Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review

Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.

Treatment and Maintenance of Interstitial Cystitis/Bladder Pain Syndrome in Female Patients with Cetirizine-Famotidine: A Case Series

Purpose: Interstitial cystitis/Bladder pain syndrome is an inflammatory disorder of the bladder, for which histamine has been implicated in the pathogenesis of the disease. The condition is often refractory to standard-of-care medical treatments, including the antihistamines hydroxyzine or cimetidine, and procedures. Herein we report a physician-sponsored proof-of-principle case series of four adult female patients with chronic painful bladder and frequent urination, who were treated once daily with a low dose H1 + H2 histamine receptor antagonist combination. Materials and Methods: Four adult females with Interstitial cystitis/Bladder pain syndrome were treated once daily with a compounded oral dosage form containing the H1 receptor antagonist-cetirizine 8 mg in combination with the H2 receptor antagonist-famotidine 22 mg. The case series consists of a retrospective review of the symptom severity prior to versus following H1 + H2 treatment. Results and Conclusions: The once daily dual histamine receptor antagonist therapy substantially reduced the pain and urination frequency, and prophylactically maintained all four patients long-term with substantially reduced disease severity. The reduction in symptom severity was achieved at amounts that do not exceed the US FDA approved and exceptionally safe daily doses for the two over-the-counter monotherapies. This case series provides proof-of-principle evidence that a dual antihistamine combination of cetirizine plus famotidine effectively treated and maintained female patients, who were previously refractory to standard-of-care medications and/or procedures.

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Biomechanical Mapping of the Female Pelvic Floor: Prolapse versus Normal Conditions

Background: Quantitative biomechanical characterization of pelvic supportive structures and functions in vivo is thought to provide insight into pathophysiology of pelvic organ prolapse (POP). An innovative approach—vaginal tactile imaging—allows biomechanical mapping of the female pelvic floor to quantify tissue elasticity, pelvic support, and pelvic muscle functions. The Vaginal Tactile Imager (VTI) records high definition pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. Objective: To explore an extended set of 52 biomechanical parameters for differentiation and characterization of POP relative to normal pelvic floor conditions. Methods: 96 subjects with normal and POP conditions were included in the data analysis from multi-site observational, case-controlled studies;42 subjects had normal pelvic floor conditions and 54 subjects had POP. The VTI, model 2S, was used with an analytical software package to calculate automatically 52 biomechanical parameters for 8 VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in 2 planes, relaxation, and reflex contraction). The groups were equalized for subject age and parity. Results: The ranges, mean values, and standard deviations for all 52 VTI parameters were established. 33 of 52 parameters were identified as statistically sensitive (p 0.05;t-test) to the POP development. Among these 33 parameters, 11 parameters show changes (decrease) in tissue elasticity, 8 parameters show deteriorations in pelvic support and 14 parameters show weakness in muscle functions for POP versus normal conditions. Conclusions: The biomechanical mapping of the female pelvic floor with the VTI provides a unique set of parameters characterizing POP versus normal conditions. These objectively measurable biomechanical transformations of pelvic tissues, support structures, and functions under POP may be used in future research and practical applications.

Tactile and Ultrasound Image Fusion for Functional Assessment of the Female Pelvic Floor

Introduction: The true etiology of pelvic organ prolapse and urinary incontinence and variations observed among individuals are not entirely understood. Tactile (stress) and ultrasound (anatomy, strain) image fusion may furnish new insights into the female pelvic floor conditions. This study aimed to explore imaging performance and clinical value of vaginal tactile and ultrasound image fusion for characterization of the female pelvic floor. Methods: A novel probe with 96 tactile and 192 ultrasound transducers was designed. Women scheduled for a urogynecological visit were considered eligible for enrollment to observational study. Intravaginal tactile and ultrasound images were acquired for vaginal wall deformations at probe insertion, elevation, rotation, Valsalva maneuver, voluntary contractions, involuntary relaxation, and reflex pelvic muscle contractions. Biomechanical mapping has included tactile/ultrasound imaging and functional imaging. Results: Twenty women were successfully studied with the probe. Tactile and ultrasound images for tissues deformation as well as functional images were recorded. Tactile (stress) and ultrasound (strain) images allowed creation of stress-strain maps for the tissues of interest in absolute scale. Functional images allowed identification of active pelvic structures and their biomechanical characterization (anatomical measurements, contractive mobility and strength). Fusion of the modalities has allowed recognition and characterization of levator ani muscles (pubococcygeal, puborectal, iliococcygeal), perineum, urethral and anorectal complexes critical in prolapse and/or incontinence development. Conclusions: Vaginal tactile and ultrasound image fusion provides unique data for biomechanical characterization of the female pelvic floor. Bringing novel biomechanical characterization for critical soft tissues/structures may provide extended scientific knowledge and improve clinical practice.

Tactile Imaging Markers to Characterize Female Pelvic Floor Conditions

The Vaginal Tactile Imager (VTI) records pressure patterns from vaginal walls under an applied tissue deformation and during pelvic floor muscle contractions. The objective of this study is to validate tactile imaging and muscle contraction parameters (markers) sensitive to the female pelvic floor conditions. Twenty-two women with normal and prolapse conditions were examined by a vaginal tactile imaging probe. We identified 9 parameters which were sensitive to prolapse conditions (p < 0.05 for one-way ANOVA and/or p < 0.05 for t-test with correlation factor r from -0.73 to -0.56). The list of parameters includes pressure, pressure gradient and dynamic pressure response during muscle contraction at identified locations. These parameters may be used for biomechanical characterization of female pelvic floor conditions to support an effective management of pelvic floor prolapse.

伴或不伴盆腔脏器脱垂的患者耻尾肌中骨骼肌重链多肽3和肌球蛋白结合蛋白H的表达

Objective: The purpose of this study was to compare gene expression of skeletal muscle heavy-chain polypeptide 3(MYH3) and myosin binding protein H (MyBP- H) in the pubococcygeus muscle of patients with pelvic organ prolapse and controls. Study design: Genes previously identified by microarray genechip analysis of pubococcygeus muscle biopsies were examined using real-time quantitative reverse transcriptase polymerase chain reaction (RT- PCR) analysis. Specimens were obtained from 17 patients with stage III or IV pelvic organ prolapse and 23 controls with minimal to no prolapse. Glyceraldehyde 3- phosphate dehydrogenase (GAPDH) was used as the housekeeping gene. Samples and controls were run in triplicatein separate wells, and the levels of gene expression were analyzed quantitatively using the comparative critical threshold(Ct) method. Differences in gene expression were analyzed using Wilcoxon rank-sum testing. Results: Significant differences in gene expression were observed between patients with prolapse and controls for both genes. Skeletal muscle myosin heavy-chain polypeptide 3 was 6.5 times underexpressed in patients with pelvic organ prolapse compared to controls (P = .028). Similarly, myosin binding protein H was 3.2 times underexpressed in patients with prolapse (P = .042). Overall,patients had a mean age of 62.4 ± 6.5 years compared with controls with a mean age of 45.3 ± 7.4 years (P < .001),so analysis was also performed on an age-matched subset of 8 patients and controls (mean ages of 58.1 ± 5.4 years and 53.3 ± 5.0 years, respectively, P = .02) with similar results.Prolapse patients in this subset were similar in parity and race to controls but had lower body mass index (23.2 vs 29.9, P = .04). MYH3 was 10.9 times underexpressed in patients with pelvic organ prolapse compared to controls (P = .027). My BPH was 10.4 times underexpressed in patients with prolapse (P = .036). Conclusion: These findings suggest that the differences between patients with advanced pelvic organ prolapse and controls may be related to differential gene expression of structural proteins related to myosin. Specifically, advanced pelvic organ prolapse may be related to down-regulation of skeletal muscle heavy-chain polypeptide 3 and myosin binding protein H.

继发于骶椎阴道固定术网带腐蚀的骨髓炎需行椎板切除术

BACKGROUND: Severe infectious morbidity associated with the use of synthetic mesh and abdominal sacral colpopexy is rare. Pelvic abscess, sinus tract formation, enterovaginal fistula, and osteomyelitis have been reported. CASE: This case involves a patient who presented with staphylococcal bacteremia and vaginal erosion of a sacral colpopexy synthetic mesh. Despite prolonged courses of intravenous antibiotics and complete removal of the mesh material, she developed osteomyelitis. Progressive neurologic symptoms required a decompression laminectomy to facilitate a complete recovery and resolution of symptoms. CONCLUSION: In the treatment of abdominal sacral colpopexy mesh erosion, we recommend maintaining a high index of suspicion for secondary infections.

患者年龄对增加泌尿生殖系统手术后发病率和死亡率的影响

Objective: The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus reconstructive procedures for prolapsein elderly women. Study design: We conducted a retrospective cohort study utilizing data from 1998 to 2002 from the Nationwide Inpatient Sample. Multivariable logistic regression was performed to obtain odds ratios estimating the effect of age on risk of death and complications, adjusting for comorbidities and demographic factors. Results: There were 264,340 women in our study population. Increasing age was associated with higher mortality risks per 1000 women ( < 60 years, 0.1; 60- 69 years,0.5; 70- 79 years, 0.9; ≥ 80 years, 2.8; P < .01) and higher complication risks per 1000 women ( < 60 years, 140; 60- 69 years, 130; 70- 79 years, 160; ≥ 80 years, 200; P < .01). Using multivariable logistic regression, increasing age was associated with an increased risk of death (60- 69 years, odds ratio [OR]3.4[95% CI 1.7- 6.9]; 70- 79 years, OR 4.9 [95% CI 2.2- 10.9]; ≥ 80 years, OR 13.6 [95% CI 5.9- 31.4]), compared with women < 60 years. The risk of perioperative complications was also higher in elderly women 80 years of age and older (OR 1.4 [95% CI 1.3- 1.5]) compared with younger women. Elderly women 80 years and over who underwent obliterative procedures had a lower risk of complication compared with those who underwent reconstructive procedures for prolapse (17.0% vs 24.7% , P < .01). Conclusion: Although the absolute risk of death is low,elderly women have a higher risk of mortality and morbidity following urogynecologic surgery.

应用自体直肌筋膜和异体筋膜在耻骨阴道吊带治疗中的结局比较

Objective: The purpose of this study was to compare autologous versus cadaveric grafts in pubovaginal slings. Study design: Women who had pubovaginal slings from 1994 to 2003 completed history, questionnaires, prolapse staging, and cough stress testing. Failure was defined by recurrent urinary incontinence symptoms and reoperation for stress incontinence. Group differences were evaluated using Student t test or chis-quare test. The log-rank test was used to evaluate time to failure between the groups. Results: Of 303 women enrolled, 153 had autologous and 150 had cadaveric grafts. Regular urine leakage (39.6% vs 28.3% , P = .04) and reoperation for stress incontinence (12.7% vs 3.3% , P = .003) occurred more in the cadaveric versus autologous group, respectively. Adjusting for differing follow-up times, the cadaveric versus autologous group experienced higher rates of urinary incontinence (16 vs 5 per 100 women-years, P < .0001) and higher rates of reoperation (4 vs 1 per 100 women-years, P < .0003). Conclusion: Autologous grafts used in pubovaginal slings have superior continence outcomes compared with cadaveric fascia.

重度盆腔脏器脱垂治疗的妇女体型及生活质量

Objective: Women who seek treatment for pelvic organ prolapse strive for an improvement in quality of life. Body image has been shown to be an important component of differences in quality of life. To date, there are no data on body image in patients with advanced pelvic organ prolapse. Our objective was to compare body image and quality of life in women with advanced pelvic organ prolapse with normal controls. Studydesign: We used a case-control study design. Cases were defined as subjects who presented to a tertiary urogynecology clinic with advanced pelvic organ prolapse (stage 3 or 4). Controls were defined as subjects who presented to a tertiary care gynecology or women s health clinic for an annual visit with normal pelvic floor support (stage 0 or 1) and without urinary incontinence. All patients completed a valid and reliable bodyimage scale and a generalized (Short Form Health Survey) and condition-specific (Pelvic Floor Distress Inventory- 20) quality- of- life scale. Linear and logistic regression analyses were performed to adjust for possible confounding variables. Results:Forty-seven case and 51 control subjects were enrolled.After controlling for age, race, parity, previous hysterectomy,and medical comorbidities, subjects with advanced pelvic organ prolapse were more likely to feel self-conscious (adjusted oddsratio 4.7; 95% confidence interval 1.4 to 18, P = .02), less likely to feel physically attractive (adjusted odds ratio 11; 95% confidence interval 2.9 to 51, P < .001), less likely to feel feminine(adjusted odds ratio 4.0; 95% confidence interval 1.2 to 15, P = .03), and less likely to feel sexually attractive (adjusted odds ratio 4.6; 95% confidence interval 1.4 to 17, P = .02) than normal controls. The groups were similar in their feeling of dissatisfaction with appearance when dressed, difficulty looking at themselves naked, avoiding people because of appearance, and overall dissatisfaction with their body. Subjects with advanced pelvic organ prolapse suffered significantly lower quality of life on the physical scale of the SF- 12 (mean 42; 95% confidence interval 39 to 45 versus mean 50; 95% confidence interval 47 to 53, P < .009). However, no differences between groups were noted on the mental scale of the SF- 12 (mean 51; 95% confidence interval 50 to 54 versus mean 50; 95% confidence interva l47 to 52, P = .56). Additionally, subjects with advanced pelvic organ prolapse scored significantly worse on the prolapse, urinary,and colorectal scales and overall summary score of Pelvic Floor Distress Inventory- 20 than normal controls (mean summary score 104; 95% confidence interval 90 to 118 versus mean 29; 95% confidence interval 16 to 43, P < .0001), indicating a decrease in condition-specific quality of life. Worsening body image correlated with lower quality of life on both the physical and mental scales of the SF- 12 as well as the prolapse, urinary,and colorectal scales and overall summary score of Pelvic Floor Distress Inventory- 20 in subjects with advanced pelvic organ prolapse. Conclusion: Women seeking treatment for advanced pelvic organ prolapse have decreased body image and overall quality of life. Body image may be a key determinant for quality of life in patients with advanced prolapse and may be an important outcome measure for treatment evaluation in clinical trials.

An overlooked effect of systemic anticholinergics:alteration on accommodation amplitude

AIM： To investigate the effect of oral solifenacin succinate, tolterodine-L-tartarate and oxybutinin hydrochloride（HCl） on accommodation amplitude.·METHODS： Female overactive bladder syndrome（OAB）patients who were planned to use oral anticholinergics,patients that uses solifenacin succinate 5 mg（Group I,n =25）, tolterodine-L-tartarate 4 mg（Group II, n =25）,and oxybutinin HCl 5 mg b.i.d.（Group III, n =25） and age matched healthy female subjects（Group IV, n =25） were recruited and complete ophthalmological examination and accommodation amplitude assessment were done at baseline and 4wk after initiation of treatment.·RESULTS： The mean age of 100 consecutive female subjects was 51.6 ±5.7（40-60）y and there were no statistically significant difference with regard to the mean age（P =0.107） and baseline accommodation amplitude（P =0.148） between study groups. All treatment groups showed a significant decrease in accommodation amplitude following a 4-week course of anticholinergic treatment（P =0.008 in Group I, P =0.002 in Group II, P =0.001 in Group III）, but there was no statistically significant difference in Group IV（P =0.065）.·CONCLUSION： A 4-week course of oral anticholinergic treatment have statistically significant effect on accommodation amplitude. Clinicians should avoid both overestimating this result, as this would unnecessarily restrict therapeutic possibilities, and also underestimating it which may lead to drug intolerance.

Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse;erosion;infection;transfusion;cystotomy;chronic pain;lower urinary tract symptoms;and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of $22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs for robotic surgery was $207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life

AIM： To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would signifcantly decrease subjective symptoms of stress urinary incon-tinence （SUI） and improve patient satisfaction.METHODS： Women who underwent a combined sling removal and laparoscopic Burch procedure between 2009 and 2014 were matched via age and sling-type in a 1：2 ratio to women who only underwent a sling removal. Those who underwent surgery within 6 mo of data collection were excluded from the study, as were women who underwent multi-stage surgery. Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6 （UDI-6） and incontinence impact ques-tionnaire-7 （IIQ-7） per the standard clinical practice. All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard follow-up questions. Research staff contacted participants via email, mail, and telephone using the same questionnaire template and script. Data was analyzed by using c2 test for categorical data, and Student’s t test and Wilcoxon Rank Sum test for continuous data. The measure of effect was determined by logistic regression analysis.RESULTS： A total of 48 women out of 146 selected patients were successfully recruited with n = 22 in the Burch cohort and n = 26 in the control cohort. The mean age was 54.7 ± 7.8 years and mean body mass index was 22.0 ± 13.9 kg/m2. The majority of patients were Caucasian （73.3%）, postmenopausal （91.1%）, non-smokers （57.9%）, with a history of hysterectomy （81.4%）. Six nineteen point six percent of women presented after at least 2 years from placement, which was signifcantly more common in the Burch cohort. Pain was the most common chief complaint （64.4%） in both groups at the time of initial presentation, and 78.9% of women reported concomitant urinary incontinence. There was no signifcant difference in pre-operative UDI-6 and IIQ-7 scores between the two cohorts. However, the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of 28.41 points compared to a decrease of 4.01 points in the control group （P = 0.02, 95%CI： 3.84 to 44.97）.Although not statistically significant, the Burch cohort was 58% more likely to show an overall improvement in their score after surgery and 40% more likely to meet the minimal important difference of 11 points （RR = 1.58, 95%CI： 0.97 to 2.57; RR 1.40, 95%CI： 0.79 to 2.46）. The difference in IIQ scores was nonsignificant. There was no signifcant difference in blood loss, complications, or postoperative pain or dyspareunia.CONCLUSION： Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptom-related quality of life scores.

Gynecological Surgery and the Robot

As the only robotic device with FDA approval for gynecological surgery, the da Vinci? Surgical System dominates robot-assisted surgery in the field. Benefits to the Surgeon include decreased risk of neck and back injury secondary to improved ergonomics. However, patients benefit greatly due to decreased length of stay, decreased blood loss and analgesic requirements. Unfortunately the initial economic impact of purchasing and maintaining a robot is great but must be balanced with the potential savings from reduced length of stay and earlier return to normal activity. This article looks at the indications for robot-assisted surgery in gynecology. Assessing the efficacy of this modality compared to both straight stick (Laparoscopy) and open procedures. We discuss the impact and implications for surgical training imposed by robotic surgery. Furthermore, we assess the safety of robotic surgery from both the surgeons prospective and as a surgical modality.

The Utility of Endovaginal Ultrasound in the Design of a Sacrospinous Ligament Anchoring Device in Patients with and without Pelvic Organ Prolapse

Objective: To determine whether endovaginal ultrasound is a reliable measure in visualization of the sacrospinous ligament among women with prolapse versus women without prolapse, and thus might be clinically applicable in the design of an ultrasound-guided device for performing sacrospinous ligament anchor placement as a treatment for pelvic organ prolapse. Methods: In the first phase of this study we performed a sacrospinous anchor placement in four normal fresh-frozen female pelves. Afterwards, an endovaginal ultrasound was performed to visualize the anchor localization which was validated by dissection of the cadaveric pelves. In the second phase of the study: two groups of volunteer females with and without pelvic organ prolapsed (POP-group, vs NON-POP group) were evaluated by endovaginal ultrasound to localize the sacrospinous ligament. Results: Cadaveric dissection demonstrated accurate anchor placement into the 8/8 sacrospinous ligament. We performed endovaginal ultrasound in a total of 17 N-POP and 10 (POP) patients. Among the N-POP group, the right and left ischial spines were visible in 6/17 (35%) and (6/17) 35% vs 0/10 (0%) for both right and left sides in POP group (p = 0.008). The right sacrospinous ligament was visualized in 4/17 (23%) N-POP subjects and 0/10 POP subjects (p = 0.27) and the left sacrospinous ligament was visualized in 7/17 (41%) N-POP subjects and 2/10 POP subjects (p = 0.48). Conclusions: Sacrospinous ligament and the ischial spines couldn’t be reliably visualized among women with or without pelvic organ prolapse using endovaginal ultrasound, although the structures are visualized more in some of the non-prolapsed women. The sacrospinous anchoring device demonstrated accurate placement by cadaveric dissections.

盆腔脏器下降以及盆底功能紊乱症状

Objective: This study evaluates the relationship between symptoms of pelvic floor disorders, and measurement of pelvic organ prolapse. Study design: This retrospective cross-sectional study assessed prolapse in 905 women in an academic urogynecologic practice using the Pelvic Organ Prolapse Quantification exam. Symptoms were assessed with a Likert symptom questionnaire and the Urogenital Distress Inventory. Relationships between symptoms and prolapse were analyzed using Spearman’ s correlation. Results: Symptoms of “ bulging” correlated moderately to the greatest extent of prolapse (r = 0.4, P <.001). Frequency of bother progressively increases when the leading edge descends from -3 and 0. Between ? 1 and ? 5, 90% of women report bother. Symptoms typically attributed to anterior or posterior wall prolapse did not correlate with descent of the respective compartment. Conclusion: “ Bulging” is the principle symptom that correlates with prolapse severity. We found no discrete anatomic position that discriminates between prolapse as a disease state and normal anatomic variation.

盆腔器官脱垂阴式手术时输尿管梗阻的发生率及术中膀胱镜的应用价值

Objective: The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy. Study design: The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy. Results: Thirty-seven patients (5.3% ) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3% , respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1% . Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5% , respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9% ) had true ureteral injuries. Conclusion: Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1% . Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.

骶骨阴道固定术中应用阔筋膜、聚丙烯人造膜的随机对照研究

Objective: To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. Methods: Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the χ 2 test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test. Results: One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall). Conclusions: Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates.

Nuclear lncRNA CERNA1 enhances the cisplatin-induced cell apoptosis and overcomes chemoresistance via epigenetic activation of BCL2L10 in ovarian cancer

Ovarian cancer(OC)is the most lethal type of cancer among female genital tumors.1 Along with debulking surgeries,platinum is the first-line chemotherapy treatment,whereas chemoresistance is the biggest obstacles in a poor prognosis of oc.2 Identifying a novel therapeutic target for OC chemoresistance remains an urgent need.