Publications by authors named "Ling-Hong Tseng"

40 Publications

Focusing on long-term complications of mid-urethral slings among women with stress urinary incontinence as a patient safety improvement measure: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2021 Jun;100(24):e26257

Department of Obstetrics and Gynecology, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan City, Taiwan.

Background: There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure.

Methods: A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications.

Results: A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported.

Conclusions: Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000026257DOI Listing
June 2021

Long-term Outcomes of Self-Management Gellhorn Pessary for Symptomatic Pelvic Organ Prolapse.

Female Pelvic Med Reconstr Surg 2020 11;26(11):e47-e53

From the Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan.

Objective: The aim of this study is to estimate the long-term survival and to identify adverse events associated with the use of Gellhorn pessaries over a 9-year period.

Methods: This was a retrospective case series study at a tertiary urogynecology unit in Taiwan. Between January 2009 and June 2017, 93 patients who opted for self-management Gellhorn pessaries to treat symptomatic pelvic organ prolapse (POP) and who were continuously followed-up were enrolled. Long-term use was defined as use for longer than 1 year. Length of use, factors that predicted discontinuation, and adverse events were analyzed and reviewed by chart or telephone inquiry.

Results: The cumulative probabilities of continued pessary use at 1 and 5 years were 62.4% and 47.2%, respectively. Of those who discontinued use, 34 (70.8%) participants discontinued use within 1 year, and the mean duration of use was 13.7 months (range, 0-75 months; median, 5 months). Most of the participants stopped using the pessary because of bothersome adverse events such as pessary expulsion, vaginal pain, de novo urinary incontinence, and erosion/infection.

Conclusions: Self-management Gellhorn pessary was safe and relatively effective and increased patients' autonomy and ability to manage their POP. One third of the patients discontinued use by 1 year, and half of the patients discontinued use at 5 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SPV.0000000000000770DOI Listing
November 2020

Clinical outcomes on tension-releasing suture appendage on single-incision sling devices for postoperative voiding dysfunction involving undue tape tension.

Int Urogynecol J 2019 09 28;30(9):1509-1517. Epub 2018 Nov 28.

Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital Keelung, Keelung Medical Centre, 222, Maijin Road, Keelung, Taiwan, 204, Republic of China.

Introduction And Hypothesis: To determine the clinical outcomes of adding a tension-releasing suture (TRS) appendage for manipulation of over-tensioned single-incision slings (SIS) as a means to relieve postoperative voiding dysfunction.

Methods: A retrospective observational study conducted from January 2010 to July 2017. The records of patients with urodynamic stress incontinence (USI) without needing concurrent procedures who underwent anti-incontinence surgery using MiniArc, Solyx, and Ajust with voiding dysfunction were collated and analyzed. The primary outcome measure was the recovery of normal post-void residual urine (PVR) after TRS manipulation. The secondary outcome measures were the pain intensity noted during manipulation (quantified by visual analog scale) and the continence rate [assessed by (1) objective cure: 1-h pad test weight < 2 g and absence of USI; (2) subjective cure index score ≤ 1 on question 3 of the UDI-6: "Urine leakage related to physical activity, coughing, or sneezing?"].

Results: There were 73 patients with high post-void residual (PVR) urine. The 42 (9.5%) patients with over-tensioned slings were managed with TRS manipulation while the 31 patients (7%) with high PVR and no sling over-tension were managed with intermittent catheterization. All patients in both groups regained normal PVR. The TRS-manipulated group demonstrated an objective cure rate of 92.9% (39/42) and subjective cure rate of 91% (38/42). Pain experienced during TRS manipulation was significantly higher with the Ajust system (p = 0.018). Three patients had persistence of USI, two with MiniArc and one with Solyx.

Conclusions: The TRS manipulation is a well-tolerated procedure that can effectively relieve voiding dysfunction for over-tensioned SIS without affecting continence cure rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-018-3826-9DOI Listing
September 2019

Prophylactic midurethral sling insertion during transvaginal pelvic reconstructive surgery for advanced prolapse patients with high-risk predictors of postoperative de novo stress urinary incontinence.

Int Urogynecol J 2019 09 18;30(9):1541-1549. Epub 2018 Oct 18.

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

Introduction And Hypothesis: Our aim was to evaluate the clinical outcome of continent women with high-risk predictors for de novo stress urinary incontinence (SUI) offered prophylactic midurethral sling (MUS) insertion during vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP).

Materials And Methods: This was a prospective cohort study in patients with POP stage ≥ 3 and maximum urethral closure pressure (MUCP) <60 cmHO and functional urethral length (FUL) <2 cm. Patients were divided into PRS and PRS + MUS groups. Surgery commenced with vaginal hysterectomy, application of Uphold® and insertion of MUS to the PRS + MUS group. Main outcome measures were incidence of de novo urodynamic stress incontinence (USI), lower urinary tract symptoms (LUTS), quality of life (QoL), and topographic and anatomical relationship of implanted mesh.

Results: Based on sample size calculation, 40 patients were recruited-20 in each group. Rate of de novo USI in PRS + MUS was 5% objectively and 10% subjectively, while in the PRS it was 50% objectively and 60% subjectively. No significant difference was noted in patient demographics. Intraoperative blood loss was greater for PRS + MUS but was not statistically significant. No organ injuries, mesh exposure, or infections occurred. Postoperatively, MUCP significantly increased from 43.3 ± 8.9 to 58.5 ± 19.2 cmHO and FUL from 17.2 ± 1.9 to 20.3 ± 3.1 mm in the PRS + MUS group. Residual urine significantly decreased. No patient had bladder outlet obstruction (BOO). Sonographic assessment showed no difference in mesh mobility with urethral kinking observed in 11 (55%) patients with MUS.

Conclusion: Based on a validated small sample, prophylactic MUS for continent women at high risk for postoperative USI with advanced POP lowers its incidence to 5%. Continence is achieved in 95%. Concern for complications, LUTS, and QoL did not significantly differ.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-018-3787-zDOI Listing
September 2019

Evaluation of Clinical Outcome and Risk Factors for Failure of Single-incision Midurethral Short Tape Procedure (Solyx Tape) for Stress Urinary Incontinence.

J Minim Invasive Gynecol 2019 May - Jun;26(4):688-694. Epub 2018 Jul 21.

Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan, Republic of China (Dr. Wu); Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China (Dr. Wu).

Study Objective: To evaluate the clinical outcome and identify risk factors for failure of the Solyx (Boston Scientific Corporation, Marlborough, MA) single-incision sling (SIS) in the treatment of urodynamic stress incontinence (USI).

Design: A retrospective observational study (Canadian Task Force classification II-2).

Setting: A tertiary referral center.

Patients: Patients diagnosed with USI without needing concurrent procedures that underwent continence surgery using the Solyx SIS from February 2015 to May 2017.

Interventions: Anti-incontinence surgery.

Measurements And Main Results: The primary outcome of this study was the rate of objective cure defined as the absence of demonstrable leakage of urine on the cough stress test and a 1-hour pad test weight of less than 2g. The secondary outcome was the rate of subjective cure defined as a negative response to Urinary Distress Inventory question 3 (no leakage on coughing, sneezing, or laughing) and the identification of the different risk factors of cure failure. A total of 113 patients were evaluated in the study. Postoperative USI and the 1-hour pad test significantly improved from 24.2 ± 26.9 gm (range, 19.1-29.3) to 2.5 ± 8.7 gm (range, 0.9-4.2); p <0.001 through 1 year. Data analysis showed an objective cure rate of 90% (102/113) and a subjective cure rate of 86% (97/113). USI recurred in 11 patients with no repeat surgery done becausesymptoms were tolerable to the patients. No patient had bladder outlet obstruction. Peak flow rates 23.7 ± 9.1 ml/s (20.0-27.4) and residual urine volume 38.5 ± 25.8 ml (29.8-47.2) were within normal limits with no significant changes. Previous anti-incontinent surgery, previous prolapsed surgery, intrinsic sphincter deficiency, maximum urethral closure pressure <40cm HO, and neurogenic disease were significant risk factors for sling failure. Subjective assessment on the quality of life significantly improved (p <0.001).

Conclusion: The Solyx SIS is an effective and safe treatment option for women with USI, showing high objective and subjective cure rates with a low incidence of complications 1 year after treatment. The identified independent risk factors forfailure are related to poor urethral function and previous pelvic reconstructive surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2018.07.013DOI Listing
August 2019

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.12927DOI Listing
April 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2014.08.012DOI Listing
December 2015

Urethral overdilation for women with voiding dysfunction.

Taiwan J Obstet Gynecol 2015 Feb;54(1):54-7

Division of Urology, University of Alabama School of Medicine, Birmingham, AL, USA.

Objective: This was a retrospective study of the efficacy of urethral overdilation (UOD) for women with voiding dysfunction.

Materials And Methods: Thirty-six patients diagnosed with voiding dysfunction were enrolled. The main indications for UOD included women with poor compliance (30 patients, 83.3%) and obstructive symptoms with high residual urine (6 patients, 16.7%). We utilized a method called UOD (wide caliber), dilating the urethra up to 54 Fr. Patients were re-evaluated every 3 months with serial free flow rate and ultrasound residual in the first year and then as scheduled. Outcome measure was based on the change in videourodynamic parameters, Urogenital Distress Inventory-6 (UDI-6) questionnaire, and International Prostate Symptom Score (IPSS).

Results: Mean follow up period of 33.2 months (range: 13-61 months). Failure or success depended on the change in videourodynamic parameters, UDI-6 score, and IPSS. The mean age with the Success Group (n = 22, 61.1%) and Failure Group (n = 14, 39.3%) was 52.8 years and 54.1 years, respectively. Our data showed significant improvements in mean UDI-6 score and IPSS after treatment (11.5-5.7, p = 0.032 and 14.8-5.2, p = 0.006, respectively). By analyzing multiple parameters (age, parity, body mass index, videourodynamics parameters, anesthesia bladder capacity, UDI-6 score, and IPSS) between the success and failure groups, we found only anesthesia bladder capacity reached statistical significance (536 mL vs. 418 mL, p = 0.005).

Conclusion: The present study provides evidence that UOD, as a minimally invasive procedure, achieves a satisfactory cure rate on short-term follow-up for women with voiding dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2014.11.008DOI Listing
February 2015

Advances in the methods for discovering novel painful bladder syndrome therapies.

Authors:
Ling-Hong Tseng

Expert Opin Drug Discov 2014 Apr 7;9(4):423-32. Epub 2014 Mar 7.

University of Chang Gung, Chang Gung Memorial Hospital, School of Medicine, Lin-Kou Branch, Department of Obstetrics and Gynecology , 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333 , Taiwan +886 3328 1200 ext.8258 ; +886 3328 8252 ;

Introduction: Advances in the treatment of interstitial cystitis or bladder pain syndrome (IC/BPS) depend on a good understanding of its pathogenesis. Presently, oral medicine and intravesical drug instillations may be the most popular therapies in daily practice. To improve the efficacy of intravesical drug delivery, the system requires modulation through coupling them to novel carriers. Numerous investigators have attempted alternative reconstructive procedures for bladder replacement/repair using scaffolds. These scaffolds include acellular extracellular matrix grafts or tissue-derived cell-seeded extracellular matrix grafts as well as the transplantation of mesenchymal progenitor cells into the damaged bladder.

Areas Covered: This review focuses on the current available IC/BPS treatments and the different strategies employing nanotechnology or tissue engineering in the discovery of novel IC/BPS therapies.

Expert Opinion: Current studies in the discovery of novel IC/BPS therapies are still imperfect, with novel approaches that use biocompatible nanomaterials or tissue engineering still ongoing. These nanoformulations give the benefit of protecting easily degradable molecules and enhance targeted delivery. Tissue engineering holds the promise of regenerating damaged tissues and organs by replacing damaged tissue and/or by stimulating the body's own repair mechanisms to heal previously irreparable tissues and organs. For these reasons, nanotechnology and tissue engineering could play key roles in the discovery of novel painful bladder syndrome therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1517/17460441.2014.894975DOI Listing
April 2014

Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery--a systemic review.

Taiwan J Obstet Gynecol 2013 Sep;52(3):311-7

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Lin-Kou Branch and University of Chang Gung School of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.

Pelvic organ prolapse (POP) is a common condition in women. Women with POP often experience pelvic discomfort, urinary and fecal problems, sexual dysfunction, and an overall decrease in their quality of life. Surgical treatment is a feasible option if conservative management fails. Various surgical techniques have been proposed to correct POP with or without the use of graft material. Owing to recent U.S. Food and Drug Administration warnings about mesh-related complications, sacrospinous ligament fixation (SSF), as a traditional vaginal procedure, may play an important role again. To answer this question and evaluate quantitatively the efficacy of SSF in POP, we conducted a systemic review of the available data about SSF and POP. Interventions had to include SSF as a point of attachment. To eliminate confounding bias and effect modification, at least one arm must include SSF without mesh or graft. All follow-up periods were allowed. Information on the following parameters was extracted and entered into a database: study design, type of intervention, number of patients, follow-up in months, cure rate, recurrence rate, intra/postoperative complications, and/or uni/bilateral, preventive/therapeutic, or concomitant procedures. Published papers from the years 1995 to 2011 were selected for analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2012.11.002DOI Listing
September 2013

Effect of extracorporeal magnetic energy stimulation on bothersome lower urinary tract symptoms and quality of life in female patients with stress urinary incontinence and overactive bladder.

J Obstet Gynaecol Res 2013 Nov 15;39(11):1526-32. Epub 2013 Jul 15.

Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linko Medical Center, Chang Gung University, Taoyuan, Taiwan.

Aims: The aim of this study was to investigate the efficacy of extracorporeal magnetic stimulation (EMS) for the treatment of bothersome and severe symptoms of stress urinary incontinence (SUI) and overactive bladder syndrome (OAB) in female patients.

Material And Methods: A retrospective review was conducted on patients with SUI and OAB who were referred to EMS therapy. Successful treatment for the bothersome symptoms of OAB and SUI was defined as score ≤1 for questions 2 and 3 on the Urodynamic Distress Inventory-6. The objective cure of SUI and OAB was defined as no urinary leakage during the cough stress test and any urgency, urge incontinence and voiding frequency of less than eight times per 24 h based on the 3-day bladder diary, after the 9 weeks of treatment, respectively.

Results: Ninety-three patients with SUI or OAB underwent a 9-week course of EMS at 20 min twice weekly. Seventy-two (77%) patients completed EMS treatment. Geographical factor and poor economic status were two main factors for dropout. A total of 94.1% (32 of 34) and 86.8% (33 of 38) of subjects had successful treatment for the bothersome symptoms of OAB and SUI, respectively. In contrast, the cure rate for OAB and SUI was only 61.7% and 42.1%, respectively. There was also a significant improvement in both Urogenital Distress Inventory Short Form (bothersome on lower urinary tract symptoms) and the Incontinence Impact Questionnaire Short Form (quality of life) total score in both groups after EMS.

Conclusions: EMS is a safe and effective alternative method for treating SUI and OAB. Further studies are needed to evaluate the long-term efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.12090DOI Listing
November 2013

Clinical outcome after laparoscopic assisted vaginal hysterectomy with transvaginal uterosacral ligament fixation.

Taiwan J Obstet Gynecol 2012 Sep;51(3):363-7

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taiwan.

Objective: We report here the clinical outcome of a simplified method to suspend the vaginal cuff during laparoscopic assisted vaginal hysterectomy.

Materials And Methods: This is a retrospective study. Fifty patients underwent laparoscopic assisted vaginal hysterectomy and received transvaginal uterosacral ligament fixation for vaginal cuff support (LAVHUS). Follow-up examinations were conducted for at least 24 months and included vaginal examination with prolapse grading using the POP-Q system. Subjective outcomes were measured using a questionnaire that asked patients to describe postoperative lower urinary tract symptoms and satisfaction with the procedure.

Results: The mean follow-up duration was 106 weeks (range 102-120 weeks).The postoperative POP-Q point C and total vaginal length were effectively sustained during this period. There were no intraoperative or postoperative complications, and no adverse postoperative lower urinary tract symptoms were reported.

Conclusion: The present study demonstrated satisfactory subjective and objective clinical outcomes following LAVHUS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2012.07.008DOI Listing
September 2012

Sexual function following outside-in transobturator midurethral sling procedures: a prospective study.

Int Urogynecol J 2012 Dec 12;23(12):1693-8. Epub 2012 May 12.

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

Introduction And Hypothesis: Midurethral tapes have shown favorable clinical outcomes for treating stress urinary incontinence (SUI), but the effects of outside-in transobturator midurethral sling procedures (TOT) on women's sexual function are unclear. We hypothesized that TOT might improve sexual function in women with SUI and therefore conducted this study to investigate sexual function alteration among women who underwent TOT for urodynamic stress incontinence (USI).

Methods: From November 2009 to October 2010, we recruited 102 women scheduled for correction of USI by TOT procedures in a tertiary hospital. In addition to urogynecologic history, pelvic examination, and urodynamic testing, participants were required to complete three validated questionnaires: Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Preoperative and postoperative results of these validated questionnaires were evaluated.

Results: Eighty-three patients comprising 57 sexually active and 26 sexually inactive patients participated in the 12-month evaluation. Of the 83 patients undergoing TOT, six (7.2 %) had postoperative SUI 12 months postoperatively. Both UDI-6 and IIQ-7 scores were significantly improved postoperatively. The total PISQ-12 score did not change significantly after surgery. Postoperatively, the individual incontinence-related items of the PISQ-12 improved, but climax with intercourse and negative emotional reactions during intercourse worsened (both with p <0.001). There was a negative correlation between SUI-related items on UDI-6 and those on PISQ-12 preoperatively.

Conclusions: TOT procedures for correcting USI had favorable clinical outcomes and did not alter overall sexual function; however, climax during sexual intercourse and emotional response worsened postoperatively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-012-1792-1DOI Listing
December 2012

Sexual function in women following transvaginal mesh procedures for the treatment of pelvic organ prolapse.

Int Urogynecol J 2012 Oct 10;23(10):1455-60. Epub 2012 Mar 10.

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

Introduction And Hypothesis: Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women's sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP).

Methods: A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery.

Results: At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains.

Conclusions: Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-012-1713-3DOI Listing
October 2012

Use of a pessary in treatment of pelvic organ prolapse: quality of life, compliance, and failure at 1-year follow-up.

J Minim Invasive Gynecol 2011 Jan-Feb;18(1):68-74

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, China.

Study Objectives: To estimate the effect of pessary use on symptom improvement and quality of life in women with pelvic organ prolapse, to examine factors that influence patient choice and continued use of a pessary, and to determine reasons associated with discontinuation of pessary use.

Design: Retrospective study (Canadian Task Force classification II-3).

Setting: Outpatient urogynecologic clinic of a university hospital.

Patients: Seventy-two patients with symptomatic pelvic organ prolapse were evaluated for pessary insertion between March 2006 and August 2008.

Interventions: Insertion of a Gellhorn pessary.

Measurements And Main Results: Urinary symptoms and quality of life were assessed using the Urinary Distress Inventory incontinence questionnaire (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) at baseline and postinsertionally at 2 months and at 1 year. Frequency of choosing pessary use or surgery and rate of continuous use of a pessary was compared between groups. Compared with baseline findings, at 1 year, UDI-6 and IIQ-7 demonstrated significant improvement in frequency of micturition, stress incontinence, voiding function, and bowel evacuation. Substantially more older or menopausal women opted for a pessary rather than surgery, and significantly more sexually active women preferred surgery. Women with diabetes mellitus or occult stress urinary incontinence and those without family support are more likely to discontinue pessary use.

Conclusions: Use of a pessary in treatment of pelvic organ prolapse is associated with good compliance, and results in significant improvement in quality of life and urinary and bowel symptoms. Women with diabetes or occult stress urinary incontinence and those without family support should receive intensive counseling before placement of a pessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2010.09.006DOI Listing
May 2011

Expression of matrix metalloproteinase-2 and tissue inhibitors of metalloproteinase-1 (TIMP-1, TIMP-2 and TIMP-3) in women with uterine prolapse but without urinary incontinence.

Eur J Obstet Gynecol Reprod Biol 2010 Nov 3;153(1):94-8. Epub 2010 Aug 3.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taiwan, ROC.

Objective: To investigate the activities of matrix metalloproteinase-2 (MMP-2) and its inhibitors, tissue inhibitor of metalloproteinase-1, -2 and -3 (TIMP-1, TIMP-2 and TIMP-3), in the pelvic support and nonsupport tissue of women with uterine prolapse but without urinary incontinence.

Study Design: Paired samples of uterosacral ligament and cervical tissue were obtained from 11 postmenopausal and 8 premenopausal women with severe uterine prolapse. Nine premenopausal women without prolapse were selected as normal controls. Immunoreactivity of MMP-2 and TIMPs was demonstrated by immunohistochemistry. Steady state of MMP-2 as well as TIMPs messenger RNA (mRNA) expression was analyzed by polymerase chain reaction (PCR) with quantitative expression determined by multiplex PCR.

Results: A significantly higher expression of MMP-2 mRNA and lower expression of TIMP-2 mRNA were found in uterosacral ligament in uterine prolapse women compared to controls. In the cervical tissue, however, the MMP-2 and TIMPs mRNA expression was comparable between prolapse and control groups. With regard to menopausal status, there was no significant difference in MMP-2 and TIMPs mRNA expression between premenopausal and postmenopausal women with uterine prolapse.

Conclusions: An increase in MMP-2 mRNA and a decrease in TIMP-2 mRNA expression in uterosacral ligament are related to uterine prolapse in women without urinary incontinence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2010.06.008DOI Listing
November 2010

Genome-based expression profiling study of Hunner's ulcer type interstitial cystitis: an array of 40-gene model.

Int Urogynecol J 2010 Aug 4;21(8):911-8. Epub 2010 Mar 4.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.

Introduction And Hypothesis: The aim of this study was to explore potential molecular mechanisms contributing to the pathogenesis of Hunner's ulcer type interstitial cystitis (IC).

Methods: Dataset acquisitions from Gene Expression Omnibus under platform accession no GSE 11783. We compared global gene expression profiles in bladder epithelial cells from IC patients with Hunner's ulcer corresponding to normal controls. We re-sampling and exploit the correlation structure presented in the dataset through the transcriptional response. For each patient, two bladder biopsies were studied, one from an ulcer area and one from a non-ulcer area. RNA was extracted, and all labeled samples were hybridized to Human Genome U133 Plus 2.0 Array (Affymetrix, CA, USA).

Results: The Mahalanobis distance in hierarchical cluster analysis revealed a model of 40 genes expression which is increased in IC and ulcerated IC. Our results can be summarized as follows: First, the expressions of major histocompatibility complex (MHC) class IF and II molecules, leukocyte immunoglobulin-like receptors, hepatitis A virus cellular receptor 2, and interleukin 32 were increased in bladder epithelial from IC and ulcerative IC area. Next, there is an indication of antigen-mediated aggregation of the high-affinity Fc epsilon and gamma RI leading to allergic inflammation through the disease status. Third, the high-affinity Fc gamma RI subunit facilitated T-cell-mediated immune response through the disease status. Such changes, jointly termed "bladder remodeling," can constitute an important long-term consequence of Hunner's ulcer type IC.

Conclusions: Our results indicate that genome-based expression profiling can be used for the diagnostic tests of Hunner's ulcer type IC in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-010-1129-xDOI Listing
August 2010

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

Int Urogynecol J 2010 Jan 9;21(1):79-84. Epub 2009 Sep 9.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan, 333, Taiwan.

Introduction And Hypothesis: To explore the potential molecular mechanisms contributing to the pathogenesis of pelvic organ prolapse (POP) with the aid of high-density oligonucleotide microarrays.

Methods: We 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).

Results: The 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.

Conclusions: Our results support the use of genome-based expression profiling as a commonplace platform for diagnostic tests of POP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-009-0990-yDOI Listing
January 2010

Expression of nerve growth factor immunoreactivity and messenger RNA in ischemic urinary bladder.

Neurourol Urodyn 2010 Mar;29(3):512-6

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

Aims: The bladder contractile dysfunction resulting from acute ischemia may be attributed to nerve growth factor (NGF) overexpression. This study was conducted to evaluate the acute and mid-term effects of bladder ischemia on the temporal expression of NGF immunoreactivity and mRNA.

Materials And Methods: Bladder ischemia was induced by ligation of bilateral vesical arteries in female rats. We examined the NGF content of bladder detrusor muscle at 1 day, 1 week and 4 weeks after artery ligation. Immunoreactivity of NGF was studied by immunofluorescent staining and Western blot. The NGF mRNA was analyzed by real-time polymerase chain reaction.

Results: The immunofluorescence of NGF at 1 week and 4 weeks was significantly reduced when compared to sham-operated group (P < 0.05). This decreased tendency was also found in Western blot test. An increased expression of NGF mRNA was noted at 1 day, 1 week and 4 weeks, but had no significant change when compared to sham-operated group (P > 0.05).

Conclusions: Our study showed bilateral vesical artery ligation may cause damage of detrusor muscle and there is decreased NGF immunofluorescence and elevated NGF mRNA in bladder suggesting an expression disparity following ischemia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.20756DOI Listing
March 2010

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

Neurourol Urodyn 2010 Nov;29(8):1439-43

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan.

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

Methods: With the aid of Affymetrix GeneChip Rat Genome U34A arrays, we examined microarray gene expression profiles in bladder wall tissue from female Sprague-Dawley rats within the first 3 weeks following spinal cord injury. Gene transcripts expressed in rat bladder wall tissue at 3 days, 7 days, and 3 weeks following spinal cord injury were compared to normal rat bladder wall tissue.

Results: The Mahalanobis distance in hierarchical cluster analysis revealed a 48-gene model, which contained high expressions in rat bladder wall tissue at 3 days, 7 days, and 3 weeks following spinal cord injury. According to gene ontology, plausible molecular alterations in rat bladder wall tissue following spinal cord injury include: (1) the release of nerve growth factor (NGF) and transforming growth factor beta 1 (Tgfb1) (2) the secretion of histamine from mast cells, (3) the occurrence of blood coagulation, (4) the occurrence of N-terminal protein myristoylation, and (5) Axon guidance mediated by Ena/Vasodilator-stimulated phosphoprotein (Ena/VASP) promotes reestablishment of the bladder reflex following spinal cord injury. Such changes, jointly termed "bladder remodeling," can constitute an important long-term consequence of neurogenic bladder dysfunction.

Conclusion: The success of this innovation has supported the use of microarray-based expression profiling as a commonplace platform for the pathogenesis and therapeutic interventions of experimental neurogenic bladder dysfunction. dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.20769DOI Listing
November 2010

Genome-based expression profiling as a single standardized microarray platform for the diagnosis of endometrial disorder: an array of 126-gene model.

Fertil Steril 2010 Jun 27;94(1):114-9. Epub 2009 Mar 27.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Taiwan, Republic of China.

Objective: To assess the molecular signatures underlying endometrial disorder using cDNA microarray.

Design: Gene expression-based oligonucleotide array of the normal endometrium.

Setting: University hospital.

Patient(s): Humans.

Intervention(s): Endometrial tissues were obtained from 28 normal cycling women undergoing endometrial biopsy. RNA was extracted from each tissue and all labeled samples were hybridized to Affymetrix Human U133 plus 2.0 array.

Main Outcome Measure(s): Transcriptional response.

Result(s): Hierarchical cluster analysis with the Mahalanobis distance revealed a "126-gene" model, which are up-regulated at mid-secretory phase, moderately expressed at late-secretary phase, and down-regulated at late-secretory phase. Furthermore, the mechanisms underlying the receptivity of human endometrium at mid-secretary phase can be summarized: first, complex metabolic reactions are involved. Second, the activation of complement and coagulation cascades promotes muscle contraction, chemotaxis, phagocyte recruitment, and peritoneal inflammation. Third, Ephrin A-mediated axon guidance promotes retrograde menstruation. Fourth, autophagic degradation is suggested to be responsible for the new blood vessel formation. In addition, DKK1 is up-regulated, indicating that WNT signaling pathway may contribute to the development of endometrial disorders.

Conclusion(s): The success of this innovation has supported the use of microarray-based genome expression profiling as a single standardized platform for diagnosis of endometrial disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2009.01.130DOI Listing
June 2010

Genome-based expression profiles as a single standardized microarray platform for the diagnosis of bladder pain syndrome/interstitial cystitis: an array of 139 genes model.

Int Urogynecol J Pelvic Floor Dysfunct 2009 May 13;20(5):515-22. Epub 2009 Feb 13.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Taoyuan 333, Taiwan.

Introduction And Hypothesis: The aim of the study was to investigate the molecular signatures underlying bladder pain syndrome/interstitial cystitis (BPS/IC) using cDNA microarray.

Methods: Microarray gene expression profiles were [corrected] studied in a matched case-control study [corrected] by using a system of conditional regression modeling.

Results: The main [corrected] findings are summarized as follows: Firstly, a "139-gene" model was discovered to contain high expressions of bladder epithelium, which feature in BPS/IC. Secondly, complex metabolic reactions, including carbohydrate, lipid, cofactors, vitamins, xenobiotics, nucleotide, and amino acid metabolisms, were [corrected] found to have a strong relationship with bladder smooth muscle contraction through IC status. Thirdly, we [corrected] found the transcriptional regulations of IC-induced bladder smooth muscle contraction status, including the level of contractile force, tissue homeostasis, energy homeostasis, and the development of the [corrected] nervous system. In addition, our study suggested the mast-cell activation mediated by the high-affinity receptor of Fc epsilon [corrected] RI triggering allergic inflammation through IC status. Such genetic changes, jointly termed "bladder remodeling," [corrected] can constitute an important long-term consequence of BPS/IC. [corrected].

Conclusions: The success of this innovation has supported the use of microarray-based expression profiling as a single standardized platform for diagnosis of PBS/IC and offers [corrected] drug discovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-009-0822-0DOI Listing
May 2009

Genome-based expression profiles as a single standardized microarray platform for the diagnosis of experimental interstitial cystitis: an array of 75 genes model.

Int Urogynecol J Pelvic Floor Dysfunct 2009 May 20;20(5):509-13. Epub 2009 Jan 20.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Tao-Yuan, Taiwan.

Introduction And Hypothesis: To investigate the molecular signature underlying experimental interstitial cystitis (IC) using cDNA microarray.

Methods: Microarray gene expression profiles are studied in bladder epithelium of C57BL/6 mice with ovalbumin or substance P-induced experimental IC versus Escherichia coli lipopolysaccharide-induced bacterial cystitis.

Results: Main findings are summarized as follows: firstly, a "75-gene" model was discovered to contain high expressions of bladder epithelium which feature in experimental IC. Secondly, glucose, lipid, nucleotide, xenobiotics, and amino acid metabolisms are involved in. Thirdly, T-cell-mediated immune and inflammatory responses are observed. Fourthly, Wnt, Tgf-beta, Mapk, and insulin growth factor receptor signaling pathways are also involved in. In addition, experimental IC leads to Ephrin- and Semaphorin-mediated axon guidance promoting parasympathetic inflammatory reflexes.

Conclusions: Further characterization of human IC-induced gene expression profiles would enable the use of genome-based expression profiling for the therapeutic targets and diagnosis of IC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-008-0801-xDOI Listing
May 2009

Factors affecting voiding function in urogynecology patients.

Taiwan J Obstet Gynecol 2008 Dec;47(4):417-21

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Tao-Yuan, Taiwan.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1028-4559(09)60009-7DOI Listing
December 2008

Meconium peritonitis in utero---the value of prenatal diagnosis in determining neonatal outcome.

Taiwan J Obstet Gynecol 2008 Dec;47(4):391-6

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

Objective: Meconium peritonitis (MP) is a chemical peritonitis caused by fetal intestinal perforation in utero. Its incidence is rare, but serious neonatal morbidity or even mortality can occur if the diagnosis is not made until after birth. Prenatal diagnosis is important in prompting early postnatal surgical intervention, and so improving neonatal outcome.

Materials And Methods: Fourteen cases diagnosed in utero with MP from January 1996 to December 2005 were enrolled in this study. The final diagnoses were established by surgical findings or postnatal radiography. The prenatal ultrasound features, neonatal birth characteristics, surgical findings, postnatal management and neonatal outcomes were reviewed.

Results: All infants received follow-up care at our hospital. Prenatal ultrasound findings included fetal ascites (100%), intra-abdominal calcification (93%), dilated bowel loops (57%), pseudocysts (29%), and polyhydramnios (50%). Four infants (4/14; 28.5%) did not undergo postnatal surgery, but survived well. The mean gestational age at detection was significantly earlier in the non-surgery group (23+/-3.6 weeks) than in the surgery group (31.7+/-2.5 weeks). One infant (7.1%) died because of sepsis after two neonatal operations. The overall survival rate was 92.9%.

Conclusion: MP can be diagnosed by prenatal ultrasound, and the neonatal outcome is favorable. Early detection is not associated with poor neonatal outcome, and selective termination is unnecessary. Resolution of dilated bowel loops and polyhydramnios predict a low rate of postnatal surgical intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1028-4559(09)60004-8DOI Listing
December 2008

Randomized comparison of tolterodine with vaginal estrogen cream versus tolterodine alone for the treatment of postmenopausal women with overactive bladder syndrome.

Neurourol Urodyn 2009 ;28(1):47-51

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University of Chang Gung School of Medicine, Tao-Yuan, Taiwan.

Aims: To investigate whether vaginal estrogen cream combined with tolterodine is more effective than tolterodine alone in the treatment of postmenopausal women with overactive bladder (OAB).

Materials And Methods: This is an unblinded study without placebo. A preliminary study consisted of tolterodine 2 mg twice per day for 3 months had been conducted for 25 postmenopausal women with OAB. Over a period of 11 months, 80 postmenopausal women with OAB underwent a prospective randomized trial. These patients were equally randomized into two groups. The interventions for the 12-week treatment period included 2 mg tolterodine twice per day for the group A and 2 mg tolterodine twice per day/vaginal conjugated equine estrogen 0.625 mg twice a week for the group B. Identical pre- and post-treatment assessments included bladder diary, Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7).

Results: All 80 women (65.2 years, range 58-73) completed this study. The between groups comparison showed that the group B had significant improvements in mean daytime frequency and voided volume after treatment (14.8-5.8 vs. 14.1-6.4, P = 0.001 and 115.8-141.9 vs. 108.5-134.5, P = 0.007, respectively). Additionally, a comparison of the final total scores of UDI-6 and IIQ-7 between the two groups revealed that the group B had a statistically significant improvement in quality of life than that in the group A (8.6-6.9 vs. 9.5-7.2, P < 0.001 and 9.4-6.1 vs. 10.2-6.5, P < 0.001, respectively). Changes in the other symptoms, including nocturia, urgency and urge incontinence, were not statistically significant but actually achieved improved in both groups.

Conclusions: A combination of vaginal estrogen cream and tolterodine is a potential therapy for postmenopausal women with OAB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.20583DOI Listing
February 2009

Resolution of elevated postvoid residual volumes after correction of severe pelvic organ prolapse.

Int Urogynecol J Pelvic Floor Dysfunct 2008 Sep 7;19(9):1261-6. Epub 2008 May 7.

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

We hypothesized that elevated postvoid residual volume (PVRV) would resolve postoperatively in women with severe pelvic organ prolapse (POP) and investigated risk factors that might hamper its resolution. Retrospectively, we enrolled 57 patients undergoing surgery for severe POP. All patients had preoperative PVRV > or = 100 ml documented by ultrasound and catheterization. Presurgical voiding difficulty, urodynamic and cystoscopic data, and surgical outcome were analyzed. The incidence of postsurgical elevated PVRV was 15.8% and 3.5% was symptomatic. Patients with postsurgical elevated PVRV had larger preoperative residual volume than those with normal postsurgical PVRV (P = 0.037). By multivariable analysis, concomitant anti-incontinence surgery was the single independent predictor of postsurgical elevated PVRV (odds ratio = 5.38, P = 0.031). A majority of patients with severe POP had their elevated PVRV resolved postoperatively. Although concomitant anti-incontinence surgery increased the risk of developing elevated PVRV after repair, most remained asymptomatic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-008-0619-6DOI Listing
September 2008

The individual fetal weight/estimated placental weight ratios in monochorionic twins with selective intrauterine growth restriction.

Prenat Diagn 2008 Mar;28(3):217-21

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan, ROC.

Objectives: To evaluate the individual fetal weight/estimated placental weight ratios (F/P ratio) of the two fetuses in monochorionic (MC) twins with selective intrauterine growth restriction (IUGR).

Material And Methods: MC twin with selective IUGR was defined as an estimated fetal weight below the 10th percentile in one twin of MC pregnancy. The estimated individual placental weight was obtained by cutting the placenta along the vascular equator into two territories. A total of 15 MC twins with selective IUGR and 18 MC twins without selective IUGR were included in this study.

Results: The individual F/P ratio in the IUGR twin is significantly higher than that in the appropriate for gestational age (AGA) one in MC twin with selective IUGR (6.4 vs 4.0 respectively, p < 0.001). In MC twin without IUGR, the F/P ratios are not significantly different between the two fetuses (5.4 vs 5.1, respectively).

Conclusion: The high F/P ratio in the IUGR twin in MC with selective IUGR may be due to the placental reserve phenomenon, so that a smaller placental territory may suffice to perfuse the IUGR twin. In other words, in MC twin gestations with an IUGR twin, the fetal weights are not proportional to the placental masses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.1918DOI Listing
March 2008