COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

Objective.To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI). Methods. The clinical data of 95 USI cases or accompany USI treated by surgical procedures (Kelly operation 63 cases, Colposuspension 32 cases) was analysed retrospectively in our department. Results.The cure rates during three months after operation were 92.9% in Colposuspension group and 68.9% in Kelly operation group (P<0.05), and decreased to 73.7% and 57.5% one year after operation in Colposuspension group and Kelly operation group respectively (P>0.05). Abnormal senses rates of sexual intercouse was 3.7% in Cloposuspension and 7.3% in Kelly operation group. The length of retaining Folly catheter after Colposuspension was more than Kelly operation. [WT5”BX]Conclusion.[WT5”BZ]The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

“Four Sacral Needles” Therapy for Female Stress Incontinence

Objective： To make a retrospective control study of the curative effects of ＂Four sacral needles＂ method and conventional acupuncture therapy on female stress incontinence. Methods：A treatment group was treated by ＂Four sacral needles＂ method, in which four sacral points were electroacupunctured with special insertion of needles to excite the pudendal nerve and induce the rhythmic contraction of the pelvic floor muscles, thereby increasing the strength of the pelvic floor muscles and improving ability in urinary continence. A control group was treated by conventional acupuncture therapy, in which corresponding points were acupunctured according to syndrome-based classification. Results： In the 31 cases of the treatment group treated by ＂Four sacral needles＂ method, 100% symptom improvement occurred in 22（71.0% ）after an average of 21 treatments （3-63 treatments）. In the 34 cases of the control group treated by conventional acupuncture therapy, 100% symptom improvement occurred in 0 after 30 treatments. The curative effect was better in the treatment group than in the control group（p〈 0.01）.The curative effect improved with an increase in the number of treatments in the treatment group. Conclusion： ＂Four sacral needles＂ method is more effective than conventional acupuncture therapy in treating female stress incontinence.

Ten-Year Outcomes of Transobturator Mid-Urethral Sling for Treatment of Stress Urinary Incontinence in Hong Kong Chinese Women with or without Reconstructive Pelvic Floor Surgery

Objective: To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years. Methods: This was a prospective observational study on Chinese women undergoing the insertion of TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form (IIQ-7)) and adverse events were also collected. Results: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant differences in objective cure rate (84.2% vs. 90.5%, p = 0.55) and subjective cure rate (78.9% vs. 83.3%, p = 0.58). Conclusion: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.

Contemporary diagnostics and treatment options for female stress urinary incontinence

Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.

Analysis of coping styles of elderly women patients with stress urinary incontinence

Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to improve quality of life in these patients.Methods:Cross-sectional surveys addressing SUI cognition and coping techniques of 520 elderly women patients with SUI were administered between July 2013 and February 2014.Results:Elderly women with SUI had significantly higher avoidance and acceptanceresignation scores than the normal population(p<0.05).Age,marital status,education level and stress urinary incontinence cognitive level all influenced the medical coping style of these patients.Conclusions:Elderly female patients with SUI differ in the factors that influence their coping styles;therefore,clinical and community medical staff should include a comprehensive analysis that takes these factors into consideration when working with patients with SUI to guide them in adopting a positive coping style.

Experimental Effect of Umbilical Cord Mesenchymal Stem Cells on Stress Urinary Incontinence Rats Model and Efficient Tracking in vivo with MRI

Objective To assess the effect of intra-sphincteric injections of human umbilical cord mesenchymal stem cells(HUMSCs)on leak point pressure(LPP)changes in an animal model of stress urinary incontinence(SUI).Meanwhile,to investigate in vivo MRI tracking HUMSCs in SUI rats using a clinically available paramagnetic contrast agent(Gd-DTPA)and commercially available effentence transfection reagents..Materials and Methods HUMSCs were dual labeled with Gd-DTPA and PKH26,the labeling efficiency and longevity of Gd-DTPA maintenance were measured and cell viability and proliferation were assessed.39 female Sprague–Dawley SUI rats.12 normal rats and 12 SUI rats received periurethral injection of PBS and 12 SUI rats were given periurethral injection of dual labeled HUMSCs.3 SUI rat sreceived periurethral injection of u nlabeled HUMSCs.Six weeks after injection,LPP was undertaken in animals.All rats were sacrificed and frozen urethra sections were submitted to pathology and immunohistochemistry assessment.Results The labeling efficiency of Gd-DTPA was up to 80%,the labeling procedure did not influence cell viability and proliferation.The signal intensity on T1-weighted imaging and T1 values of labeled cells were significantly higher than those of unlabeled cells.In vitro,differentiated HUMSCs expressed myosin heavy chain(MHC)and desmin,markers of striated muscles.In vivo,immunohistochemistry of rat urethras revealed dual labeled HUMSCs in situ and at the injection site.LPP was significantly improved in animals injected with HUMSCs.Atrophic urethras with implanted HUMSCs were positively stained for MHC and desmin.The distribution and migration of labeled cells could be tracked by MRI more than 14 days after t ransplantation.Conclusion HUMSCs have the ability to differentiate striated muscles,as demonstrated by MHC and desmin expression.Periurethral injection of HUMSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved LPP.MRI can track Gd-DTPA–labled HUMSCs in an animal model of SUI in vivo.

Clinical value of needleless sling in treatment of female stress urinary incontinence

BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.

Needleless Contasure versus TVT-O in Women with Stress Urinary Incontinence

Objectives: The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of Single Incision needleless Mini-Slings compared with tension-free Standard Mid-urethral Sling in the surgical management of female stress urinary incontinence, but with less side effects. Methods: The study will be conducted in Zagazig University Hospitals. From 2018 to Sept. 2019, 40 cases were enrolled in the study and were randomized by envelope technique at the time of surgery to either a trans-obturator vaginal tape (TOT) or Needleless anti-incontinence procedure. The patients will be divided into 2 groups: Group 1 patient treated by standard sling (TOT). Group 2 those treated by mini-sling. Parameters in perioperative period such as operating time, intraoperative hemorrhage volume, length of stay in hospital, intraoperative complications, and postoperative pain of each patient were recorded. The sample size was calculated to be 40 cases (20 cases will be treated by standard slings, 20 case will be treated by mini-sling). Results: A total of 40 patients assessed for eligibility were randomized into Needleless groups. There were no significant differences in age, body mass index, process, parity, pad test or the assessment of preoperative quality of life between the two groups. In the perioperative period, statistically significant differences between the two groups were found in operating time, intraoperative hemorrhage volume, groin pain scores at 24 h after operation and length of stay in hospital (P < 0.001). After two weeks of follow-up, a statistically significant difference between the two groups was found in groin pain/femori-bus internus pain scores, but there were no significant differences in cure rates, pad test, complications or ICIQ-SF. After 1 year, there were no significant differences between the Needleless and TOT groups in cure rates, pad test, groin pain or ICIQ-SF (P > 0.05). Both groups registered a significant improvement in the quality of life (P < 0.001), but there were no significant differences between the two groups (P > 0.05). Conclusion: We conclude that compared with the TOT surgery, single-incision Needleless sling in the treatment of female stress urinary incontinence is simpler and quicker and has less hemorrhage during surgery as well as faster recovery and it also can obviously reduce the inguinal region pains after operation and shorten hospital stays. In summary, single-incision Needleless sling is a kind of convenient, safe and effective minimally invasive surgery for urinary incontinence.

Female Stress Urinary Incontinence Treatment by Forming an Uretro-Vesical Angle with or without Mesh

Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.

Efficacy of biofeedback on stress urinary incontinence in women receiving pelvic floor muscle training: a meta-analysis

Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.

The Psycho-Social Impact of Urinary Incontinence on the Quality of Life among Kuwaiti Women with Type 2 Diabetes Mellitus

This study was conducted to determine the psycho-social impact of urinary incontinence (UI) on the quality of life of 250 Kuwaiti women with type 2 diabetic mellitus (DM). A survey method, using a 33-item 5-point Likert scale Arabic questionnaire adapted from the King’s Health Questionnaire (KHQ), was employed for data collection from February to May, 2014 while all the participants were receiving treatment for UI at a specialized urology center in Kuwait. Participants with UI and a co-morbidity of type 2 DM and obesity were 20 to 65 years old. Results showed the following variables were statistically significant for frequency of urine leak: Age was (χ2 = 36.877, df = 3, P ≤ 0.000). Parity showed nulliparous women reported less urine leak compared to parous women: Chi-square was (χ2 = 24.83, df = 12, P ≤ 0.016). Type 2 DM for more than 3 years duration had the highest incidence of several leaks per day. BMI of above 25 kg/m2 caused daily urine leak: Chi-square (χ2 = 17.912, df = 9, P ≤ 0.036). Participants’ self reports of good general health were those who leaked urine either 2 - 3 times weekly or occasionally. Finally, the impact of incontinence on their lifestyle was reported as extreme by 128 (51.2%), and 6 (2.4%) reported little or no impact on their quality of life: Chi-square was (χ2 = 52.392, df = 18, P ≤ 0.000). In conclusion, this study showed a clear correlation between UI and reduced quality of life. Midwives are well positioned to correct the myth that UI is an inevitable byproduct of childbearing. Midwives should explain to all pregnant women how childbirth can be a risk factor and provide anticipatory guidance by teaching preventive measures like pelvic floor exercises before and after delivery. Family members should assist sufferers in coping with their challenges by dispelling any form of stigmatization, joining them in practicing pelvic floor exercises, and encouraging, empathizing and supporting them emotionally.

Female urinary incontinence in China after 15 years’efforts:Resultsfrom large-scale nationwide surveys

Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dynamics of female UI in China,and can inform further policies and have international implications.This study used three nationwide investigations:A national cross-sectional survey in 2021;another nationwide cross-sectional survey in 2006;and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019.The weighted prevalence of female UI and its subtypes,including stress UI(SUI),urgency UI(UUI),and mixed UI(MUI),were estimated as primary outcomes.Knowledge,attitude and care-seeking behaviors of UI were evaluated.It was found that the weighted prevalence of female UI was 16.0%(95%CI,13.3%–19.1%)with SUI remaining the predominant subtype(7.0%)in 2021,followed by MUI(6.5%)and UUI(1.9%).The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021.52.7%(95%CI,45.9%–59.4%)of women were aware that UI was a medical condition,and only 10.1%of women with UI sought health care.After 15 years of development,there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in ChinaDthey were found to be associated with UI prevalence.The UI prevalence in China was significantly lower in 2021 compared to that in 2006.Despite the achievement,UI remains a public health problem,especially given China's fast aging and three-child policy.More innovations,especially those that can facilitate care seeking,are needed to address this prevalent yet treatable condition.

Urinary incontinence among Jordanian women:Prevalence,types,and associated factors

ObjectiveUrinary incontinence (UI) is a prevalent condition with a negative impact on women's quality of life. Data about UI among Jordanian women are lacking;therefore, we aimed to investigate the prevalence, types, and associated factors.MethodsA cross sectional nationwide survey was conducted between 1 March 2020 and 15 April 2020. Women were included if they were 18 years of age or more and had access to the internet. Data collected included women's characteristics, UI types, and associated factors. UI was inventoried by asking women if they have UI (yes/no), and the Arabic language validated International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form was used. Age-group specific prevalence rates of UI were estimated, and associated factors were studied using logistic regression analyses.ResultsData from 2118 women were analysed. The median age was 40 (range 18–85) years;58.3% gave birth three or more times;and 64.1% consistently reported having UI. Limited mobility and being multiparous increased the likelihood of reporting UI. Compared to women with normal body mass index, overweight and obese women were 1.9 times and 4.4 times more likely to report UI, respectively.ConclusionThe prevalence of UI among Jordanian women is 64.1%, with mixed UI and stress UI being the more prevalent types in women younger than 60 years old. Age, parity body mass index, and limited mobility are all associated factors with UI. The results of this study provide healthcare policy makers with the necessary information to increase awareness and knowledge regarding UI.

Urethral complications after tension-free vaginal tape procedures:A surgical management case series

AIM： To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS： This study encompasses a retrospective review of nine patients presented with urethral complic-ations after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset （〈 12 mo） or late onset （〉 12 mo） according to when they were frst reported.RESulTS： Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence （7/9 patients）, urinary retention/voiding dysfunction （4/9 patients）, urethritis （4/9 patients）, relapse of stress-incontinence （3/9 patients）, recurrent urinary tract infections （5/9 patients）, and hematuria （1/9 patient）. In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. COnCluSIOn： Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

Single incision slings:Are they ready for real life?

AIM： To review of the efficacy and safety outcomes of different single incision slings （SIS） systems, also in comparison with traditional slings.METHODS： A literature search was conducted in PubMed/MEDLINE database. The research was re-stricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence （SUI）. The studies had to assess effcacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The fnal selection included 19 papers fulflling the aforementioned criteria. Two authors independently reviewed the selected papers.RESULTS： Four different SIS systems were analysed： Ajust , Ophira , Altis and MiniArc . The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings （MUS） in terms of objective cure （all P 〉 0.005）. Only one paper showed a statistically lower success rate in MiniArc？ vs Advant-age？ slings （40% vs 90%） and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to com-pare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust？ and MiniArc？, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains. CONCLUSION： SIS showed similar effcacy to that of traditional slings but lower short-term pain, complication and failure rates.

Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction： A Nested Case-control Study

Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.

Expression and significance of lysyl oxidase-like 1 and fibulin-5 in the cardinal ligament tissue of patients with pelvic floor dysfunction

Pelvic organ prolapse （POP） is a disabling disorder in women characterized by a loss of pelvic floor support, leading to the herniation of the uterus into or through the vagina. POP is a complex problem that likely involves multiple mechanisms with limited therapies available, and is associated with defects in connective tissue including elastic fibers. This study was designed to investigate the expression of fibulin-5 and lysyl oxidase-like 1 （LOXL1） in the cardinal ligament in samples taken from the POP group compared to the non-POP group. Specimens were obtained during abdominal hysterectomy from the cardinal ligament of 53 women with POP and 25 age- and par- ity- matched women with non-POP among post-menopausal women with benign gynecologic pathology. Protein expression was evaluated using the immunohistochemical staining method. For statistical analyses, chi-square test and Spearman＇s correlation were used with the statistical package SPSS13.0 system. Our results showed that both fibulin-5 and LOXL1 expressions were decreased in the cardinal ligament in the POP group compared to the non- POP group （P 〈 0.05）. The expression of fibulin-5 and LOXL1 were correlated closely with the stage of POP, ac- companied by stress urinary incontinence and frequency of vaginal delivery （P 〈 0.05）, but had no relationship with post-menopausal state （P 〉 0.05）. The expression of fibulin-5 was positively associated with LOXL1 in POP （P 〈 0.05）. We conclude that changes in fibulin-5 and LOXL1 expression may play a role in the development of POP.

Inside out transobturator vaginal tape versus tention-free vaginal tape for primary female stress urinary incontinence： meta-analysis of randomized controlled trials

Background Inside out transobturator vaginal tape （TVT-O） and tension-free vaginal tape （TVT） are predominant surgical treatments for female stress urinary incontinence. This meta-analysis evaluated the complications and cure rates of TVT-O versus TVT. Methods A comprehensive literature search was conducted according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials with no language restriction. Two authors independently assessed papers for eligibility and methodological quality. Estimates were measured by relative risk with 95% confidence intervals. Outcome measures were objective cure, subjective cure and complications. Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment, Development, and Evaluation （GRADE） system. Results Twenty randomized controlled trials met the inclusion criteria, and a pooled estimate of effectiveness and complications was made. Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were： 0.20 （0.09-0.45）, for bladder injury, 0.37 （0.16-0.86） for hematoma, and 2.35 （1.57-3.51） for postoperative pain, suggesting an 80% risk reduction of bladder injury, 63% risk reduction of hematoma, and a 1.35% risk elevation for postoperative pain with TVT-O. There was no significant difference between complications of urinary tract infection 1.14 （0.78-1.65）, lower urinary tract symptoms 1.60 （0.67-3.79）, recatheterization 0.93 （0.59-1.44）, and tape erosion 0.90 （0.48-1.67）, total objective cure rate 1.06 （0.39-2.84） and for the subjective cure rate 0.98 （0.93-1.04）. The quality rating for each outcome and recommendations was high for objective cure, bladder injury, hematoma, lower urinary tract symptoms, and tape erosion and moderate for subjective cure, pain, and urinary tract infection. Conclusions TVT-O is associated with a reduced risk of bladder injury and hematoma and an elevated risk of postoperative pain. Other complications, including tape erosion,urinary tract infection, lower urinary tract symptoms, and recatheterization, are similar to those of TVT.

Burch colposuspension for stress urinary incontinence: a 14-year prospective follow-up

We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.