Effectiveness of intravaginal electrical stimulation combined with electromyography biofeedback-mediated pelvic floor muscle training for postpartum symptomatic pelvic organ prolapse: protocol for the PROSPECT randomized trial.

BACKGROUND: Pelvic organ prolapse (POP) is seen in up to 30-70% of women presenting for routine gynecology care and 10% of women suffering from bothersome POP symptoms. Vaginal childbirth is one of the most prominent contributing factors for POP. Pelvic muscle training (PFMT) is considered effective to improve mild to moderate POP symptoms. In addition, higher-intensity, supervised PFMT aided by biofeedback and electrical stimulation may confer greater benefit. However, the long-term efficacy of the PFMT combined with electromyography biofeedback is unknown, which indicates the need for further evidence. METHODS: This multicenter randomized controlled trial compares the effectiveness and cost-effectiveness of conventional PFMT versus biofeedback-mediated PFMT plus neuromuscular electrical stimulation (NMES) for postpartum symptomatic POP women. The primary outcome is the proportion of patients with the improvement of at least one POP-Q stage at 36 months after randomization. The primary economic outcome measure is incremental cost per quality-adjusted life year at 36 months. Two hundred seventy-four women from four outpatient medical centers are randomized and followed up with pelvic floor examination, questionnaires, and pelvic ultrasonography imaging. All participants are arranged for three appointments over 12 weeks. NMES and electromyography biofeedback via intravaginal probe are added to PFMT for participants in the biofeedback-mediated PFMT group. Group allocation could not be blinded from participants and healthcare staff that deliver intervention but remain masked from medical staff that carry out PFM assessment. An intention-to-treat analysis of the primary outcome will estimate the difference of the proportion of POP-Q stage improvement between the trial groups right after the intervention, and during the follow-up until 36 months, using the chi-square test and multilevel mixed models respectively. A logistic regression analysis was used for adjusting for important baseline variables that are unbalanced. DISCUSSION: The trial results will provide evidence of the effectiveness of electromyography biofeedback-mediated PFMT in improving women's POP-Q staging, quality of life, and cost-effectiveness. TRIAL REGISTRATION: CCTR Registry ChiCTR210002171917 . Registered on March 6, 2019.

The relationship between aging and uterine endometrial lesions detected by transvaginal ultrasound in elderly women / 中华老年医学杂志

Objective To explore the characteristics of endometrial lesions and uterine cavity abnormality by transvaginal sonography(TVS)and the potential impact of aging on those. Methods 1052 elderly women(aged ≥60 years)underwent hysteroscopy endometrial curettage based on TVS providing an indication of abnormal uterine cavity at our hospital from January 2010 to December 2017 ,and their clinical and pathological data were analyzed.1052 patients were divided by age into a <65 years group and a ≥65 years group. And age tertile stratifications of lower tertile group ,middle tertile group ,and upper tertile group were used to investigate the correlation between ageing and endometirum diseases. Results A total of 1052 elderly women were included ,and the simple endometrial thickening was the most common etiological factor (53.2％ ) ,followed by abnormal endometrial echoes(36.9％ )and endometrial cavity fluid(9.9％ ).All the pathological results of polyps and endometrial cancer accounted for 57.8％ and 4.2％ ,respectively.Age tertile stratification analysis suggested that the proportions of endometrial cavity fluid was 6.1％ (n=20)in the lower tertile group , 5.9％ (n=20)in the middle tertile group ,and 16.7％ (n=64)in the upper tertile group(χ2 =23.40 ,P<0.01). An increasing proportion along with aging for precancerous lesions was 0.0％ (n=0) ,2.4％(n= 8) ,3.1％ (n = 12)(χ2 = 9.04 ,P < 0.01)in lower/middle/upper age tertile groups.But the proportion of endometrial cancer was decreased with ageing [lower/middle/upper tertiles :6.1％ (n=20) ,4.7％ (n=16) ,2.1％ (n=8)(χ2 =7.23 ,P<0.01]. Conclusions TVS is an effective methodfor screening uterine cavity lesions in elderly women. The TVS-detected prevalence of endometrial cavity fluid increases with ageing. The hysteroscopy endometrial pathological examination shows that endometrial cancer decreases and precancerous lesions increase with ageing.

Clinical analysis of Prolift pelvic reconstructive surgery for advanced pelvic organ prolapse in elderly women / 中华老年医学杂志

Objective To evaluate the safety and efficacy of Prolift pelvic reconstructive surgery for advanced pelvic organ prolapse in elderly patients,and to investigate its impact on pelvic floor function and sexual function.Methods Totally 42 patients aged 60-79 years with advanced pelvic organ prolapse [Pelvic Organ Prolapse Quantification (POP-Q) stage Ⅲ,n=30; POP-Q Ⅳ,n=12)were selected in this study.All patients underwent total Prolift procedure,and were followed up at month 1 and 6 after operation.Operation time,bleeding volume and postoperative complications were recorded.The impact of total Prolift procedure on pelvic floor function in patients were assessed by pelvic floor distress inventory short form 20 (PFDI-20),the pelvic floor incontinence questionnaire 7 (PFIQ-7) and the pelvic organ prolapsed and incontinence sexual quality questionnaire 31 (PISQ-31).Results The operative time was (35-78) minutes[mean time:(42±25) minutes].Bleeding volume was (50 300) ml [mean volume:(137±58) ml].No bladder injury,rectum injury and postoperative complications were observed.All patients were cured,and no one recurred.The scores of PFDI-20 and PFIQ-7 were decreased in patients after sugery at 1 and 6-month follow-up as compared with beforesugery (4.5±1.4,0 vs.47.9±12.2; 7.8±4.3,0 vs.76.3±17.9,respectively,all P＜0.01).There were no significant differences in scores of PFIQ-7 between before and after sugery at 1-and 6-months follow-up (52.3±4.3 vs.49.8±6.3,51.1±6.5,P＞0.05).Conclusions Prolift pelvic reconstructive surgery is an safe and effective treatment for advanced pelvic organ prolapse,which can significantly improve quality of life in elderly patients.

Peritoneal tuberculosis mimicking advanced ovarian carcinoma in elderly women:three case reports and literature review / 中华老年医学杂志

Objective To document peritoneal tuberculosis mimicking ovarian malignancy in elderly post-menopausal women and to review pertinent literature.Methods The records of 3 women with peritoneal tuberculosis who were managed at Beijing Hospital from January 2003 to September 2009 were reviewed.Results Three patients with peritoneal tuberculosis mimicking ovarian malignancy all presented with the classical symptoms of advanced-stage ovarian carcinoma,including ascites,abdominopelvic masses,elevated serum CA125,bloating and progressive emaciation.Two patients received laparotomy revealing peritoneal tuberculosis but no malignancy.All the patients were treated with anti-tuberculosis chemotherapy.Conclusions Medical awareness of peritoneal tuberculosis is still lacking and many women with this disease are initially thought to have ovarian malignancy and undergo unnecessary extended surgery.Laparoscopy including biopsies seems to be a sufficient and safe method to provide diagnosis of peritoneal tuberculosis.If laparoscopy is not feasible,laparotomy should be performed.Ascites and high level of CA125 do not necessarily indicate that the clinical picture is malignant in post-menopausal women.

Clinical observation of effect of modified vaginal paravaginal repair on pelvic floor reconstruction in 52 cases / 中华老年医学杂志

Objective To explore the efficacy and safety of modified vaginal paravaginal repair (VPVR) in treatment of symptomatic paravaginal defect cystocele(PDCC). Methods This study was an observational case series of 52 consecutive women in Beijing hospital from January 2007 to August 2009, with symptomatic paravaginal defect cystocele. Among them, 6 patients had anterior wall colporrhaphy. Preoperative and postoperative pelvic evaluations were performed with the POP-Q system. All the cases underwent vaginal approach to paravaginal repair, 49 cases underwent vaginal hysterectomy simultaneously. Patients were followed up for 1 to 24 months. Criteria for objective cure were defined as the anterior vaginal walls at grade 0 and firmly apposing to the lateral pelvic sidewalls.Results Of the 52 patients, 30 had grade Ⅱ , 17 had grade Ⅲ, and 5 had grade Ⅳ paravaginal defect cystocele. In all patients the VPVR was performed successfully. No complication happened during and after operation. The average operation time was (65 ±18) min (45-110 min) and estimated blood loss was (95 ± 27) ml (50-200 ml). Patients were followed up postoperatively for 3 to 24months, with a mean of (10. 1±3.1) months. The PDCC recurred in 6 cases, 5 patients had grade Ⅰcystocele and 1 had grade Ⅲ cystocele. Conclusions The vaginal approach to the correction of paravaginal defect cystocele is highly effective in our population.

Efficacy of laryngeal mask airway Guardian and laryngeal mask airway Supreme in patients undergoing gynecological surgery / 中华麻醉学杂志

Objective To compare the efficacy of laryngeal mask airway Guardian (GLMA) and laryngeal mask airway Supreme (SLMA) in patients undergoing gynecological surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients aged 19-80 yr weighing 50-70 kg undergoing gynecological surgery were randomly divided into 2 groups: SLMA group (group S, n = 59) and GLMA group (group G, n =61). LMA was inserted after induction of anesthesia with propofol 2.0-2.5 mg/kg, sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg. All the patients were mechanically ventilated. BP, HR, SpO2, PETCO2 and Ppeak were monitored during operation. The rate of successful placement, placement time, fiberoptic bronchoscope grade, airway sealing pressure, airway pressure during normal ventilation with tidal volume of 8 ml/kg, airway pressure and air leakage during ventilation with large tidal volume of 20 ml/kg, air leakage during opertion, complications, anesthesia time, duration of surgery, extubation time and emergence time were recorded. Results There was no significant difference in the rate of successful placement, placement time, airway pressure during normal ventilation and during ventilation with large tidal volume, blood stain at LMA removal, incidence of sore throat, choking hoarseness and dysphagia, anesthesia time, duration of surgery, extubation time, and emergence time between the two groups (P ＜ 0.05). The BP,HR, SpO2, Ppeak and PETCO2 were within the normal range during operation in both groups. The fiberoptic bronchoscope grade and airway sealing pressure were significantly higher, and the incidence of air leakage during ventilation with large tidal volume and during operation was significantly lower in group G than in group S (P ＜ 0.01).Conclusion GLMA and SLMA can provide adequate ventilation during operation with fewer complications and can be used effectively for gynecological surgery. The efficacy of GLMA is better.

Effect of Minimally Invasive Operation on Early Endometrial Carcinoma and Level of Patients' Satisfaction / 中国康复理论与实践

@#Objective To study laparoscopic pelvic lymphyectomy combined with vaginal hystectomy in the treatment of patients with stage Ⅰ endometrial carcinoma.Methods The data of 77 patients with stage Ⅰ endometrial carcinoma were reviewed retrospectively. These patients divided into the laparoscopic group and abdominal group according to the operation style. The operation time, blood loss, postoperation complication, rehabilition of the digestion tract, satisfaction degree to the operation of two groups were compared.Results There was no serious complications in the both groups. In the laparoscopic group, the operation time was longer than the abdominal group ( P<0.01), but so far as to the blood loss, the time of rehabilition of the digestion tract, the number of lymphyectomy, the postoperation pain alleviation and the degree of postoperation depression were superior to the abdominal group ( P<0.01).Conclusion Though the Laparoscopic operation takes longer time than the abdominal operation, it has much more advantage: mimimal blood loss, minimal abdominal scar, rapid postoperation rehabilition, much better pain alleviate, less urine retention.