Publications by authors named "Myung Jae Jeon"

55 Publications

Hormone autocrination by vascularized hydrogel delivery of ovary spheroids to rescue ovarian dysfunctions.

Sci Adv 2021 Apr 28;7(18). Epub 2021 Apr 28.

Institute of Women's Life Medical Science, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.

The regeneration potential of implantable organ model hydrogels is applied to treat a loss of ovarian endocrine function in women experiencing menopause and/or cancer therapy. A rat ovariectomy model is used to harvest autologous ovary cells while subsequently producing a layer-by-layer form of follicle spheroids. Implantation of a microchannel network hydrogel with cell spheroids [vascularized hydrogel with ovarian spheroids (VHOS)] into an ischemic hindlimb of ovariectomized rats significantly aids the recovery of endocrine function with hormone release, leading to full endometrium regeneration. The VHOS implantation effectively suppresses the side effects observed with synthetic hormone treatment (i.e., tissue overgrowth, hyperplasia, cancer progression, deep vein thrombosis) to the normal levels, while effectively preventing the representative aftereffects of menopause (i.e., gaining fatty weight, inducing osteoporosis). These results highlight the unprecedented therapeutic potential of an implantable VHOS against menopause and suggest that it may be used as an alternative approach to standard hormone therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/sciadv.abe8873DOI Listing
April 2021

Correction to: Aberrant Expression of Sodium-Potassium-Chloride Cotransporter in Endometriosis.

Reprod Sci 2021 Mar 24. Epub 2021 Mar 24.

Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43032-021-00551-0DOI Listing
March 2021

Aberrant Expression of Sodium-Potassium-Chloride Cotransporter in Endometriosis.

Reprod Sci 2021 Mar 11. Epub 2021 Mar 11.

Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Cell membrane ion channels have important roles in cell migration during cancer development and metastasis. Although endometriosis is a benign gynecological disease, some migration and invasion characteristics of endometriosis are similar to those of cancer. However, only a few studies have examined cell membrane ion channels and their associations with endometriosis. This study aimed to investigate the effects of these ion channels on development of endometriosis. A total of 39 women who underwent laparoscopic ovarian cyst enucleation were included in the study population. Eutopic endometrium or ectopic endometrium tissues were obtained from each patient based on allocation to an endometriosis group (n=21) or a control group (n=18). Quantitative real-time PCR (qRT-PCR) and western blot analyses were performed to quantify NKCC1, NKCC2, and CLCN3 mRNA expression and protein concentrations. SiRNA transfection and migration assays of the endometrial stromal cells were performed to test the effects of the ion channels on the migration ability. The qRT-PCR and western blot analyses revealed significantly elevated mRNA expression and protein expression of NKCC1, NKCC2, and CLCN3 in the ectopic endometrial tissue from the patients with endometriosis (p < 0.05). Migration assay of siRNA transfected cells suggested a decreased migratory potential of the endometrial stromal cells (p < 0.001). The magnitudes of expression of NKCC1, NKCC2, and CLCN3 were positively correlated with endometrioma size. The increased expression of NKCC1, NKCC2, and CLCN3 in endometriosis offers opportunities to understand mechanisms of endometriosis and develop novel therapeutic approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43032-021-00531-4DOI Listing
March 2021

Posterior repair versus no posterior repair for posterior vaginal wall prolapse resolved under simulated apical support at the time of native tissue apical suspension.

Int Urogynecol J 2021 Feb 26. Epub 2021 Feb 26.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea.

Introduction And Hypothesis: The aim of this study was to evaluate the impact of an adjuvant posterior repair (PR) on treatment outcomes of native tissue apical suspension.

Materials And Methods: This retrospective cohort study included 194 women who underwent iliococcygeus or uterosacral ligament suspension with or without PR for Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 posterior vaginal wall prolapse that resolved under simulated preoperative apical support and who completed a 1-year follow-up. The primary outcome was composite surgical failure defined as the presence of vaginal bulge symptoms, descent of the vaginal apex more than one-third of the way into the vaginal canal (apical recurrence), anterior or posterior vaginal wall descent beyond the hymen (anterior or posterior recurrence), or retreatment for prolapse. Secondary outcomes included anatomical outcomes, perioperative outcomes, obstructed defecation, dyspareunia, and adverse events.

Results: One hundred thirty women underwent concomitant PR, and 64 did not. Surgical failure rates were significantly higher in the group not receiving PR than in the group receiving PR (29.7% vs. 12.3%, p < 0.01). Anatomically, anterior and apical recurrence was more common in the group not receiving PR (p < 0.05). Concomitant PR was associated with a longer operating time and more blood loss (p < 0.01). However, there were few adverse events related to PR, and the rates of de novo obstructed defecation and dyspareunia were low in both groups, with no significant difference between the groups.

Conclusion: Concomitant PR at the time of native tissue apical suspension may reduce the recurrence of symptomatic anterior and apical prolapse without significant morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-021-04728-8DOI Listing
February 2021

Optimized culture system to maximize ovarian cell growth and functionality in vitro.

Cell Tissue Res 2021 Feb 13. Epub 2021 Feb 13.

Wake Forest Institute for Regernative Medicine, Wake Forest School of Medicine, Medical Center Boulvard, Winston Salem, NC, 27157, USA.

Ovaries are the primary physiological source of female sex hormones, which play a crucial role in maintaining ovarian cycle, determining secondary sexual characteristics and preparing the endometrium for implantation. In vitro follicle engineering has been used to investigate follicle development, including ovarian hormone production and gamete maturation. To engineer functional follicles, culture and expansion of the primary ovarian cells are essential. However, the phenotypic and functional characteristics of primary ovarian cells are often lost during culture. The objective of this study is to develop an optimized culture system for maintaining ovarian cell growth and functionality. Granulosa cells (GCs) and theca cells (TCs) were isolated from female rats. The addition of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) to the basal culture media significantly enhanced the secretion of estradiol from GCs and androstenedione from TCs. Serum concentrations of 5% and 10% had a similar role in promoting ovarian cell expansion and secretion of estradiol and androstenedione hormones from both types of cells. Growth differentiation factor 9 (GDF9), bone morphogenic protein 15 (BMP15), BMP7 and basic fibroblast growth factor (bFGF) enhanced GC proliferation and estradiol production, respectively. Among them, the effect of bFGF was most significant. bFGF also enhanced TC proliferation. When GCs and TCs were cultured in 5% serum, gonadotropin and bFGF-containing medium, they proliferated exponentially throughout the culture period of up to 40 days while maintaining their functional characteristics. Taken together, these results indicate that our medium formula is optimal for maximizing proliferation of functionally differentiated ovarian cells.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00441-021-03415-wDOI Listing
February 2021

Comparison of treatment outcomes for native tissue repair and sacrocolpopexy as apical suspension procedures at the time of hysterectomy for uterine prolapse.

Sci Rep 2021 Feb 4;11(1):3119. Epub 2021 Feb 4.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.

Concomitant apical suspension should be performed at the time of hysterectomy for uterine prolapse to reduce the risk of recurrent prolapse. Native tissue repair (NTR) and sacrocolpopexy (SCP) are commonly used apical suspension procedures; however, it remains unclear which one is preferred. This study aimed to compare the treatment outcomes of NTR and SCP in terms of surgical failure, complication and reoperation rates. Surgical failure was defined as the presence of vaginal bulge symptoms, any prolapse beyond the hymen, or retreatment for prolapse. This retrospective cohort study included 523 patients who had undergone NTR (n = 272) or SCP (n = 251) along with hysterectomy for uterine prolapse and who had at least 4-month follow-up visits. During the median 3-year follow-up period, the surgical failure rate was higher in the NTR group (21.3% vs 6.4%, P < 0.01), with a low rate of retreatment in both groups. Overall complication rates were similar, but complications requiring surgical correction under anesthesia were more common in the SCP group (7.2% vs 0.4%, P < 0.01). As a result, the total reoperation rate was significantly higher in the SCP group (8.0% vs 2.6%, P = 0.02). Taken together, NTR may be a preferred option for apical suspension when hysterectomy is performed for uterine prolapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-82732-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862299PMC
February 2021

Engineering Functional Rat Ovarian Spheroids Using Granulosa and Theca Cells.

Reprod Sci 2021 Jan 28. Epub 2021 Jan 28.

Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA.

Although menopausal hormone therapy (MHT) is the most effective approach to managing the loss of ovarian activity, serious side effects have been reported. Cell-based therapy is a promising alternative for MHT. This study constructed engineered ovarian cell spheroids and investigated their endocrine function. Theca and granulosa cells were isolated from ovaries of 10-week-old rats. Two types of engineered ovarian cell spheroids were fabricated through forced aggregation in microwells, multilayered spheroids with centralized granulosa aggregates surrounded by an outer layer of theca cells and mixed ovarian spheroids lacking spatial rearrangement. The ovarian cell spheroids were encapsulated into a collagen gel. Non-aggregated ovarian cells served as controls. The endocrine function of the engineered ovarian spheroids was assessed over 30 days. The structure of the spheroids was well maintained during culture. The secretion of 17β-estradiol from both types of engineered ovarian cell spheroids was higher than in the control group and increased continuously in a time-dependent manner. Secretion of 17β-estradiol in the multi-layered ovarian cell spheroids was higher than in the non-layered constructs. Increased secretion of progesterone was detected in the multi-layered ovarian cell spheroids at day 5 of culture and was sustained during the culture period. The initial secretion level of progesterone in the non-layered ovarian cell spheroids was similar to those from the controls and increased significantly from days 21 to 30. An in vitro rat model of engineered ovarian cell spheroids was developed that was capable of secreting sex steroid hormones, indicating that the hormone secreting function of ovaries can be recapitulated ex vivo and potentially adapted for MHT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43032-020-00445-7DOI Listing
January 2021

Pelvic floor muscle function recovery using biofabricated tissue constructs with neuromuscular junctions.

Acta Biomater 2021 02 13;121:237-249. Epub 2020 Dec 13.

Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1094, USA. Electronic address:

Damages in pelvic floor muscles often cause dysfunction of the entire pelvic urogenital system, which is clinically challenging. A bioengineered skeletal muscle construct that mimics structural and functional characteristics of native skeletal muscle could provide a therapeutic option to restore normal muscle function. However, most of the current bioengineered muscle constructs are unable to provide timely innervation necessary for successful grafting and functional recovery. We previously have demonstrated that post-synaptic acetylcholine receptors (AChR) clusters can be pre-formed on cultured skeletal muscle myofibers with agrin treatment and suggested that implantation of AChR clusters containing myofibers could accelerate innervation and recovery of muscle function. In this study, we develop a 3-dimensional (3D) bioprinted human skeletal muscle construct, consisting of multi-layers bundles with aligned and AChR clusters pre-formed human myofibers, and investigate the effect of pre-formed AChR clusters in bioprinted skeletal muscle constructs and innervation efficiency in vivo. Agrin treatment successfully pre-formed functional AChR clusters on the bioprinted muscle constructs in vitro that increased neuromuscular junction (NMJ) formation in vivo in a transposed nerve implantation model in rats. In a rat model of pelvic floor muscle injury, implantation of skeletal muscle constructs containing the pre-formed AChR clusters resulted in functional muscle reconstruction with accelerated construct innervation. This approach may provide a therapeutic solution to the many challenges associated with pelvic floor reconstruction resulting from the lack of suitable bioengineered tissue for efficient innervation and muscle function restoration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.actbio.2020.12.012DOI Listing
February 2021

Suture Complication Rates and Surgical Outcomes According to the Nonabsorbable Suture Materials Used in Vaginal Uterosacral Ligament Suspension: Polyester versus Polypropylene.

J Minim Invasive Gynecol 2020 Dec 11. Epub 2020 Dec 11.

Department of Obstetrics and Gynecology, Seoul National University Hospital (all authors); Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Dr. Jeon), Seoul, Republic of Korea. Electronic address:

Study Objective: To evaluate suture complication rates and surgical outcomes according to the nonabsorbable suture materials used in vaginal uterosacral ligament suspension (USLS) surgery. Multifilament polyester (polyethylene terephthalate [PET]) and monofilament polypropylene (PP) sutures were compared.

Design: Retrospective cohort study.

Setting: Single teaching hospital.

Patients: Total of 229 patients who underwent transvaginal USLS and completed a 1-year follow-up.

Interventions: Use of PET and PP sutures for transvaginal USLS procedures.

Measurements And Main Results: PP sutures were used in 149 patients, and PET sutures were used in 80 patients. The suture-related complication rates, including granulation tissue and suture erosion at the vaginal apex, were significantly higher in the PET suture group than in the PP suture group (46.3% vs 20.1%, p <.01). However, there was no significant difference in the rates of surgical failure (defined as the presence of vaginal bulging symptoms, apical descent ≥ half of the total vaginal length, anterior or posterior vaginal wall descent beyond the hymen, or retreatment for prolapse) between the 2 groups (p = .84).

Conclusion: Compared with the use of multifilament PET sutures, the use of monofilament PP sutures in transvaginal USLS may reduce suture-related complications without increasing surgical failure rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2020.12.008DOI Listing
December 2020

Non-absorbable versus absorbable sutures for anterior colporrhaphy: study protocol for a randomised controlled trial in South Korea.

BMJ Open 2020 06 16;10(6):e034218. Epub 2020 Jun 16.

Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, The Republic of Korea.

Introduction: The anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures.

Methods And Analysis: This is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192.

Ethics And Dissemination: This study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.

Trial Registration Number: NCT03736811.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-034218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304798PMC
June 2020

Long-term outcomes after sacrocolpopexy with or without transobturator tape.

Int Urogynecol J 2020 May 1. Epub 2020 May 1.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea.

Introduction And Hypothesis: The aim of this study was to report the long-term outcomes after sacrocolpopexy (SCP) with or without transobturator tape (TOT).

Methods: We conducted a planned secondary analysis of a prospective, observational study comparing urinary outcomes in women who underwent SCP with or without TOT based on the results of a prolapse-reduction stress test. Patients were enrolled between November 2008 and December 2011 and were followed up 5 years after surgery. The primary outcomes were 5-year success rates for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) estimated using the Kaplan-Meier method. SUI success was defined as a negative cough stress test, no bothersome SUI symptoms, and no additional anti-incontinence surgery. POP success was defined as no vaginal bulge symptoms, no apical descent greater than one-third of the total vaginal length or anterior or posterior vaginal wall prolapse beyond the hymen, and no retreatment for prolapse.

Results: Of 240 women enrolled, 175 (73%) completed 5 years of follow-up. The estimated SUI success rate was 91.1% in the TOT group and 56.5% in the no TOT group (difference, 34.6%; 95% confidence interval, 24.1 to 45.1). The estimated POP success rate was 90.0% in the TOT group and 92.9% in the no TOT group (difference, -2.9%; 95% confidence interval, -10.7 to 4.9).

Conclusions: The advantage of concomitant TOT for SUI after SCP that was seen at 2 years remained at 5 years. Long-term POP failure rates after SCP are low and not affected by concomitant TOT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-020-04306-4DOI Listing
May 2020

Risk Factors Associated with Endometrial Pathology in Premenopausal Breast Cancer Patients Treated with Tamoxifen.

Yonsei Med J 2020 Apr;61(4):317-322

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

Purpose: To evaluate factors associated with endometrial pathology during tamoxifen use in premenopausal breast cancer (BC) patients.

Materials And Methods: We reviewed the medical records of premenopausal BC patients treated with tamoxifen who underwent endometrial biopsy with or without hysteroscopy. Clinical characteristics were compared between women with endometrial pathology (endometrial hyperplasia or cancer) and those with normal histology or endometrial polyps.

Results: Among 284 endometrial biopsies, endometrial hyperplasia was diagnosed in 7 patients (2.5%), endometrial cancer was diagnosed in 5 patients (1.8%), normal histology was noted in 146 patients (51.4%), and endometrial polyp was present in 114 patients (40.1%). When comparing women with endometrial cancer (n=5) to women with normal histology, abnormal uterine bleeding was more common (=0.007), and endometrial thickness was greater (=0.007) in women with endometrial cancer. Chemotherapy for BC was also more common in patients with endometrial cancer (=0.037). When comparing women with endometrial polyps and those with endometrial hyperplasia or cancer, the presence of abnormal uterine bleeding was more common in patients with endometrial hyperplasia or cancer (<0.001); however, tamoxifen duration and endometrial thickness did not differ significantly between the two groups.

Conclusion: In premenopausal BC patients treated with tamoxifen, abnormal uterine bleeding, increased endometrial thickness, and chemotherapy for BC were associated with the occurrence of endometrial cancer. These findings may provide useful information for gynecologic surveillance and counseling during tamoxifen treatment in premenopausal BC patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3349/ymj.2020.61.4.317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105402PMC
April 2020

A multicenter cross-sectional study on the prevalence of overactive bladder and its impacts on the quality of life in gynecologic outpatients.

Obstet Gynecol Sci 2020 Mar 20;63(2):181-186. Epub 2020 Feb 20.

Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: The present study assessed the prevalence of overactive bladder (OAB) symptoms in gynecologic outpatients and the effects of OAB on a patient's quality of life.

Methods: The survey was completed by adult female patients who visited the gynecology clinic for examination or treatment of gynecologic conditions. The subjects who met the exclusion criteria were excluded. The survey included a questionnaire assessing general characteristics, the purpose of the visit, diagnosis, and the presence or absence of OAB. The subjects were asked whether they were under medical treatment for OAB symptoms, and the degree of discomfort in daily activities was evaluated.

Results: In total, 1,990 female subjects visiting the gynecology clinics of 4 different institutions were recruited. On OAB Symptom Score, 188 subjects responded with scores of ≥2 for question #3 (≥1 time(s) weekly). The severity of OAB symptoms was as follows: 345 subjects had mild OAB, 127 subjects had moderate OAB, and 12 subjects had severe OAB. The prevalence of OAB symptoms was 10.30%.

Conclusion: The present study confirmed that OAB symptoms are common, with a prevalence of 10.30%. Patients with OAB symptoms frequently neglect to seek medical intervention. Our findings will help inform patients to recognize their condition and seek medical assistance, especially in gynecologic outpatient clinics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5468/ogs.2020.63.2.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073364PMC
March 2020

Anterior repair versus no anterior repair for anterior vaginal wall prolapse resolved under simulated apical support at the time of uterosacral ligament suspension.

Int Urogynecol J 2020 10 11;31(10):2043-2049. Epub 2020 Feb 11.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea.

Introduction And Hypothesis: The aim of this study was to compare treatment outcomes 1 year after uterosacral ligament suspension (USLS) with or without concomitant anterior repair (AR) for anterior vaginal wall prolapse resolved under simulated apical support.

Methods: This retrospective cohort study included 179 women who underwent USLS with or without concomitant AR for Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 anterior vaginal wall prolapse resolved under simulated apical support, and who completed a 1-year follow-up. The primary outcome was composite surgical failure defined as anterior anatomical recurrence (point Ba>0), symptomatic recurrence (presence of vaginal bulge symptoms), or retreatment for prolapse. Secondary outcomes included changes in POPQ values and Urogenital Distress Inventory-6 (UDI-6) scores, perioperative outcomes, and complications.

Results: Eighty-six women underwent concomitant AR, and 93 did not. The group receiving AR had more advanced anterior and apical prolapse. Surgical failure rates were significantly higher in the group not receiving AR than in the group receiving AR (21.5% vs 7.0%, p < 0.01). However, there were no differences in the mean point Ba and C values and UDI-6 scores through 12 months postoperatively between the two groups. Operating times were longer, and adverse events, such as immediate postoperative urinary retention and minor wound complications, were more frequent in the group receiving AR (p < 0.05).

Conclusions: Concomitant AR at the time of USLS seems to reduce the recurrence of anterior vaginal wall prolapse without significant morbidity. Considering the small difference in anatomical outcomes, a longer follow-up period will be required to confirm this.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-020-04229-0DOI Listing
October 2020

Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women.

PLoS One 2020 10;15(2):e0228566. Epub 2020 Feb 10.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.

Objective: Although sacrocolpopexy (SCP) can provide durable apical support, the use of mesh may give rise to various complications, including vaginal mesh erosion. The aim of this study was to identify the risk factors for vaginal mesh erosion after SCP in Korean women.

Methods: This retrospective cohort study included 363 women who underwent SCP with type 1 polypropylene mesh. They were evaluated at 1, 4, and 12 months after surgery and then annually thereafter with respect to anatomy and complications. Univariate and multivariate analyses using the Cox proportional hazard model were performed to identify the risk factors for mesh erosion.

Results: During the median 2-year follow-up period, vaginal mesh erosion was found in 29 women (8.0%). Among them, 19 (65.5%) required surgical correction. Estrogenic status was the only independent risk factor for mesh erosion. The risk for mesh erosion was 4.5 times higher in premenopausal women than in menopausal women not on estrogen replacement therapy (ERT) (95% confidence intervals [CI] 1.9-10.9, p<0.01). Menopausal women on ERT also had an increased risk, with a statistically marginal significance (hazard ratio 2.5, 95% CI 0.9-6.6; p = 0.07).

Conclusions: Premenopausal or menopausal women on ERT are at high risk for mesh erosion after SCP with type 1 polypropylene mesh, and two-thirds of mesh erosion cases require reoperation. This information should be incorporated into patient counseling and treatment decisions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228566PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010236PMC
May 2020

Preoperative POPQ versus Simulated Apical Support as a Guideline for Anterior or Posterior Repair at the Time of Transvaginal Apical Suspension (PREPARE trial): study protocol for a randomised controlled trial.

BMJ Open 2020 01 6;10(1):e034170. Epub 2020 Jan 6.

Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.

Introduction: Transvaginal reconstructive surgery is the mainstay of treatment for symptomatic pelvic organ prolapse. Although adequate support for the vaginal apex is considered essential for durable surgical repair, the optimal management of anterior and posterior vaginal wall prolapse in women undergoing transvaginal apical suspension remains unclear. The objective of this trial is to compare surgical outcomes of pelvic organ prolapse quantification (POPQ)-based surgery with outcomes of simulated apical support-based surgery for anterior or posterior vaginal wall prolapse at the time of transvaginal apical suspension.

Methods And Analysis: This is a randomised, multicentre, non-inferiority trial. While women who are assigned to the POPQ-based surgery group will undergo anterior or posterior colporrhaphy for all stage 2 or greater anterior or posterior vaginal prolapse, those assigned to simulated apical support-based surgery will receive anterior or posterior colporrhaphy only for the prolapse unresolved under simulated apical support. The primary outcome measure is the composite surgical success, defined as the absence of anatomical (anterior or posterior vaginal descent beyond the hymen or descent of the vaginal apex beyond the half-way point of vagina) or symptomatic (the presence of vaginal bulge symptoms) recurrence or retreatment for prolapse by either surgery or pessary, at 2 years after surgery. Secondary outcomes include the rates of anterior or posterior colporrhaphy, the changes in anatomical outcomes, condition-specific quality of life and sexual function, perioperative outcomes and adverse events.

Ethics And Dissemination: This study was approved by the institutional review board of each participating centre (Seoul National University College of Medicine/Seoul National University Hospital, Chonnam National University Hospital, Seoul St. Mary's Hospital, International St. Mary's Hospital). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.

Trial Registration Number: NCT03187054.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-034170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955571PMC
January 2020

Surgical decision making for symptomatic pelvic organ prolapse: evidence-based approach.

Authors:
Myung Jae Jeon

Obstet Gynecol Sci 2019 Sep 22;62(5):307-312. Epub 2019 Jul 22.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea.

Surgery is the mainstay of treatment for symptomatic pelvic organ prolapse (POP), and a variety of procedures can be performed to correct POP. When deciding on the proper surgical procedure, the surgeon must take into consideration the individual patient's risk for surgical complication and prolapse recurrence and her preference. This review will discuss the key issues faced in the surgical decision-making process for POP and recommendations based on the current scientific evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5468/ogs.2019.62.5.307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737063PMC
September 2019

The effect of diagnosis-related group payment system on the quality of medical care for pelvic organ prolapse in Korean tertiary hospitals.

PLoS One 2019 20;14(8):e0220895. Epub 2019 Aug 20.

Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea.

Purpose: To assess changes in clinical practice patterns after implementing diagnosis-related group (DRG) payment system in July 2013 and its effect on the quality of care for pelvic organ prolapse (POP).

Materials And Methods: Using the 2011-2016 administrative database from National Health Insurance claim data, we reviewed medical information of 7362 patients who underwent hysterectomies for POP in Korean tertiary hospitals. We compared changes in several variables including length of stay, concomitant procedures, outpatient visits and readmission within 30 days after discharge, and retreatment for POP or stress urinary incontinence within postoperative 1 year before and after DRG system.

Results: After the introduction of DRG system, the average length of stay decreased (7.74 ± 2.88 to 6.63 ± 2.18 days, p<0.001) without increasing readmission rates. However, the number of outpatient visits increased (2.78±2.33 to 2.98±2.47, p<0.001). Regarding concomitant procedures, the rates of colpopexy and midurethral slings significantly decreased (7.87% and 9.84% to 4.93% and 2.93%, respectively, all p<0.001). Even though there was no difference in the reoperation rates, pessary insertion for recurrent POP significantly increased after the introduction of DRG system (0.10% to 0.38%, p = 0.015).

Conclusion: The implementation of DRG in Korean tertiary hospitals has led to increase of outpatient visits and reduced surgical management for POP, which indicates that the uniform application of DRG influences the quality of care for POP patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220895PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701833PMC
March 2020

Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women.

Yonsei Med J 2019 Aug;60(8):791-795

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.

Purpose: To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women.

Materials And Methods: The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status.

Results: In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, =0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, =0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables.

Conclusion: The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3349/ymj.2019.60.8.791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660434PMC
August 2019

Risk factors for the failure of iliococcygeus suspension for uterine prolapse.

Eur J Obstet Gynecol Reprod Biol 2018 Jun 2;225:210-213. Epub 2018 May 2.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: The objective of this study was to evaluate the risk factors for the failure of iliococcygeus suspension (ICG) for uterine prolapse and estimate its long-term success rates using a clinically relevant criterion.

Study Design: This retrospective cohort study included 144 women who underwent transvaginal reconstructive surgery including ICG for symptomatic pelvic organ prolapse. Surgical failure was defined as anatomic recurrence (descent of the vaginal apex beyond the halfway point of the vagina or descent of the anterior or posterior vaginal wall beyond the hymen), symptomatic recurrence (vaginal bulge symptoms), or retreatment for prolapse.

Results: During the median 4-year follow-up period, surgical failure was observed in 20 women (13.9%). Multivariate analysis with the Cox proportional hazard model showed that advanced prolapse (preoperative pelvic organ prolapse quantification [POP-Q] stage >II and point C >0) and uterus-saving techniques were independent risk factors for failure. When the ICG was performed as a vault suspension procedure together with hysterectomy, the estimated 4-year success rates were 100% for mild prolapse (POP-Q stage II or point C ≤0) and 91.2% for advanced prolapse. When the procedure was done as a hysteropexy, the corresponding success rates decreased to 75.3% and 48.0%, respectively.

Conclusions: This study indicates that the severity of prolapse and the uterus-saving technique affect the prognosis after ICG. The ICG provides a durable apical vaginal support when performed together with hysterectomy, irrespective of the severity of the prolapse. In addition, it appears to be an acceptable hysteropexy option for mild uterine prolapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2018.05.001DOI Listing
June 2018

Non-alcoholic fatty liver disease as a risk factor for female sexual dysfunction in premenopausal women.

PLoS One 2017 30;12(8):e0182708. Epub 2017 Aug 30.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

Objective: Non-alcoholic fatty liver disease (NAFLD) has become a common and important chronic liver disease worldwide. Previous studies have indicated that NAFLD has an adverse effect on the quality of life, but information is lacking about the impact of NAFLD on female sexual dysfunction. The aim of this study was to determine the association between NAFLD and female sexual dysfunction in premenopausal women.

Methods: This retrospective study consisted of premenopausal women who were sexually active and visited the outpatient clinic for a routine health check-up between January 2010 and December 2011. Based on the examination of the liver ultrasound scan, the study population was divided into 2 groups: cases with NAFLD and normal controls (cases without NAFLD). The female sexual function was compared between the two groups of cases. For the assessment of sexual function, a female sexual function index (FSFI) questionnaire was used.

Results: Four hundred seventy women were included, and the prevalence of NAFLD and female sexual dysfunction were 67/470 (14.3%) and 238/470 (50.6%), respectively. Cases with NAFLD had a lower total FSFI score and higher rate of female sexual dysfunction than the normal control [median score of total FSFI (interquartile range): 24.7 (21.9-27.8) in NAFLD vs. 26.7 (23.7-29.8) in normal control, p<0.005; the female sexual dysfunction: 64.2% in NAFLD vs. 48.4% in normal control, p<0.05]. This difference in female sexual dysfunction between the two groups remained significant after adjustment.

Conclusion: NAFLD is associated with female sexual dysfunction in premenopausal women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182708PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576732PMC
October 2017

Effect of a pH-Balanced Vaginal Gel on Dyspareunia and Sexual Function in Breast Cancer Survivors Who Were Premenopausal at Diagnosis: A Randomized Controlled Trial.

Obstet Gynecol 2017 05;129(5):870-876

Departments of Obstetrics and Gynecology and Pathology, Ewha Womans University School of Medicine, and the Department of Obstetrics and Gynecology, College of Medicine, and the Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.

Objective: To assess whether a pH-balanced vaginal gel containing lactic acid is more effective than a placebo (lactate-free gel) in improving dyspareunia and sexual function among breast cancer survivors who were premenopausal at diagnosis and had dyspareunia after adjuvant chemotherapy.

Methods: In a single-center, double-blind, randomized trial, a pH-balanced gel or placebo was administered three times per week at bedtime as well as during sexual intercourse for 8 weeks. The primary outcome was the improvement of dyspareunia measured by pain score of the Female Sexual Function Index after the treatment. Secondary outcomes included the total and individual domains of Female Sexual Function Index score, sexual dysfunction (a total Female Sexual Function Index score less than 25.0), vaginal pH, vaginal maturation index, and adverse events related to the intervention. A sample size of 47 per group was planned to achieve 80% power to detect a 19% difference in the primary outcome.

Results: From October 2009 and March 2013, 167 women were screened and 136 were randomized: 69 to a pH-balanced gel and 67 to placebo. Baseline characteristics were similar in both groups. Although there was no difference between the two groups, both experienced a significant improvement of dyspareunia. The increase in median pain score from baseline was 1.2 in both groups (median [interquartile range] from 2.8 [2.0-4.0] to 4.0 [2.8-4.8] in the pH-balanced group and from 3.2 [2.0-4.0] to 4.4 [3.2-4.8] in the placebo group; all P<.01). Overall Female Sexual Function Index score and the frequency of sexual dysfunction also did not differ between the two groups although there was a significant improvement. On the other hand, vaginal pH and vaginal maturation index were slightly but significantly improved only in the pH-balanced group. There were no severe adverse events in either group.

Conclusion: The pH-balanced vaginal gel is not superior to the placebo in improving dyspareunia and overall sexual function.

Clinical Trial Registration: ClinicalTrials.gov, https://www.clinicaltrials.gov, NCT00981305.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000001988DOI Listing
May 2017

Prognostic Effects of Adjuvant Chemotherapy-Induced Amenorrhea and Subsequent Resumption of Menstruation for Premenopausal Breast Cancer Patients.

Medicine (Baltimore) 2016 Apr;95(14):e3301

From the Department of Obstetrics and Gynaecology, Seoul National University College of Medicine, Seoul, Korea.

Chemotherapy-induced amenorrhea (CIA) is a side effect that occurs in patients with breast cancer (BC) as a result of chemotherapy. These patients require special treatments to avoid infertility and menopause. However, the factors controlling CIA, resumption of menstruation (RM), and persistence of menstruation after chemotherapy are unknown. The long-term prognosis for premenopausal patients with BC and the prognostic factors associated with CIA and RM are subject to debate. We performed a retrospective study by reviewing the medical records of 249 patients with BC (stage I to stage III) who were treated with cytotoxic chemotherapy. The median patient age was 43 (range, 26-55 years) and the median duration of follow-up was 64 months (range, 28-100 months). The medical records indicated that 219 patients (88.0%) scored as positive for the hormone receptor (HR); the majority of these patients completed chemotherapy and then received additional therapy of tamoxifen. Our analyses revealed that 88.0% (n = 219) of patients experienced CIA, and the percentage of RM during follow-up was 48.6% (n = 121). A total of 30 patients (12.0%) did not experience CIA. Disease-free survival (DFS) was affected by several factors, including tumour size ≥2 cm, node positivity, HR negative status, and body mass index ≥23 kg/m. Multivariate analysis indicated that tumour size ≥2 cm remained as a significant factor for DFS (hazard ratio = 3.3, P = 0.034). In summary, this study finds that the majority of premenopausal patients with BC (stage I to stage III) who receive chemotherapy experience CIA and subsequent RM. Although tumour size ≥2 cm is negatively associated with DFS, RM after CIA is not associated with poor prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000003301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998816PMC
April 2016

MicroRNAs 125a and 125b inhibit ovarian cancer cells through post-transcriptional inactivation of EIF4EBP1.

Oncotarget 2016 Feb;7(8):8726-42

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

The aim of the present study was to identify the specific miRNAs involved in regulation of EIF4EBP1 expression in ovarian cancer and to define their biological function. miRNA mimics and miRNA inhibitors were used in quantitative PCR, western blotting, and luciferase reporter assays to assess cell migration, invasiveness, and viability. miR-125a and miR-125b were downregulated in ovarian cancer tissue and cell lines relative to healthy controls. Increased expression of miR-125a and miR-125b inhibited invasion and migration of SKOV3 and OVCAR-429 ovarian cancer cells and was associated with a decrease in EIF4EBP1 expression. The inverse relationship between miR-125a and miR-125b was corroborated by cotransfection of a luciferase reporter plasmid. Furthermore, miR-125a and miR-125b caused apoptosis and decreased cell viability and migration in an apparently EIF4EBP1-directed manner. Collectively, these results indicate that miR-125a and miR-125b are important posttranscriptional regulators of EIF4EBP1 expression, providing rationale for new therapeutic approaches to suppress tumour invasion and migration using miR-125a, miR-125b, or their mimics for the treatment of ovarian cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18632/oncotarget.6474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891000PMC
February 2016

Dose-response relationship between cigarette smoking and female sexual dysfunction.

Obstet Gynecol Sci 2015 Jul 16;58(4):302-8. Epub 2015 Jul 16.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. ; Health Promotion Center, Seoul National University Hospital, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.

Objective: To evaluate whether smoking is a risk factor for female sexual dysfunction (FSD) and to determine the relationship between the cumulative smoking dose and FSD in premenopausal women.

Methods: The study population consisted of sexually active premenopausal women. The frequency of FSD and female sexual function index (FSFI) total score were evaluated according to the smoking status (never/former and current smokers). Evaluation of sexual function was done using FSFI questionnaire, and women with FSFI score of ≤26.55 were considered to have FSD. In current smokers, sexual function was also evaluated according to the cumulative smoking dose and nicotine dependency.

Results: A total of 900 women were included, and the frequency of current smokers and the frequency of FSD were 62 (6.9%) and 496 (55.1%), respectively. In current smokers, the frequency of FSD was significantly higher and the median total FSFI score was significantly lower than in never/former smokers, and this difference of FSD remained significant after adjustment for confounding variables. Among current smokers, the cumulative smoking dose (pack-years) and the total FSFI score showed negative correlation, in which increased cumulative smoking dose was associated with lower total FSFI score (r=-0.278, P<0.05). In terms of nicotine dependency, the total FSFI score of moderately to heavily nicotine dependent smokers was significantly lower than that of lightly dependent smokers.

Conclusion: In premenopausal women, current smoking was an independent risk factor for FSD. And cumulative smoking dose and nicotine dependency were associated with higher risk of FSD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5468/ogs.2015.58.4.302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515480PMC
July 2015

Subclinical Hypothyroidism is not a Risk Factor for Female Sexual Dysfunction in Korean Middle-Aged Women.

Thyroid 2015 Jul 25;25(7):784-8. Epub 2015 Jun 25.

1 Department of Obstetrics and Gynecology, Seoul National University College of Medicine , Seoul, Korea.

Background: Previous studies have suggested that subclinical hypothyroidism is associated with the risk of anxiety or depression and can affect quality of life. However, there is a paucity of information regarding the relationship between subclinical hypothyroidism and female sexual dysfunction.

Methods: The study population consisted of sexually active middle-aged women (≥40 years old) who visited the center for health promotion and optimal aging at Seoul National University Hospital for a health check-up between 2010 and 2011. Sexual function was evaluated by the female sexual function index (FSFI) questionnaire, and female sexual dysfunction was defined as a FSFI score of ≤26.55. FSFI scores and female sexual dysfunction frequencies were compared between cases with subclinical hypothyroidism and healthy controls. Nonparametric methods were used for statistical analysis.

Results: A total of 1086 women were included, and the frequency of subclinical hypothyroidism and female sexual dysfunction was 138 (12.7%) and 741 (68.2%), respectively. The total FSFI score and the scores in each domain were not different between the two groups (median total FSFI score (interquartile range): 23.8 (20.2-27.5) for normal thyroid status vs. 24.4 (20.6-27.6) for subclinical hypothyroidism, p=n.s.). The frequency of female sexual dysfunction was not different between the two groups, either (68.4% for normal thyroid status vs. 67.4% for subclinical hypothyroidism, p=n.s.). These findings were consistent even after adjustment for confounding variables.

Conclusions: Subclinical hypothyroidism is not a risk factor for sexual dysfunction in middle-aged women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/thy.2015.0015DOI Listing
July 2015

Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors.

Psychooncology 2015 Sep 17;24(9):1097-103. Epub 2015 Feb 17.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.

Objective: We aim to examine changes in sexual activity and function among younger breast cancer survivors who were sexually active before diagnosis and to investigate risk factors for negative impacts on them.

Methods: An observational cohort study enrolled 304 premenopausal and sexually active women diagnosed with early stage breast cancer. Questionnaires were completed, and sexual activity was measured at two time points: after surgery, to assess sexual activity and function before diagnosis, and then at least 12 months after the completion of chemotherapy or endocrine therapy. For each domain of the Female Sexual Function Index, a score below 3 was classified as indicative of a sexual problem. Each sexual problem was considered to be dysfunctional if it was associated with distress.

Results: The median age at the last survey was 46.0 years (range: 23-57). Of the participants, 35 (11.5%) became sexually inactive after treatment. Among the 269 women who remained sexually active, 31.6% were currently experiencing sexual dysfunction, which was significantly higher compared with the frequency before diagnosis. In the multivariate logistic regression model, chemo-related menopause, thyroid dysfunction, and depression were independent risk factors for sexual inactivity. Chemo-related menopause was a significant risk factor for sexual dysfunction.

Conclusions: Chemo-related menopause was significantly associated with both sexual inactivity and dysfunction after treatment. Thyroid dysfunction and depression were risk factors for sexual inactivity in younger breast cancer survivors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pon.3772DOI Listing
September 2015

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

J Cell Mol Med 2015 Feb;19(2):501-9

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

The balanced turnover of collagen is necessary to maintain the mechanical strength of pelvic supportive connective tissues. Homeobox (HOX) A11 is a key transcriptional factor that controls collagen metabolism and homoeostasis in the uterosacral ligaments (USLs), and the deficient HOXA11 signalling may contribute to alterations in the biochemical strength of the USLs, leading to pelvic organ prolapse (POP). However, it is unknown how HOXA11 transcripts are regulated in the USLs. In this study, we found that microRNA (miRNA)-30d and 181a were overexpressed in women with POP, and their expression was inversely correlated with HOXA11 mRNA levels. The overexpression of miR-30d or 181a suppressed HOXA11 mRNA and protein levels in 293T cells, whereas the knockdown of these miRNAs enhanced HOXA11 levels and collagen production. Cotransfection of a luciferase reporter plasmid containing the 3'-untranslated region of HOXA11 with miR-30d or 181a mimic resulted in decreased relative luciferase activity. Conversely, cotransfection with anti-miR-30d or 181a increased luciferase activity. Taken together, these results indicate that both miR-30d and 181a are important posttranscriptional regulators of HOXA11 in the USLs and could be a potential therapeutic target for POP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jcmm.12448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407598PMC
February 2015

Perioperative and postoperative morbidity after sacrocolpopexy according to age in Korean women.

Obstet Gynecol Sci 2015 Jan 16;58(1):59-64. Epub 2015 Jan 16.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea. ; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

Objective: This study aimed to compare perioperative and postoperative morbidity of older and younger women undergoing sacrocolpopexy (SCP).

Methods: A retrospective study included 271 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse from November 2008 to June 2013 at our institution. By the review of medical records, perioperative and postoperative data including the length of the surgery, estimated blood loss, blood transfusion, the length of hospital stay, wound complications and febrile morbidity were collected. In addition, cardiovascular, pulmonary, gastrointestinal, genitourinary, or neurological adverse events were retrieved. The need for an indwelling urinary catheter or performance of clean intermittent self-catheterization, mesh erosion rate and the number of days required for each were included in the postoperative outcomes. For the outcome variable analyzed in this study, the patients was dichomotized into women aged 65 and older and those younger than 65.

Results: One hundred and thirty-five (49.8%) patients were younger than 65 and 136 (50.2%) were aged 65 and older. Older women had higher body mass index, vaginal parity and prior surgery for hysterectomy than younger women (P<0.05). And older women had higher baseline comorbidities, such as hypertension, diabetes, cardiac disease (P<0.05), and their American society of Anesthesiologist class was higher (P<0.001). In the perioperative and postoperative complication, older group showed no differences in most of the operation-related complication rates, but gastrointestinal complication rate. Also, mesh erosion rate was not found to be significantly different between the two groups at the last visit.

Conclusion: Older women undergoing laparotomic SCP have similar perioperative and postoperative morbidities as younger women, suggesting surgeons can counsel older and younger women similarly in terms of operative risks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5468/ogs.2015.58.1.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303754PMC
January 2015

Significant gastrointestinal morbidity after sacrocolpopexy: The incidence and risk factors.

Obstet Gynecol Sci 2014 Jul 15;57(4):304-9. Epub 2014 Jul 15.

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

Objective: This study aimed to quantify the risk of significant gastrointestinal (GI) morbidity after sacrocolpopexy (SCP), and to identify related risk factors.

Methods: A retrospective study was performed of 258 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse (POP) from November 2008 to August 2013. By the review of medical records, the frequency of significant GI morbidity that resulted in a prolonged initial hospitalization, readmission, or reoperation was assessed. Thereafter, risk factors for significant GI morbidity were assessed using univariate and multivariate analyses.

Results: Ten patients (3.9%) were identified as having significant GI morbidity; nine (3.5%) had a prolonged initial hospital stay or were readmitted for the medical treatment of postoperative ileus and 1 (0.4%) underwent reoperation for small bowel obstruction. The occurrence of significant GI morbidity was significantly associated with patient's age and prior laparotomy. By multivariable logistic regression analysis, age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.27; P=0.03) and prior laparotomy (OR, 6.82; 95% CI, 1.37-34.07; P=0.02) were found as independent risk factors for significant GI morbidity.

Conclusion: One in 25 (3.9%) women after SCP experiences significant GI morbidity. Particularly, women with older age and prior laparotomy have a higher risk for significant GI morbidity. This data will aid preoperative counseling for Korean POP patients undergoing SCP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5468/ogs.2014.57.4.304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124092PMC
July 2014