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

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

Alteration of elastin metabolism in women with pelvic organ prolapse.

PURPOSE: Although there are many studies about the effects of vaginal birth, the effects of menopause on pelvic floor support have not been identified. We compared elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse, and defined the menopausal regulation of this process. MATERIALS AND METHODS: The study group consisted of 35 women who underwent hysterectomy for pelvic organ prolapse. The control group consisted of 39 women without pelvic organ prolapse. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of mRNA, and protein for neutrophil elastase, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by real-time quantitative polymerase chain reaction and ELISA, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin, an inhibitor of neutrophil elastase, was also determined. ANOVA, the Kruskal-Wallis test and multivariate linear regression were used for statistical analysis. RESULTS: Expression of neutrophil elastase and matrix metalloproteinase-2 mRNA was higher in women with pelvic organ prolapse than in those without pelvic organ prolapse. Compared to before menopause, neutrophil elastase and matrix metalloproteinase-2 showed a significant decrease in postmenopausal women without pelvic organ prolapse, although these remained increased in postmenopausal women with pelvic organ prolapse. Alpha-1-antitrypsin was significantly less in postmenopausal women with pelvic organ prolapse than in postmenopausal women without pelvic organ prolapse. The activities of neutrophil elastase, matrix metalloproteinase-2 and matrix metalloproteinase-9 were increased in women with pelvic organ prolapse, and these trends were similar to neutrophil elastase and matrix metalloproteinase-2 expression even after adjustment for age, parity and menopausal status. CONCLUSIONS: After menopause increased elastolytic protease has a significant role in the development of pelvic organ prolapse.

Risk factors associated with voiding dysfunction after anti-incontinence surgery.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to investigate the risk factors of voiding dysfunction occurring within 1 month after surgical treatment of urinary incontinence. METHODS: Medical records of 903 women who underwent anti-incontinence surgery at Yonsei Medical Health System from January 1999 to April 2007 were reviewed. The patient demographics, urodynamic parameters, pelvic organ prolapse stage, surgical procedures, and concomitant surgery were retrospectively evaluated. Postoperative voiding dysfunction was defined as post-void residual urine measuring greater than 100 cc at two or more successive trials. RESULTS: Age, menopausal status, maximum flow rate, average flow rate, post-void residual, anti-incontinence surgery type, stage of pelvic organ prolapse, and concomitant prolapse surgery were associated predictors of voiding dysfunction after anti-incontinence surgery. In multivariate analysis, concomitant anterior colporrhaphy (OR 2.4; 95% CI 1.38-4.11) was the only independent risk factor. CONCLUSIONS: The most important risk factor associated with voiding dysfunction was concomitant anterior colporrhaphy.

The relationship between COL3A1 exon 31 polymorphism and pelvic organ prolapse.

PURPOSE: We investigated the role of COL3A1 exon 31 polymorphism (a single base substitution from guanine to adenine at +2092), resulting in the replacement of alanine with threonine at the 698th amino acid of COL3A1, in the pathogenesis of pelvic organ prolapse. MATERIALS AND METHODS: A total of 72 postmenopausal Korean women who were not on hormonal replacement therapy and who had a history of vaginal childbirth were enrolled in this study. The patient group consisted of 36 women diagnosed with stage II or greater pelvic organ prolapse irrespective of urodynamic stress incontinence. The control group consisted of 36 healthy volunteers with pelvic organ prolapse quantification system stage 0 or I disease without urodynamic stress incontinence. After extracting the genomic DNA from peripheral blood leukocytes the polymorphism of exon 31 of COL3A1 was typed by restriction fragment length polymorphism (Alu I restriction fragment length polymorphism) and confirmed by direct sequencing. RESULTS: Frequency of the G allele was significantly higher in patients with pelvic organ prolapse than in controls (0.8 vs 0.6, p = 0.002). In women with the G allele the OR for pelvic organ prolapse was 3.2 (95% CI 1.4-7.3). CONCLUSIONS: COL3A1 exon 31 polymorphism may have a role in determining the risk of pelvic organ prolapse in women with risk factors such as aging, vaginal childbirth and hypoestrogenism.

Preoperative maximum urethral closure pressure and valsalva leak point pressure as predictive parameters for midurethral sling.

OBJECTIVE: To evaluate the efficacy of tension-free vaginal tape (TVT) and transobturator tape (TOT) according to urethral function based on a preoperative urodynamic study (UDS). STUDY DESIGN: Preoperative Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP) were compared with the actual surgical outcome, and patients were followed for > 1 year. Student's t test, chi2 test, multiple regression analysis and receiver operating character curve analysis were used for statistical analysis. Of the 437 patients, 225 received TVT and 212 patients received TOT. RESULTS: Age, parity, body mass index, menopausal status, hormone replacement therapy and previous surgical history showed no significant difference between the groups. Advanced pelvic organ prolapse, concomitant hysterectomy and vault suspension were more common in the TOT group, whereas concomitant anterior colporrhaphy was more common in the TVT group. The treatment outcome of TVT was not associated with VLPP and MUCP. However, cutoff values of VLPP > or = 72.5 cm H2O and MUPC > or = 42 cm H2O were most predictive of successful surgical outcomes in TOT group, revealing a sensitivity of 95.7% and a positive predictive value of 98.4%. CONCLUSION: Preoperative MUCP and VLPP can predict the treatment outcome of TOT but not TVT.

Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency.

OBJECTIVE: The aim of this study was to compare the treatment outcome of 3 sling procedures for stress urinary incontinence with intrinsic sphincter deficiency. STUDY DESIGN: This retrospective study included 253 patients who underwent incontinence surgery (pubovaginal sling [PVS] = 87, tension-free vaginal tape [TVT] = 94, and transobturator tape [TOT] = 72) for urodynamic stress incontinence with intrinsic sphincter deficiency. Analysis of variance, chi(2) test, Fisher's exact test, Kaplan-Meier survival analysis, and Cox proportional hazard regression were used for statistical analysis. RESULTS: Overall complication rates were not significantly different. At 2 years postoperatively, the cumulative cure rates of the PVS, TVT, and TOT groups were significantly different (87.25%, 86.94%, and 34.89%, respectively; P < .0001). The risk of treatment failure in women who received TOT was 4.6 times higher than in women who underwent PVS. The 7-year cumulative cure rates of PVS and TVT groups were 59.10% and 55.09%, respectively. CONCLUSION: PVS and TVT were more efficacious, but the long-term cure rates were low.

Surgical therapeutic index of tension-free vaginal tape and transobturator tape for stress urinary incontinence.

BACKGROUND/AIMS: The aim of this study was to obtain the surgical therapeutic index (STI) of tension-free vaginal tape (TVT) and transobturator tape (TOT) and compare it with the previously obtained result of Burch colposuspension. METHODS: The study population consisted of 121 patients who were diagnosed as having stress urinary incontinence, underwent TVT or TOT between January 1, 2000 and June 30, 2005 and were followed up for at least 1 year. Patients with detrusor overactivity, urinary tract infection, intrinsic sphincter deficiency and pelvic organ prolapse more than stage II according to the POP-Q system were excluded. The cure and complication rates were investigated, and the STI (median percent cure rate/median percent complication rate) of each operation was calculated. RESULTS: Of the 121 patients, 61 underwent TVT and 60 received TOT. Patient characteristics and the results of preoperative urodynamic studies showed no significant difference between the two groups. The STI of TOT (2.72, 4.08, 4.23, 5.29) was higher than that of Burch colposuspension (1.19, 2.27, 2.89, 3.53) and TVT (2.77, 3.69, 3.23, 3.17) irrespective of follow-up months (at 1, 3, 6, 12 months). CONCLUSION: TOT seems to be a more suitable surgical procedure for stress urinary incontinence with urethral hypermobility.

Risk factors for the recurrence of pelvic organ prolapse.

BACKGROUND/AIMS: To investigate the risk factors for the recurrence of prolapse after traditional pelvic reconstructive surgery. METHODS: The medical records of 212 patients who received traditional restorative reconstructive surgeries for symptomatic pelvic organ prolapse from March 1999 to April 2006 were retrospectively analyzed. Recurrence was defined as any prolapse of stage II or greater according to the Pelvic Organ Prolapse Quantification system. The log-rank test and Cox regression of the Kaplan-Meier survival analysis were used in univariate analysis, and the Cox proportional hazard model was used in multivariate analysis. RESULTS: The median follow-up period was 24 (range 1-84) months and the number of patients suffering from recurrence was 36 (17.0%). Age, parity, repetitive heavy lifting/chronic constipation, family history, hormone replacement therapy status, and preoperative stage all had an influence on the outcome, although preoperative stage IV was the only independent risk factor (hazard ratio (HR) 5.6, 95% CI 1.1-29.3, p = 0.044). Analyzing by compartments, preoperative stage IV (HR 18.6, 95% CI 2.1-162.3, p = 0.018) was an independent risk factor for the recurrence in anterior compartment, not for posterior or apical. CONCLUSIONS: Patients with a far advanced preoperative stage (stage IV), especially in cases of anterior prolapse, are more likely to experience a recurrence after traditional reconstructive surgery.

Implication of ADAM-8, -9, -10, -12, -15, -17, and ADAMTS-1 in implantational remodeling of a mouse uterus.

In the present study, whether the ADAM-8, -9, -10, -12, -15, -17, and ADAMTS-1 proteins might play a role in mouse uterus during periimplantation period was investigated. Immunoblotting analyses demonstrated that all ADAM proteins consistently appeared throughout days 1 to 8 of pregnancy but with a variation depending on the species of ADAM gene, the progression of pregnancy, and the site of the uterus. Immunohistochemical analyses indicated that ADAM proteins were localized in the luminal or glandular epithelial layers with a varying intensity depending on the species of ADAM and the progression of pregnancy. Particularly ADAM-8, -12, and -15, were predominantly located in the implantation site of the uterine tissues, whereas little or no protein was localized in the interimplantation site. Based upon these observations, it is suggested that the ADAMs might play an important role in the remodeling of the mouse uterus during the periimplantation period.

The relationship between maximal urethral closure pressure and functional urethral length in anterior vaginal wall prolapse patients according to stage and age.

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n = 13), 50s (n = 53), 60s (n = 54), and 70 and over (n = 16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n = 35), stage III (n = 76), and stage IV (n = 25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.

A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients.

This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.

The significance of bladder trabeculation in the female lower urinary system: an objective evaluation by urodynamic studies.

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.

Analysis of the success rates of Burch colposuspension in relation to Valsalva leak-point pressure.

OBJECTIVE: To compare the success rates of Burch colposuspension in relation to a Valsalva leak-point pressure (VLPP) cutoff level of 60 cm H2O and to examine other predictive factors for intrinsic sphincter deficiency, such as maximal urethral closure pressure (MUCP) and functional urethral length (FUL), in an attempt to define the urodynamic contraindications to Burch colposuspension. STUDY DESIGN: From March 1999 to February 2001, among patients who had undergone Burch colposuspension after being diagnosed as having stress urinary incontinence at the Yonsei University Medical Center Urogynecology Clinic, 79 patients eligible for continuous postoperative follow-up were enrolled in the study. Patients with past histories of hysterectomy and/or incontinence surgery were excluded from the study, and all patients included in the study had pelvic organ prolapse stage II or less. Urodynamic studies were performed as a preoperative evaluation, and recurrence of stress urinary incontinence after surgery was diagnosed through thorough history and meticulous urodynamic evaluations. RESULTS: The mean age was 57.66 +/- 9.99 years, mean parity was 3.71 +/- 4.38, menopausal rate and mean age at menopause were 81.0% (64 of 79) and 50.31 +/- 4.60 years, respectively, and the proportion of patients receiving hormone replacement therapy was 10.1% (8 of 79). The success rates in 2 groups, VLPP > or = 60 cm H2O (n=55) and < 60 cm H2O (n=24) were 94.55% and 91.67%, respectively, demonstrating no statistical significance (p > 0.05). The MUCP and FUL values were within normal ranges in both groups (MUCP, 66.98 +/- 24.04 versus 66.23 +/- 22.89 cm H2O, p>0.05; and FUL, 36.33 +/- 7.31 versus 38.71 +/- 8.54 mm, p > 0.05), without a significant difference. The Pearson correlation coefficients for VLPP versus MUCP and VLPP versus FUL were 0.50 (p < 0.001) and 0.57 (p < 0.001), respectively, demonstrating a significant positive correlation. CONCLUSION: A VLPP level < 60 cm H2O does not represent an absolute contraindication to Burch colposuspension, provided that other parameters, such as MUCP and FUL, are within acceptable ranges. To select appropriate candidates for Burch colposuspension, a comprehensive evaluation of urodynamic parameters is mandatory.

NGF and HB-EGF: potential biomarkers that reflect the effects of fesoterodine in patients with overactive bladder syndrome.

PURPOSE: To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. MATERIALS AND METHODS: This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. RESULTS: Urinary levels of NGF/Cr (OAB: 1.13±0.9 pg/mg; control: 0.5±0.29 pg/mg) and HB-EGF/Cr (OAB: 8.73±6.55 pg/mg; control: 4.45±2.93 pg/mg) were significantly higher in subjects with OAB than in controls (p<0.001). After 16 weeks of fixed-dose fesoterodine treatment, urinary NGF/Cr levels (baseline: 1.13±0.08 pg/mg; 16 weeks: 0.60±0.4 pg/mg; p=0.02) and HB-EGF/Cr levels significantly decreased (baseline: 8.73±6.55 pg/mg; 16 weeks: 4.72±2.69 pg/mg; p=0.03, respectively). Both the OABSS and OAB q scores improved (p<0.001). However, there were no a statistically significant correlations between these urinary markers and symptomatic scores. CONCLUSION: Urinary levels of NGF and HB-EGF may be potential biomarkers for evaluating outcome of OAB treatment. Fixed-dose fesoterodine improved OAB symptoms. Future studies are needed to further examine the significance of urinary NGF and HB-EGF levels as therapeutic markers for OAB.

Expression of integrins, cyclooxygenases and matrix metalloproteinases in three-dimensional human endometrial cell culture system.

The objective of this investigation was to establish a three-dimensionally cultured human endometrium which could be used as a tissue model for the mechanism study of implantation in vitro. By using human endometrial stromal (ES) and epithelial cells (EE) from hysterectomy specimens, reconstruction of endometrium in culture was established by first layering a collagen gel containing ES cells, then overlaying with the Matrigel containing endometrial epithelial (EE) cells. Ultrastructural examination of the 48 h-endometrial cell culture revealed monolayered columnar EE cells with microvilli on the collagen layer containing ES cells and appearance of the tight junctions and desmosomes between EE cells, a cell layer closely resembling the native endometrium. Immunohistochemical characterization of the reconstructed endometrium showed a strong immunoreactivity for cytokeratin, integrin alpha1, alpha4 and beta3 subunits, cyclooxygenases-1 and -2, matrix metalloproteinases-1, -2, -3 and -9, and tissue inhibitor of metalloproteinases-1 and -2 in the EE cells comparable to the native endometrial epithelium. ES cells also showed stronger immunoreactivity for cyclooxygenases, integrins and MMPs, but less for cytokeratin. Gelatin zymographic analyses of the media obtained from the reconstructed endometrium model showed gelatinase activity bands at 57, 60, 72, 92 and 97 kDa molecular weight, respectively. The present study provides a possibility that our three-dimensionally cultured endometrium model could mimic the morphological and functional characteristics of the native endometrium. The model could be used to clarify the roles of various molecules involved in the human implantation.

Lifetime expression of stem cell markers in the uterine endometrium.

OBJECTIVE: To identify stem cells in uteri from the fetal to the postmenopausal period. DESIGN: Descriptive, controlled study. SETTING: Tertiary academic medical center. PATIENT(S): Forty archived uterine endometrial samples. INTERVENTION(S): Immunohistochemistry with c-kit/CD117, CD34, bcl-2, and Ki67. MAIN OUTCOME MEASURE(S): Immunostaining. RESULT(S): C-kit/CD117, CD34, bcl-2, and Ki67 were consistently expressed in the stroma of the basalis layer. Bcl-2 was restricted to the fetal uterine endometrium. CONCLUSION(S): By studying the immunolocalization of stem cell markers (i.e., c-kit, CD34, and bcl-2), we found that stem cells are present continuously in the uterine endometrium from the fetal period. The cells seem to be located mainly in the stroma of the basalis and to be independent of hormonal regulation to avoid cyclic shedding. A small number of latent stem cells dormant in the stroma of the basalis were found to have the potential for mesenchymal differentiation.

Selective processing of a follicular matrix metalloproteinase-2 isoform by human oviducal fluid.

The present study demonstrates that a unique isoform of matrix metalloproteinase (MMP)-2 present in human follicular fluid (FF) can be processed selectively by human oviducal fluid (OF). A gelatin zymogram of untreated FF showed distinct 88-, 84- and 62-kDa gelatinases. Treatment of FF with EDTA resulted in the appearance of 110-kDa gelatinase (GA110). Most gelatinases, except for the 88- and 84-kDa gelatinases, were abolished by pretreatment with EDTA or phenanthroline, but not by pretreatment with a serine/threonine protease inhibitor. When EDTA-pretreated FF was mixed with OF, the GA110 of the FF was specifically reduced. The reduction in GA110 was dependent upon the amount of OF protein and the incubation period after mixing. Treatment of FF with aminophenylmercuric acetate reduced GA110 activity, but this reduction was accompanied by a concomitant increase of 62-kDa gelatinase activity. Anti-human MMP-2 antibody strongly reacted with both GA110 and 62-kDa gelatinases of FF, but only GA110 immunoreactivity was abolished when FF was mixed with OF. The results suggest that the GA110 of FF is an MMP-2 isoform that can be processed selectively by OF.

Relationship between urinary endogenous steroid metabolites and lower urinary tract function in postmenopausal women.

To investigate the relationship between the endogenous steroid hormones and the lower urinary tract function in postmenopausal women. Thirty postmenopausal volunteer women who did not have lower urinary tract symptoms or hormone replacement therapy were enrolled in this study. Urodynamic studies included uroflowmetry, multi-channel cystometry, and urethral pressure profilometry were conducted. Gas Chromatography- Mass Spectroscopy(GC-MS) was used to measure the urinary endogenous steroid hormone metabolites. The relationship between the urinary profile of the endogenous steroids and the urodynamic parameters of these patients were investigated. The mean ages of the patients were 60.6 +/- 5.5 years, and the Body Mass Index (BMI) averaged 24.56 +/- 2.23 (kg/m2). Of the progesterone metabolites, pregnandiol was significantly related to the residual volume in the uroflowmetry and the functional urethral length parameters (R=0.98, p=0.000; R= -0.65, p=0.04). Pregnantriol was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.64, p=0.04; R=0.82, p=0.01; R=0.04, p=0.04; R=- 0.79, p=0.01). In the androgen metabolites, androstenedione, 5-AT, 11- keto Et, 11-betahydroxy Et, THS, and THE were significantly related to the residual volume in uroflowmetry (R=0.92, p=0.001; R=0.84, p=0.008; R=0.99, p=0.000; R=0.72, p=0.03; R=0.97, p=0.000; R=0.85, p=0.00). beta-THF/alpha-THF was significantly related to the maximum flow rate, the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=-0.76, p=0.02; R=0.67, p=0.04; R=0.74, p=0.02; R=-0.92, p=0.000). alpha-cortol was significantly related to the residual volume in uroflowmetry, the maximum urethral closure pressure and the functional urethral length (R=0.81, p=0.01; R=0.71, p=0.03; R=-0.87, p=0.000). Of the estrogen metabolites, estrone (E1) was significantly related to the normal desire to void (R=0.68, p=0.04) and 17beta-estradiol/estrone was also significantly related to the normal and strong desire to void (R=-0.70, p=0.03 and R=-0.74, p=0.02, respectively). The urinary progesterone and androgen metabolite concentrations were positively related to the residual volume in uroflowmetry and positively or negatively related to MUCP and FUL. However, the urinary estrone concentration was positively related to the normal desire to void and 17beta-estradiol/estrone was significantly related to the normal and strong desire to void.

The effect of pelvic organ prolapse on lower urinary tract function.

Pelvic organ prolapse (POP) is a process in which the pelvic contents, including the reproductive organ, bladder, rectum, and/or small intestines become herniated through defects in the vaginal wall. The pelvic organs are closely related to the urinary tract and thus various urinary functions can be affected. The purpose of this study was to evaluate the relationship between pelvic organ prolapse and lower urinary tract function by urodynamic studies. From March 1999 to May 2000, 40 patients with pelvic organ prolapse who underwent urodynamic studies (uroflowmetry, filling cystometry, urethral pressure profile) without barrier reduction of prolapse were analyzed. The majority of the cases of low grade POP involvedpatients with anterior wall prolapse, whereas the higher POP stages were more frequent in women with cervical cuff prolapse. Symptoms of stress urinary incontinence and hesitancy were more frequent in the patients with anterior wall prolapse. The urodynamic study showed a statistically significant increase in MUCP in patients with POP stage IV and the leading point of POP was cervical cuff. The subjective urinary symptoms of patients with POP appear to be less reliable as a diagnostic tool. POP had no adverse effect on the bladder storage function. However, POP affected the voiding function through an increase in MUCP, especially in patients with stage IV prolapse and when the leading point of POP was cervical cuff. Following the surgical correction of POP, an evaluation of the preoperative changes in the urodynamic study parameters should be performed.

Comparison of outcomes between Burch colposuspension with and without concomitant abdominal hysterectomy.

A total abdominal hysterectomy may cause a postoperative vesicourethral dysfunction due to an injury to the pelvic nerves. However, many incontinent women with benign diseases of the uterus and its adnexae have undergone a Burch colposuspension with a concomitant abdominal hysterectomy. This study was undertaken to compare the outcomes of a Burch colposuspension performed alone with that of a Burch with a concomitant abdominal hysterectomy. This study included 132 women, who, were treated for primary urinary incontinence from February 1999 to February 2002 and were diagnosed with stress urinary incontinence by means of the urodynamic test at the Department of Obstetrics and Gynecology at Yonsei University Hospital. Forty-two women underwent a Burch colposuspension alone (Burch group) and 90 women underwent a Burch colposuspension with a concomitant abdominal hysterectomy (hysterectomy group). Between the Burch and hysterectomy groups, the mean age, parity, menopausal rate, Hormone Replacement Therapy (HRT) rate, 1 year follow-up outcomes and postoperative complications were compared using the subjective and objective stress tests according to the retrospective chart review. The mean age (54.6 +/- 0.5 vs 58.6 +/- 9.2 years, p=0.382), parity (3.3 +/- 1.2 vs 3.6 +/- 1.7), menopausal rate (71.4 vs 77.7%), or HRT rate (23.3 vs 11.2%) of the two groups were similar. Complications related to surgery were encountered in 5 patients (11.9%) in the Burch group and in 7 patients (7.8%) in the hysterectomy group (p=0.842). One year follow-up subjective symptoms were encountered in 2 patients in the Burch group and in 4 patients in the hysterectomy group (p=1.00). The stress test was positive in only one patient in the hysterectomy (p=1.00). No significant difference was observed in the 1 year follow-up outcomes, which were 91.4% (32/35 patients) in the Burch and 91.2% (73/80) in the hysterectomy groups. The results showed that there were no adverse effects on the 1 year follow-up outcomes or complications in patients who underwent a Burch colposuspension with an abdominal hysterectomy.