The effect of body mass index on survival in advanced epithelial ovarian cancer.

Controversy remains regarding the effect of obesity on the survival of patients with ovarian cancer in Asia. This study examined the impact of obesity on the survival outcomes in advanced epithelial ovarian cancer (EOC) using Asian body mass index (BMI) criteria. The medical records of patients undergoing surgery for advanced (stage III and IV) EOC were reviewed. Statistical analyses included ANOVA, chi-square test, Kaplan-Meier survival and Cox regression analysis. Among all 236 patients, there were no differences in overall survival according to BMI except in underweight patients. In a multivariate Cox analysis, surgical optimality and underweight status were independent and significant prognostic factors for survival (HR, 2.302; 95% CI, 1.326-3.995; P=0.003 and HR, 8.622; 95% CI, 1.871-39.737; P = 0.006, respectively). In the subgroup of serous histology and optimal surgery, overweight and obese I patients showed better survival than normal weight patients (P = 0.012). We found that underweight BMI and surgical optimality are independent risk factors for the survival of patients with advanced ovarian cancer. High BMI groups (overweight, obese I and II) are not associated with the survival of advanced EOC patient. However, in the subgroup of EOC patients with serous histology and after optimal operation, overweight and obese I group patients show better survival than the normal weight group patients.

Detection of microRNA as novel biomarkers of epithelial ovarian cancer from the serum of ovarian cancer patients.

OBJECTIVE: MicroRNA (miRNA) is an abundant class of small noncoding RNAs that act as gene regulators. Recent studies have suggested that miRNA deregulation is associated with the initiation and progression of human cancer. However, information about cancer-related miRNA is mostly limited to tissue miRNA. The aim of this study was to find specific profiles of serum-derived miRNAs of ovarian cancer based on a comparative study using a miRNA microarray of serum, tissue, and ascites. METHODS: From 2 ovarian cancer patients and a healthy control, total RNA was isolated from their serum, tissue, and ascites, respectively, and analyzed by a microarray. Under the comparative study of each miRNA microarray, we sorted out several miRNAs showing a consistent regulation tendency throughout all 3 specimens and the greatest range of alteration in serum as potential biomarkers. The availability of biomarkers was confirmed by qRT-PCR of 18 patients and 12 controls. RESULTS: Out of 2222 kinds of total miRNAs that were identified in the microarray analysis, 95 miRNAs were down-regulated and 88 miRNAs were up-regulated, in the serum, tissue, and ascites of cancer patients. Among the miRNAs that showed a consistent regulation tendency through all specimens and showed more than a 2-fold difference in serum, 5 miRNAs (miR-132, miR-26a, let-7b, miR-145, and miR-143) were determined as the 5 most markedly down-regulated miRNAs in the serum from ovarian cancer patients with respect to those of controls. Four miRNAs (miR-132, miR-26a, let-7b, and miR-145) out of 5 selected miRNAs were significantly underexpressed in the serum of ovarian cancer patients in qRT-PCR. CONCLUSIONS: Serum miR-132, miR-26a, let-7b, and miR-145 could be considered as potential candidates as novel biomarkers in serous ovarian cancer. Also, serum miRNAs is a promising and useful tool for discriminating between controls and patients with serous ovarian cancer.

Circulating endothelial progenitor cells in gynaecological cancer.

OBJECTIVES: To compare the frequency and absolute numbers of circulating endothelial progenitor cells (EPCs) in healthy control subjects and patients with gynaecological cancer, and to test the hypothesis that cancer treatment lowers EPC numbers. METHODS: Patients with cervical or ovarian cancer and healthy control subjects provided peripheral blood samples for the isolation of mononuclear cells. EPCs were identified by quadruple immunofluorescence staining and flow cytometry as CD45(-)/CD34(+)/CD133(+)/vascular endothelial growth factor receptor 2 (VEGFR2)(+) cells. RESULTS: In total, 28 participants were enrolled. Circulating EPCs were present at higher frequencies (and in greater absolute numbers) in patients with cervical or ovarian cancer (n = 14) than in controls (n = 14). Concurrent chemoradiation therapy or surgery significantly reduced the frequency and number of EPCs in patients with gynaecological cancer, compared with pretreatment levels. CONCLUSIONS: EPC levels decline throughout cancer treatment; their measurement may therefore be a useful surrogate marker to monitor treatment response.

Assessment of cervical cancer screening policy in Korea for women over age 65.

OBJECTIVES: The purpose of this study was to evaluate the efficacy of cervical cancer screening (CCS) in Korean women over 65 years of age and to determine the age at which CCS becomes inefficacious, so that providers and policy makers can be more informed about when to stop screening. MATERIALS AND METHODS: The data of 999 women, who underwent CCS followed by colposcopy at the Korea University hospital from January 2007 to May 2012, were retrospectively evaluated. Age groups were classified as <21 (n=11), 21-29 (n=128), 30-65 (n=768), and >65 (n=92). To evaluate the value of CCS in women older than 65, age groups were simply divided into ≤ 65 or >65. Participants were also categorized into five strata of age groups (≤ 55 vs. >55, ≤ 60 vs. >60, ≤ 65 vs. >65, ≤ 70 vs. >70, and ≤ 75 vs. >75) that were compared to the sample to assess a cutoff-age at which to cease screening based on decreased efficacy. RESULTS: The mean age was 45.5 ± 13.7 (range 14-80). There were no differences in the pathologic results for cervical intraepithelial neoplasia (CIN) values of < CIN2 vs. ≥ CIN2, or ≤ CIN3 vs. cancer among the groups. There was a significantly higher incidence of cancer compared with ≤ CIN3 in women aged >65 (13.0%) vs. ≤ 65 (6.6%), (p=0.037). To assess the cervical cancer incidence (CCI) from the larger number of cases by age, a prediction formula was calculated from a national dataset. CCI (per 100,000) continuously increased by age even for those in their 90 s. CONCLUSION: CCS is still necessary in Korean women older than 65 since there is a substantial CCI rate occurring in these women. It is time to consider new guidelines that include the appropriate age and conditions for discontinuing screening.

The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity.

OBJECTIVE: To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure. DESIGN: Retrospective cohort study. SETTING: Gynecological oncology center. POPULATION: One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma. METHODS: The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut-off points to define appropriate cone depth. MAIN OUTCOME MEASURES: Cone depth to avoid endecervical margin involvement. RESULTS: Ninety-one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut-off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut-off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut-off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut-off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002). CONCLUSIONS: Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.

Candidates for tumor markers of cervical cancer discovered by proteomic analysis.

Cervical cancer is the second most common gynecological cancer among Korean women. While nationwide screening program has developed, the pathogenesis of cervical cancer is unknown. The aim of this study was to compare the protein expression profiles between cervical squamous carcinomas and normal cervical tissues in order to identify proteins that are related to the cancer. Three cervical cancer tissue samples and three normal cervical tissue samples were obtained and protein expression was compared and was identified in the samples with the use of matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). A total of 20 proteins that showed up-regulated expression in the cervical cancer tissue samples were selected and identified. Seven proteins were matched to allograft inflammatory factor 1 (AIF-1), actine-like protein 2 (ALP2), brain type fatty acid-binding protein (B-FABP), NCK adaptor protein 1 (NCK-1), islet cell autoantigen 1 (ICA69), cationic trypsinogen (PRSS1), and cyclin-dependent kinase 4 (CDK4), but the remaining 13 proteins were unidentifiable. After confirmation by RT-PCR, Western blotting and immunohistochemistry, we found that B-FABP, NCK-1, and CDK4 were related to the pathogenesis of cervical cancer. These proteins are suggested as candidates of new pathological tumor markers for cervical cancer.

Transvaginal single-port natural orifice transluminal endoscopic surgery for benign uterine adnexal pathologies.

Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option.

The relationship between fat depot-specific preadipocyte differentiation and metabolic syndrome in obese women.

OBJECTIVE: Obesity is strongly associated with metabolic syndrome, but not all obese individuals display a clustering of metabolic risk factors. Recent studies have shown that in vitro subcutaneous (SC)-preadipocyte differentiation is negatively associated with obesity. These results suggest that impaired adipogenesis is an important factor linking obesity to metabolic disorders. We examined whether in vitro preadipocyte differentiation is associated with metabolic syndrome, independent of obesity. DESIGN/PATIENTS/MEASUREMENTS: Paired adipose tissue samples were obtained from the 13 nonobese women and the 65 obese women. The CD34(+)/CD31(-) cells were isolated from the stromal-vascular fraction of both SC and omental (OM) fat depots by immune magnetic separation, and the subset was cultured with a differentiation cocktail. Then, we analysed the relationship between the degree of preadipocyte differentiation and metabolic factors. RESULTS: Obese women without metabolic syndrome (n = 37) had significantly higher SC-preadipocyte differentiation than equally obese women with metabolic syndrome (n = 28); however, OM-preadipocyte differentiation was similar in both groups. SC-preadipocyte differentiation was strongly correlated with triglycerides, HDL cholesterol, homoeostasis model assessment of insulin resistance and OM-adipocyte size. However, OM-preadipocyte differentiation was not correlated with any of these parameters. CONCLUSIONS: This study identified that SC-preadipocyte differentiation is associated with metabolic syndrome independent of obesity, whereas OM-preadipocyte differentiation is not. These findings suggest that, in the setting of obesity, an enhanced adipogenic capacity of SC depots could be protective for metabolic syndrome. Our data underscores an interaction between adipose tissue homoeostasis and metabolic disorder.

The relationship between blood mercury level and osteoporosis in postmenopausal women.

OBJECTIVE: Postmenopausal women have a higher prevalence of osteoporosis compared with premenopausal women. Postmenopause status has been found to be an independent risk factor for osteoporosis. Several studies have reported that heavy metals, including lead (Pb), mercury (Hg), cadmium (Cd), and arsenic (As), have detrimental effects on bone. The aim of this study was to evaluate the association among heavy metals, including Pb, Hg, Cd, and As, bone mineral density, and osteoporosis in postmenopausal Korean women. METHODS: We conducted a cross-sectional study of 481 postmenopausal women, all of whom were enrolled in the Korean National Health and Nutrition Examination Survey in 2008. Bone mineral density was measured using dual-energy x-ray absorptiometry. Blood Pb, Hg, and Cd and urinary As levels were measured. RESULTS: Postmenopausal women with higher blood Hg levels were more likely to be younger and have higher vitamin D levels, fish consumption, and prevalence of osteoporosis. On multivariate logistic regression analysis, postmenopausal women with blood Hg levels in the fourth quartile had a 0.36-fold decreased risk of having osteoporosis compared with those with levels in the first quartile, after adjustments for age, body mass index, alcohol intake, smoking history, exercise, use of oral contraceptive pills, hormone therapy, intake of caloric energy and calcium, fish consumption, and vitamin D level. However, there was no association between other heavy metals and osteoporosis. CONCLUSIONS: High blood Hg levels were associated with a lower risk of having osteoporosis in postmenopausal women. Because biomarkers of all four metals measured in this study reflect recent exposures, further studies are necessary to clarify the association of osteoporosis with the level of heavy metals in biomarkers for long-term exposure such as hair or fingernail.

Clinicopathologic characteristics of granulosa cell tumors of the ovary: a multicenter retrospective study.

OBJECTIVE: To evaluate the clinicopathologic characteristics and prognostic factors of ovarian granulosa cell tumors. METHODS: Medical records of 113 patients presenting between January 1995 and December 2007 were retrospectively reviewed. RESULTS: One-hundred two patients had adult type disease, with a mean age of 46.2 years (range, 18 to 83 years) and a mean follow-up period of 54.7 months (range, 1 to 155 months). The distribution of FIGO stages was 86 patients at stage I, 11 at stage II, and 5 at stage III. During follow-up, ten patients recurred at a mean time of 48 months (range, 4 to 109 months). Among them, three patients died after a mean of 57 months (range, 25 to 103 months). In recurrence analysis, advanced stage (p=0.032) and presence of residual disease (p=0.012) were statistically significant, and age<40 years, premenopause and positive washing cytology were marginally significant (p<0.1). In multivariate analysis, stage was the only factor associated with recurrence; adjuvant chemotherapy and fertility-sparing surgery were not statistically significant. Among 36 patients with fertility-sparing operations, eight patients had nine pregnancies and delivered seven babies. Eleven patients had juvenile type tumors; the mean age was 20.0 years (range, 8 to 45 years) and the mean follow-up period was 69.8 months (range, 20 to 156 months). The distribution of FIGO stage was nine patients at stage I and two at stage III. There were no recurrences or deaths reported. Four patients had seven pregnancies and delivered six babies. CONCLUSION: Stage is the only factor associated with disease-free survival, and fertility-sparing surgery may be a treatment option for women with early-stage disease who want to retain fertility.

Primary hepatoid adenocarcinoma of the endometrium with a high alphafetoprotein level.

Primary hepatoid adenocarcinoma of the endometrium is a rare tumour that is similar to hepatocellular carcinoma histologically. Here, a patient with primary hepatoid carcinoma of the endometrium with a high alphafetoprotein (AFP) level (90,508 ng/mL) is presented in a 75-year-old woman. The pelvic computed tomography and magnetic resonance imaging suggested a submucosal leiomyoma with degeneration or endometrial hyperplasia. However, the endometrial biopsy revealed a primary hepatoid carcinoma of the endometrium. The patient underwent a staging laparotomy including a total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymph node sampling with pelvic cytology. The AFP level can be highly elevated in hepatoid carcinoma of the endometrium.

Relationship between serum estradiol and follicle-stimulating hormone levels and urodynamic results in women with stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The purpose of the current study was to determine the relationship between the serum estradiol (E2) and follicle-stimulating hormone (FSH) levels and the urodynamic study results in women with stress urinary incontinence (SUI). METHODS: Eighty women were selected among patients who underwent urodynamic testing for SUI. Basic demographic features were evaluated and laboratory tests were performed. Multiple linear regression analyses were performed among the serum E2 and FSH levels and urodynamic results. RESULTS: E2 had a negative correlation with the Q-tip test in post-menopause. FSH had positive correlations with the post-void residual volume in the uroflowmetry and the voiding and flow times in the pressure-flow study in all of the patients and a negative correlation with the peak flow rate in the pressure-flow study in pre-menopause. CONCLUSIONS: E2 and FSH were associated with urodynamic parameters in female patients with SUI.

Open cornual resection versus laparoscopic cornual resection in patients with interstitial ectopic pregnancies.

OBJECTIVE: To compare laparotomy and laparoscopic management of interstitial ectopic pregnancies. STUDY DESIGN: The medical records of 109 patients diagnosed with interstitial ectopic pregnancies at the Korea University Medical Center, the Republic of South Korea, between January 1998 and October 2009 were reviewed retrospectively. Eighty-eight women were treated by open cornual resection or laparoscopic cornual resection. A case-controlled study was performed. The outcomes were operative time, length of hospital stay, estimated blood loss, blood transfusion, and complication. Nominal variables were analyzed by the Fisher's exact test or the χ(2) test. RESULTS: The frequency of cornual ectopic pregnancies was 4.31% at this medical center. In patients with a cornual resection, primary laparotomy was performed in 49 women and laparoscopy was performed in 39 women. Laparoscopy was converted to laparotomy in five patients. There were no statistically significant differences between the two groups for the mean operation time, estimated blood loss, blood loss of more than 1000 mL, blood transfusion requirements, and complications. The mean number of postoperative hospital days was shorter in the laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus 5.89 ± 1.86 days, respectively; P<0.001). CONCLUSION: Laparoscopic cornual resection is a safe and less invasive procedure with a reasonable complication rate and shorter hospital stay.

Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy.

BACKGROUND: To compare the vaginal route and laparoscopic suture for vaginal cuff closure (VCC) in patients undergoing a total laparoscopic hysterectomy (TLH). METHODS: A total of 471 women who required hysterectomy were allocated to two groups. 261 women had TLH via VCC by the vaginal route and 210 women had TLH via VCC by laparoscopic suture. All TLHs were performed by the same laparoscopic surgeon. RESULTS: The cuff-related complications included vaginal disruption (3.4%), dehiscence (1.27%), vaginal vault bleeding (1.91%), vaginal spotting (19.32%), granulation (1.27%), cuff infection (1.49%), and yellowish vaginal discharge (6.16%). No difference in vaginal cuff complications was found between the laparoscopic and vaginal approach. The median operation time was significantly shorter for the laparoscopic suture (76.74 min, range 40-220; 95% CI 74.84-83.45) than the vaginal route for VCC (85.77 min, range 45-290; 95% CI 86.87-95.36) after hysterectomy (p < 0.001). CONCLUSION: For VCC with TLH, laparoscopic suture was a safe and less time-consuming procedure. The cuff-related complications were similar in the two groups.

An unusual presentation of a severely calcified parasitic leiomyoma in a postmenopausal woman.

We report the case of a calcified parasitic leiomyoma in a 51-year-old postmenopausal woman with lower abdominal discomfort. She had no history of surgery. Workup confirmed a calcified leiomyoma. On laparoscopy, the mass was separate from the uterus and adhered to the bowel and bladder. Histopathological examination confirmed a calcified leiomyoma. A calcified parasitic leiomyoma in a postmenopausal woman is rare. Most prior cases were in persons with a history of a laparoscopic myomectomy. The diagnosis can be made by radiological findings. Laparoscopic excision is the treatment of choice in such cases.

Relationship between the serum CA-125 level and bone mineral density in healthy pre- and post-menopausal women.

BACKGROUND: Osteoporosis and tumour-associated antigen (TAA) levels are associated with inflammatory processes, but little remains known about TAA levels and bone mineral density (BMD). AIMS: We determined whether or not high-normal TAA levels are associated with a lower BMD in healthy women. METHODS: A total of 3769 healthy women were enrolled from the health screening programme over 5 years. Each participant had undergone a basic health examination. Serum carbohydrate antigen (CA)-125, CA-19-9, carcinoembryonic antigen (CEA) and alpha-fetoprotein levels were evaluated as tumour markers. The correlations between serum TAA levels and BMD were analysed. RESULTS: Carbohydrate antigen 125 and CEA levels were positively associated with a higher BMD in the pre-menopause. In the post-menopause, the CA-125 level was positively associated with BMD. In the pre-menopause, CA-125 (r = 0.102; P < 0.001) and CEA levels (r = 0.134; P < 0.001) had a significant correlation with BMD. In the post-menopause, CA-125 was negatively associated with alkaline phosphatase (r = -0.298; P < 0.001). CONCLUSIONS: There was a significant positive association between CA-125 and BMD in healthy women. Additional basic and clinical studies on the relationship between CA-125 and bone are needed.

Prenatally detected congenital perineal mass using 3D ultrasound which was diagnosed as lipoblastoma combined with anorectal malformation: case report.

We report a case of prenatally diagnosed congenital perineal mass which was combined with anorectal malformation. The mass was successfully treated with posterior sagittal anorectoplasty postnatally. On ultrasound examination at a gestational age of 23 weeks the fetal perineal mass were found on the right side. Any other defects were not visible on ultrasonography during whole gestation. Amniocentesis was performed to evaluate the fetal karyotyping and acetylcholinesterase which were also normal. As the fetus grew up, the mass size was slowly increased more and more. At birth, a female neonate had a perineal mass on the right side as expected. During operation, the anal sphincteric displacement was found near the mass and reconstructed through posterior sagittal incision. This is the first reported case of prenatally diagnosed congenital perineal mass, after birth which was diagnosed as lipoblastoma and even combined with anorectal malformation. This case shows that it can be of clinical importance to be aware of this rare fetal perineal mass in prenatal diagnosis and counseling.

Expression pattern of the class I homeobox genes in ovarian carcinoma.

OBJECTIVE: Although some sporadic reports reveal the link between the homeobox (HOX) genes and ovarian carcinoma, there is no comprehensive analysis of the expression pattern of the class I homeobox genes in ovarian carcinoma that determines the candidate genes involved in ovarian carcinogenesis. METHODS: The different patterns of expression of 36 HOX genes were analyzed, including 4 ovarian cancer cell lines and 4 normal ovarian tissues. Using a reverse transcription-polymerase chain reaction (RT-PCR) and quantification analysis, the specific gene that showed a significantly higher expression in ovarian cancer cell lines than in normal ovaries was selected, and western blot analysis was performed adding 7 ovarian cancer tissue specimens. Finally, immunohistochemical and immunocytochemical analyses were performed to compare the pattern of expression of the specific HOX gene between ovarian cancer tissue and normal ovaries. RESULTS: Among 36 genes, 11 genes had a different level of mRNA expression between the cancer cell lines and the normal ovarian tissues. Of the 11 genes, only HOXB4 had a significantly higher level of expression in ovarian cancer cell lines than in normal ovaries (p=0.029). Based on western blot, immunohistochemical, and immunocytochemical analyses, HOXB4 was expressed exclusively in the ovarian cancer cell lines or cancer tissue specimens, but not in the normal ovaries. CONCLUSION: We suggest HOXB4 may be a novel candidate gene involved in ovarian carcinogenesis.

Primary small cell carcinoma of the endometrium: report of a case with immunochemical studies.

BACKGROUND: Small cell carcinoma (SCC) is a well-known tumor that occurs predominantly in the lung. These tumors may also occur in the female genital tract, where it occurs most commonly in the cervix. Primary SCC of the endometrium is extremely rare. We report a case of an endometrial tumor that was a combination of an SCC and endometrioid adenocarcinoma with squamous components and that penetrated half of the thickness of the uterine wall. CASE: A 59-year-old, postmenopausal woman suffering from postmenopausal bleeding presented for care. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node dissection, followed by concurrent chemoradiotherapy. Immunohistochemical studies showed neuroendocrine differentiation with positive CD 56, chromogranin and synaptophysin markers. CONCLUSION: Immunohistochemical analyses are helpful in diagnosing and differentiating primary SCC of the endometrium from benign and malignant diseases of the endometrium.

Years from menopause-to-surgery is a major factor in the post-operative subjective outcome for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The purpose of the current study was to determine the main factors associated with post-operative subjective outcome in post-menopausal patients with pelvic organ prolapse. METHODS: Ninety-four women were selected among patients who underwent surgery for grade 3 or 4 prolapse. The outcome was evaluated by the Patient Global Impression of Improvement (PGI-I) scale. Multivariate ordinal regression analysis was performed. RESULTS: The number of patients with improvement (1 or 2 on the PGI-I scale) was 88 (93.7%). Age and years from menopause-to-surgery were negatively (beta = -0.16, P = 0.01) and positively (beta = 0.14, P = 0.01) associated with the PGI-I scale. The aging effect was lost after adjusting for prolapse grade. CONCLUSION: The greater the number of years from menopause-to-pelvic organ prolapse surgery, the less satisfied were the patients. The association between older patients and greater satisfaction appears to be a confounding effect of prolapse grade.