Publications by authors named "Tsia-Shu Lo"

114 Publications

Concurrent anti-stress urinary incontinence (SUI) surgery for advanced pelvic organ prolapse (POP) surgery and SUI: an Asian perspective footnote from the Pan-Asia meeting.

Int Urogynecol J 2021 Jun 31;32(6):1329-1330. Epub 2021 May 31.

Kuching Specialist Hospital, KPJ Healthcare Group, Kuching, Sarawak, Malaysia.

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http://dx.doi.org/10.1007/s00192-021-04879-8DOI Listing
June 2021

Immunochemical and urodynamic outcomes after polypropylene mesh explant from the pelvic wall of rats.

Int Urogynecol J 2021 May 26. Epub 2021 May 26.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.

Introduction And Hypothesis: To analyze the immunochemical and urodynamic outcomes after partial versus complete excision of transvaginal polypropylene mesh (PPM) from pelvic walls of rats.

Methods: Forty-eight female Sprague-Dawley (SD) rats were randomly distributed into seven groups: control, mesh total removal 60 days (M-T 60D), mesh total removal 180 days (M-T 180D), mesh partial removal 60 days (M-H 60D), mesh partial removal 180 days (M-H 180D), sham 60 days (Sham 60D), and sham 180 days (Sham 180D). In the mesh groups, PPM was inserted and partially (0.3 × 0.3 cm) or completely removed 30 days later. In the Sham group, the space between the vagina and bladder was dissected without placing or removing the synthetic mesh at day 1 and day 30 later. Urodynamic studies, immunochemical analysis, and Western blot were done at days 60 and 180.

Results: The M-T 60D voiding pressure was significantly decreased compared to the Sham 60D and M-H 60D. The voiding interval of M-T 60D was significantly shorter than that of M-H 60D. In the M-T 60D and M-T 180D groups, the leak point pressure was significantly less than in their corresponding sham groups. IL-1 and TNF-α were significantly more intense in M-T 60D compared to M-H 60D and Sham 60D. NGF was significantly greater in M-T 60D compared to Sham 60D. There were no significant differences in MMP-2 and CD-31s throughout the group.

Conclusion: Total mesh excision incites a host inflammatory response and transitory lower urinary tract dysfunction. Despite the good outcomes after total excision, the invasiveness and surgical risk associated with repeated procedures should not be underestimateded.
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http://dx.doi.org/10.1007/s00192-021-04842-7DOI Listing
May 2021

Impact of intrinsic sphincter deficiency on mid-urethral sling outcomes.

Int Urogynecol J 2021 May 18. Epub 2021 May 18.

Department of Obstetrics and Gynecology, Kuching Specialist Hospital, Sarawak, Malaysia.

Introduction And Hypothesis: Our primary objective was to study outcomes of patients with intrinsic sphincter deficiency (ISD) following mid-urethral slings (MUS) at 1-year. Our secondary objective was to delineate factors affecting success in these patients.

Methods: Six hundred eighty-eight patients who had MUS between January 2004 and April 2017 were reviewed retrospectively; 48 women were preoperatively diagnosed with ISD. All completed urodynamic studies and validated quality-of-life (QOL) questionnaires at baseline and 1 year. Primary outcomes were objective and subjective cure of stress incontinence, defined as no involuntary urine leakage during filling cystometry and 1-h pad test < 2 g and negative response to Urogenital Distress Inventory-6 Question 3. Ultrasound was performed to determine tape position, urethral mobility and kinking at 1 year.

Results: Women with ISD had significantly lower objective and subjective cure rates of 52.1% and 47.9%, respectively, compared to an overall of 88.2% and 85.9%. QOL scores significantly improved in those with successful surgeries. The sling type did not make a difference. Multivariate logistic regression identified reduced urethral mobility [OR 2.11 (1.24-3.75)], lower maximum urethral closure pressure (MUCP) [OR 1.61 (1.05-3.41)] and tape position [OR 3.12 (1.41-8.71)] to be associated with higher odds of failed slings for women with ISD.

Conclusions: Although there are good overall success in women undergoing MUS, those with ISD have significantly lower cure rates at 1 year. Factors related to failure include reduced urethral mobility, low MUCP and relative tape position further away from the bladder neck. Optimal management of patients with ISD and reduced urethral mobility remains challenging.
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http://dx.doi.org/10.1007/s00192-021-04757-3DOI Listing
May 2021

Surgical Trend and Volume Effect on the Choice of Hysterectomy Benign Gynecologic Conditions.

Gynecol Minim Invasive Ther 2021 Jan-Mar;10(1):1-9. Epub 2021 Jan 30.

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

With the advance of minimally invasive surgery (MIS), the surgical trends of hysterectomy changed significantly during past 2 decades. Total number (age-standardized) of all types of hysterectomy decreased, which may be due to the availability of some other alternatives, e.g. hysteroscopy, laparoscopic myomectomy. However, laparoscopic hysterectomy (LH) still remains the mainstream of surgical treatment. LH significantly increases for benign gynecologic conditions in Taiwan and worldwide. The increase of LH was accompanied with decrease of TAH; VH kept stationary, and SAH increased slightly. The increase in popularity of LH and SAH; provides evidence of surgical trends and a paradigm shift for hysterectomy. This time-frame shift suggests LH has reached a u during the later years. Older patients tend to receive AH, while middle-aged women tend to receive LH. Oder surgeons tend to perform AH, while younger surgeons tend to perform LH. However, all type hysterectomy and LH were more commonly performed by older surgeons aged over 50 years. It means both patients and surgeons became older during the time-frames. The above phenomena may also happen due to less young surgeons entered in the gynecologic practice. Most of the LHs were performed by high-volume surgeons, however, there is a shift from high-volume, to medium- and low-volume surgeons. The above scenario may be due to the wide spread of LH techniques. Surgical volume has important impacts on both complications and costs. The high-volume surgeons have lower complications, which result in lower costs. In the future, how to increase the use of LH, to improve the training and monitoring system deserves more attentions.
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http://dx.doi.org/10.4103/GMIT.GMIT_68_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968603PMC
January 2021

The efficacy and complications of using transvaginal mesh to treat pelvic organ prolapse in Taiwan: A 10-year review.

Taiwan J Obstet Gynecol 2021 Mar;60(2):187-192

Department of Obstetrics and Gynecology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan; Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan; Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.

Transvaginal mesh (TVM) insertion for the treatment of pelvic organ prolapse (POP) is significantly associated with lower failure rates, although its use remains controversial due to the potential risk of mesh-related complications. In this review, we collected the published literature regarding the use of TVM to treat POP in an attempt to assess both the efficacy and complications related to TVM usage in Taiwan. We searched 25 English language articles using PubMed related to TVM in Taiwan from 2010 to 2019. The present article focuses on the efficacy and complications of TVM and analyzes the data. There were 25 studies on TVM selected for this review. Regarding their success rate, 21 out of the 22 studies (95.5%) had more than a 90% objective success rate. Twenty studies (90.9%) had less than 10% major complications of TVM. Twenty out of the 25 studies (80.0%) had 5% or less mesh exposure. For self-cut TVM and the later single-incision TVM, both the complication rates and exposure rates decreased. The rate of de novo dyspareunia ranged from 2.6% to 14.3%, and the incidence decreased yearly from 2011 to 2019. This review showed both the high treatment efficacy and low complication rate of TVM usage for the short-term treatment of POP in Taiwan. However, a longer-term study is needed to draw a conclusion regarding the safety of this treatment.
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http://dx.doi.org/10.1016/j.tjog.2021.01.031DOI Listing
March 2021

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

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

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

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

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

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

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

Mid Urethral Slings for the Treatment of Urodynamic Stress Incontinence in Overweight and Obese Women: Surgical Outcomes and Preoperative Predictors of Failure.

J Urol 2020 10 20;204(4):787-792. Epub 2020 Apr 20.

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

Purpose: We evaluated mid urethral sling outcomes in overweight and obese patients compared to normal weight patients and identified risk factors for failure in this population.

Materials And Methods: Records of 688 women between January 2004 and July 2017 were retrospectively reviewed. Patients received urodynamic studies, 1-hour pad test, Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, and were divided into normal weight, overweight and obese. Objective cure at 1 year was defined as no involuntary urine leakage during filling cystometry and pad test less than 2 gm. Subjective cure was established by negative response to question 3 on Urogenital Distress Inventory-6. McNemar's test, chi-square test, Mann-Whitney U and Fisher's exact test were used for paired categorical variables. Independent samples t-tests and paired t-test were used for continuous parametric variables. Multivariate logistic regression was used to identify risk factors for failure.

Results: Objective and subjective cure in normal, overweight and obese patients was 91.4% and 89.1%, 87.5% and 86%, and 76% and 70.1%, respectively. There was no difference in surgical complications. Obese patients had worse quality of life scores preoperatively and postoperatively. Risk factors in obese patients with failed mid urethral sling included 66 years old or older (OR 2.02, 1.56-3.98), menopause (OR 4.21, 1.21-14.22), previous prolapse surgery (OR 4.57, 2.36-8.52), diabetes (OR 2.79, 1.61-5.99) and intrinsic sphincter deficiency (OR 5.06, 3.08-9.64).

Conclusions: Obese women with mid urethral sling had lower objective and subjective cure at 1 year and worse quality of life scores compared to normal and overweight women. Risk factors for failure include age, diabetes, menopause, previous prolapse surgery and intrinsic sphincter deficiency.
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http://dx.doi.org/10.1097/JU.0000000000001085DOI Listing
October 2020

Author's Reply.

J Minim Invasive Gynecol 2021 01 22;28(1):146-147. Epub 2020 Aug 22.

Taiwan, Republic of China.

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http://dx.doi.org/10.1016/j.jmig.2020.08.010DOI Listing
January 2021

Midurethral sling surgery for stress urinary incontinence: an Asian perspective footnote from the Pan-Asia meeting.

Int Urogynecol J 2021 Mar 16;32(3):473-476. Epub 2020 Jul 16.

Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Kuching, Sarawak, Malaysia.

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http://dx.doi.org/10.1007/s00192-020-04416-zDOI Listing
March 2021

Immunochemical analysis on polypropylene mesh: does mesh size make a difference?

Int Urogynecol J 2021 Jan 10;32(1):47-55. Epub 2020 Jul 10.

Department of Obstetrics and Gynecology, National University Hospital of Singapore, Singapore, Singapore.

Introduction And Hypothesis: The aim of the study is to demonstrate the impact of the size of implanted mesh in relation to its immunohistochemical reaction implanted into animal models.

Methods: An experimental study utilizing 54 female Sprague Dawley (SD) rats was divided into five groups: control, sham, and study groups (mesh-small [M-S], mesh-medium [M-M], mesh-large [M-L]). The M-S group used a mesh size of 0.2 × 0.2 cm, the M-M group a mesh size of 0.5 × 0.5 cm, and the M-L a mesh size of 0.7 × 1.0 cm. The sham group underwent vaginal dissection with no mesh implantation. The rats were sacrificed using isoflurane overdose on days 7 and 30. The mesh with the surrounding vaginal and bladder wall tissues were removed and processed for histochemical and western blot analysis.

Results: There is a significant increase in IL-1 and TNF-α immunoreactivity in the M-M and M-L groups on day 7 when compared with the sham group with p values of 0.001 and < 0.001 respectively. M-L showed significantly higher immunoreactivity to TNF-α persisting until day 30. All study groups presented a significantly higher immunoreactivity to MMP-2 and NGF on day 7. However, reactivity to NGF does not persist to day 30 in all groups. Immunoreactivity to CD 31 on days 7 and 30 appears significantly greater in the M-M and M-L groups, with the reaction in the M-L group continuing until day 30.

Conclusion: Mesh size is directly proportional to the inflammatory reaction in the host tissue. The prolonged inflammatory process leads to delayed tissue remodeling and angiogenesis, which could delay mesh-tissue integration.
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http://dx.doi.org/10.1007/s00192-020-04399-xDOI Listing
January 2021

Laser Acupuncture Alleviates Symptoms and Improves Quality of Life in Women with Overactive Bladder: A Double-Blind, Pilot Randomized Controlled Trial.

Evid Based Complement Alternat Med 2020 25;2020:1705964. Epub 2020 Apr 25.

Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan.

Objective: The aim of this study was to investigate the clinical efficacy of laser acupuncture for the treatment of women with overactive bladder (OAB) in Taiwan.

Methods: A double-blind randomized controlled trial was conducted on female patients with OAB symptoms referred from gynecologists, and subjects were divided into two groups using blocked randomization. LaserPan (RJ-Laser, Germany) was applied to seven selected acupuncture points. The subjects received laser acupuncture 3 times per week for 3 weeks, 9 sessions in total. Basic patient data, Overactive Bladder Symptom Score (OABSS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores were recorded prior to first treatment and at the end of 3, 6, and 9 treatments.

Results: Thirty patients were enrolled, and twenty-seven patients completed all treatments in this study. The OABSS total score of the experimental group decreased significantly by 3.13 ( ≤ 0.001), 4.60 ( ≤ 0.001), and 3.79 ( ≤ 0.001) after 3, 6, and 9 treatments, respectively, compared with that of the control group. The IIQ-7 score declined significantly from baseline by 4.57 (=0.003) and 3.63 (=0.023) after 3 and 6 treatments, respectively, compared with that of the control group. Similarly, the UDI-6 score of the experimental group exhibited a significant decrease from baseline by 1.90 (=0.042) and 2.25 (=0.025) after 6 and 9 interventions, respectively, compared with that of the control group.

Conclusions: This study demonstrates that laser acupuncture can alleviate OAB symptoms and improve quality of life. This noninvasive device could be an effective therapy for women with OAB.
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http://dx.doi.org/10.1155/2020/1705964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201846PMC
April 2020

Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year.

J Minim Invasive Gynecol 2021 01 13;28(1):107-116. Epub 2020 May 13.

Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh).

Study Objective: To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms.

Design: Retrospective cohort study.

Setting: Tertiary-care university hospital.

Patients: Patients with symptomatic anterior or apical POP stage III and above.

Interventions: All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit.

Measurements And Main Results: Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%.

Conclusion: A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.
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http://dx.doi.org/10.1016/j.jmig.2020.05.002DOI Listing
January 2021

Is maternal serum inhibin A a good predictor in preterm labor? - Experience from a community hospital in Taiwan.

Biomed J 2020 04 6;43(2):183-188. Epub 2020 May 6.

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

Background: We aimed to determine whether inhibin A could be a reliable and accurate predictor of preterm birth, and discuss the possible pathogenic processes of inhibin A leading to preterm birth.

Methods: A retrospective cohort study was conducted on consecutive singleton pregnant women who underwent the second-trimester quad screen test at a gestational age of 15-20 weeks at Keelung Chang-Gung Memorial Hospital from March 2011 to May 2015. Data including maternal characteristics and pregnancy outcomes were collected from an electric medical record database. Data regarding pregnancy terminations before a gestational age of 24 weeks and regarding pregnancies that involved chromosomal or congenital anomalies were excluded from this analysis. One-way analysis of variance was used to compare second-trimester α-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A in women with preterm deliveries versus those with term deliveries.

Results: Although a total of 935 women with singleton pregnancies were enrolled, pregnancy outcome and complete maternal data were obtained from only 770 (82.3%)of them. In total, 687 (89.2%) women delivered at or after 37 weeks of gestation and 83 (10.8%) women delivered before 37 weeks of gestation. The results showed that the inhibin A level was significantly increased in the preterm labor group (p = 0.009). A cutoff inhibin A value above 2.25 was identified statistical significantly in the preterm labor group.

Conclusions: From our results, an inhibin A level above 2.25 multiples of the median in the quad screen test may be associated with preterm labor afterward. Closely monitoring for uterine contractions or cervical length measurement in the second trimester may be indicated in patients with unexplained elevated inhibin A levels.
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http://dx.doi.org/10.1016/j.bj.2019.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283573PMC
April 2020

Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes.

Sci Rep 2020 02 6;10(1):1944. Epub 2020 Feb 6.

Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan.

Patients with pelvic organ prolapse (POP) often have accompanying lower urinary tract symptoms. Symptoms such as stress urinary incontinence(SUI-) and detrusor overactivty(DO) would co-exist in a number of patients. Management entails relieving the obstructive element. To determine the clinical outcome of patients with urodynamics mixed type urinary incontinence(MUI-U) after vaginal pelvic reconstructive surgery(PRS), a retrospective study was conducted. MUI-U was defined as having urodynamic findings of both of DO/DOI (derusor overactivity incontinence) and SUI-. Main outcome measures: Objective cure- absence of involuntary detrusor contraction on filling cystometry and no demonstrable leakage of urine during increased abdominal pressure; Subjective cure- assessment index score of <1 on UDI-6 question #2 and #3. Of the 82 patients evaluated, 14 underwent vaginal PRS with concomitant mid-urethral sling(MUS) insertion while 68 had vaginal PRS alone. Pre-operatively, 49(60%) patients had stage III and 33(40%) had stage IV prolapse. Post-operatively, 1-year data shows an objective cure of 56% (46/82) and subjective cure of 54% (44/82). MUI-U was significantly improved. Improvement of SUI and results of the 1-hour pad test were more pronounced in patients with concomitant MUS insertion. Ergo, vaginal PRS cures symptoms of MUI-U in >50% of patients and concomitant MUS can be offered to SUI predominant MUI.
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http://dx.doi.org/10.1038/s41598-020-58594-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005146PMC
February 2020

Dissecting of the paravesical space associated with lower urinary tract dysfunction - a rat model.

Sci Rep 2020 02 3;10(1):1718. Epub 2020 Feb 3.

Fellow of the Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China.

To determine the association of opening the paravesical space in relation to its occurrence of de novo SUI in an animal model. Thirty five female Sprague Dawley rats were divided into 5 groups of 7 rats each: Control group, Sham groups(F, H), and Study groups(MF, MH). Groups labeled with "F" had the paravesical space opened, "H" had tissue dissection with no opening of the space, and "M" had mesh implanted inside the vaginal wall. Urodynamic studies, immunohistochemical analysis, and western blot were done at day 40. The mean weight and age of 35 rats were 302.1 ± 25.1 grams and 12.8 ± 1.2 weeks old. No significant differences were noted among the control, Sham F, Sham H, Study MF, and Study MH on the voiding pressure and voided volume. The Sham F and Study MF (opened paravesical space) groups had significantly lower values on leak point pressures (LPP) (p = 0.026; p < 0.001) and shorter voiding intervals (p = 0.032; p = 0.005) when compared to other groups. Immunohistochemical analysis showed IL-1 and TNF-α to be intensely increased for the Study MF group (p = 0.003; p = <0.001). MMP-2 and CD 31 markers were also significantly higher in the Study MH and MF group. NGF expression was significantly increased in the Study MF and Sham F groups. Thus, opening of the paravesical space causes an increased inflammatory reaction, which leads to tissue destruction and lower urinary tract dysfunction, exemplified in the study with low leak point pressure and shortened voiding intervals.
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http://dx.doi.org/10.1038/s41598-020-58604-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997187PMC
February 2020

Outcomes of urodynamic mixed urinary incontinence and urodynamic stress incontinence with urgency after mid-urethral sling surgery.

Int Urogynecol J 2020 09 31;31(9):1949-1957. Epub 2020 Jan 31.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan, Republic of China.

Introduction And Hypothesis: Mixed urinary incontinence (MUI) is defined as symptomatic complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. The paucity of research, especially on the surgical management of MUI, limits its best management.

Methods: This is a retrospective study to determine the outcomes of mixed urinary incontinence after mid-urethral sling surgery with two groups, urodynamic stress incontinence (USI) with urgency and urodynamic mixed urinary incontinence (MUI-UD; USI and detrusor overactivity [DO]).

Results: Ninety women (USI + urgency group) with preoperative USI and urgency and no demonstrable DO/DOI attained an objective cure of 82.2%, whereas the remaining 67 (MUI-UD group) women with both USI and DO/DOI were reported to have an objective cure of only 55.2%. Subjective cures were 81.1% and 53.7% respectively. The type of incontinence surgery does not affect postoperative outcomes in either of the groups. Demographic factors identified to have a significant negative effect on cure rates were postmenopausal status (p = 0.005), prior hysterectomy (p = 0.028), pre-operative smaller blafdder capacity (p = 0.001), and a larger volume of pre-operative pad test (p = 0.028). A lower mid-urethral closure pressure (MUCP) was significant with post-operative failure of treatment with MUI-UD group (68.8 ± 36.2 cmHO vs 51.9 ± 24.7 cmHO; p = 0.033).

Conclusions: Although there is evidence for a good cure of the stress component of MUI, urodynamic investigation with its findings prior to management of MUI could have greater implications for selective patient centered counseling. Presence of DO or DOI on urodynamics resulted in poorer objective and subjective outcomes.
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http://dx.doi.org/10.1007/s00192-019-04213-3DOI Listing
September 2020

Use of vaginal mesh; an Asian perspective footnote from the pan-Asia meeting.

Int Urogynecol J 2020 04 13;31(4):675-677. Epub 2020 Jan 13.

Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ, Healthcare Group, Kuching, Sarawak, Malaysia.

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http://dx.doi.org/10.1007/s00192-019-04219-xDOI Listing
April 2020

Outcomes and failure risks in mid-urethral sling insertion in elderly and old age with urodynamic stress incontinence.

Int Urogynecol J 2020 04 12;31(4):717-726. Epub 2019 Dec 12.

Department of Obstetrics & Gynaecology, National University Hospital of Singapore, Singapore, Singapore.

Introduction And Hypothesis: To study the surgical outcomes and risk factors for failure of three types of mid urethral slings(MUS) surgeries in elderly and old age women with urodynamic stress incontinence(USI).

Methods: Three different types of MUS surgeries [single incision sling(SIS), trans-obturator tape(TOT), retro-public mid-urethral sling-tension-free vagina tape (TVT)]were performed among three age groups of women (young <64 yr, elderly 65-74 yr and old >75 yr) with USI. They were followed up for 1 year.

Results: Complete postoperative data was available for 688 women. After 1 year, overall objective cure rate was 88.2% and subjective cure rate was 85.9%. Among the young, elderly, and old age women objective cure rates were 91.0%, 80.6%, 66.7% and subjective cure rates were 89.2%, 77.6%, 58.3% respectively. Urodynamic parameters demonstrated flow rate, higher post-void bladder residual, smaller cystometric capacity, and lower maximum urethral closure pressure were significantly lower among old and elderly group. Subjectively, urinary distress inventory-6 (UDI-6) and incontinence impact questionnaire-7(IIQ-7) improved significantly in all groups with significant changes from baseline only in older women. Intrinsic sphincter deficiency(ISD) was found to be significantly associated with failure in older women. Other preoperative comorbidities were equally distributed among all the three age groups. The operative time, perioperative complications, and length of hospital stay showed no difference between the study groups.

Conclusions: MUS surgery is safe for the young and aging patients with USI and demostrated significant improvement in its outcomes, but objective and subjective cure rates decreases with age. ISD was also found to be significantly associated with failure.
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http://dx.doi.org/10.1007/s00192-019-04171-wDOI Listing
April 2020

Time-frame comparison of hystero-preservation in the surgical treatment of uterine prolapse: a population-based nation-wide follow-up descriptive study, 2006-2013 versus 1997-2005.

Int Urogynecol J 2020 09 4;31(9):1839-1850. Epub 2019 Dec 4.

Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, No. 901, Chunag-Hwa Rd., Yu Kang, Tainan, Taiwan.

Introduction And Hypothesis: The purpose of our study was to describe the surgical trend and time-frame comparison between 1997-2005 (1period) and 2006-2013 (2nd period) of hystero-preservation for uterine prolapse, based upon a nationwide population-based National Health Insurance (NHI) claim data in Taiwan.

Methods: Women, who underwent primary surgeries for uterine prolapse, either uterine suspension with hystero-preservation or hysterectomy during 1997-2013, were identified from National Health Insurance Research Database (NHIRD).We analyzed the related variables including surgical types (hystero-preservation or hysterectomy), patient age and concomitant anti-incontinence surgery, surgeon age, gender, and service volume; and hospital accreditation level, and service volume.

Results: We identified a total of 46,968 inpatients, 6629 (14.11%) hystero-preservation group, and 40,339 (85.89%) hysterectomy group. Hystero-preservation significantly increased during the 17 year follow-up study period (1997 to 2013) (P value =0.0147). The overall surgeries for uterine prolapse increased among patients ≥70 years, with concomitant anti-incontinence surgery, surgeons ≥45 years, high volume surgeons, and hospitals. Multiple logistic regression revealed hysterectomy was less used in 2nd period (OR 0.45, 95%, confidence interval (CI) 0.43-0.48). Hysterectomy was more often used in patient aged ≥50 years, surgeon aged ≥45 years, and low volume hospitals. In case of concomitant anti-incontinence surgery (OR 0.48, CI 0.45-0.52), high volume surgeons (more than 30 surgeries) and hospitals (more than 73 surgeries) hystero-preservation was more often used.

Conclusions: Time-frames, younger patients, concomitant anti-incontinence surgery, younger surgeons, and high volume surgeons and hospitals increase hystero-preservation for uterine prolapse. Surgeons and hospitals should be ready to respond to the wishes of female patients who want to preserve the uterus.
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http://dx.doi.org/10.1007/s00192-019-04128-zDOI Listing
September 2020

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

Risks of interstitial cystitis among patients with systemic lupus erythematosus: A population-based cohort study.

Int J Urol 2019 09 16;26(9):897-902. Epub 2019 Jul 16.

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

Objective: To investigate whether the risk of interstitial cystitis increases among the patients with systemic lupus erythematosus.

Methods: This was a nationwide population-based cohort study. Data were obtained from the National Health Insurance Research Database in Taiwan. Women aged >18 years newly diagnosed as systemic lupus erythematosus during 2001-2008 were identified as the control group. The comparison included individuals randomly selected from the National Health Insurance Research Database in the year of 2000, by matching one systemic lupus erythematosus participant with eight non-systemic lupus erythematosus participants with sex and age. These participants were followed up until being diagnosed as interstitial cystitis, or the end of 2011. Women diagnosed with lupus cystitis were excluded from this study.

Results: This study included 7240 women with systemic lupus erythematosus and 57 920 women without systemic lupus erythematosus as controls. The incidence rate of interstitial cystitis was significantly higher in the systemic lupus erythematosus group, with an incidence rate ratio of 2.26 (95% confidence interval 1.57-3.27, P < 0.0001). After adjustment, the risk increased by 2.45-fold (adjusted hazard ratio 2.45, 95% confidence interval 1.57-3.27, P < 0.05). Age as a factor increases incidence rate ratios among all age groups, 2.12-, 3.32- and 4.65-fold. Age ≥45 years had an increased adjusted hazard ratio (2.07, 95% confidence interval 1.37-3.13, P < 0.05). Comorbidities, for example, hypertension, diabetes mellitus, dyslipidemia and renal disease, were insignificant.

Conclusions: This is the first population-based cohort study showing a higher incidence of interstitial cystitis among patients with systemic lupus erythematosus. These findings support the concordance of interstitial cystitis with autoimmune diseases, and the temporal relationship to develop interstitial cystitis in patients with systemic lupus erythematosus.
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http://dx.doi.org/10.1111/iju.14065DOI Listing
September 2019

Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study.

J Minim Invasive Gynecol 2020 01 28;27(1):65-73.e1. Epub 2019 Mar 28.

Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan (Dr. Wu); Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan (Dr. Wu). Electronic address:

Study Objective: To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan.

Design: A retrospective cohort study.

Setting: A population-based National Health Insurance Research Database.

Patients: Women undergoing various types of hysterectomy for noncancerous lesions.

Interventions: Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables.

Measurements And Main Results: A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers.

Conclusion: This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.
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http://dx.doi.org/10.1016/j.jmig.2019.02.020DOI Listing
January 2020

Clinical relevance and treatment outcomes of vesicovaginal fistula (VVF) after obstetric and gynecologic surgery.

Taiwan J Obstet Gynecol 2019 Jan;58(1):111-116

Fellow, Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines.

Objective: Vesicovaginal fistulas (VVF) are consequences from obstetric and gynecologic surgery. Treatment approach from either abdominal or vaginal route have its own pros and cons. The study aims to present the anatomical, clinical and lower urinary tract symptom outcomes of women with VVF.

Materials And Methods: A retrospective case series conducted patients with VVF. Data regarding pre-operative evaluation, surgical treatment, and post-operative follow-ups were collected. Surgical approach depended on the cause, type, number, size, location, and time of onset of the fistula. Post-operatively, foley catheter was maintained for at least 1 week with cystoscopy performed prior to removal. Follow-up evaluation included cystoscopy, bladder diary, UDI-6 and IIQ-7 questionnaires and multi-channel urodynamic study.

Results: Of the 15 patients that were evaluated, 1 had spontaneous closure, 8 were repaired vaginally and 6 abdominally. Patients repaired vaginally were significantly noted to have a mean age of 50.3 ± 7.1 years with VVFs located adjacent the supra-trigone area having a mean distance of 1.7 ± 0.5 cm from the ureteric orifice. Its operative time and hospital stay were significantly shorter. In contrast, abdominally repaired patients had mean age of 38.0 ± 8.2 years and VVFs with mean distance of 0.4 ± 0.4 cm from the ureteric orifice. Post-operatively, 2 cases (14.2%, 2/14) of VVF recurrence and de novo urodynamic stress incontinence (USI) (25%, 2/8) were noted after vaginal repair and 3 cases (50%, 3/6) of concurrent ureteric injury and overactive bladder after abdominal repair.

Conclusion: Treatment outcomes for vaginal and abdominal repair yielded good results. Though the vaginal route had higher incidence of recurrence and de novo USI, its less invasiveness, faster recovery period, and no association with post-op overactive bladder made it more preferable than the abdominal approach.
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http://dx.doi.org/10.1016/j.tjog.2018.11.021DOI Listing
January 2019

Ultrasonography and clinical outcomes following anti-incontinence procedures (Monarc vs MiniArc): A 3-year post-operative review.

PLoS One 2018 4;13(12):e0207375. Epub 2018 Dec 4.

Department of Obstetrics & Gynecology, Subang Jaya Medical Center, Ramsay Sime Darby Health Care, Selangor, Malaysia.

Objective: To compare the ultrasonographic positional changes of mid-urethral sling(MUS) tape in relation to symphysis pubis, and the different clinical outcomes among women who underwent MUS insertion with MiniArcTM or MonarcTM for the treatment of stress urinary incontinence 3 years after.

Materials And Methods: A retrospective follow-up study on patients with clinically confirmed stress urodynamic incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound.

Results: A total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from rest to Valsalva (1.1 ±0.4 mm vs. 0.3 ±0.3 mm, p = 0.001). Tightness of the sling assessed from the major and minor axis of the urethral core had no significant difference in both groups at rest and during Valsalva. Urethral kinking percentage and the location of the sling did not yield statistical difference.

Conclusion: Maintenance of continence rates of mid-urethral slings depends on the compressive effect of the sling on the urethra, urethral kinking, and sling fixation. From 6months to 3 years, MiniArc changed its position in both x- and y-axis over time, which the authors attribute to loosening of the anchoring mechanism since no clinical relevance could be sought.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207375PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279016PMC
April 2019

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

Anterior-apical single-incision mesh surgery (uphold): 1-year outcomes on lower urinary tract symptoms, anatomy and ultrasonography.

Int Urogynecol J 2019 07 14;30(7):1163-1172. Epub 2018 Jul 14.

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

Introduction And Hypothesis: Our primary objective is to determine the presence of SUI at 6-12 months after surgery. The secondary objective is to determine the objective and subjective outcomes of POP.

Methods: A retrospective study conducted between February 2015 and July 2016 at Chang Gung Memorial Hospital. The subjects had had symptomatic anterior or apical prolapse with stage III or IV and undergone pelvic reconstructive surgery using Uphold™ LITE. Patients completed a 3-day voiding diary, urodynamic study, real-time ultrasonography and validated quality-of-life questionnaires at baseline and 12-month follow-up. Primary outcome was the absence of USI. Secondary outcomes included the objective cure rate of POP, ≤ stage 1 at the anterior/apical vaginal wall, and the subjective cure rate, negative feedback to POPDI-6.

Results: Ninety-five women were eligible. Six were excluded because of incomplete data. The postoperative de novo USI and SUI were 22.7 and 19.7%, respectively. There was significant improvement of USI in patients who had MUS insertion (93.8%) and bladder outlet obstruction (96.7%). The objective and subjective cure rate for prolapse was 95.5 and 94.3%, respectively. POP-Q measurements pre- and postoperatively were significantly improved at all points except for Gh and Pb. There was a significant difference in the distance between the bladder neck to the distal end of the mesh during straining both at both the postoperative 3rd month and 1 year.

Conclusions: Uphold™ mesh has a 20% incidence of de novo USI with acceptable objective and subjective cure rates at 1 year postoperatively. The de novo USI rate was high but not bothersome enough to require surgery.
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http://dx.doi.org/10.1007/s00192-018-3691-6DOI Listing
July 2019

Trans-vaginal mesh surgery for management of recurrent pelvic organ prolapse following abdominal sacrocolpopexy.

Taiwan J Obstet Gynecol 2018 Apr;57(2):311-314

Fellow of the Division of Urogynecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines.

Objective: To evaluate the outcome of transvaginal mesh surgery as a management of recurrent pelvic organ prolapse, in patients previously treated with sacrocolpopexy.

Case Report: A series of three patients who developed recurrent pelvic organ prolapse more than 9 years after sacrocolpopexy. A 50-year-old and two 77-year-old patients who presented with recurrent pelvic organ prolapse at 9, 15 and 17 years, respectively after the primary abdominal sacrocolpopexy were managed by transvaginal mesh surgery.

Conclusion: Management of recurrent pelvic organ prolapse using transvaginal mesh would be an option for patients treated previously by sacrocolpopexy.
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http://dx.doi.org/10.1016/j.tjog.2018.02.023DOI Listing
April 2018

Clinical outcomes of detrusor underactivity in female with advanced pelvic organ prolapse following vaginal pelvic reconstructive surgery.

Neurourol Urodyn 2018 09 17;37(7):2242-2248. Epub 2018 Apr 17.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China.

Aim: To determine the impact of vaginal pelvic reconstructive surgery (PRS) on detrusor underactivity (DU) patients having advanced pelvic organ prolapse (POP).

Methods: A retrospective study of patients who underwent PRS for advanced POP (POP-Q ≥ 3) with DU. Data regarding preoperative evaluation, surgical procedure, and post-operative management were collated. Patients were considered to have DU when detrusor pressure at maximum flow (P Q ) was ≤10 cmH 0 and peak flow rate (Q ) of ≤12 mL/s. Post-operative values more than the cut-off were considered objectively cured. Subjective cure was defined as having a negative response to UDI-6 Question 5, "Do you experience difficulty emptying your bladder?"

Results: A total of 49 patients were evaluated. Majority of the population were post-menopausal and multiparous. Preoperatively, 38 patients (75%) had stage III prolapse and 13 patients (26%) had stage IV. Subjective cure rate of DU was 76% (37/49) and objective cure rate was 47% (23/49). Post-operative DU (P < 0.001) significantly improved together with patients having normal urodynamic diagnosis (P < 0.001). Voiding function showed significant increase in Q (P < 0.001) and P Q (P < 0.001) while PVR (P < 0.001) and cystometric capacity (P < 0.001) significantly decreased. These findings were observed in 89% (43/49) of patients with post-void residual urine (PVR) of <200 mL, 63% (31/49) with Q  > 12 mL/s, and 57% (28/49) with P Q  >10 cmH 0.

Conclusion: Reversal of short-term or long-term obstruction through vaginal pelvic reconstructive surgery enables bladders to regain detrusor muscle function. Although objective cure of DU was at 47%, detrusor function recovered in 57% of patients provided that mechanical obstruction was the cause.
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http://dx.doi.org/10.1002/nau.23576DOI Listing
September 2018