Efficacy and safety of intraurethral Erbium:YAG laser treatment in women with stress urinary incontinence following failed intravaginal laser therapy: a retrospective study.

Urinary incontinence (UI) is a prevalent condition affecting 25-45% of women and is linked to factors such as menopause, parity, high body mass index, and radical pelvic surgery. Among the three types of UI, stress incontinence (SUI) is the most common, accounting for almost 50% of cases, followed by urgency and overflow incontinence. UI has been found to be associated with reduced quality of life and mental stress. Non-invasive laser treatment is the safest and most effective option for managing SUI, with intraurethral Erbium SMOOTHTM laser treatment holding promise for patients experiencing SUI even after undergoing previous failed intravaginal Erbium:YAG laser treatment. The study recruited 93 female patients with mild to moderate SUI who had received two courses of intravaginal Erbium:YAG laser between January 2015 and June 2018. Of these, 22 patients (23%) who continued to experience SUI after a four-week interval for a second intravaginal Erbium:YAG laser were selected for intraurethral laser treatment in January 2019. The efficacy of the treatment was evaluated by comparing the pre- and post-treatment ICIQ-UI SF score. The urethral length was measured before the procedure. The main procedure involved delivering non-ablative laser energy using Erbium SMOOTHTM technology 2940 nm via a 4-mm cannula with personalized length and fluence was 1.5 J/cm. The 22 female patients with persistent SUI received intraurethral Erbium:YAG laser treatment. Their average age was 47.5 years, with an average of 2 parities and a mean body mass index of 20.97. All patients completed the ICIQ-SF questionnaire before and 3 months after the procedure. Of the patients, 77% reported improvement in symptoms, with 6 reporting strong improvement and 11 reporting improvement. The treatment was well-tolerated, with mild and transient adverse effects such as urinary infection in 1 patient (4.5%) and mild pain in 7 patients (31.8%). Intraurethral laser treatment may be helpful for Taiwanese women with persistent SUI after vaginal laser treatment. However, patients with prior pelvic surgery or pelvic organ prolapse history may limit the efficacy of intraurethral laser. Additional research is necessary to comprehensively investigate the advantages of intraurethral laser therapy. However, using intraurethral Erbium SMOOTHTM laser treatments to rejuvenate tissues and enhance structural support could be a promising avenue for managing stress urinary incontinence in Taiwanese women.

Primary Vaginal Melanoma With Rhabdoid Features: A Case Report and Literature Review.

Primary vaginal melanoma is a rare mucosal neoplasm, which is more aggressive than cutaneous melanoma. Information regarding its morphologic patterns is limited. In particular, the rhabdoid phenotype, mostly observed in metastatic or recurrent cutaneous melanomas, has yet to be reported at this anatomic location. Hence, a potential diagnostic difficulty may arise because of the inability to recognize this unusual histologic variant and its immunohistochemical aberrance. In this report, we describe the case of a primary vaginal melanoma in a 62-year-old woman, who exhibited both rhabdoid and small blue round cell morphologies, absence of S100 protein, and aberrant expression of desmin, CD56, and FLI-1. This report can facilitate the task of expanding the morphologic spectrum of vaginal melanoma, and prevent misdiagnosis and inadequate medical treatment.

The Risks for Ovarian, Endometrial, Breast, Colorectal, and Other Cancers in Women With Newly Diagnosed Endometriosis or Adenomyosis: A Population-Based Study.

OBJECTIVE: Recent studies report a link between endometriosis and ovarian cancer (OC). Using a population-based cohort study to confirm the association between endometriosis and cancer is desirable. We thus examined the magnitude of the risks of OC, endometrial cancer (EC), breast cancer, colorectal cancer (CRC), and other cancers in women with newly diagnosed endometriosis or adenomyosis (internal endometriosis). METHODS/MATERIALS: Women older than 20 years with claims data between 2003 and 2005 were identified from the Longitudinal Health Insurance Dataset containing 1 million individuals randomly sampled from the National Health Insurance Research Database. Those with preexisting malignancies, hysterectomy, or oophorectomy were excluded. The endometriosis cohort (n = 2266, including 768 cases of pure adenomyosis) and comparison cohort (n = 9064), formed by 1:4 matching, were followed up until incidence cancer, dropout, or December 31, 2008. Outcome measures included cancer incidence and adjusted hazard ratio by Cox model adjusted for age group, comorbidities, and endometriosis medication use. RESULTS: With 9842 person-years of follow-up in endometriosis cohort and 36,274 person-years of follow-up in comparison cohort, there were increased risks of all cancers (adjusted hazard ratio, 1.8; 95% confidence interval, 1.4-2.4), OC (4.56, 1.72-12.11), and EC (4.05, 1.20-13.66). The ovarian endometriosis group was associated with increased risk of subsequent OC (4.37, 1.07-17.83). The adenomyosis group was strongly associated with both OC (5.50, 1.95-15.50) and EC (5.13, 1.36-19.40). Increased risk of subsequent CRC was observed in women with adenomyosis with coexistent endometriosis at other sites (13.04, 2.21-77.04). However, no statistically significant increased risk of breast or other cancers was observed. CONCLUSIONS: Having limitations such as lacking of parity information which may affect the magnitude of risk estimates, this study demonstrates that ovarian endometriosis has a 4-fold increased risk of OC. Adenomyosis may associate with a 4- to 5-fold increased risk of OC and EC, and unexpectedly, a 13-fold increased risk of CRC.

Preliminary outcome of non-ablative vaginal Erbium laser treatment for female stress and mixed urinary incontinence.

OBJECTIVE: This prospective study presents a preliminary result to compare the clinical efficacy of patients with stress urinary incontinence and mixed urinary incontinence using minimal invasive Er:YAG vaginal laser. MATERIALS AND METHODS: A total of 20 patients were included, in which were 10 patients with SUI and 10 patients with MUI (stress and urge incontinence), and underwent a 2940 nm Er:YAG laser with a special SMOOTH mode in an outpatient office without anesthesia or postoperative medications. All patients completed two sessions of treatment with an interval time of 28 days. At three months after treatment, all patients were asked to a clinical visit for evaluate the clinical outcome by pre-treatment and post-treatment ICIQ-SF questionnaire. At pretreatment and 3 months after the completion of two therapy sessions, patients were asked to answer the ICIQ-SF questionnaire. The questionnaire consists of three scales for assessment of the treatment outcome of urinary incontinence as: no change (no change score), improvement (decrease score 1-5), and strong improvement (decrease score >5) for two groups of patients with SUI and MUI. All the results were compared by Student's t test with two way analysis of variance between the two groups. RESULTS: A total of 20 patients presented with SUI symptom relief and improvement with treatment satisfaction. All 10 patients with SUI reported improvement after vaginal laser treatment, 70% with marked improvement and 30% with improvement. All 10 patients with MUI also had improvement, 40% with marked improvement and 60% with improvement. There was no statistically significant difference in the treatment outcome between the two groups. CONCLUSIONS: Vaginal Erbium laser produce provides vaginal collagen remodeling and synthesis that may repair and restore the pelvic floor function. Despite of sample limitation and short follow up, this treating procedure presented a good and a safe clinical outcome in patients with SUI and with MUI by assessment of ICIQ-SF questionnaire.

Application of amniotic fluid stem cells in repairing sciatic nerve injury in minipigs.

Many studies have demonstrated that combining nerve conduits with neural stem cells or growth factors can repair peripheral nerve injury in rodents. However, nerve damage does occur with longer gaps in human than in rodents, thus findings from rodent studies are difficult to translate to clinical practice. Minipigs have a longer gap that is more closely applicable to the challenge of human nerve grafting in extensive traumatic nerve damage. In this study, human amniotic fluid stem cells (AFSCs) and polylactate nerve conduits were used to repair sciatic nerve injury in minipigs. The AFSCs exhibited the properties of mesenchymal stem cells with a propensity toward neural stem cells. Measurements of compound muscle action potential implied that administration of conduits with AFSCs was beneficial in function recovery in the minipig model compared with conduits alone. The results of diffusion tensor magnetic resonance imaging (DTI) based fiber tractography assay in the minipig model suggest that combining AFSCs with conduits could expedite the repair of sciatic nerve injury. Further, MR-based DTI provides an effective and non-invasive method to visualize the sciatic nerve and to monitor the regeneration progress of injured nerve in a longitudinal study.

Prediction of newborn birth weight based on the estimation at 20-24 weeks of gestation.

OBJECTIVE: The aim of this study was to develop a mathematical equation to predict the birth weight during the second trimester at 20-24 weeks of gestation. MATERIALS AND METHODS: In a university hospital, 110 healthy pregnant women were eligible for inclusion at 20-24 weeks of gestation. We recorded the maternal weight (pre-pregnancy, mid-pregnancy, and at delivery) and body mass index (BMI), newborn birth weight, time period from ultrasound examination to term delivery, and also the fetal biometrics sonographically at 20-24 weeks of gestation. Pearson's correlation was used to verify the extent of the relationship between all the above measurements and the newborn birth weight. Multiple regressions with the stepwise method were used to analyze maternal weight factors, fetal biometrical factors, and pregnancy interval. An equation for term birth weight estimation during the second trimester was determined. RESULTS: Maternal BMI at mid-pregnancy, time interval from mid-pregnancy to term, and abdominal circumference had the highest correlation with newborn birth weight (r = 0.388, 0.341, and 0.315, respectively, p < 0.05). Using the stepwise regression analysis, an optimal formula with variance of 0.303 was derived: estimated birth weight = -700 + 49.766 × (mid-pregnancy BMI [kg/m2]) + 13.362 × (time interval from mid-pregnancy to term delivery [days]) + 68.696 × (abdominal circumference [cm]). CONCLUSION: We propose an accurate, simple, and easy formula to better assess the newborn birth weight at mid-pregnancy for the Asian population. Mid-pregnancy BMI was a more significant factor for birth weight estimation than other maternal weight factors in this study.

Suburethral slingplasty using a self-fashioned Gynemesh for treating urinary incontinence and anterior vaginal wall prolapse.

OBJECTIVE: This study was conducted to evaluate the effectiveness of self-fashioned Gynemesh for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse, and the factors involved in mesh erosion. MATERIALS AND METHODS: From March 2004 to September 2006, 65 women with urinary incontinence, with or without pelvic organ prolapse or prior surgery for prolapse or incontinence, were recruited for this study. A self-fashioned Gynemesh was used for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse. Patients in this study underwent suburethral slingplasty and/or concomitant pelvic reconstructive operations. A general linear model univariate analysis was performed to assess the relationships between mesh erosion and various variables. RESULTS: The mean postoperative follow-up was 33 months. Those patients with anterior wall prolapse presented as completely cured postoperatively. The cure rate for urinary incontinence was 80%, and the improvement rate was 17%. Vaginal mesh erosion was discovered in four patients (6%) during the postoperative follow-up. These four patients remained continent after the removal of the eroded mesh. The interactive effects for mesh erosion by a general linear model analysis were menopausal women with advanced anterior vaginal wall prolapse (p < 0.05) and women with advanced anterior vaginal wall prolapse with concomitant sacrospinous ligament fixation (p < 0.05). CONCLUSION: We found that using self-fashioned Gynemesh for tension-free suburethral and anterior vaginal slingplasty provided a high success rate (97%) in the 3 years of follow-up. Mechanical rejection may be one of the causes of vaginal mesh erosion.

Fetal acidosis from obstetric interventions during the first vaginal delivery.

OBJECTIVE: The aim of this study was to analyze the blood gas values of umbilical cord blood in newborns of first vaginal deliveries with or without obstetric interventions. MATERIALS AND METHODS: In a prospective descriptive study conducted during the 6-month period from August 2003 through February 2004 at a university hospital, we analyzed the umbilical cord blood gas results of 80 term newborns delivered vaginally from healthy nulliparous women. Multivariate logistic analysis was used to evaluate the associations between fetal acidosis (pH<7.20) and any obstetric interventions. RESULTS: The mean of umbilical cord blood arterial pH was 7.26 (standard deviation, 0.072). After controlling for the confounding factors with multivariate logistic regression, fetal acidosis (pH<7.20) was found to be significantly associated with oxytocin augmentation (odds ratio [OR], 16.48; 95% confidence interval [CI], 1.21-226.1) and vacuum extraction (OR, 10.76; 95% CI, 1.025-112.9). In contrast, there was no significant relationship between fetal acidosis with episiotomy (OR, 1.096; 95% CI, 0.07-16.6) or epidural anesthesia (OR, 0.074; 95% CI, 0.003-2.09). CONCLUSION: Oxytocin augmentation and vacuum extraction were significantly related to low cord arterial pH values (pH<7.20), but there were no adverse effects to the newborns of first vaginal deliveries.

Uterine rupture at scar of prior laparoscopic cornuostomy after vaginal delivery of a full-term healthy infant.

A 30-year-old, gravida 2, para 0 woman who had a history of a laparoscopic cornuostomy for a left interstitial pregnancy was admitted for a vaginal delivery due to labor pains at 40 weeks gestation. A prolonged placental delivery, persistent abdominal pain, and hemorrhagic shock were noted after the delivery of the infant. An emergency laparotomy was carried out, and the diagnosis of a uterine rupture at the scar of a prior cornuostomy was confirmed. The entire placenta extruded through the rupture wound into the abdominal cavity. A Medline computer search revealed that a similar case of a uterine rupture after full-term vaginal delivery has yet to be reported. In order to prevent a uterine rupture, we suggest that a planned cesarean delivery, before the onset of labor in a subsequent pregnancy, may be safer for a patient with a scarred uterus from a prior cornuostomy for an interstitial pregnancy.

Primary non-Hodgkin's lymphoma of the uterus, cervix and parametrium treated by combined immunochemotherapy.

Primary malignant lymphoma of the female genital tract is extremely rare and no standard treatment has been established. The present patient is menopausal with diffuse large B-cell lymphoma of the uterine body, endocervix and parametrium. She underwent a simple total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by treatment with a new regimen, combined immunochemotherapy with rituximab (monoclonal antibody), cyclophosphamide vincristine, and prednisolone. The patient had complete remission in the follow-up 3 years after this therapy. We suggest this treatment is a useful therapy for a patient with primary malignant lymphoma of the uterine body.

Acute necrotizing pancreatitis complicating uteroplacental apoplexy.

OBJECTIVE: Abruptio placentae induced by acute pancreatitis during pregnancy is very rare. We present a pregnant woman with a series of complications due to acute necrotizing pancreatitis. CASE REPORT: Presented herein is a 21-year-old, nulliparous woman at 33 weeks' gestation. The initial episode of abdominal pain was thought to be acute appendicitis (which in actuality was identified to be acute pancreatitis) and was complicated with abruptio placentae, uteroplacental apoplexy, and intrauterine fetal demise. Sterile necrotizing pancreatitis was confirmed by computerized axial tomography and total negativity of bacterial cultures taken from blood and ascites during the hospitalization. Nonsurgical management with conservative treatment was employed and the patient recovered gradually. CONCLUSION: Acute pancreatitis is difficult to diagnose during pregnancy. It presents as a systemic inflammatory response syndrome resulting in hemodynamic changes and may lead to abruptio placentae. Nonsurgical conservative treatment may be useful in such patients.