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1.
Taiwan J Obstet Gynecol ; 60(5): 920-923, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507675

RESUMO

OBJECTIVE: We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer. CASE REPORT: A 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months. CONCLUSION: This report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.

2.
Medicine (Baltimore) ; 100(24): e26257, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128853

RESUMO

BACKGROUND: There are 3 different types of mid-urethral sling, retropubic, transobturator and single incision performed for women with stress urinary incontinence. Prior studies comparing these three surgeries merely focused on the successful rate or efficacy. But nevertheless, what is more clinically important dwells upon investigating postoperative complications as a safety improvement measure. METHODS: A systematic review via PubMed, Ovid, and the Cochrane Database of Systematic Review and studies were applied based on the contents with clearly identified complications. Selected articles were reviewed in scrutiny by 2 individuals to ascertain whether they fulfilled the inclusion criteria: complications measures were clearly defined; data were extracted on study design, perioperative complications, postoperative lower urinary tract symptoms, postoperative pain, dyspareunia, and other specified late complications. RESULTS: A total of 55 studies were included in the systemic review. Perioperative complications encompassed bladder perforation, vaginal injury, hemorrhage, hematoma, urinary tract infection. There were postoperative lower urinary tract symptoms including urine retention and de novo urgency. Furthermore, postoperative pain, tape erosion/ extrusion, further stress urinary incontinence surgery, and rarely, deep vein thrombosis and injury of inferior epigastric vessels were also reported. CONCLUSIONS: Complications of mid-urethral sling are higher than previously thought and it is important to follow up on their long-term outcomes; future research should not neglect to address this issue as a means to improve patient safety.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Complicações Pós-Operatórias/etiologia , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Humanos , Metanálise como Assunto , Pessoa de Meia-Idade , Segurança do Paciente/normas , Melhoria de Qualidade , Projetos de Pesquisa , Slings Suburetrais/normas , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Bexiga Urinária/lesões , Vagina/lesões , Adulto Jovem
3.
Female Pelvic Med Reconstr Surg ; 26(11): e47-e53, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31393340

RESUMO

OBJECTIVE: The aim of this study is to estimate the long-term survival and to identify adverse events associated with the use of Gellhorn pessaries over a 9-year period. METHODS: This was a retrospective case series study at a tertiary urogynecology unit in Taiwan. Between January 2009 and June 2017, 93 patients who opted for self-management Gellhorn pessaries to treat symptomatic pelvic organ prolapse (POP) and who were continuously followed-up were enrolled. Long-term use was defined as use for longer than 1 year. Length of use, factors that predicted discontinuation, and adverse events were analyzed and reviewed by chart or telephone inquiry. RESULTS: The cumulative probabilities of continued pessary use at 1 and 5 years were 62.4% and 47.2%, respectively. Of those who discontinued use, 34 (70.8%) participants discontinued use within 1 year, and the mean duration of use was 13.7 months (range, 0-75 months; median, 5 months). Most of the participants stopped using the pessary because of bothersome adverse events such as pessary expulsion, vaginal pain, de novo urinary incontinence, and erosion/infection. CONCLUSIONS: Self-management Gellhorn pessary was safe and relatively effective and increased patients' autonomy and ability to manage their POP. One third of the patients discontinued use by 1 year, and half of the patients discontinued use at 5 years.


Assuntos
Prolapso de Órgão Pélvico/terapia , Pessários/estatística & dados numéricos , Autogestão , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Pessários/efeitos adversos , Estudos Retrospectivos
4.
Int Urogynecol J ; 30(9): 1509-1517, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30488270

RESUMO

INTRODUCTION AND HYPOTHESIS: To determine the clinical outcomes of adding a tension-releasing suture (TRS) appendage for manipulation of over-tensioned single-incision slings (SIS) as a means to relieve postoperative voiding dysfunction. METHODS: A retrospective observational study conducted from January 2010 to July 2017. The records of patients with urodynamic stress incontinence (USI) without needing concurrent procedures who underwent anti-incontinence surgery using MiniArc, Solyx, and Ajust with voiding dysfunction were collated and analyzed. The primary outcome measure was the recovery of normal post-void residual urine (PVR) after TRS manipulation. The secondary outcome measures were the pain intensity noted during manipulation (quantified by visual analog scale) and the continence rate [assessed by (1) objective cure: 1-h pad test weight < 2 g and absence of USI; (2) subjective cure index score ≤ 1 on question 3 of the UDI-6: "Urine leakage related to physical activity, coughing, or sneezing?"]. RESULTS: There were 73 patients with high post-void residual (PVR) urine. The 42 (9.5%) patients with over-tensioned slings were managed with TRS manipulation while the 31 patients (7%) with high PVR and no sling over-tension were managed with intermittent catheterization. All patients in both groups regained normal PVR. The TRS-manipulated group demonstrated an objective cure rate of 92.9% (39/42) and subjective cure rate of 91% (38/42). Pain experienced during TRS manipulation was significantly higher with the Ajust system (p = 0.018). Three patients had persistence of USI, two with MiniArc and one with Solyx. CONCLUSIONS: The TRS manipulation is a well-tolerated procedure that can effectively relieve voiding dysfunction for over-tensioned SIS without affecting continence cure rates.


Assuntos
Complicações Pós-Operatórias/cirurgia , Slings Suburetrais/efeitos adversos , Técnicas de Sutura , Incontinência Urinária por Estresse/cirurgia , Retenção Urinária/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Ferida Cirúrgica/cirurgia , Resultado do Tratamento , Retenção Urinária/etiologia
5.
J Minim Invasive Gynecol ; 26(4): 688-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30040998

RESUMO

STUDY OBJECTIVE: To evaluate the clinical outcome and identify risk factors for failure of the Solyx (Boston Scientific Corporation, Marlborough, MA) single-incision sling (SIS) in the treatment of urodynamic stress incontinence (USI). DESIGN: A retrospective observational study (Canadian Task Force classification II-2). SETTING: A tertiary referral center. PATIENTS: Patients diagnosed with USI without needing concurrent procedures that underwent continence surgery using the Solyx SIS from February 2015 to May 2017. INTERVENTIONS: Anti-incontinence surgery. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was the rate of objective cure defined as the absence of demonstrable leakage of urine on the cough stress test and a 1-hour pad test weight of less than 2g. The secondary outcome was the rate of subjective cure defined as a negative response to Urinary Distress Inventory question 3 (no leakage on coughing, sneezing, or laughing) and the identification of the different risk factors of cure failure. A total of 113 patients were evaluated in the study. Postoperative USI and the 1-hour pad test significantly improved from 24.2 ± 26.9 gm (range, 19.1-29.3) to 2.5 ± 8.7 gm (range, 0.9-4.2); p <0.001 through 1 year. Data analysis showed an objective cure rate of 90% (102/113) and a subjective cure rate of 86% (97/113). USI recurred in 11 patients with no repeat surgery done becausesymptoms were tolerable to the patients. No patient had bladder outlet obstruction. Peak flow rates 23.7 ± 9.1 ml/s (20.0-27.4) and residual urine volume 38.5 ± 25.8 ml (29.8-47.2) were within normal limits with no significant changes. Previous anti-incontinent surgery, previous prolapsed surgery, intrinsic sphincter deficiency, maximum urethral closure pressure <40cm H2O, and neurogenic disease were significant risk factors for sling failure. Subjective assessment on the quality of life significantly improved (p <0.001). CONCLUSION: The Solyx SIS is an effective and safe treatment option for women with USI, showing high objective and subjective cure rates with a low incidence of complications 1 year after treatment. The identified independent risk factors forfailure are related to poor urethral function and previous pelvic reconstructive surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Uretra/fisiopatologia , Incontinência Urinária/cirurgia , Urodinâmica
6.
Int Urogynecol J ; 30(9): 1541-1549, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30338371

RESUMO

INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the clinical outcome of continent women with high-risk predictors for de novo stress urinary incontinence (SUI) offered prophylactic midurethral sling (MUS) insertion during vaginal pelvic reconstructive surgery (PRS) for advanced pelvic organ prolapse (POP). MATERIALS AND METHODS: This was a prospective cohort study in patients with POP stage ≥ 3 and maximum urethral closure pressure (MUCP) <60 cmH2O and functional urethral length (FUL) <2 cm. Patients were divided into PRS and PRS + MUS groups. Surgery commenced with vaginal hysterectomy, application of Uphold® and insertion of MUS to the PRS + MUS group. Main outcome measures were incidence of de novo urodynamic stress incontinence (USI), lower urinary tract symptoms (LUTS), quality of life (QoL), and topographic and anatomical relationship of implanted mesh. RESULTS: Based on sample size calculation, 40 patients were recruited-20 in each group. Rate of de novo USI in PRS + MUS was 5% objectively and 10% subjectively, while in the PRS it was 50% objectively and 60% subjectively. No significant difference was noted in patient demographics. Intraoperative blood loss was greater for PRS + MUS but was not statistically significant. No organ injuries, mesh exposure, or infections occurred. Postoperatively, MUCP significantly increased from 43.3 ± 8.9 to 58.5 ± 19.2 cmH2O and FUL from 17.2 ± 1.9 to 20.3 ± 3.1 mm in the PRS + MUS group. Residual urine significantly decreased. No patient had bladder outlet obstruction (BOO). Sonographic assessment showed no difference in mesh mobility with urethral kinking observed in 11 (55%) patients with MUS. CONCLUSION: Based on a validated small sample, prophylactic MUS for continent women at high risk for postoperative USI with advanced POP lowers its incidence to 5%. Continence is achieved in 95%. Concern for complications, LUTS, and QoL did not significantly differ.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Slings Suburetrais , Incontinência Urinária por Estresse/prevenção & controle , Idoso , Feminino , Humanos , Incidência , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores de Risco , Resultado do Tratamento , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/etiologia , Vagina/cirurgia
7.
J Obstet Gynaecol Res ; 42(4): 427-33, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26786248

RESUMO

AIM: The aim of this study was to investigate the contributing factors of persistent detrusor overactivity (DO) in women with advanced pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair. METHODS: We retrospectively evaluated consecutive patients with DO and advanced POP who had undergone TVM in a tertiary hospital between 2010 and 2014. All patients received evaluations, including a structured urogynecological questionnaire, pelvic examination using the POP-Quantification System, scores of the Urogenital Distress Inventory and Incontinence Impact Questionnaire, and urodynamic testing before TVM repair and 6 months after surgery. Patient demographics, lower urinary tract symptoms, including urinary urgency, incontinence and frequency, and urodynamic findings were analyzed between women with and without persistent DO at 12 months after surgery. RESULTS: Of 326 patients with POP who underwent TVM repair, 63 with preoperative DO were included. Urinary urgency was present in 27 (42.9%), and urgency incontinence was present in 26 (41.3%) patients. Nineteen (30.2%) patients had persistent DO after surgery. Patients with persistent DO had lower preoperative maximal flow rate (MFR), higher preoperative detrusor pressure at maximum flow, higher postoperative residual urine volume and higher rates of concomitant sacrospinous ligament suspension compared to those without DO. In the multivariate analysis, preoperative MFR and concomitant sacrospinous ligament suspension were associated with persistent DO. CONCLUSION: Twenty percent of women with advanced POP had DO, and most of these cases resolved after prolapse repair. For women with lower preoperative MFR and concomitant sacrospinous ligament suspension, preoperative counseling should consist of a discussion about persistent DO and relevant urinary symptoms following TVM repair.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Bexiga Urinária Hiperativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Retrospectivos , Incontinência Urinária , Urodinâmica , Vagina/cirurgia
8.
Taiwan J Obstet Gynecol ; 54(6): 682-5, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26700985

RESUMO

OBJECTIVE: To investigate the predictors of persistence or resolution of preoperative urgency urinary incontinence (UUI) in women following transvaginal mesh (TVM) repair for advanced pelvic organ prolapse (POP). MATERIAL AND METHODS: Patients with advanced POP undergoing TVM repair between 2008 and 2013 in a tertiary hospital were recruited. All patients underwent evaluation including a structured urogynecological questionnaire, voiding diary, pelvic examination using the POP-quantitation system, and urodynamic testing before and after surgery, and intraoperative cystoscopy. Patient demographics, lower urinary tract symptoms, urodynamic findings, and severity of prolapse were analyzed between women with and without preoperative UUI. RESULTS: Of 174 patients who underwent TVM repair, 49 (28.2%) had preoperative UUI; after operation, 23 (13.2%) were found to have postoperative UUI and 13 (7.5%) developed de novo UUI. For those 49 patients with preoperative UUI, 10 (20.4%) had persistent UUI and 19 (38.8%) developed de novo stress urinary incontinence postoperatively. The prevalence of preoperative bladder outlet obstruction, preoperative maximal cystometric capacity (MCC) < 300 mL, preoperative severe bladder trabeculation, and duration of POP symptoms > 60 months were significantly higher in patients with persistent UUI than without it. Logistic regression demonstrated that preoperative MCC<300 mL, severe bladder trabeculation, and duration of POP symptoms > 60 months were associated with persistent UUI after prolapse repair. CONCLUSION: For women with identified preoperative risk factors, including MCC<300 mL, severe bladder trabeculation, and POP symptoms > 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária de Urgência/etiologia , Idoso , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Tono Muscular/fisiologia , Músculo Liso/fisiopatologia , Prolapso de Órgão Pélvico/complicações , Complicações Pós-Operatórias , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Tempo , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Incontinência Urinária por Estresse/etiologia , Urodinâmica/fisiologia
9.
Taiwan J Obstet Gynecol ; 54(6): 709-15, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26700990

RESUMO

OBJECTIVE: To assess the clinical significance of low compliance bladder (LCB) in women with lower urinary tract symptoms. MATERIALS AND METHODS: Medical records of 1490 women undergoing videourodynamic studies (VUSs) were reviewed. Comprehensive medical histories, physical examinations, bladder diaries, and results of multichannel VUS were analyzed. This study adopted an end filling detrusor pressure (EFP) greater than 20 cmH2O to define LCB. RESULTS: Among the study patients (n = 1490), 9.1% were diagnosed with LCB using a cutoff value of 17.5 cmH2O, which had a sensitivity and specificity of 89% and 92.7%, respectively. Results of multivariate analysis indicated that age (p = 0.005), maximum cystometric capacity (MCC; p = 0.002), detrusor overactivity (DO; p = 0.001), pelvic organ prolapse (POP; p = 0.018), recurrent urinary tract infection (p = 0.001), and radical abdominal hysterectomy (RAH; p < 0.001) as independent prognostic factors. Furthermore, our study results indicate that the MCC, urinary tract infection, and a history of RAH have a positive correlation with LCB, whereas, age, POP, and DO have a negative correlation with LCB. CONCLUSION: Our idea using EFP (≥17.5 cmH2O) for screening women with LCB is feasible for clinical use.


Assuntos
Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Fatores Etários , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Prognóstico , Recidiva , Estudos Retrospectivos , Sensibilidade e Especificidade , Bexiga Urinária Hiperativa/fisiopatologia , Infecções Urinárias/fisiopatologia
10.
Taiwan J Obstet Gynecol ; 54(1): 54-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25675920

RESUMO

OBJECTIVE: This was a retrospective study of the efficacy of urethral overdilation (UOD) for women with voiding dysfunction. MATERIALS AND METHODS: Thirty-six patients diagnosed with voiding dysfunction were enrolled. The main indications for UOD included women with poor compliance (30 patients, 83.3%) and obstructive symptoms with high residual urine (6 patients, 16.7%). We utilized a method called UOD (wide caliber), dilating the urethra up to 54 Fr. Patients were re-evaluated every 3 months with serial free flow rate and ultrasound residual in the first year and then as scheduled. Outcome measure was based on the change in videourodynamic parameters, Urogenital Distress Inventory-6 (UDI-6) questionnaire, and International Prostate Symptom Score (IPSS). RESULTS: Mean follow up period of 33.2 months (range: 13-61 months). Failure or success depended on the change in videourodynamic parameters, UDI-6 score, and IPSS. The mean age with the Success Group (n = 22, 61.1%) and Failure Group (n = 14, 39.3%) was 52.8 years and 54.1 years, respectively. Our data showed significant improvements in mean UDI-6 score and IPSS after treatment (11.5-5.7, p = 0.032 and 14.8-5.2, p = 0.006, respectively). By analyzing multiple parameters (age, parity, body mass index, videourodynamics parameters, anesthesia bladder capacity, UDI-6 score, and IPSS) between the success and failure groups, we found only anesthesia bladder capacity reached statistical significance (536 mL vs. 418 mL, p = 0.005). CONCLUSION: The present study provides evidence that UOD, as a minimally invasive procedure, achieves a satisfactory cure rate on short-term follow-up for women with voiding dysfunction.


Assuntos
Uretra/fisiopatologia , Cateterismo Urinário/métodos , Retenção Urinária/terapia , Micção/fisiologia , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Retenção Urinária/diagnóstico , Retenção Urinária/fisiopatologia
11.
Expert Opin Drug Discov ; 9(4): 423-32, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24606198

RESUMO

INTRODUCTION: Advances in the treatment of interstitial cystitis or bladder pain syndrome (IC/BPS) depend on a good understanding of its pathogenesis. Presently, oral medicine and intravesical drug instillations may be the most popular therapies in daily practice. To improve the efficacy of intravesical drug delivery, the system requires modulation through coupling them to novel carriers. Numerous investigators have attempted alternative reconstructive procedures for bladder replacement/repair using scaffolds. These scaffolds include acellular extracellular matrix grafts or tissue-derived cell-seeded extracellular matrix grafts as well as the transplantation of mesenchymal progenitor cells into the damaged bladder. AREAS COVERED: This review focuses on the current available IC/BPS treatments and the different strategies employing nanotechnology or tissue engineering in the discovery of novel IC/BPS therapies. EXPERT OPINION: Current studies in the discovery of novel IC/BPS therapies are still imperfect, with novel approaches that use biocompatible nanomaterials or tissue engineering still ongoing. These nanoformulations give the benefit of protecting easily degradable molecules and enhance targeted delivery. Tissue engineering holds the promise of regenerating damaged tissues and organs by replacing damaged tissue and/or by stimulating the body's own repair mechanisms to heal previously irreparable tissues and organs. For these reasons, nanotechnology and tissue engineering could play key roles in the discovery of novel painful bladder syndrome therapies.


Assuntos
Cistite Intersticial/terapia , Animais , Cistite Intersticial/etiologia , Humanos , Nanoestruturas/uso terapêutico , Engenharia Tecidual
12.
Taiwan J Obstet Gynecol ; 52(3): 311-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24075365

RESUMO

Pelvic organ prolapse (POP) is a common condition in women. Women with POP often experience pelvic discomfort, urinary and fecal problems, sexual dysfunction, and an overall decrease in their quality of life. Surgical treatment is a feasible option if conservative management fails. Various surgical techniques have been proposed to correct POP with or without the use of graft material. Owing to recent U.S. Food and Drug Administration warnings about mesh-related complications, sacrospinous ligament fixation (SSF), as a traditional vaginal procedure, may play an important role again. To answer this question and evaluate quantitatively the efficacy of SSF in POP, we conducted a systemic review of the available data about SSF and POP. Interventions had to include SSF as a point of attachment. To eliminate confounding bias and effect modification, at least one arm must include SSF without mesh or graft. All follow-up periods were allowed. Information on the following parameters was extracted and entered into a database: study design, type of intervention, number of patients, follow-up in months, cure rate, recurrence rate, intra/postoperative complications, and/or uni/bilateral, preventive/therapeutic, or concomitant procedures. Published papers from the years 1995 to 2011 were selected for analysis.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Ligamentos/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos
13.
J Obstet Gynaecol Res ; 39(11): 1526-32, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23855601

RESUMO

AIMS: The aim of this study was to investigate the efficacy of extracorporeal magnetic stimulation (EMS) for the treatment of bothersome and severe symptoms of stress urinary incontinence (SUI) and overactive bladder syndrome (OAB) in female patients. MATERIAL AND METHODS: A retrospective review was conducted on patients with SUI and OAB who were referred to EMS therapy. Successful treatment for the bothersome symptoms of OAB and SUI was defined as score ≤1 for questions 2 and 3 on the Urodynamic Distress Inventory-6. The objective cure of SUI and OAB was defined as no urinary leakage during the cough stress test and any urgency, urge incontinence and voiding frequency of less than eight times per 24 h based on the 3-day bladder diary, after the 9 weeks of treatment, respectively. RESULTS: Ninety-three patients with SUI or OAB underwent a 9-week course of EMS at 20 min twice weekly. Seventy-two (77%) patients completed EMS treatment. Geographical factor and poor economic status were two main factors for dropout. A total of 94.1% (32 of 34) and 86.8% (33 of 38) of subjects had successful treatment for the bothersome symptoms of OAB and SUI, respectively. In contrast, the cure rate for OAB and SUI was only 61.7% and 42.1%, respectively. There was also a significant improvement in both Urogenital Distress Inventory Short Form (bothersome on lower urinary tract symptoms) and the Incontinence Impact Questionnaire Short Form (quality of life) total score in both groups after EMS. CONCLUSIONS: EMS is a safe and effective alternative method for treating SUI and OAB. Further studies are needed to evaluate the long-term efficacy.


Assuntos
Terapia de Campo Magnético , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária por Estresse/terapia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos
14.
Taiwan J Obstet Gynecol ; 51(3): 363-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23040918

RESUMO

OBJECTIVE: We report here the clinical outcome of a simplified method to suspend the vaginal cuff during laparoscopic assisted vaginal hysterectomy. MATERIALS AND METHODS: This is a retrospective study. Fifty patients underwent laparoscopic assisted vaginal hysterectomy and received transvaginal uterosacral ligament fixation for vaginal cuff support (LAVHUS). Follow-up examinations were conducted for at least 24 months and included vaginal examination with prolapse grading using the POP-Q system. Subjective outcomes were measured using a questionnaire that asked patients to describe postoperative lower urinary tract symptoms and satisfaction with the procedure. RESULTS: The mean follow-up duration was 106 weeks (range 102-120 weeks).The postoperative POP-Q point C and total vaginal length were effectively sustained during this period. There were no intraoperative or postoperative complications, and no adverse postoperative lower urinary tract symptoms were reported. CONCLUSION: The present study demonstrated satisfactory subjective and objective clinical outcomes following LAVHUS.


Assuntos
Histerectomia Vaginal/métodos , Laparoscopia/métodos , Ligamentos/cirurgia , Sacro , Vagina/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Prolapso de Órgão Pélvico/etiologia , Prolapso de Órgão Pélvico/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Doenças Uterinas/cirurgia
15.
Int Urogynecol J ; 23(12): 1693-8, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22581238

RESUMO

INTRODUCTION AND HYPOTHESIS: Midurethral tapes have shown favorable clinical outcomes for treating stress urinary incontinence (SUI), but the effects of outside-in transobturator midurethral sling procedures (TOT) on women's sexual function are unclear. We hypothesized that TOT might improve sexual function in women with SUI and therefore conducted this study to investigate sexual function alteration among women who underwent TOT for urodynamic stress incontinence (USI). METHODS: From November 2009 to October 2010, we recruited 102 women scheduled for correction of USI by TOT procedures in a tertiary hospital. In addition to urogynecologic history, pelvic examination, and urodynamic testing, participants were required to complete three validated questionnaires: Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Preoperative and postoperative results of these validated questionnaires were evaluated. RESULTS: Eighty-three patients comprising 57 sexually active and 26 sexually inactive patients participated in the 12-month evaluation. Of the 83 patients undergoing TOT, six (7.2 %) had postoperative SUI 12 months postoperatively. Both UDI-6 and IIQ-7 scores were significantly improved postoperatively. The total PISQ-12 score did not change significantly after surgery. Postoperatively, the individual incontinence-related items of the PISQ-12 improved, but climax with intercourse and negative emotional reactions during intercourse worsened (both with p <0.001). There was a negative correlation between SUI-related items on UDI-6 and those on PISQ-12 preoperatively. CONCLUSIONS: TOT procedures for correcting USI had favorable clinical outcomes and did not alter overall sexual function; however, climax during sexual intercourse and emotional response worsened postoperatively.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
16.
Int Urogynecol J ; 23(10): 1455-60, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22407233

RESUMO

INTRODUCTION AND HYPOTHESIS: Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women's sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP). METHODS: A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery. RESULTS: At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains. CONCLUSIONS: Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.


Assuntos
Dispareunia/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Comportamento Sexual/fisiologia , Telas Cirúrgicas , Vagina/cirurgia , Idoso , Comorbidade , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Slings Suburetrais , Resultado do Tratamento , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia
17.
J Minim Invasive Gynecol ; 18(1): 68-74, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21195956

RESUMO

STUDY OBJECTIVES: To estimate the effect of pessary use on symptom improvement and quality of life in women with pelvic organ prolapse, to examine factors that influence patient choice and continued use of a pessary, and to determine reasons associated with discontinuation of pessary use. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Outpatient urogynecologic clinic of a university hospital. PATIENTS: Seventy-two patients with symptomatic pelvic organ prolapse were evaluated for pessary insertion between March 2006 and August 2008. INTERVENTIONS: Insertion of a Gellhorn pessary. MEASUREMENTS AND MAIN RESULTS: Urinary symptoms and quality of life were assessed using the Urinary Distress Inventory incontinence questionnaire (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) at baseline and postinsertionally at 2 months and at 1 year. Frequency of choosing pessary use or surgery and rate of continuous use of a pessary was compared between groups. Compared with baseline findings, at 1 year, UDI-6 and IIQ-7 demonstrated significant improvement in frequency of micturition, stress incontinence, voiding function, and bowel evacuation. Substantially more older or menopausal women opted for a pessary rather than surgery, and significantly more sexually active women preferred surgery. Women with diabetes mellitus or occult stress urinary incontinence and those without family support are more likely to discontinue pessary use. CONCLUSIONS: Use of a pessary in treatment of pelvic organ prolapse is associated with good compliance, and results in significant improvement in quality of life and urinary and bowel symptoms. Women with diabetes or occult stress urinary incontinence and those without family support should receive intensive counseling before placement of a pessary.


Assuntos
Cooperação do Paciente , Prolapso de Órgão Pélvico/terapia , Pessários , Qualidade de Vida , Incontinência Urinária por Estresse/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/terapia
18.
Eur J Obstet Gynecol Reprod Biol ; 153(1): 94-8, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20685029

RESUMO

OBJECTIVE: To investigate the activities of matrix metalloproteinase-2 (MMP-2) and its inhibitors, tissue inhibitor of metalloproteinase-1, -2 and -3 (TIMP-1, TIMP-2 and TIMP-3), in the pelvic support and nonsupport tissue of women with uterine prolapse but without urinary incontinence. STUDY DESIGN: Paired samples of uterosacral ligament and cervical tissue were obtained from 11 postmenopausal and 8 premenopausal women with severe uterine prolapse. Nine premenopausal women without prolapse were selected as normal controls. Immunoreactivity of MMP-2 and TIMPs was demonstrated by immunohistochemistry. Steady state of MMP-2 as well as TIMPs messenger RNA (mRNA) expression was analyzed by polymerase chain reaction (PCR) with quantitative expression determined by multiplex PCR. RESULTS: A significantly higher expression of MMP-2 mRNA and lower expression of TIMP-2 mRNA were found in uterosacral ligament in uterine prolapse women compared to controls. In the cervical tissue, however, the MMP-2 and TIMPs mRNA expression was comparable between prolapse and control groups. With regard to menopausal status, there was no significant difference in MMP-2 and TIMPs mRNA expression between premenopausal and postmenopausal women with uterine prolapse. CONCLUSIONS: An increase in MMP-2 mRNA and a decrease in TIMP-2 mRNA expression in uterosacral ligament are related to uterine prolapse in women without urinary incontinence.


Assuntos
Metaloproteinase 2 da Matriz/genética , Inibidor Tecidual de Metaloproteinase-2/genética , Prolapso Uterino/metabolismo , Adulto , Idoso , Colágeno/metabolismo , Feminino , Humanos , Metaloproteinase 2 da Matriz/análise , Metaloproteinase 9 da Matriz/análise , Metaloproteinase 9 da Matriz/genética , Pessoa de Meia-Idade , RNA Mensageiro/análise , Inibidor Tecidual de Metaloproteinase-1/análise , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-2/análise , Inibidor Tecidual de Metaloproteinase-3/análise , Inibidor Tecidual de Metaloproteinase-3/genética , Incontinência Urinária/metabolismo
20.
Int Urogynecol J ; 21(8): 911-8, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20204322

RESUMO

INTRODUCTION AND HYPOTHESIS: The aim of this study was to explore potential molecular mechanisms contributing to the pathogenesis of Hunner's ulcer type interstitial cystitis (IC). METHODS: Dataset acquisitions from Gene Expression Omnibus under platform accession no GSE 11783. We compared global gene expression profiles in bladder epithelial cells from IC patients with Hunner's ulcer corresponding to normal controls. We re-sampling and exploit the correlation structure presented in the dataset through the transcriptional response. For each patient, two bladder biopsies were studied, one from an ulcer area and one from a non-ulcer area. RNA was extracted, and all labeled samples were hybridized to Human Genome U133 Plus 2.0 Array (Affymetrix, CA, USA). RESULTS: The Mahalanobis distance in hierarchical cluster analysis revealed a model of 40 genes expression which is increased in IC and ulcerated IC. Our results can be summarized as follows: First, the expressions of major histocompatibility complex (MHC) class IF and II molecules, leukocyte immunoglobulin-like receptors, hepatitis A virus cellular receptor 2, and interleukin 32 were increased in bladder epithelial from IC and ulcerative IC area. Next, there is an indication of antigen-mediated aggregation of the high-affinity Fc epsilon and gamma RI leading to allergic inflammation through the disease status. Third, the high-affinity Fc gamma RI subunit facilitated T-cell-mediated immune response through the disease status. Such changes, jointly termed "bladder remodeling," can constitute an important long-term consequence of Hunner's ulcer type IC. CONCLUSIONS: Our results indicate that genome-based expression profiling can be used for the diagnostic tests of Hunner's ulcer type IC in clinical practice.


Assuntos
Cistite Intersticial/genética , Perfilação da Expressão Gênica , Modelos Genéticos , Estudos de Casos e Controles , Cistite Intersticial/diagnóstico , Cistite Intersticial/metabolismo , Feminino , Genes MHC Classe I , Genes MHC da Classe II , Testes Genéticos , Receptor Celular 2 do Vírus da Hepatite A , Humanos , Interleucinas/genética , Proteínas de Membrana/genética , Receptores de IgE/genética , Receptores de IgG/genética
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