Cost analysis of four types of surgeries for pelvic organ prolapse in a Japanese population.

INTRODUCTION AND HYPOTHESIS: To compare the perioperative costs analysis between laparoscopic/transvaginal and the mesh/non-mesh surgeries for pelvic organ prolapse (POP) in Japan. MATERIALS AND METHODS: From April 2013 to April 2017, 890 patients who underwent POP surgeries were enrolled in this study. Regarding transvaginal native tissue repair (TV-NTR: transvaginal hysterectomy with colpocleisis), transvaginal mesh surgery (TVM), laparoscopic native tissue repair (L-NTR: laparoscopic hysterectomy and uterosacral ligament colposuspension), and laparoscopic sacrocolpopexy (LSC), a retrospective observational study was performed. Patients' age, operation time, blood loss, perioperative complications, length of hospital stay, pre-/postoperative quality of life (QOL) scores, were reviewed from the medical records. The net income, which was calculated by using the income (the operation/anesthesia fee) and the costs (the labor and consumables costs for operation/anesthesia), was evaluated. RESULTS: The operation fees of the L-NTR ($4250) and the LSC ($4833) groups were higher than that of the TV-NTR ($2652) and the TVM ($2913) groups. The labor costs and consumables costs of operation were higher in the LSC ($1589) and the L-NTR ($1500) groups than the TV-NTR ($180) and the TVM ($178) groups. The consumables costs for anesthesia in the four groups were equal. The operation hours were significantly shorter in the TV-NTR and the TVM groups than the L-NTR and the LSC groups. CONCLUSIONS: We found that TVM operation was an economically excellent and the most efficient POP operation with shorter operation time and less consumables.

Port-site metastasis after laparoscopic surgery for mature cystic teratoma.

In this case, a 27-year-old nulliparous woman with a pelvic multiple cystic mass was treated and found with ovarian mature cystic teratoma associated with port-site metastasis (PSM). Suspecting recurrence of mature cystic teratoma, a second laparoscopic surgery found a small mass, on the right under abdomen's peritoneal membrane, at the laparoscopic port sites of the initial operation. Pathological report of the peritoneal mass and left ovarian tumor confirmed a mature cystic teratoma. To the best of the authors' knowledge, this is the first reported PSM in associated with benign ovarian tumor.

Expression of p53 in endometrial polyps with special reference to the p53 signature.

We herein examined the significance of the p53 expression in endometrial polyps (EMPs). A total of 133 EMPs, including 62 premenopausal and 71 postmenopausal women with EMP, were immunohistochemically studied for the expression of estrogen receptor (ER)-alpha, Ki-67 and p53. Apoptotic cells were identified using a TUNEL assay. A DNA sequence analysis of TP53 exons 5 to 9 was performed. Among the premenopausal EMPs, a multivariate analysis showed the labeling index (LI) for Ki-67 to correlate significantly with that for p53 (P<0.001), but not that for apoptosis. On the contrary, among the postmenopausal EMPs, the LI for Ki-67 correlated significantly with that for apoptosis (P<0.001). The p53 signature (p53S) was defined by endometrial epithelial cells, which are morphologically benign in appearance but display 12 or more consecutive epithelial cell nuclei with strong p53 immunostaining. The p53S was found in nine (12.7%) postmenopausal EMPs (mean age: 70.2 years). The median Ki-67 index for the p53S was 7%, with no significant difference from that of the glands of the postmenopausal EMPs without the p53S (P=0.058). The median apoptotic index for the p53S was 0%, which was significantly lower than that of the postmenopausal EMPs without the p53S (P=0.002). Two of four p53Ss showed TP53 mutations according to the DNA sequence analysis. The presence of the p53S is not rare in postmenopausal EMPs with an advanced age. Among postmenopausal EMPs, the LI of Ki-67 significantly correlates with that of apoptosis. However, such a positive correlation between the LI of Ki-67 and apoptosis is not observed in p53S.

Retrospective study of tension-free vaginal mesh operation outcomes for prognosis improvement.

AIM: The aim of this study is to look at the weak points of tension-free vaginal mesh (TVM) operation for pelvic organ prolapse by reviewing recurrent cases. METHODS: Five hundred and twenty-six transobturator TVM operations were performed at the University of Occupational and Environmental Health hospital from August 2006 to December 2011. Thirty-seven patients with pelvic organ prolapse quantification (POP-Q) stage II or higher after their initial operations were diagnosed as recurrent and were enrolled in the present study. The patients' characteristics, procedures of the initial and second operations, and the recurrence rates in the pelvic organs were retrospectively reviewed. RESULTS: The median age, parity and body mass index of the patients were 66.5 years (range, 48-80), 2.2-times (range, 1-5) and 24.1 kg/m(2) (range, 17.6-32.1), respectively. The mean/median follow-up periods of the whole group were 29.7/35.9 months and the recurrent prolapse rate was 7.0% (37/526 cases). We performed reoperations in eight cases (8/526 cases; 1.5%). The median recurrent period after the initial operations was 6.9 months (range, 1-24). All recurrent cases showed severe prolapse with POP-Q stage III to IV before the initial operations. The uterus showed the most frequent recurrent prolapse after anterior posterior TVM or anterior TVM. CONCLUSION: Because the uterus is the most recurrent organ after TVM operations, TVM operations may not be sufficient for apical suspension.

Expression of estrogen receptor-α as a prognostic factor in patients with uterine serous carcinoma.

OBJECTIVES: Although the expression of estrogen receptor (ER) is usually found in uterine endometrioid adenocarcinomas, it has recently been reported to be found in some uterine serous carcinomas (USCs). This report describes the clinicopathologic features of USC with an expression of ER-α, with special reference to the prognostic significance of ER-α. METHODS: The immunohistochemical expression of ER-α was examined in 33 USCs. Greater than 10% staining was defined as an overexpression of ER-α. Cox univariate and multivariate analyses for USCs were performed. RESULTS: A total of 7 USCs (21.2%) exhibited an expression of ER-α. All tumors were pure-type USCs and strongly demonstrated an overexpression of p53. The cancer-specific 5-year survival rates of patients with USC without an expression of ER-α and USC with an expression of ER-α were 54.5% and 0.0%, respectively (P = 0.04). The univariate analyses showed an expression of ER-α to be a significant prognostic indicator in patients with USC (P < 0.05). However, multivariate analyses for USCs showed that the surgical stage was an independent prognostic factor, whereas the significance of ER immunoreactivity disappeared. CONCLUSIONS: Uterine serous carcinoma with an expression of ER-α was associated with advanced-staged tumors and a significantly worse prognosis than that without an expression of ER-α. When an endometrial biopsy specimen reveals USC with an expression of ER-α and an overexpression of p53, the presence of an extrauterine lesion is suggested.