressure, voiding volume, bladder capacity, residual volume, and number of non-voiding contractions, and the total elastin/collagen amount was increased but collagen concentration was decreased at days 7 and 28. Immunoreactivity and mRNA levels of IGF-1, TGF-β1, and β3-adrenoceptor were increased at days 7 and/or 28. M2 immunoreactivity and M3 mRNA levels of muscarinic receptor were increased at day 7. M2 immunoreactivity was increased, but M2/M3 mRNA and M3 immunoreactivity levels were decreased at day 28. Brain derived-neurotrophic factor mRNA was increased, but immunoreactivity was decreased at day 7. HEK293 cell transplantation caused no difference compared to SCI + PBS group. hAFSCs co-localized with neural cell markers and expressed BDNF, TGF-β1, GFAP, and IL-6. The present results showed that SCI bladders released IGF-1 and TGF-β1 to stimulate elastin and collagen for bladder wall remodelling, and hAFSC transplantation improved these changes, which involved the mechanisms of BDNF, muscarinic receptors, and β3-adrenoceptor expression.
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http://dx.doi.org/10.1038/s41598-020-67163-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308393PMC
June 2020

Amniotic Fluid Stem Cells Improve Rat Bladder Dysfunction After Pelvic Nerve Transection.

Cell Transplant 2020 Jan-Dec;29:963689720909387

College of Medicine, Chang Gung University, Taoyuan.

The effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder dysfunction after pelvic nerve transection (PNT) remain to be clarified. Five groups of female Sprague-Dawley rats were studied including sham operation, unilateral PNT alone or plus hAFSCs transplantation, and bilateral PNT alone or plus hAFSCs transplantation. hAFSCs were injected at the site of PNT. Cystometries, neurofilament density within bladder nerves, and the expressions of bladder protein gene-product 9.5 (PGP9.5), growth-associated protein 43 (GAP-43), nerve growth factor (NGF), p75 (NGF receptor), CXCL12, CCL7, and enkephalin were studied. Compared to sham-operation group, bladder weight increased and neurofilament density decreased at 10 and 28 days after unilateral and bilateral PNT, but all improved after hAFSCs transplantation. Unilateral PNT could increase bladder capacity, residual volume, and number of nonvoiding contractions but decrease peak voiding pressure and leak point pressure. Bilateral PNT caused overflow incontinence and increased the number of nonvoiding contractions. These cystometric parameters improved after hAFSCs transplantation. After PNT, bladder PGP9.5 mRNA and immunoreactivities decreased at 10 and 28 days, GAP-43 mRNA and immunoreactivities increased at 10 days and decreased at 28 days, both NGF and p75 mRNAs and immunoreactivities increased at 10 and/or 28 days, and enkephalin immunoreactivities decreased at 10 and 28 days, but these were all improved after hAFSCs transplantation. Our results showed that bladder dysfunction induced by PNT could be improved by hAFSCs transplantation, and PGP9.5, GAP-43, and neurotrophins could be involved in the mechanisms of nerve regeneration after hAFSCs transplantation.
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http://dx.doi.org/10.1177/0963689720909387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444231PMC
June 2021

Comparison of urodynamic results and quality of life between women with interstitial cystitis and overactive bladder.

Taiwan J Obstet Gynecol 2020 Jan;59(1):39-42

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Objectives: Some symptoms of overactive bladder overlap with those of interstitial cystitis. This study was conducted to compare the urodynamic results and quality of life of patients with the two conditions.

Materials And Methods: Urodynamic data were retrospectively analyzed in 55 females with interstitial cystitis and 171 females with overactive bladder between 2012 and 2016. Females with overactive bladder were divided into detrusor overactivity group and non-detursor overactivity group based on urodynamic results. All recruited patients completed validated questionnaires including incontinence impact questionnaire (IIQ-7), urogenital distress inventory (UDI-6), and short form 12 health survey (SF-12). Patient demographics, total scores of questionnaires, and urodynamic results were compared among interstitial cystitis, detrusor overactivity, and non-detrusor overactivity groups.

Results: The age and body mass index of interstitial cystitis patients were significantly lower than that of overactive bladder patients. The severity of urinary symptoms was higher in interstitial cystitis group than in non-detrusor overactivity group from questionnaire, but similar as detrusor overactivity group. Interstitial cystitis group had lower maximum flow rate, lower residual urine volume, lower maximum cystometric capacity, and higher maximal urethral closure pressure compared with non-detrusor overactivity group. However, there was no significant difference in urodynamic parameters between interstitial cystitis and detrusor overactivity groups.

Conclusion: Interstitial cystitis and overactive bladder have a negative impact on quality of life, but urodynamic studies are not effective in distinguishing between interstitial cystitis and detrusor overactivity.
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http://dx.doi.org/10.1016/j.tjog.2019.11.005DOI Listing
January 2020

Comparative study of transobturator sling with and without concomitant prolapse surgery for female urodynamic stress incontinence.

J Obstet Gynaecol Res 2018 Aug 28;44(8):1466-1471. Epub 2018 Jun 28.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Aim: To demonstrate the clinical and urodynamic outcomes of transobturator sling (TOT) with or without concomitant prolapse surgery for the treatment of urodynamic stress incontinence (USI).

Methods: We recruited 143 consecutive patients diagnosed with USI, who received outside-in TOT in a university hospital. Preoperative and postoperative examinations were implemented using structured urogynecological questionnaires, pelvic organ prolapse quantification examination and urodynamic testing. Patient demographics, surgical and urodynamic results were compared between TOT with and without concomitant prolapse surgery.

Results: The mean follow-up was 30.1 months (range 12-57). Postoperative stress urinary incontinence (SUI) occurred in 10 (7%) patients at 3 months and 10 (7%) patients at 12 months postoperatively. There was no significant difference in prevalence of postoperative SUI between groups of TOT only and TOT combined with pelvic surgery. Preoperative urodynamic results demonstrated that TOT only (n = 96) had a higher maximal flow rate and a lower residual urine amount when compared to TOT combined with pelvic surgery (n = 47). A significant decrease in maximal urethral closure pressure (MUCP) was found in 119 patients who received postoperative urodynamic examination. In comparison with preoperative urodynamic data, postoperative urodynamic results showed a significant decrease in MUCP in the TOT combined with prolapse surgery group, but no significant urodynamic changes in the group of TOT only.

Conclusion: Both TOT and TOT combined with prolapse surgery can be effective in correcting SUI in patients with USI 12 months postoperatively, with significant changes in MUCP.
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http://dx.doi.org/10.1111/jog.13683DOI Listing
August 2018

Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment.

Taiwan J Obstet Gynecol 2018 Jun;57(3):360-363

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Objective: To investigate urinary and psychological symptoms in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) after intravesical hyaluronic acid (HA) treatment.

Materials And Methods: Thirty patients with newly diagnosed with IC/BPS undergoing 4 weekly intravesical HA instillations followed by 5 monthly instillations were recruited. Pre-treatment evaluation included a urinalysis and urinary culture, a 3-day voiding diary, and cystoscopy with hydrodistention of the bladder. Questionnaires containing hospital anxiety and depression scale (HADS), O'Leary-Sant score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and a pain visual analog scale were completed before and after treatment. Thirty age-matched, asymptomatic women were recruited as controls for assessing HADS scores, and comparison of urinary and psychological symptoms in patients before and after HA treatment.

Results: The mean age (range 25-71 years old) and symptomatic duration (range 1-11 years) were 47 and 4.5, respectively. When compared with the control group, patients with IC/BPS had a significant increase in HADS depression subscale score and total score. Frequency, nocturia, bladder capacity, IC symptom and problem index scores, and pain score improved after 6 months of intravesical HA treatment. After HA treatment, 73% (n = 22) of patients showed improvement in their urological symptoms, but no significant changes were found in their HADS and PISQ-12 scores.

Conclusions: Bladder pain and lower urinary tract symptoms in patients with IC/BPS may improve after a 6-month intravesical HA treatment. However, no significant changes in their psychological and sexual functional scores were found.
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http://dx.doi.org/10.1016/j.tjog.2018.04.006DOI Listing
June 2018

Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study.

Taiwan J Obstet Gynecol 2018 Jun;57(3):340-345

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Objective: The study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.

Materials And Methods: 866 women delivering their newborns at a tertiary hospital were recruited. All women were asked to complete several questionnaires including demographic and obstetric data, Short Form 12 health survey (SF-12), Urogenital Distress Inventory Short Form (UDI-6), and Incontinence Impact Questionnaire Short Form (IIQ-7). All women were interviewed via telephone to answer the same questionnaires at 12 months postpartum.

Results: There were 446 (51.5%) self-reported SUI women during pregnancy. Out of 560 women delivered vaginally, 70 (12.5%) had SUI at 12 months postpartum; in 306 women undergoing Cesarean delivery, 22 (7.2%) experienced SUI 12 months after delivery. Risk factors of SUI during pregnancy included body weight and body mass index at first visit. At 12 months postpartum, parity stood out as the risk factor of persistent SUI in vaginal delivery group, but no significant risk factor was found in Cesarean group. Women with SUI during pregnancy featured worse mental component summary (MCS) score of SF-12, compared to women without SUI. At 12 months postpartum, women with persistent SUI in vaginal delivery group had higher mean UDI-6 and IIQ-7 scores than those without SUI.

Conclusion: Persistent SUI is more prevalent in the vaginal delivery group than Cesarean group. Both SUI during pregnancy and after childbirth have negative impact on the quality of life in women undergoing vaginal delivery.
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http://dx.doi.org/10.1016/j.tjog.2018.04.003DOI Listing
June 2018

Improvement in bladder dysfunction after bladder transplantation of amniotic fluid stem cells in diabetic rats.

Sci Rep 2018 02 1;8(1):2105. Epub 2018 Feb 1.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

To examine the effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder function and molecular changes in diabetic rats, 60 female Sprague-Dawley rats were used for study. Three groups were assigned including sham control rats, streptozotocin (STZ, 60 mg/kg)-induced diabetic rats and STZ-induced diabetic rats plus bladder hAFSCs transplantation. Compared to controls, diabetic rats had decreased body weight but increased bladder weight. Cystometries showed non-voiding contraction, residual volume, voided volume and intercontraction interval increased significantly in diabetic rats at week 4 and 12 after DM induction, but improved after hAFSCs transplantation. The immunoreactivities and mRNAs of nerve growth factor (NGF) decreased significantly in diabetic bladder at week 4 and 12 after DM induction, but recovered after hAFSCs transplantation. The immunoreactivities and mRNAs of M2 and M3 muscarinic receptor increased significantly in diabetic bladder at week 4 after DM induction but recovered after hAFSCs transplantation. The immunoreactivity of 8-hydroxy-20-deoxyguanosine increased significantly in diabetic bladder at week 4 and 12 after DM induction but reduced after hAFSCs transplantation. The present study showed bladder dysfunction in STZ-induced diabetic rats could be improved by hAFSCs transplantation into bladder, which may be related to the recovery of bladder NGF and muscarinic receptors.
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http://dx.doi.org/10.1038/s41598-018-20512-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794746PMC
February 2018

Effect of non-ablative laser treatment on overactive bladder symptoms, urinary incontinence and sexual function in women with urodynamic stress incontinence.

Taiwan J Obstet Gynecol 2017 Dec;56(6):815-820

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Objective: To investigate the effects of non-ablative laser treatment on overactive bladder (OAB) syndromes, stress urinary incontinence and sexual function in women with urodynamic stress incontinence (USI).

Materials And Methods: Between April 2015 and June 2015, consecutive patients with USI with OAB syndromes underwent two sessions of Erbium:YAG laser treatment in a tertiary hospital. Patients received validated urological questionnaires, urodynamic studies, 1-h pad test and measurement of vaginal pressure before, one and three months after laser treatment. Questionnaires at 12 months were completed by telephone interview. Adverse effects and patients' satisfaction were also assessed.

Results: We included 30 patients with a mean age of 52.6 ± 8.8 years. Three months after therapy, mean 1-h pad test significantly decreased (P = 0.039). Significant improvement in OAB symptoms in four questionnaires were noted at three months post treatment, but not sustained for 12 months in two of them. Three months after therapy, mean vaginal pressure significantly improved (P = 0.009). Of 24 (82.7%) sexually active patients, 62.5% (15/24) and 54.2% (13/24) of their sexual partners reported improved sexual gratification three months later. No major adverse effects were noticed.

Conclusions: Erbium:YAG laser treatment can resolve USI and coexistent OAB symptoms three months after therapy. Sexual experience is also improved. However, repeated laser therapy may be necessary after six months.
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http://dx.doi.org/10.1016/j.tjog.2017.10.020DOI Listing
December 2017

Amniotic fluid stem cells ameliorate bladder dysfunction induced by chronic bladder ischemia in rat.

Neurourol Urodyn 2018 01 12;37(1):123-131. Epub 2017 Jun 12.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Aims: This study investigated the protective effect of human amniotic fluid-derived stem cells (hAFSCs) against bladder overactivity in rat model of atherosclerosis-induced chronic bladder ischemia.

Methods: Adult female Sprague-Dawley rats were divided into six groups: (1) Normal control with a regular diet for 8 weeks, (2) Sham-operation, (3) arterial balloon endothelial injury (AEI) of common iliac artery (AEI only), and post-AEI consecutive hAFSCs treatment for (4) 1 day, (5) 3 days, and (6) 7 days. Groups 2-6 were given 2% cholesterol diet for 8 weeks after operation (sham or AEI). Bladder functions were analyzed by cystometry at 8 weeks in controls and after operation in groups 2-6. Wall morphology of common iliac artery was examined by hematoxylin and eosin stain. Bladder oxidative stress and inflammatory markers were studied by immunohistochemistry of 8-hydroxy-2'-deoxyguanosine (8OHdG), malondialdehyde (MDA), and tumor necrosis factor-alpha (TNF-alpha).

Results: Bladder overactivity with decreased voided volumes and intercontraction intervals and increased residual volumes was seen in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days. Compared with controls and shams, the wall thickness of iliac artery was increased in AEI only group, but improved after hAFSCs treatment for 3 and 7 days. The expressions of 8OHdG, MDA, and TNF-alpha were increased in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days.

Conclusions: Bladder overactivity caused by chronic bladder ischemia can be improved by hAFSCs treatment, probably by acting through down-regulation of oxidative stress and TNF-alpha expressions.
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http://dx.doi.org/10.1002/nau.23316DOI Listing
January 2018

Bladder Transplantation of Amniotic Fluid Stem Cell may Ameliorate Bladder Dysfunction After Focal Cerebral Ischemia in Rat.

Stem Cells Transl Med 2017 04 3;6(4):1227-1236. Epub 2017 Jan 3.

Stroke Center and Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan, Republic of China.

The objective is to investigate whether human amniotic fluid stem cells (hAFSCs) grafting into the bladder may influence bladder functional and molecular changes in an animal stroke model. Female rats were divided into three groups: sham, middle cerebral artery occlusion (MCAO) alone, and MCAO plus 1 × 10 hAFSCs transplanting into bladder wall. Bladder function was analyzed by cystometry at days 3 and 10 after MCAO. The expressions of bladder nerve growth factor (NGF), M2-muscarinic, M3-muscarinic, and P2X1 receptors were measured by immunohistochemistry and real-time polymerase chain reaction. When compared with sham-operated group, MCAO alone rats had significant increase in residual volume and decrease in voided volume and intercontraction interval; however, these bladder dysfunctions were improved following hAFSCs transplantation. The immunoreactivities of NGF, M3, and P2X1 significantly decreased at days 3 and 10, but M2 increased at day 3 after MCAO. Following hAFSCs transplantation, the immunoreactivities of NGF and P2X1 significantly increased at day 3, and M2 increased at day 10 after MCAO. The mRNAs of NGF, M2, and M3 significantly increased at day 3, but NGF and M2 decreased at day 10 after MCAO. Following hAFSCs transplantation, there was significant decrease in M2 mRNA at day 3 and increase in P2X1 mRNA at days 3 and 10 after MCAO. Bladder dysfunction caused by MCAO can be improved by hAFSCs transplanting into bladder which may be related to the expressions of bladder NGF, and muscarinic and P2X1 receptors. Stem Cells Translational Medicine 2017;6:1227-1236.
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http://dx.doi.org/10.1002/sctm.16-0212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442832PMC
April 2017

Effect of umbilical cord blood stem cells transplantation on bladder dysfunction induced by cerebral ischemia in rats.

Taiwan J Obstet Gynecol 2016 Oct;55(5):672-679

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Objective: To demonstrate the effect of human umbilical cord blood-derived CD34 cells on bladder dysfunction induced by cerebral ischemia in rats.

Materials And Methods: Female rats were subjected to either 60 minute middle cerebral artery occlusion (MCAO) or a sham operation. Rats were divided into four groups: sham operation, MCAO without treatment, infusion with 1×10 CD34 cells 30 minutes before MCAO, and infusion with 1×10 CD34 cells 3 hours after MCAO. Bladder function was analyzed by cystometry at 1 day, 3 days, and 7 days after MCAO. Expressions of nerve growth factor (NGF), M and M muscarinic receptors were measured by immunohistochemistry and real time polymerase chain reaction.

Results: Cystometric results showed that, following MCAO, rats have a significant increase in peak voiding pressure and residual volume. Conversely, there is a significant decrease in voided volumes and intercontraction intervals. Cystometric variables after pre- and postischemic CD34 treatment nearly returned to levels found in sham-operated rats. The expression of bladder NGF and M was decreased after MCAO, but significantly increased following preischemic CD34 treatment. There was decreased expression of bladder M mRNA despite an increased level of M immunoreactivity at 3 days and 7 days after MCAO. Expression of bladder M immunoreactivity and mRNA nearly returned to sham group levels after preischemic CD34 treatment.

Conclusion: Bladder dysfunction in a rat model caused by MCAO may be restored to normal micturition by treatment with human umbilical cord blood-derived CD34 cells and may be related to the expressions of NGF, M, and M in the bladder.
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http://dx.doi.org/10.1016/j.tjog.2015.11.002DOI Listing
October 2016

Outcome of coexistent overactive bladder symptoms in women with urodynamic urinary incontinence following anti-incontinence surgery.

Int Urogynecol J 2017 Apr 27;28(4):605-611. Epub 2016 Sep 27.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, 333.

Introduction And Hypothesis: The objective was to investigate the outcome of stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms in women with urodynamic stress incontinence (USI) after transobturator sling procedures (TOTs).

Methods: We evaluated 109 consecutive patients with USI, who had undergone TOT in a tertiary hospital between 2012 and 2014. All patients received evaluations, including structured urogynecological questionnaires and pelvic organ prolapse quantification examination before, and 3 and 12 months after surgery. One-hour pad test and urodynamic testing were performed before and 3-6 months postoperatively. Patient demographics, lower urinary tract symptoms, and urodynamic results were analyzed between pure USI and USI with OAB symptoms.

Results: Persistent SUI occurred in 8 patients at 3 months (7.3 %) and 7 patients at 12 months (6.4 %) postoperatively. The most common OAB symptom was frequency (54.1 %), followed by urgency urinary incontinence (52.3 %), urinary urgency (42.2 %), and nocturia (33 %). Most of these OAB symptoms were resolved at the 3-month and 12-month follow-ups both in patients treated with TOT only and in those treated with TOT combined with other pelvic surgeries. There was no significant difference in the preoperative urodynamic changes between patients with pure USI and USI without OAB groups. However, postoperative urodynamic results showed a significant decrease in the maximal urethral closure pressure in the group of patients with USI and OAB symptoms, but no significant urodynamic changes in the group with pure USI.

Conclusions: Coexistent OAB symptoms are common in women who were diagnosed with USI and most of these symptoms may resolve 3 and 12 months after TOT.
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http://dx.doi.org/10.1007/s00192-016-3153-yDOI Listing
April 2017

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

J Obstet Gynaecol Res 2016 Apr 19;42(4):427-33. Epub 2016 Jan 19.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Aim: 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.

Methods: We retrospectively evaluated consecutive patients with DO and advanced POP who had undergone TVM in a tertiary hospital between 2010 and 2014. All patients received evaluations, including a structured urogynecological questionnaire, pelvic examination using the POP-Quantification System, scores of the Urogenital Distress Inventory and Incontinence Impact Questionnaire, and urodynamic testing before TVM repair and 6 months after surgery. Patient demographics, lower urinary tract symptoms, including urinary urgency, incontinence and frequency, and urodynamic findings were analyzed between women with and without persistent DO at 12 months after surgery.

Results: Of 326 patients with POP who underwent TVM repair, 63 with preoperative DO were included. Urinary urgency was present in 27 (42.9%), and urgency incontinence was present in 26 (41.3%) patients. Nineteen (30.2%) patients had persistent DO after surgery. Patients with persistent DO had lower preoperative maximal flow rate (MFR), higher preoperative detrusor pressure at maximum flow, higher postoperative residual urine volume and higher rates of concomitant sacrospinous ligament suspension compared to those without DO. In the multivariate analysis, preoperative MFR and concomitant sacrospinous ligament suspension were associated with persistent DO.

Conclusion: Twenty percent of women with advanced POP had DO, and most of these cases resolved after prolapse repair. For women with lower preoperative MFR and concomitant sacrospinous ligament suspension, preoperative counseling should consist of a discussion about persistent DO and relevant urinary symptoms following TVM repair.
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http://dx.doi.org/10.1111/jog.12927DOI Listing
April 2016

The Protective Effect of Human Umbilical Cord Blood CD34+ Cells and Estradiol against Focal Cerebral Ischemia in Female Ovariectomized Rat: Cerebral MR Imaging and Immunohistochemical Study.

PLoS One 2016 13;11(1):e0147133. Epub 2016 Jan 13.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Human umbilical cord blood derived CD34+ stem cells are reported to mediate therapeutic effects in stroke animal models. Estrogen was known to protect against ischemic injury. The present study wished to investigate whether the protective effect of CD34+ cells against ischemic injury can be reinforced with complemental estradiol treatment in female ovariectomized rat and its possible mechanism. Experiment 1 was to determine the best optimal timing of CD34+ cell treatment for the neuroprotective effect after 60-min middle cerebral artery occlusion (MCAO). Experiment 2 was to evaluate the adjuvant effect of 17β-estradiol on CD34+ cell neuroprotection after MCAO. Experiment 1 showed intravenous infusion with CD34+ cells before MCAO (pre-treatment) caused less infarction size than those infused after MCAO (post-treatment) on 7T magnetic resonance T2-weighted images. Experiment 2 revealed infarction size was most significantly reduced after CD34+ + estradiol pre-treatment. When compared with no treatment group, CD34+ + estradiol pre-treatment showed significantly less ADC reduction at 2 h and 2 d, less CBF reduction at 2 h and less hyperperfusion at 2 d. The immunoreactivity of c-Fos, c-Jun and GFAP was attenuated, and BDNF showed significant recovery from 2 h to 2 d after MCAO, especially after CD34+ + estradiol pre-treatment. The present study suggests pre-treatment with CD34+ cells with complemental estradiol can be most protective against ischemic injury, which may act through stabilization of cerebral hemodynamics and normalization of the expressions of immediate early genes and BDNF.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147133PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711929PMC
July 2016

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

Taiwan J Obstet Gynecol 2015 Dec;54(6):709-15

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Taoyuan, Taiwan. Electronic address:

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.
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http://dx.doi.org/10.1016/j.tjog.2015.10.003DOI Listing
December 2015

Predictors of persistence of preoperative urgency incontinence in women following pelvic organ prolapse repair.

Taiwan J Obstet Gynecol 2015 Dec;54(6):682-5

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Objective: To investigate the predictors of persistence or resolution of preoperative urgency urinary incontinence (UUI) in women following transvaginal mesh (TVM) repair for advanced pelvic organ prolapse (POP).

Material And Methods: Patients with advanced POP undergoing TVM repair between 2008 and 2013 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, voiding diary, pelvic examination using the POP-quantitation system, and urodynamic testing before and after surgery, and intraoperative cystoscopy. Patient demographics, lower urinary tract symptoms, urodynamic findings, and severity of prolapse were analyzed between women with and without preoperative UUI.

Results: Of 174 patients who underwent TVM repair, 49 (28.2%) had preoperative UUI; after operation, 23 (13.2%) were found to have postoperative UUI and 13 (7.5%) developed de novo UUI. For those 49 patients with preoperative UUI, 10 (20.4%) had persistent UUI and 19 (38.8%) developed de novo stress urinary incontinence postoperatively. The prevalence of preoperative bladder outlet obstruction, preoperative maximal cystometric capacity (MCC) < 300 mL, preoperative severe bladder trabeculation, and duration of POP symptoms > 60 months were significantly higher in patients with persistent UUI than without it. Logistic regression demonstrated that preoperative MCC<300 mL, severe bladder trabeculation, and duration of POP symptoms > 60 months were associated with persistent UUI after prolapse repair.

Conclusion: For women with identified preoperative risk factors, including MCC<300 mL, severe bladder trabeculation, and POP symptoms > 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.
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http://dx.doi.org/10.1016/j.tjog.2014.08.012DOI Listing
December 2015

Voiding dysfunction in women following cesarean delivery.

Taiwan J Obstet Gynecol 2015 Dec;54(6):678-81

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Objective: This study was conducted to investigate the prevalence of postpartum voiding difficulty (PVD) in women after cesarean delivery that required urethral catheterization, and to illustrate its relationship with various relevant obstetric factors.

Material And Methods: For this observational study, 489 pregnant women who had cesarean delivery at ≥ 36 gestational weeks were recruited in a tertiary hospital. Urethral catheterization was implemented in women who could not void spontaneously after cesarean delivery. Patient characteristics, obstetric parameters, and incidences of obstructive voiding symptoms at 3 months postpartum were compared between women who had PVD and no PVD.

Results: Fifty-six cesarean deliveries (11.5%) resulted in PVD. Maternal age > 35 years, emergency cesarean delivery, operation time > 60 minutes, and postoperative analgesia were significantly different between women with and without PVD. Logistic regression demonstrated that emergency cesarean delivery (odds ratio = 5.031, p < 0.001), operation time > 60 minutes (odds ratio = 2.918, p = 0.002), and postoperative analgesia (odds ratio = 7.610, p = 0.007) were independent risk factors of PVD. Nonetheless, all women had resolution of PVD by the time of hospital dismissal. At 3-month postoperative follow-up, three women (5.4%) had symptoms of straining and/or incomplete emptying.

Conclusion: Our results showed that emergency cesarean delivery, prolonged operation time and postoperative analgesia are the main contributing factors of PVD after cesarean delivery. If urinary retention can be detected in time, transient PVD is not detrimental to urinary function and does not subsequently lead to voiding problems.
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http://dx.doi.org/10.1016/j.tjog.2014.08.011DOI Listing
December 2015

Effects of sacral nerve stimulation on postpartum urinary retention-related changes in rat bladder.

Taiwan J Obstet Gynecol 2015 Dec;54(6):671-7

College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.

Objective: To examine the effect of sacral nerve stimulation (SNS) on the urodynamic function and molecular structure of bladders in rats following acute urinary retention (AUR) after parturition.

Material And Methods: Thirty primiparous rats were divided into three groups: postpartum, postpartum+AUR, and postpartum+AUR+SNS. AUR was achieved by clamping the distal urethra of a rat for 60 minutes. The postpartum+AUR+SNS group received electrical stimulation 60 minutes daily for 3 days after AUR. In addition to cystometric studies and external urethral sphincter electromyography, the expression of caveolins and nerve growth factor (NGF) and caveolae number in bladder muscle were analyzed.

Results: The postpartum+AUR group has significantly greater residual volume than the postpartum group, but the residual volume decreased significantly after SNS treatment. The postpartum+AUR group had significantly lower peak voiding pressure, a longer bursting period and lower amplitude of electromyograms of external urethral sphincter activity than the postpartum and postpartum+AUR+SNS groups. The postpartum+AUR rats had higher NGF expression, lower caveolin-1 expression, and fewer caveolae in bladder muscle compared with the postpartum rats. Conversely, the caveolin-1 expression and caveolae number increased, and the NGF expression decreased after SNS treatment.

Conclusion: Bladder dysfunction after parturition in a rat model caused by AUR may be restored to the non-AUR structural and functional level after SNS treatment.
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http://dx.doi.org/10.1016/j.tjog.2015.10.001DOI Listing
December 2015

Effect of suburethral prolene mesh for suburethral function and histology in a stress urinary incontinence mouse model.

Int J Urol 2015 Nov 2;22(11):1068-74. Epub 2015 Sep 2.

Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.

Objectives: To create a mouse model pertaining to mesh-elicited suburethral functional and histological changes after vaginal distention, and to examine the possible mechanism behind these complications.

Methods: We divided 48 virgin female C57BL/6 mice into four groups: vaginal distention alone, vaginal distention followed by prolene mesh implantation, vaginal distention followed by sham mesh implantation and untreated control. Each group was divided into two subgroups for conscious cystometrogram, leak-point pressure testing and harvesting of suburethral tissue 4 or 10 days after vaginal distention. The suburethral tissues underwent immunohistochemistry and western blot analysis of nerve growth factor, matrix metalloproteinase 2 and tissue inhibitor of metalloproteinase 2. Urodynamic results were compared among groups using one way ANOVA, with Tukey's multiple comparisons post-test for pair wise comparisons.

Results: Leak-point pressure in the vaginal distention and vaginal distention + sham mesh groups were significantly lower than in the control and vaginal distention + mesh groups at day 4. Leak-point pressure in the vaginal distention + mesh group were significantly higher than in the other three groups at both day 4 and 10. Immunohistochemistry and western blotting showed increased matrix metalloproteinase 2 and tissue inhibitor of metalloproteinase 2 levels in the vaginal distention + mesh group at day 4 and 10. Furthermore, nerve growth factor expression was increased in the same area and same group at 10 days.

Conclusions: Increased suburethral tissue matrix metalloproteinase and nerve growth factor expression might be related to tissue remodeling after prolene mesh implantation for stress urinary incontinence.
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http://dx.doi.org/10.1111/iju.12888DOI Listing
November 2015

Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery.

Taiwan J Obstet Gynecol 2014 Dec;53(4):481-5

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Objective: This study was conducted to investigate the risk factors of third- and fourth-degree lacerations following vaginal deliveries in Taiwanese women, and to offer clinical guidance for the reduction of severe perineal lacerations.

Materials And Methods: A total of 1879 women who underwent vaginal deliveries assisted by midline episiotomy at a tertiary hospital were included. Obstetric risk factors were analyzed for women with and without third- and fourth-degree lacerations.

Results: Two hundred and five deliveries (10.9%) resulted in third- or fourth-degree lacerations. Parity, duration of first and second stages of labor, rate of instrument-assisted vaginal deliveries, the newborn's birth weight and head circumference, and the ratio of the newborn's birth weight to maternal body mass index were significantly different between women with and without severe perineal lacerations. Logistic regression demonstrated that nulliparity (odds ratio = 3.626, p < 0.001), duration of second stage of labor (odds ratio = 1.102, p = 0.044), instrument-assisted vaginal delivery (odds ratio = 4.102, p < 0.001), and newborn's head circumference (odds ratio = 1.323, p < 0.001) were independent risk factors of severe perineal lacerations. Instrument-assisted vaginal delivery was a common independent risk factor for severe lacerations shared between primiparous and multiparous women.

Conclusions: With regard to severe perineal lacerations during vaginal delivery, there are multiple obstetric contributory factors despite routine episiotomy, among them, nulliparity, longer labor duration, greater newborn head circumference, and instrument-assisted vaginal delivery. The latter should only be performed after careful evaluation.
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http://dx.doi.org/10.1016/j.tjog.2013.07.002DOI Listing
December 2014

Trends in reoperation for female stress urinary incontinence: A nationwide study.

Neurourol Urodyn 2015 Sep 27;34(7):693-8. Epub 2014 Jul 27.

Department of Urology, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan.

Aims: Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence.

Methods: Records of female patients who had received a primary surgical treatment for stress incontinence from January 2000 to December 2006 were retrieved. Among these, patients who had reoperations during follow-up till December 2010 were identified. The data were analyzed for reoperation rates, surgery methods, patient demography, surgeon, and hospital attributes.

Results: Among 14,613 patients with a mean follow-up of 86.28 ± 26.76 months, 563 (3.85%) had reoperations, an incidence rate of 54.37 per 10,000 person year (PY). Injection procedures had the highest reoperation rate of 893.30/10,000 PY. The adjusted hazard ratio (HR) of reoperation was higher for mid-urethral sling when compared to pubovaginal sling (HR 1.54, 95% CI 1.16-2.05) or retropubic urethropexy including Burch operation (HR 1.30, 95% CI 1.04-1.61). Surgeons with high service volumes tended to have fewer reoperations. No correlations were noted between the reoperation rate with patient age, surgeon age/gender, year of operation and hospital status. However, urologists had higher reoperation rates than gynecologists. For repeat surgery, the majority of patients chose the same specialty but different surgical types. Mid-urethral sling was used most commonly in 48.85% of reoperations.

Conclusions: Substantial number of patients need reoperation for stress incontinence. The choice of primary surgery type and surgeon specialty may affect the reoperation rates. Mid-urethral sling is the most common reoperation choice.
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http://dx.doi.org/10.1002/nau.22648DOI Listing
September 2015

The surgical trends and time-frame comparison of primary surgery for stress urinary incontinence, 2006-2010 vs 1997-2005: a population-based nation-wide follow-up descriptive study.

Int Urogynecol J 2014 Dec 28;25(12):1683-91. Epub 2014 Jun 28.

Department of Obstetrics and Gynecology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

Introduction And Hypothesis: The purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006-2010, and a time-frame comparison with 1997-2005, based upon the National Health Insurance (NHI) claims data in Taiwan.

Methods: Women who underwent various primary surgeries for SUI during 2006-2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis.

Results: During the follow-up study, midurethral sling (MUS) application increased significantly from 53.09 % in 2006 to 78.74 % in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68 % to 12.99 %, and pubovaginal sling treatment (PVS) from 9.33 % to 3.46 %. MUS was most commonly used among all patients' and surgeons' age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38 %) than urologists (57.91 %); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006-2010 vs 1997-2005. SUI surgeries increased in patients aged ≥60, surgeons aged ≥ 50, and in regional hospitals.

Conclusion: This follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.
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http://dx.doi.org/10.1007/s00192-014-2443-5DOI Listing
December 2014

Bladder dysfunction induced by cerebral hypoperfusion after bilateral common carotid artery occlusion in rats.

Neurourol Urodyn 2015 Aug 13;34(6):586-91. Epub 2014 May 13.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Aims: The role of forebrain in controlling micturition has been studied extensively using rat model with ischemic injury; however, the influence of cerebral hypoperfusion on voiding function remains unclear. The study was conducted to evaluate the bladder dysfunction and the temporal expression of bladder nerve growth factor (NGF) after cerebral hypoperfusion induced by bilateral common carotid artery occlusion (BCCAO).

Materials And Methods: Forty female rats were subjected to either BCCAO or sham operation. Cerebral T2-weighted magnetic resonance images (MRI) and diffusion and perfusion change were studied to characterize the extent of the ischemic injury in the cortex and hippocampus. On 1, 7, and 28 days after BCCAO, the bladder dysfunction was assessed by cystometric studies, and the expressions of NGF in bladder muscle and urothelium were measured by immunohistochemistry and real-time polymerase chain reaction.

Results: In the MRI study, cerebral blood flow in the cortex and hippocampus was significantly decreased from 1 day and subsequently returned to sham-operated level at 28 days after BCCAO. Compared with the sham-operated group, significant reduction in voided volume and intercontraction interval was found from 1 to 28 days after cerebral hypoperfusion. The NGF immunoreactivity and mRNA in the bladder muscle and urothelium were transiently increased at 1 day, and declined significantly at 28 days after BCCAO.

Conclusions: Our results indicate that bladder dysfunction may be caused by cerebral hypoperfusion and is less likely related to bladder NGF expression.
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http://dx.doi.org/10.1002/nau.22628DOI Listing
August 2015

How antepartum and postpartum acute urinary retention affects the function and structure of the rat bladder.

Int Urogynecol J 2014 Aug 11;25(8):1105-13. Epub 2014 Feb 11.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, Republic of China, 333,

Introduction And Hypothesis: To examine the effect of acute urinary retention (AUR) on the urodynamic function and molecular structure of rat bladders in pregnancy and after parturition.

Methods: Forty-eight nulliparous rats were distributed into AUR and non-AUR groups. AUR was induced by clamping the distal urethra of each rat after infusing 3 ml of saline for 60 min. Plasma progesterone levels and cystometric data were evaluated on the 14th day of gestation, 3 and 10 days postpartum, and in virgin rats. The immunoreactivity of caveolins and nerve growth factor (NGF) was analyzed. The number of caveolae in bladder muscle cells was evaluated by electron microscopy.

Results: Progesterone levels significantly increased during pregnancy and 3 days postpartum. In cystometric results, the AUR group has significantly shorter intercontraction interval, lower void volume and greater residual volume compared with the non-AUR. AUR rats exhibited higher NGF immunoreactivity, lower caveolin-1 immunoreactivity, and less caveolae in the bladder compared with the non-AUR. The caveolin-1 and NGF immunoreactivity and the number of caveolae in the bladder decreased during pregnancy and 3 days postpartum compared with virgin rats. By using Pearson correlations, we found significant correlations between urodynamic variables (residual volumes and intercontraction intervals) and the expressions of caveolin-1, caveolae and NGF in the AUR rats on the 14th day of gestation and 3 days postpartum.

Conclusions: Bladder dysfunction in pregnancy and immediately postpartum in a rat model caused by AUR is associated with the plasma progesterone level change and the expressions of caveolin, caveolae, and NGF in bladder muscle cells.
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http://dx.doi.org/10.1007/s00192-013-2320-7DOI Listing
August 2014

Effects of sex hormones on cell proliferation and apoptosis in the urinary bladder muscle of ovariectomized rat.

Taiwan J Obstet Gynecol 2013 Sep;52(3):335-40

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan. Electronic address:

Objective: To reveal the exogenous effects of sex hormones on cell proliferation and apoptosis in the detrusor muscle of ovariectomized rat urinary bladder.

Materials And Methods: Proliferating cell nuclear antigen (PCNA) and in-situ apoptosis detection kit were used to evaluate cell proliferation and death in the detrusor muscle of castrated female rats after 1 day, 3 days, and 7 days of supplementary sex steroid hormone administration, including estrogen, progesterone, and testosterone. The percentage of cells positive for PCNA (proliferative index) and for apoptosis (apoptotic index) in various groups was calculated.

Results: When compared to the group of bilateral ovariectomy without hormonal supplementation, the groups given 3 days and 7 days of estrogen supplementation (p = 0.031 and p = 0.005, respectively) and the group given 7 days of combined supplementation with estrogen and progesterone (p = 0.044) had a significant increase in the proliferative indices. A significant decrease of apoptotic index was found in the group given 7 days of estrogen supplementation when compared to bilateral ovariectomy without hormonal supplementation (p = 0.035).

Conclusions: Exogenous estrogen supplementation stimulates proliferation and slows down apoptosis in the detrusor muscle of ovariectomized rat urinary bladder, an effect not counteracted by concomitant use of progesterone. Our results may have clinical implications for estrogen supplementation in offering benefits to menopausal women with lower urinary tract syndromes, based on evaluating the relationship between cell apoptosis and cell proliferation.
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http://dx.doi.org/10.1016/j.tjog.2012.11.003DOI Listing
September 2013