Impact of mirabegron versus solifenacin on autonomic function and arterial stiffness in female overactive bladder syndrome: a randomized controlled trial.

The study aims to elucidate the impact of mirabegron versus solifenacin on autonomic function and peripheral arterial conditions in women with overactive bladder syndrome (OAB). All consecutive women with OAB were randomized to receive 12 weeks of mirabegron 25 mg or solifenacin 5 mg once per day. Heart rate variability, cardio-ankle vascular index, ankle-brachial pressure index, blood pressure, and heart rate were compared between the two groups. There were 87 women (mirabegron, n = 43; and solifenacin, n = 44) who completed 12-week treatment and underwent heart rate variability examination. Systolic blood pressure (median: - 4.5 to - 5.5 mmHg) and diastolic blood pressure (median: - 0.5 to - 3.5 mmHg) decreased after solifenacin treatment, and heart rate (median: + 2 bpm) increased after mirabegron treatment, despite of no between-group difference. In addition, posttreatment heart rate variability, cardio-ankle vascular index, and ankle-brachial pressure index did not differ compared with baseline; and there were no between-group differences. In conclusion, solifenacin might decrease blood pressure, and mirabegron might increase heart rate. Nonetheless, there were no significant impacts of 12-week mirabegron versus solifenacin treatment on autonomic function and arterial stiffness.

Predictors of Clinical Outcome in Women with Pelvic Organ Prolapse Who Underwent Transvaginal Mesh Reconstruction Surgery.

Background and Objectives: To identify the predictors of clinical outcomes in women with pelvic organ prolapse (POP) who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation. Materials and Methods: All women with POP who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation, were reviewed. Results: Between January 2011 and May 2019, a total of 206 consecutive women were reviewed, including 68 women receiving POP reconstruction with transobturator mesh fixation and 138 women who underwent POP reconstruction with sacrospinous mesh fixation. The least experienced surgeon (hazard ratio = 804.6) and advanced stage of cystocele (hazard ratio = 8.80) were the predictors of POP recurrence, especially those women with stage 4 of cystocele. Young age (hazard ratio = 0.94) was a predictor for mesh extrusion, especially those women with age ≤67 years. Follow-up interval (odds ratio = 1.03, p = 0.02) was also an independent predictor of mesh extrusion. High maximum flow rate (Qmax, hazard ratio = 1.03) was the sole predictor of postoperative stress urinary incontinence, especially those women with Qmax ≥19.2 mL/s. Preoperative overactive bladder syndrome (hazard ratio = 3.22) were a predictor for postoperative overactive bladder syndrome. In addition, overactive bladder syndrome rate improved after surgery in the sacrospinous group (p = 0.0001). Voiding dysfunction rates improved after surgery in both sacrospinous and transobturator groups. Conclusions: Predictors of clinical outcome in women who underwent transvaginal POP mesh reconstruction are identified. The findings can serve as a guide for preoperative consultation of similar procedures.

Optimizing Laparoscopically Extracorporeal Knot Tying Using a Novel Pusher Device.

The aim of this study was to evaluate the efficacy and feasibility of a novel pusher device for performing extracorporeal knot tying. Each of the 3 laparoscopists randomly performed 10 device-assisted double sheet bends (the device group), ten 4s modified Roeder sliding knots (the sliding group), and 10 laparoscopic traditional extracorporeal static surgeon's knots (the static group). All knots and 5 unknotted threads were measured for strength. The device group had higher knot strength, lower knotting failure rate, and shorter knotting time compared with the sliding group. The knot strengths of the successful knots in the device group were consistent with those obtained in the static group, and higher than the sliding group. Our laparoscopic novel pusher device should be an effective device in assisting knot tying with the advantages of steady and strong knot strength, lower failure rate, and shorter knotting time.

Impact of clinical audits on cesarean section rate.

OBJECTIVE: Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR. MATERIALS AND METHODS: We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups. RESULTS: The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p < 0.001) were significantly lower in the audit group than the pre-audit group. However, there was no significant difference in the rate of operative vaginal delivery between groups. Consensus on the unnecessity for cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p < 0.05). Most variables of maternal and perinatal morbidity and mortality did not differ before and after audits were implemented. CONCLUSION: Clinical audits appear to be an effective strategy for reducing the CSR. Therefore, we recommend strict monitoring of the indications in dystocia for cesarean section to reduce the CSR.

Safety and efficacy of manual syringe infusion of distending media for hysteroscopic procedures: a case-control study.

OBJECTIVES: Adverse events associated with large volumes of distending media in hysteroscopic procedures can be life-threatening. The aim of this study was to evaluate the safety and efficacy of manual syringe infusion (MI) of distending media for hysteroscopic procedures. STUDY DESIGN: Between January 2011 and December 2013, the medical records of all women who underwent hysteroscopic procedures using MI or the conventional pump-infusion method (PI, the control group) were reviewed. The Wilcoxon rank-sum test, the Chi-square test and the multivariate logistic regression analysis were employed for statistical analysis. RESULTS: The MI group (n=82) had a significantly lower average volume of infused fluid (1117 ± 712 mL vs. 2216 ± 1502 mL, respectively; p<0.001), less operative time (22.2 ± 9.7 vs. 30.4 ± 9.8 min, respectively; p<0.001) and lower postoperative abdominal pain scores (0.6 ± 0.7 vs. 0.8 ± 0.7, respectively; p=0.04) than the PI group (n=58). Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737 ± 905 mL vs. 3441 ± 1952 mL, respectively; p=0.001). Infused fluid amount (coefficient=0.08, p<0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1. CONCLUSION: The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures.

Modified novel technique for improving the success rate of applying seprafilm by using laparoscopy.

STUDY OBJECTIVE: To describe a modified surgical procedure for applying the adhesion barrier Seprafilm laparoscopically. DESIGN: Retrospective analysis with videos and illustrations showing laparoscopic application of Seprafilm. SETTING: University hospital. PATIENTS: Women undergoing fertility-sparing laparoscopic surgery (myomectomy, endometriotic ovarian cyst or dermoid cyst enucleation, and tuboplasty) via a modified technique. INTERVENTION: Two layers of Seprafilm with plastic covering were rolled together and delivered through a 10-mm trocar, and an irrigation tube was used to moisten the Seprafilm and cover the irregular postoperative rough surface of the organ. After application of Seprafilm, the patient was placed in a reverse Trendelenburg position to check whether the Seprafilm remained in situ on the target surgical surface to act as a physical barrier to adhesion development. MEASUREMENTS AND MAIN RESULTS: After changing the patient's position, illustrations and videos showed that the Seprafilm remained on the postoperative surgical surface, creating a site-specific physical barrier. On day 4 after myomectomy, second-look laparoscopy in 2 patients showed that the Seprafilm had become gel-like and remained between the intestine and posterior rough surface of the uterus. There were no systemic second-look laparoscopic data. CONCLUSION: It is feasible and easier to apply Seprafilm adhesion barrier laparoscopically using the modified technique. Further studies are warranted to prove its efficacy after such use.

Comparison of robot-assisted laparoscopic myomectomy and traditional laparoscopic myomectomy.

AIM: The benefit of robot-assisted laparoscopic myomectomy (RALM) over traditional laparoscopic myomectomy (TLM) remains undetermined. The aim of this study was to reveal any potential advantage of RALM over TLM. MATERIAL AND METHODS: Between June 2010 and October 2011, all women presenting with symptomatic uterine myomas were enrolled in this study. Perioperative variables were compared between these two groups. The patients recruited in this study were allocated into the two groups based on their financial considerations. RESULTS: A total of 42 patients received RALM (n = 20) or TLM (n = 22) for symptomatic uterine myomas. The operation time was longer in the RALM group; but the total abdominal drainage amount on postoperative day 1 was significantly less in the RALM group than the TLM group. Multivariate analysis revealed that the RALM procedure (coefficient = 79.1, P < 0.001), number of myomas (coefficient = 15.4, P = 0.002), and the presence of a cervical myoma (coefficient = 54.9, P = 0.01) were independent factors affecting operation time; the maximum myoma diameter was the only factor affecting blood loss (coefficient = 113.4, P = 0.003). However, the RALM procedure was the only factor affecting the amount of abdominal drainage on postoperative day 1 (coefficient = -86.3, P = 0.006). CONCLUSIONS: Although RALM is a longer operation than TLM, it might result in less postoperative abdominal drainage than TLM and help alleviate short-term morbidity.

Laparoscopic intracorporeal knot tying using a novel device.

BACKGROUND: Laparoscopic intracorporeal knot tying has traditionally been considered the most difficult skill in laparoscopic surgery. We developed a novel device for assisting laparoscopic intracorporeal knotting that transforms a pre-tied slip knot into a secure double sheet bend. The aim of this study is to check the feasibility of using this novel device to assist in performing laparoscopic knot tying. METHODS: We used a laparoscopic trainer with a piece of plastic artificial skin as an experimental model. Twenty laparoscopic device-assisted double sheet bends (experimental group) and 20 traditional laparoscopic two-turn flat square knots (control group) were performed in random order. After cutting the loop and the ends of each knot, all 40 knotted threads and an additional eight unknotted threads were transferred to a tensiometer to test their strength using the single-strand method. Post-knotting variables of the two groups were compared. RESULTS: Knot strength (mean ± standard deviation) did not differ between the two groups (experimental group: 2.26 ± 0.50 kg vs. control group: 2.03 ± 0.94 kg; P = 0.51). The knot efficiencies of the experimental and control group were 60.6 and 54.4% (P = 0.51), respectively. However, the experimental group had a lower knot failure rate (5 vs. 40%, P = 0.02) and shorter knotting time (37.0 ± 9.2 vs. 107.0 ± 47.7 s, P < 0.001) compared with the control group. CONCLUSIONS: This novel device significantly shortened the knotting time of laparoscopic intracorporeal knot tying, and did not compromise the success rate or strength of the knot.