Central Compartment Atopic Disease and Its Surgical Outcomes: Olfactory Changes and Technical Notes.

Background: Central compartment atopic disease (CCAD) is a recent, novel phenotype of chronic rhinosinusitis. Only a few studies have assessed olfactory function in patients with CCAD. Objectives: We aimed to investigate olfactory function changes after functional endoscopic sinus surgery (FESS) in patients with CCAD and proposed some surgical techniques to enhance the postoperative olfactory outcomes in such patients. Design: A retrospective cohort study. Methods: We collected data from 23 patients (8 men and 15 women) with CCAD who underwent FESS performed by a surgeon in Taiwan, between June 2018 and December 2021. The demographic data, olfactory function, and serum and tissue eosinophil percentages of the included patients were analyzed. The Top International Biotech Smell Identification Test (TIBSIT; Top International Biotech, Taipei, Taiwan) was used to assess olfactory function. Results: Of the 23 patients, most (95%) showed a positive reaction to aeroallergens, and 2 patients (8.7%) had asthma. Ten patients (43.5%) had peripheral eosinophilia, and 9 (39%) had eosinophilic nasal polyps. Moreover, the patients presented with variable olfactory dysfunction; the mean preoperative TIBSIT (pr-TIBSIT) score was 12.8 ± 2.3 (range: 0-43), whereas the mean postoperative TIBSIT (po-TIBSIT) score was 29.2 ± 1.9 (range: 16-44). The po-TIBSIT score was significantly better than the pre-TIBSIT score (paired t test, P < .0001). The improvement in olfactory function was not significantly correlated with the patients' age, serum eosinophil percentages, and nasal polyp eosinophil counts. Conclusion: Our findings indicate that CCAD is significantly associated with olfactory dysfunction and that FESS can effectively improve olfactory function. To optimize postoperative olfactory outcomes, precise removal of polyps from the olfactory cleft without damaging the neuroepithelium is recommended. Our study provides valuable insights into the management of CCAD patients undergoing FESS and can guide surgical decision-making to achieve optimal olfactory function outcomes.

Effect of mobile-phase modifiers on the enantioselective retention behavior of methyl mandelate with an amylose 3,5-dimethylphenylcarbamate chiral stationary phase under reversed-phase conditions.

In this study, methanol, ethanol, n-propyl alcohol, isopropyl alcohol, acetone, and tert-butanol were used as organic modifiers in reversed-phase mode chiral liquid-chromatography to systematically investigate the effects of mobile phase components on the enantioselective retention behavior of methyl mandelate with immobilized amylose 3,5-dimethylphenylcarbamate-based sorbent called Chiralpak IA. A two-site enantioselective model was used to obtain information on the recognition mechanisms by observing the dependence of the enantioselectivity and retention factor difference on the modifier content. Similar enantioselective retention behaviors were observed for all modifiers, and characteristic modifier concentration points (PL , PM , and PH ) were identified. At modifier concentrations up to PM , the weakened hydrophobic environment resulted in polymer structural relaxation, which changed the recognition mechanisms. By contrast, at concentrations beyond PH , considerably different enantioselectivity behaviors were observed, indicating that the existence of dipole-dipole interaction, which was stronger at higher modifier concentrations, contributed to the retention mechanisms. The concentrations at which these characteristic points occurred were dependent on the carbon number of the modifier molecule. Modifiers with more carbon numbers facilitated the transition in the enantioselective behaviors. These results demonstrated that the proposed method can provide a physically consistent quantitative description of enantioselective retention behavior in reversed-phase mode.

Five-year results of no-fault compensation related to childbirth injuries in Taiwan.

OBJECTIVE: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the "Childbirth Accident Emergency Relief Act" was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system. MATERIALS AND METHODS: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation. RESULTS: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor-patient relationship by immediate care and assistance from medical institutions. CONCLUSION: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

Potential Role of CXCL13/CXCR5 Signaling in Immune Checkpoint Inhibitor Treatment in Cancer.

Immune checkpoint inhibitors (ICIs), including antibodies that target programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), or cytotoxic T lymphocyte antigen 4 (CTLA4), represent some of the most important breakthroughs in new drug development for oncology therapy from the past decade. CXC chemokine ligand 13 (CXCL13) exclusively binds CXC chemokine receptor type 5 (CXCR5), which plays a critical role in immune cell recruitment and activation and the regulation of the adaptive immune response. CXCL13 is a key molecular determinant of the formation of tertiary lymphoid structures (TLSs), which are organized aggregates of T, B, and dendritic cells that participate in the adaptive antitumor immune response. CXCL13 may also serve as a prognostic and predictive factor, and the role played by CXCL13 in some ICI-responsive tumor types has gained intense interest. This review discusses how CXCL13/CXCR5 signaling modulates cancer and immune cells to promote lymphocyte infiltration, activation by tumor antigens, and differentiation to increase the antitumor immune response. We also summarize recent preclinical and clinical evidence regarding the ICI-therapeutic implications of targeting the CXCL13/CXCR5 axis and discuss the potential role of this signaling pathway in cancer immunotherapy.

A survey of career-decision factors for obstetrics and gynecology residents in Taiwan.

OBJECTIVE: The recruitment of obstetrics and gynecology residents has been challenging in Taiwan since 2000. There are a lots factors influencing applying, including career interest and prospects, lifestyle, salary, litigation, stress level, time demands of specialty work and gender consideration. The purpose of this study was to evaluate the factors influencing the career choice of current OB/GYN residents and identify the important factors influencing recruitment. MATERIALS AND METHODS: A cross-sectional questionnaire of career-decision factors was sent to all 280 residents during December, 2019. Total 16 factors were rated on a 5-point Likert and were ranking by their average score on the scale. Gender of residents was analyzed for their association with the scores by a two-sample test and two-tailed t test. RESULTS: 91 (32.5%) residents responded and 61 were female and 30 were male. The top influencing factor was being interested in clinical expertise with an average score of 4.32. The second factor was having a great sense of accomplishment in saving people with an average score of 3.82, followed by it being easier to become a medical practitioner at 3.77. The lowest scoring factor was fewer hours of work, with an average score of 1.77 and a safer working environment with a score of 2.33 was the second lowest factor. Female residents agreed that it was easier to get specialist certification with a score of 3.0. This score was significantly higher than male doctors at 2.63 with p value of 0.017. CONCLUSION: Career interest and prospects were key influencing factors for applying OB/GYN residents. Minimizing the influence of detracting factors like heavy workload and medical litigation was also effective. Enrolling new residents is key to maintaining adequate staffing in specialties in healthcare. Establishing a safer work environment and determining the optimal workload will be the next reforms in the future.

Effect of 2-propanol content on solute retention mechanisms determined using amylose tris(3,5-dimethylphenylcarbamate) chiral stationary phase under normal- and reversed-phase conditions.

The electrostatic interactions between chiral solutes and polysaccharide (PS)-based chiral selectors are the key to achieving chiral recognition; however, PS-based sorbents, derivatized of phenyl moieties, can exhibit considerably non-polar characteristics, and they are also useful for the separation of enantiomers in the reversed-phase mode. In this study, an immobilized amylose 3,5-dimethylphenylcarbamate-based sorbent was used to investigate the balance between electrostatic interactions and solvophobic interactions, with complementary effects on solute retention behavior when the isopropanol (IPA) concentration was altered. It was proposed that in both normal- and reversed-phase modes, information on the retention mechanisms could be obtained by observing the curvature of the logarithm of the retention factor versus the logarithm of the IPA concentration, and the slope values of the curves were related to the number of displaced IPA molecules upon solute adsorption. Using the proposed model and the two-site adsorption model, the retention behaviors of pantolactone (PL) enantiomers in both normal- and reversed-phase modes were investigated. The PL-sorbent interactions were classified into four types: electrostatic/enantioselective, electrostatic/nonselective, solvophobic/enantioselective, and solvophobic/nonselective. At IPA concentrations below 50 vol.% in n-hexane, the retention behaviors of PL were dominated by electrostatic/enantioselective sites, whereas at IPA concentrations beyond 50 vol.%, the solvophobic interactions of PL-sorbent were strengthened and mostly nonselective. By contrast, in the reversed-phase mode, a reverse in the enantiomeric elution order of PL was observed at 10 vol.% IPA, and considerably different enantioselectivity behaviors were found below and above 20 vol.%, indicating an abrupt change in the sorbent molecular environment. At IPA concentrations beyond 40 vol.%, the presence of PL-sorbent electrostatic interactions enhanced chiral recognition.

Investigation of Normative Value of Commercialized Taiwan Smell Identification Test.

BACKGROUND: The Taiwan Smell Identification Test (TWSIT) was developed and successfully administered in Taiwanese population since 2015. However, for sanitation reason, the original liquid-jar form of this test is not appropriate. The commercialized TWSIT was then re-designed as "scratch-and-sniff" version: the TIBSIT (Top International Biotech, Taipei, Taiwan). This project aims to investigate the normative value of TIBSIT in different age groups and genders. METHODS: Volunteers aged 20 to 80 with no subjective smell loss were recruited in a rhinology clinic. The participants were given full instructions on using the TIBSIT. RESULTS: Two hundred and nine healthy subjects (female: male =107: 102) were enrolled into this study. The median TIBSIT score in female and male subjects is 47 and 46, respectively. Subjects were further divided into three age groups: (A) 20∼34 years (n = 77), (B) 35∼54 years (n = 77), and (C) 55∼80 years (n = 55). The TIBSIT scores at the tenth percentile value at each age group of male patients are 43, 42 and 37; while the scores at the tenth percentile value at each age group of female patients are 42, 42 and 41. TIBSIT score was significantly and inversely correlated with age (Spearman rho = - 0.20, p = 0.004.). CONCLUSION: We established the normative values of the new TIBSIT in different age groups in Taiwan. Future nation-wide screening is needed for more sophisticated norms establishment.

Work hours of employed obstetricians in Taiwan.

OBJECTIVE: Obstetricians have longer work hours and work hour restriction of employed physicians will be implemented thereafter. This study was to survey the impact of work hour restriction and determine the weekly work hours of obstetricians. MATERIALS AND METHODS: Since December 1, 2017, to January 31, 2018, a questionnaire about reasonable workload investigation, impact of work hour restriction and weekly work diary was mailed to 196 employed obstetricians who delivered more than 20 newborns per months. The work types and coefficient of correlation with work hours was evaluated using the Pearson correlation coefficient (r). RESULTS: 72 returned the questionnaires, 21 (31.4%) believed that 40-49 h were reasonable, while 22 (32.8%), 13 (19.4%), 7 (10.4%), and 4 (6%) thought that 50-59, 60-69, 70-79, and >80 h were reasonable. 66 completed their weekly work diary. The average weekly work hours were 80.14 ± 6.85. If the time of awaiting delivery was calculated into total work hours, then the average work hours were 116.96 ± 12.41. The coefficient of correlation between on-duty and weekly work hours was 0.7. The average work hours of physicians with on-duty work were 92.08 ± 8.7, which were significantly higher than the work hours of those without on-duty works (63.95 ± 7.79). CONCLUSION: The weekly work hours of employed obstetricians is higher than their expected reasonable work hours. Implementation of work hour restriction will have a significant impact on medical care. It is important to determine a reasonable work hour restriction and modify the patient care model to reduce workload.

Assessment of treatment outcomes of interstitial cystitis with hydrodistention and bladder training by O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices.

OBJECTIVE: To investigate whether the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) is efficacy measure tool for interstitial Cystitis (IC) treatment with hydrodistention (HD) and bladder training (BT). MATERIALS AND METHODS: From January 2003 to March 2006, 108 consecutive IC patients were treated by HD and BT after HD. This study evaluated the efficacy of treatment with the specific questionnaire for IC, the ICSI and ICPI. Each patient filled out the questionnaire before HD and three months after HD and BT. The efficacy of the treatment was evaluated using the average scores of ICSI and ICPI. RESULTS: The mean ± margin of error, (95% confidence interval) of total scores of ICSI and ICPI were 13.89 ± 2.95, (13.33-14.45) and 12.51 ± 2.50, (12.04-12.98) before HD, respectively, and were 2.70 ± 1.16, (2.44-2.95) and 1.99 ± 1.27, (1.71-2.26) (all p < 0.005) three months after HD and BT, respectively. CONCLUSION: O'Leary-Sant ICSI and ICPI is not only a screening tool for IC but also a useful assessment tool for IC treatment outcomes.

Comparison of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion.

OBJECTIVE: To evaluate the effects of sequential vaginal and sublingual misoprostol after a vaginal loading dose for second-trimester abortion. MATERIALS AND METHODS: From January 2006 to December 2011, 173 women received an 800-µg vaginal loading dose of misoprostol. After the loading dose, 103 patients received 800 mg of misoprostol vaginally and 70 patients received 400 mg of misoprostol sublingually every 12 h until the delivery of the fetus. RESULTS: In the vaginal group, the average abortion time was 1.07 ± 1.29 days; that was 0.82 ± 0.66 days in the sublingual group. Sequential sublingual misoprostol after a vaginal loading dose of 800 mg with an administration interval of 12 h had a similar abortion rate and time to abortion. In addition, this protocol reduced unnecessary digital pelvic examinations and speculum examinations. CONCLUSION: This sequential sublingual misoprostol regimen might be a suitable regimen for mid-trimester abortion.

Trends in inpatient female urinary incontinence surgery and costs in Taiwan, 1997-2011.

OBJECTIVE: To explore the factors influencing the trends in incidence and cost for female inpatient urinary incontinence (UI) surgery from 1997 to 2011. MATERIALS AND METHODS: A dataset of one million individuals was randomly drawn from the nationwide National Health Insurance claim database covering Taiwan's population from 1997 to 2011. The participants consisted of women aged ≥20 years who underwent UI surgery. We evaluated the trends of inpatient UI incidence, the medical cost of UI surgery, and the number of UI surgeries performed from 1997 to 2011. RESULTS: A total of 1517 women underwent inpatient UI surgery from 1997 to 2011. Among these patients, the age-standardized incidence of UI surgery gradually trended upward from 1997 to 2010 but decreased in 2011. The trends were similar for medical costs, including annual inpatient cost, total medical service cost, and surgery fees. The annual inpatient cost had doubled in 2011 compared with that in 1997. However, physician visit fees, ward fees, and anesthesia fees started decreasing from 2005. The length of hospital stay and medication fees decreased during the 15-year study period. Surgeries by doctor specialty, hospital accreditation level, and patient age were stable for the study period. CONCLUSION: The trends of age-standardized incidence of UI surgery, annual inpatient cost, total inpatient cost, and surgery fees increased significantly from 1997 to 2009, and abruptly decreased from 2010 to 2011. Long-term observation evaluating the impact of Diagnosis-Related Group payment system in Taiwan is warranted to verify in the future.

Treatment strategy for urinary frequency in women.

The purpose of this paper is to discuss the differential diagnosis of the underlying etiologies of urinary frequency and the treatment strategies for urinary frequency in women. Urinary frequency is a symptom, a sign, and a condition of uncertainty and of multifactorial cause. Common causes of urinary frequency include psychosocial, medical, sexual, urological, gynecologic, endocrine, and pharmacological in origin. Hence, treatment of symptoms and possible cures need a high-level plan or strategy to overcome the multifactorial etiology. Proper investigation of the chief complaint, history and physical examinations, is needed to evaluate urinary frequency. Pregnancy test, wet smear, urinalysis, midstream urine culture, frequency-volume charts, cystourethroscopy, urodynamics, and genitourinary imaging are the basic routine of office investigations. These tools promote the accuracy of the differential diagnosis of the underlying cause of urinary frequency. It is then often helpful to adopt an algorithmic approach to the management of this complaint. Treatment of urinary frequency might be empirical, and it remains a clinical challenge to gynecologists. To cure the disease, it is important to listen to the patient and consider the condition in all its aspects and use proven techniques.

Serum ferritin levels and polycystic ovary syndrome in obese and nonobese women.

OBJECTIVE: The aim of this study is to evaluate serum ferritin levels and polycystic ovary syndrome (PCOS)-related complications in obese and nonobese women. MATERIALS AND METHODS: This retrospective study included 539 (286 with PCOS and 253 without PCOS). RESULTS: Serum ferritin correlated with menstrual cycle length, sex hormone-binding globulin, total testosterone, androstenedione, triglyceride, and total cholesterol in both obese and nonobese women. Obese women with high ferritin levels exhibited higher insulin resistance, impaired glucose tolerance, and liver enzymes (glutamic oxaloacetic transaminase, glutamic pyruvic transaminase) than obese women with low ferritin levels. However, among nonobese women, insulin resistance and risk of diabetes were not significantly different between the high and low ferritin groups. Independent of obesity, hypertriglyceridemia was the major metabolic disturbance observed in women with elevated serum ferritin levels. CONCLUSION: Elevated serum ferritin levels are associated with increased insulin resistance and risk of diabetes in obese women but not in nonobese women. However, higher serum ferritin levels were correlated with a greater risk of hyperglyceridemia in both obese and nonobese women. Therefore, hypertriglyceridemia in women with PCOS might be associated with iron metabolism.

Clinical and biochemical characteristics of women with menstrual disturbance.

OBJECTIVE: Menstrual irregularity is one of the major complaints in women of reproductive age. The aim of this study was to evaluate the complications in women with different menstrual disturbances. MATERIALS AND METHODS: This is a retrospective study. A total of 576 women were screened first, and 470 women were included later [257 women with oligo/amenorrhea (149 hyperandrogenic and 108 nonhyperandrogenic women) and 213 normocyclic controls]. Endocrine and metabolic parameters and insulin resistance were compared among different menstrual patterns. RESULTS: The average duration of menstrual cycle length was positively correlated with age, levels of androgens and prolactin, lipid profiles, and the parameters of insulin resistance. Hyperandrogenic women with amenorrhea had higher levels of androgens and more lipid profiles disorders than hyperandrogenic women with oligomenorrhea. However, nonhyperandrogenic women with amenorrhea had a degree of insulin resistance and metabolic disturbance similar to that of nonhyperandrogenic women with oligomenorrhea. Interestingly, for women with normal prolactin levels, serum prolactin levels were significantly lower in amenorrhea than oligomenorrhea in both hyperandrogenic and nonhyperandrogenic groups. CONCLUSION: The degree of menstrual disturbances does not correlate with the severity of insulin resistance and metabolic disturbances in women without excess levels of androgen. For women with normal prolactin levels, amenorrheic patients had significantly lower serum prolactin levels than oligomenorrheic patients.

Risk factors for urinary incontinence among women aged 60 or over with hypertension in Taiwan.

OBJECTIVE: To assess the associated risk factors and the prevalence of urinary incontinence (UI) among women with hypertension (H/T) aged 60 or over in Taiwan. MATERIALS AND METHODS: A total of 2410 women aged 60 or over were selected by a multistage random sampling method and a total of 1519 women completed the face-to-face interviews. Only women who answered "yes" to the question "Do you have H/T?" were included in the H/T sample. The factors were assessed by frequency and Pearson's χ(2) test using a significance level of p < 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables. RESULTS: A total of 39.7% (602 women) interviewees had H/T, among which 39.9% (240 women) had UI symptoms. The prevalence of UI among women aged 60 or over with or without H/T was significantly different (p = 0.006). Risk factors were age [odds ratio (OR) = 1.043, 95% confidence interval (CI) 1.016-1.071, per year], diabetes mellitus (DM) (OR = 1.653, 95% CI 1.105-2.474), previous urinary diseases (OR = 3.462, 95% CI 2.260-5.301), and body mass index (BMI; OR = 1.060, 95% CI 1.012-1.110, per unit). There was no significant association between UI and drug allergy, smoking, hysterectomy, hormone therapy, or gynecological surgery. CONCLUSION: UI can be a frequent and annoying problem for aged women. In women with H/T, UI is significantly related to risk factors such as age, DM, BMI, and urinary diseases. In addition, BMI is considered a key risk factor for H/T. Therefore, effective control of BMI would help in controlling H/T and UI in aged women.

Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study.

INTRODUCTION AND HYPOTHESIS: To compare the efficacy and safety of the Elevate™ anterior and posterior prolapse repair system and traditional vaginal native tissue repair in the treatment of stage 2 or higher pelvic organ prolapse. METHODS: A cohort study was conducted between January 2010 and July 2012. Patients who underwent transvaginal pelvic reconstruction surgery for prolapse were recruited. The primary outcome was anatomical success 1 year after surgery. The secondary outcome included changes in the quality of life and surgical complications. Recurrence of prolapse was defined as stage 2 or higher prolapse based upon the pelvic organ prolapse qQuantification system. RESULTS: Two hundred and one patients (100 in the Elevate™ repair group and 101 in the traditional repair group) were recruited and analyzed. The anatomical success rate of the anterior compartment was significantly higher in the Elevate™ repair group than in the traditional repair group (98 % vs 87 %, p = 0.006), but not for the apical (99 % vs. 6 %, p = 0.317) or posterior (100 % vs 97 %, p = 0.367) compartments after a median 12 months of follow-up. Both groups showed significant improvements in the quality of life after surgery with no statistical difference. Mesh-related complications included extrusion (3 %) and the need for revision of the vaginal wound (1 %). Those in the mesh repair group had a longer hospital stay (p = 0.04), operative time (p < 0.001), and greater estimated blood loss (p = 0.05). Other complications were comparable with no statistical difference. CONCLUSIONS: The Elevate™ prolapse repair system had a better 1-year anatomical cure rate of the anterior compartment than traditional repair, with slightly increased morbidity.

Safety and efficacy of unidirectional barbed suture in mini-laparotomy myomectomy.

OBJECTIVE: To estimate the safety and effectiveness of unidirectional knotless barbed suture compared to the traditional suture for repair of uterine wall defects through myomectomy via mini-laparotomy. MATERIALS AND METHODS: This was a prospective clinical study performed by a single surgeon in a medical center. Sixty-eight women with symptomatic myoma were enrolled. Their uterine wall defects were repaired either by unidirectional knotless barbed suture (Group A) or by traditional suture (Group B). The surgical time, intraoperative blood loss, and number of myomas in the two groups were analyzed by two-sample t test. RESULTS: Surgical time required from skin incision to complete closure was significantly lower in Group A than in Group B (50.2 ± 16.49 vs. 69.1 ± 25.33 min) (p = 0.0008). The intraoperative blood loss was also lower in Group A (mean, 260.9 mL; range, 20-850 mL) than in Group B (mean, 394.7 mL; range, 50-2200 mL) but not statistically significant. CONCLUSION: The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.

A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair.

INTRODUCTION AND HYPOTHESIS: The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. METHODS: This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. RESULTS: One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). CONCLUSIONS: The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.

Effects of parity and mode of delivery on urinary incontinence among postmenopausal women in Taiwan.

OBJECTIVE: To investigate the association between the prevalence of urinary incontinence and parity or mode of delivery among Taiwanese women aged 60 years or older. METHODS: Between July 1999 and December 2000, a nationwide epidemiologic study was conducted in Taiwan among 2410 women selected by a multistage random sampling method. Face-to-face interviews with 1517 women were conducted. The relationship between the prevalence of urinary incontinence and the number of vaginal deliveries or number of cesarean deliveries was assessed by frequency and Pearson χ(2) test using a significance level of less than 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables. RESULTS: Decades ago, most Taiwanese women (1435 of 1511 respondents, 94.97%,) gave birth via vaginal delivery and the rate of cesarean delivery was low (20 of 1513 respondents, 1.32%). Parity (odds ratio [OR], 2.42; 95% confidence interval [CI], 0.87-6.71; P=0.091), vaginal delivery (OR, 0.76; 95% CI, 0.39-1.47; P=0.408), and cesarean delivery (OR, 1.47; 95% CI, 0.59-3.70; P=0.409) did not increase the risk of urinary incontinence. CONCLUSION: There was no association between urinary incontinence and parity or mode of delivery among Taiwanese postmenopausal women decades after their first delivery.

Treatment of interstitial cystitis in women.

Interstitial cystitis (IC) has been described as a chronic debilitating sterile inflammatory multifactorial bladder syndrome of unknown etiology. IC is characterized by bladder pain (or suprapubic pain) associated with urgency, urinary frequency, and nocturia. Because the pathogenesis of IC remains unclear, it is still an enigma and represents a diagnostic and therapeutic challenge. The diagnosis of IC remains unclear and is based on exclusion of other diseases. Consequently, IC has usually been underdiagnosed, and the consensus on best available treatment for the disease is lacking. The current goal for the treatment of IC is usually symptomatic relief, and treatment protocols are based on empiricism. Multiple forms of therapy are available, and most patients can be managed conservatively. Nevertheless, the efficacy of most treatments is short term. This review article gives an overview of the available treatments for IC.