BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs ...BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[i.e.native tissue repair(NTR)]instead of mesh have attracted much attention.At our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in 2017.However,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.AIM To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after surgery.We retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of recurrence.The Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic hysterectomy.RESULTS The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/m2.According to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)mL.There were no perioperative complications.None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge.No cases of POP recurrence were observed 12 mo after the operation.CONCLUSION The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.展开更多
Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,...Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.展开更多
Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in pati...Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in patients with POP, so it is unknown whether they are also changed or not. Therefore, we compared plasma TGF-β1 levels in women with and without POP. Methods: Participants were 49 women with POP and 23 healthy control women. All participants were postmenopausal. We measured plasma TGF-β1 and compared data between patients with POP and controls, and between patients with uterine prolapse (UP, n = 19) and those with a cystocele (CC, n = 30). In addition, in patients, we assessed the POP quantification system (POP-Q) stage. Results: Plasma TGF-β1 levels were significantly lower in patients than in healthy controls. POP-Q stage was not significantly different between the UP and CC subgroups, but POP-Q stage IV was diagnosed in 63% of patients with UP and 7% of those with CC. Plasma TGF-β1 levels were significantly lower in the CC subgroup than in the UP subgroup. Conclusion: Plasma TGF-β1 is decreased in POP. It remains unclear whether the lower levels indicate a reduction in systemic TGF-β1 activity, but they can be assumed to reflect reduced TGF-β1 expression in POP tissues.展开更多
AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 19...AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"> Symptomatic pelvic organ prolapse (POP) impacts the sufferers</span><span style="font-family:Verdana;">...<strong>Background:</strong><span style="font-family:Verdana;"> Symptomatic pelvic organ prolapse (POP) impacts the sufferers</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;"> quality of life negatively. There is a preference for a mechanical device in certain conditions though the definitive management of POP is surgical</span><span style="font-family:Verdana;">.</span><span style="font-family:;" "=""> <b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">We conducted the study to evaluate the outcome of management of POP using mechanical devices.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It was a prospective study. It took place in the gynecology unit of the Bowen University Teaching Hospital Ogbomoso between May 2014 and April 2019. We followed up </span><span style="font-family:Verdana;">with </span><span style="font-family:Verdana;">eligible patients who opted for pessary use for a median duration of 18 months (Range 12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">84</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">months). We excluded those who refuse to participate in the study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of the</span><b> </b><span style="font-family:Verdana;">127 patients</span><b> </b><span style="font-family:Verdana;">with</span><b> </b><span style="font-family:Verdana;">symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion. We lost Six (9.2%) patients to follow up. Of the 64 women included in the analysis, 16 (25%) discontinued use at some point after four weeks, whereas 36 (56.3%) used the pessary successfully throughout the follow-up period. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% dis-impaction or constipation). After cessation of pessary use, 12 (25%) of the 48 women chose surgery, and 10 (20.8%) chose no further treatment. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings. Therefore, it is justifiable to offer pessaries in the initial management of uterovaginal prolapse to all patients who opt for conservative management and those awaiting surgery.</span></span>展开更多
Background: Extracellular matrix (ECM) remodeling is the most important pathomechanism of pelvic organ prolapse (POP). Fibroblasts are the key to ECM regulation. The passaging capacity of human vaginal wall fibroblast...Background: Extracellular matrix (ECM) remodeling is the most important pathomechanism of pelvic organ prolapse (POP). Fibroblasts are the key to ECM regulation. The passaging capacity of human vaginal wall fibroblasts (hVWFs) is limited in vitro . Here, we aimed to immortalize hVWFs through the introduction of human telomerase reverse transcriptase (hTERT). Methods: Primary cells were derived from the vaginal wall tissue of patients with POP. Cellular senescence was detected via senescence-associated β-galactosidase staining. We employed a lentiviral transfection vector to stably express hTERT in hVWFs at passage 3, generating immortalized hVWFs (i-hVWFs). We then assessed cellular proliferation via the CCK-8 and EdU assays as well as cellular migration via wound healing assays. G-banded chromosome karyotypic analysis was performed to evaluate chromosomal karyotype stability. Finally, cellular tumorigenesis capacity was assessed in nude mice. A two-tailed Student’s t test was used to compare differences between the two groups. Results: Our results showed that senescence of primary hVWFs significantly increased from passage seven. From passage 11, hVWFs showed a significantly higher senescence percentage than i-hVWFs. During the continuous passage, i-hVWFs presented stability in proliferation, migration capacity, expression of ECM regulation-related genes, and chromosome karyotype. In vivo tumorigenesis was absent in i-hVWFs. Conclusions: The senescence of hVWFs significantly increased from the seventh passage, and we successfully used hTERT to immortalize hVWFs derived from patients with POP. Studies on POP that require a long-lived hVWF line will benefit from our technique.展开更多
Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall prolapse.Methods A total of 214 patients with pelvic organ prolapse wer...Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall prolapse.Methods A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January 2021.All patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound examination.Factors related to the defecation sensory threshold were analyzed.Results(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90ml.Patients with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,p<0.001),the Bp point(r=0.345,p=0.009),the area of the levator-ani hiatus measured by transvaginal ultrasound(r=0.403,p=0.002),and parity(r=0.355,p=0.007).Conclusions Patients diagnosed with pelvic organ prolapse commonly experience an increased threshold of defecation sensation.Elevated thresholds were associated with more frequent constipation symptoms.Additionally,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.展开更多
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 coun...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.展开更多
Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries r...Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse(POP)over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1,2004 and September 30,2018 were included from 22 tertiary academic medical centers.The data were reported voluntarily and obtained from a database.We compared the proportion of each procedure in the 7 years before and 7 years after September 30,2011.The data were analyzed by performing Z test(one-sided).Results:The number of different procedures during October 1,2011-September 30,2018 was more than twice that during October 1,2004-September 30,2011.Regarding pelvic floor surgeries related to POP,the rate of synthetic mesh procedures increased from 38.1%(5298/13,906)during October 1,2004-September 30,2011 to 46.0%(14,107/30,688)during October 1,2011-September 30,2018,whereas the rate of non-mesh procedures decreased from 61.9%(8608/13,906)to 54.0%(16,581/30,688)(Z=15.53,P<0.001).Regarding synthetic mesh surgeries related to POP,the rates of transvaginal placement of surgical mesh(TVM)procedures decreased from 94.1%(4983/5298)to 82.2%(11,603/14,107)(Z=20.79,P<0.001),but the rate of laparoscopic sacrocolpopexy(LSC)procedures increased from 5.9%(315/5298)to 17.8%(2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly.The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565,https://register.clinicaltrials.gov.展开更多
Objective:This study aimed to compare the mood state of patients with severe pelvic organ prolapse(POP)before and after surgery.Methods:This prospective study enrolled 100 patients with severe POP who were surgically ...Objective:This study aimed to compare the mood state of patients with severe pelvic organ prolapse(POP)before and after surgery.Methods:This prospective study enrolled 100 patients with severe POP who were surgically treated between October 2016 and February 2019.The clinical severity of POP was evaluated using the POP Quantification(POPQ)System.Mood state evaluation,using the Hamilton anxiety(HAMA)and the Hamilton depression(HAMD)scale,was performed preoperatively and at 3 and 6 months postoperatively.Results:The POP-Q stage was significantly improved postoperatively(P<0.05).Preoperatively,the patients had varying degrees of anxiety symptoms(mean HAMA score,11.945.59 points)and depression symptoms(mean HAMD score,5.562.58 points);these scores were significantly decreased at 3 months(mean HAMA score,4.672.02 points;mean HAMD score,3.581.61 points)and 6 months postoperatively(mean HAMA score,4.882.57 points;mean HAMD score,3.381.60 points)(P<0.05).There were no differences in the HAMD and HAMA scores in both traditional prolapse surgery patients and mesh pelvic reconstruction patients preoperatively and at 3 and 6 months postoperatively(P>0.05).Conclusions:Patients with severe POP have different anxiety and depression symptoms preoperatively.Successful individualized surgical treatment is effective for improving the clinical severity of severe POP and might alleviate or improve POP-related anxiety or depression symptoms.展开更多
Background:Approximately 7%of all women will require surgery to correct pelvic organ prolapse during their lives.Of these,approximately 10%-13%will require another operation within 5 years due to recurrence of the dis...Background:Approximately 7%of all women will require surgery to correct pelvic organ prolapse during their lives.Of these,approximately 10%-13%will require another operation within 5 years due to recurrence of the disease.Increases in life expectancy and elderly individuals with estrogen deficiencies will mean higher rates of pelvic organ prolapse,significantly reducing the quality of life for millions of people.This study introduces technologies that can help treat pelvic prolapse while reducing the rate of recurrence.Methods:This paper outlines how to properly perform sacrospinous ligament fixation using the Miyazaki technique.Results:A needle was used to successfully perform a sacrospinous ligament fixation using Miyazaki's technique.Conclusions:Considering the Food and Drug Administration’s 2019 decision to permit surgeries with native tissue,this method can be used with sacrospinous ligament fixation as the primary treatment option for pelvic organ prolapse.展开更多
Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,...Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,74 female cases from our hospital who had different defects in pelvic organ prolapse were treated with the entire reconstructive pelvic surgery,in which 38 had uterus retained(observation group) and 36 cases had hysterectomy(control group).The two groups were compared.The patients with combined stress urinary incontinence had transobturator tension-free vaginal tape(TVT-O technique) at the same time.The results of operations were objectively evaluatedaccording to Pelvic Organ Prolapse Quantification sub-degree method(POP-Q) developed by the International Continence Society.Results For observation group,the average operative time was 50 min,and the average amount of bleeding was 100 mL.For control group,the average operative time was 110 min,and the average amount of bleeding was 200 mL.During the postoperative follow-up(8 ~18 months),in the observation group the structures of patients' pelvic floor were normal;stress urinary incontinence was all cured;related symptoms disappeared or were markedly improved;and no postoperative infection appeared.In control group,two cases had postoperative infection;the patients ' pelvic structures were normal during the postoperative follow-up;the related symptoms disappeared or were significantly improved.After 3 months,POP-Q score was significantly elevated in the two groups.Conclusion Full reconstructive pelvic surgery with uterus retained can complete the whole pelvic floor structure and function of all or part of the reconstruction with fast recovery and clear short-term effect.However,the long-term efficacy remains to be revealed.展开更多
Introduction and Hypothesis: The Pelvic Floor Dysfunction (PFD) is a common gynecological condition that causes significant morbidity in the affected population, increasing clinical and financial challenge for the Pub...Introduction and Hypothesis: The Pelvic Floor Dysfunction (PFD) is a common gynecological condition that causes significant morbidity in the affected population, increasing clinical and financial challenge for the Public Health Services. Methods: This study aimed to review the available evidence and interventions to promote the health of women with PFD. We used the following databases to select papers for this review: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consists of seven articles, with evidence levels 1 and 2. Results: The results of the articles point out to a greater number of activities related to the management of Urinary Incontinence (UI) behavioral support to the patient and physical therapy of the pelvic floor muscles. They were both beneficial to UI prevention and treatment. Conclusions: The physical therapy approach, when associated with cognitive and behavioral strategies, leverages UI outcomes in patients.展开更多
Vaginal tumors, whether benign or malignant, are rare. They include fibroepithelial polyps (FEPs), which are benign lesions originating in mesenchymal cells, comprised of a core of connective tissue covered by squamou...Vaginal tumors, whether benign or malignant, are rare. They include fibroepithelial polyps (FEPs), which are benign lesions originating in mesenchymal cells, comprised of a core of connective tissue covered by squamous epithelium. They are usually small and asymptomatic. When symptomatic or very large, they may cause bleeding, genital discomfort or the presence of a bulge in the vagina. In the last case, they may be mistaken for a genital prolapse. Although their physiopathology is still not clearly understood, the presence of hormonal receptors and the occurrence of FEPs during the use of hormone therapy or pregnancy suggest that changes in the stroma of these lesions may be induced by hormones. We report on the case of a patient who presented with a vaginal bulge and was referred to the urogynecology outpatient ward with a diagnosis of genital prolapse, which had actually a large fibroepithelial polyp on the posterior vaginal wall.展开更多
BACKGROUND After undergoing radical cystectomy combined with hysterectomy,female patients may suffer from pelvic organ prolapse due to the destruction of pelvic structures,which mainly manifests as the prolapse of tis...BACKGROUND After undergoing radical cystectomy combined with hysterectomy,female patients may suffer from pelvic organ prolapse due to the destruction of pelvic structures,which mainly manifests as the prolapse of tissues of the vulva to varying degrees and can be accompanied by symptoms,such as bleeding and inflammation.Once this complication is present,surgical intervention is needed to resolve it.Therefore,preventing and managing this complication is especially important.CASE SUMMARY The postoperative occurrence of acute enterocele is rare,and a case of acute small bowel vaginosis 2 mo after radical cystectomy with hysterectomy is reported.When the patient was admitted,physical examination revealed that the small bowel was displaced approximately 20 cm because of vaginocele.A team of gynecological,general surgery,and urological surgeons was employed to return the small bowel and repair the lacerated vaginal wall during the emergency operation.Eventually,the patient recovered,and no recurrence was seen in the half year of follow-up.CONCLUSION We review the surgical approach for such patients,analyze high-risk factors for the disease and suggest corresponding preventive measures.展开更多
Objective: To investigate whether administration of genistein can improve hormonal changes [estradiol and follicle stimulating hormone (FSH)] , heat shock protein 70 (Hsp70) expression, and thickness of vaginal epithe...Objective: To investigate whether administration of genistein can improve hormonal changes [estradiol and follicle stimulating hormone (FSH)] , heat shock protein 70 (Hsp70) expression, and thickness of vaginal epithelial cells in a rat model of vaginal atrophy. Methods: Twenty-five multiparous female rats were divided into five groups, namely the control group (without ovariectomy), the ovariectomy only group, and the ovariectomy groups 1, 2 and 3 receiving genistein at the doses of 0.045, 0.090 and 0.180 mg/kg body weight/day, respectively. Estradiol, FSH, and Hsp70 expression were analyzed by using the immunoassay technique. Analysis of the thickness of the vaginal epithelium was performed by histology. Results: Ovariectomy significantly decreased estradiol levels compared to the control group (P<0.05). All doses of genistein significantly increased levels of estradiol in rats with vaginal atrophy compared to the ovariectomy only group (P<0.05). Ovariectomy significantly increased FSH levels compared to the control group (P<0.05). All three doses of genistein restored FSH levels comparable to those in the control group (P>0.05). Ovariectomy significantly increased parabasal cell Hsp70 expression compared to the control group (P<0.05). Of all the genistein doses, only the dose at 0.045 mg/kg body weight/day restored the expression of Hsp70 to levels in the control group (P>0.05). Conclusions: Genistein is able to increase the thickness of the vaginal epithelium through hormone modulation and cellular stress suppression. Genistein is beneficial in the form of a herbal or alternative food for improvement of vaginal atrophy due to menopause.展开更多
<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of r...<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of rectocele and cystocele is usually performed in a hospital setting under regional (spinal or epidural) or general anesthesia, and patients commonly have to stay in the hospital for at least one or two days. The possibility of performing the surgery under local anesthesia, as an outpatient procedure with minimal bleeding and pain, no surgical assistants, with immediate discharge and, most importantly, without compromising postoperative results, is appealing. To our knowledge, no studies ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ve</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> evaluated whether performing rectocele and/or cystocele rectocele repair under local infiltration anesthesia and without separation of the vaginal mucosa from the underlying fascia achieves these goals.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The aim of this study is to describe a new surgical technique for outpatient treatment of cystocele and rectocele under local anesthesia, and our initial results. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Forty women underwent outpatient surgical repair of rectocele and/or cystocele between April and September 2020 at the ambulatory procedure room of the authors’ clinics. The technique consists of a triangular-shaped CO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> laser vaporization</span><span style="color:red;"> </span><span style="font-family:Verdana;">or electrocauterization of the posterior and/or anterior vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin suture. A perineorrhaphy was always performed concomitantly with rectocele repair, and a transobturator sling was performed in women presenting with concomitant stress urinary incontinence. Postoperative evaluation included POP-Q measurement for each patient six months after the procedure, and resolution of prolapse was considered when anterior and/or posterior vaginal wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed using Wilcoxon signed-rank test.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The mean operating time was 21 minutes (range: 14</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">38 minutes). All patients tolerated the procedure well and were discharged immediately afterwards. There were no intraoperative or postoperative complications, and all patients had satisfactory healing of the vaginal mucosa. Bleeding from the rectocele and/or cystocele repair was minimal, and nobody required extra-anesthesia or transfer to a hospital surgical theater. At six month follow-up, pre and postoperative POP-Q measurement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of points Ap, Bp, Aa and Ba were all statistical</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">l</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y significant (Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ± 0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactory resolution of both rectocele and cystocele.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Our initial results suggest that rectocele and cystocele may be safely and effectively treated under local anesthesia in an outpatient setting using this new technique.</span></span></span>展开更多
Background:Urinary catheterization after vaginal prolapse surgery can cause inconvenience for patients,elevate the risk of urinary tract infections,and potentially prolong the hospitalization.In China,there is no cons...Background:Urinary catheterization after vaginal prolapse surgery can cause inconvenience for patients,elevate the risk of urinary tract infections,and potentially prolong the hospitalization.In China,there is no consensus on the optimal time to remove the urinary catheter after vaginal prolapse surgery.Thus,it will be valuable to gain insight into the nationwide catheterization management after the vaginal prolapse surgery.Methods:From March to May 2020,an online questionnaire was shared and purposive non-probabilistic sampling was used to recruit the participants.The urogynecologists currently performing vaginal prolapse surgery and involved nurses were included in this study.Results:1363 urogynecologists and 436 nurses responded and 99.5%of them reported using transurethral indwelling catheters(TIC)for post-operative bladder drainage in their practices.The duration of initial catheterization after vaginal prolapse surgery was generally 1–7 days,with a median duration of 3 days for anterior colporrhaphy(AC)and anterior&posterior colporrhaphy(APC),and 2 days for other procedures.For the same type of surgery,the median duration of catheterization varied by region.For AC,it was shorter by 1 day in West China and South China(P<0.001);for PC,it was 2 days in most regions,while 1 day in East China(P<0.05);and for APC,it was 3 days in most regions,while 4 days in Northeast China(P<0.05).No statistically significant difference was found in duration of catheterization in hospital levels.Conclusions:The findings suggested that duration of catheterization after prolapse surgery varied greatly in China,potentially resulting in unnecessary prolonging of catheterization.Well-designed studies are urgently needed to optimize catheterization management after vaginal prolapse surgery in China.展开更多
Backgrounds:Pelvic organ prolapse commonly affects the upper two-thirds of the vagina.However,evaluating this region in its normal position presents challenges.This study aimed to assess the anatomical axis of this va...Backgrounds:Pelvic organ prolapse commonly affects the upper two-thirds of the vagina.However,evaluating this region in its normal position presents challenges.This study aimed to assess the anatomical axis of this vaginal segment using pelvic magnetic resonance imaging measurements.Methods:A retrospective study of 614 hospitalized women from two hospitals,who were rigorously screened to exclude those with Pelvic Organ Prolapse or known anatomical variations(median age:43 years,range:17-76 years).Two reference lines were used:the pubococcygeal line(PCL)and a line from the inferior pubic symphysis to the third sacral vertebra(PS3L).Distances between the distal,middle,and apical points of the upper vagina and the reference lines,as well as the angles between the upper vagina and the reference lines,were measured.Comparisons were made among different age groups.Results:The median distances from the distal,middle,and apical vaginal points to the PCL were 0.4 cm(interquartile range[IQR]:0.0-0.7 cm),2.1 cm(IQR:1.7-2.5 cm)and 3.1 cm(IQR:2.5-3.7 cm),respectively.The median PCL-vaginal angle was 29.0°(IQR:23.0-34.0°).The median distances from the distal,middle,and apical vaginal points to the PS3L were-0.5 cm(IQR:-0.9-0.0 cm),0.0 cm(IQR:-0.4-0.6 cm),and-0.2 cm(IQR:-0.9-0.0 cm),respectively.The median PS3L-vaginal angle was 0.0°(IQR:-4.0-7.0°).Women aged 50 years or older had slightly lower vaginal points and slightly larger angles than younger groups in relation to both reference lines(p<.001).The vaginal axis in younger groups appeared parallel to the PS3L.Conclusions:The axis of the upper two-thirds vagina was proximate to a line from the inferior pubic symphysis to the third sacral vertebra,particularly in younger women.It will likely become a simplified method for roughly assessing the vaginal axis in its situ at first glance.展开更多
Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance globally.However,reports with follow-up>10 years are limited.Thus,this study ai...Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance globally.However,reports with follow-up>10 years are limited.Thus,this study aimed to report outcomes in a prospective cohort with at least 10 years of follow-up.Women with stageⅢ–Ⅳsymptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary hospital.The main outcome measure was symptomatic failure.Secondary outcomes included anatomic failure,recurrence,patient satisfaction,complications,and reoperation.The Kaplan-Meier curve was used to estimate the cumulative failure rate.Of the 121 patients enrolled in the study,103(85.1%)completed a median follow-up of 11 years.The estimated probability rates of symptomatic and anatomic failure were 17.6%and 8.8%in 11 years,respectively.The estimated incidence of symptomatic failure increased by 8.2%between 5 and 11 years;however,the corresponding rate for anatomic failure was 3.7%.The most common complication was vaginal mesh exposure,and its estimated probability increased from 19.3%to 28.4%from 5 to 11 years,respectively.Office trimming resolved 80.0%of vaginal exposures.These patients did not report decreased overall satisfaction.Patients with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room(5.8%by 11 years)had lower satisfaction rates(P<0.01)and were defined as having severe mesh exposure.The rates of postoperative pain,reoperation,and Patient Global Impression of Improvement≥2 were 2.5%,3.3%,and 94.2%,respectively.The results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal wall.Vaginal mesh exposure was common in women who were largely not sexually active;however,80%of the cases could be managed in the outpatient clinic,which did not affect patient satisfaction.展开更多
文摘BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[i.e.native tissue repair(NTR)]instead of mesh have attracted much attention.At our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in 2017.However,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.AIM To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after surgery.We retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of recurrence.The Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic hysterectomy.RESULTS The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/m2.According to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)mL.There were no perioperative complications.None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge.No cases of POP recurrence were observed 12 mo after the operation.CONCLUSION The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.
基金supported by the National Key Research and Development Program of China(2018YFC1004800)the Scien-tific Research Fund of Zhejiang Provincial Education Department(Y2020433-40)。
文摘Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.
文摘Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in patients with POP, so it is unknown whether they are also changed or not. Therefore, we compared plasma TGF-β1 levels in women with and without POP. Methods: Participants were 49 women with POP and 23 healthy control women. All participants were postmenopausal. We measured plasma TGF-β1 and compared data between patients with POP and controls, and between patients with uterine prolapse (UP, n = 19) and those with a cystocele (CC, n = 30). In addition, in patients, we assessed the POP quantification system (POP-Q) stage. Results: Plasma TGF-β1 levels were significantly lower in patients than in healthy controls. POP-Q stage was not significantly different between the UP and CC subgroups, but POP-Q stage IV was diagnosed in 63% of patients with UP and 7% of those with CC. Plasma TGF-β1 levels were significantly lower in the CC subgroup than in the UP subgroup. Conclusion: Plasma TGF-β1 is decreased in POP. It remains unclear whether the lower levels indicate a reduction in systemic TGF-β1 activity, but they can be assumed to reflect reduced TGF-β1 expression in POP tissues.
基金Supported by The Assistance publique des Hpitaux de Marseille et Université de la Méditerranée Aix Marseille II (faculté de médecine)
文摘AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Symptomatic pelvic organ prolapse (POP) impacts the sufferers</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;"> quality of life negatively. There is a preference for a mechanical device in certain conditions though the definitive management of POP is surgical</span><span style="font-family:Verdana;">.</span><span style="font-family:;" "=""> <b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">We conducted the study to evaluate the outcome of management of POP using mechanical devices.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">It was a prospective study. It took place in the gynecology unit of the Bowen University Teaching Hospital Ogbomoso between May 2014 and April 2019. We followed up </span><span style="font-family:Verdana;">with </span><span style="font-family:Verdana;">eligible patients who opted for pessary use for a median duration of 18 months (Range 12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">84</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">months). We excluded those who refuse to participate in the study. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of the</span><b> </b><span style="font-family:Verdana;">127 patients</span><b> </b><span style="font-family:Verdana;">with</span><b> </b><span style="font-family:Verdana;">symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion. We lost Six (9.2%) patients to follow up. Of the 64 women included in the analysis, 16 (25%) discontinued use at some point after four weeks, whereas 36 (56.3%) used the pessary successfully throughout the follow-up period. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% dis-impaction or constipation). After cessation of pessary use, 12 (25%) of the 48 women chose surgery, and 10 (20.8%) chose no further treatment. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings. Therefore, it is justifiable to offer pessaries in the initial management of uterovaginal prolapse to all patients who opt for conservative management and those awaiting surgery.</span></span>
基金National Natural Science Foundation of China(No.81971366)Beijing Natural Science Foundation(No.Z190021)CAMS Innovation Fund for Medical Sciences(No.CIFMS 2020-I2M-C&T-B-043)
文摘Background: Extracellular matrix (ECM) remodeling is the most important pathomechanism of pelvic organ prolapse (POP). Fibroblasts are the key to ECM regulation. The passaging capacity of human vaginal wall fibroblasts (hVWFs) is limited in vitro . Here, we aimed to immortalize hVWFs through the introduction of human telomerase reverse transcriptase (hTERT). Methods: Primary cells were derived from the vaginal wall tissue of patients with POP. Cellular senescence was detected via senescence-associated β-galactosidase staining. We employed a lentiviral transfection vector to stably express hTERT in hVWFs at passage 3, generating immortalized hVWFs (i-hVWFs). We then assessed cellular proliferation via the CCK-8 and EdU assays as well as cellular migration via wound healing assays. G-banded chromosome karyotypic analysis was performed to evaluate chromosomal karyotype stability. Finally, cellular tumorigenesis capacity was assessed in nude mice. A two-tailed Student’s t test was used to compare differences between the two groups. Results: Our results showed that senescence of primary hVWFs significantly increased from passage seven. From passage 11, hVWFs showed a significantly higher senescence percentage than i-hVWFs. During the continuous passage, i-hVWFs presented stability in proliferation, migration capacity, expression of ECM regulation-related genes, and chromosome karyotype. In vivo tumorigenesis was absent in i-hVWFs. Conclusions: The senescence of hVWFs significantly increased from the seventh passage, and we successfully used hTERT to immortalize hVWFs derived from patients with POP. Studies on POP that require a long-lived hVWF line will benefit from our technique.
基金Special Fund for Prevention and Treatment of Pelvic Floor Dysfunction in Chinese Women.(Fund Approval number:2019-Z-01)。
文摘Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall prolapse.Methods A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January 2021.All patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound examination.Factors related to the defecation sensory threshold were analyzed.Results(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90ml.Patients with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,p<0.001),the Bp point(r=0.345,p=0.009),the area of the levator-ani hiatus measured by transvaginal ultrasound(r=0.403,p=0.002),and parity(r=0.355,p=0.007).Conclusions Patients diagnosed with pelvic organ prolapse commonly experience an increased threshold of defecation sensation.Elevated thresholds were associated with more frequent constipation symptoms.Additionally,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.
文摘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.
基金supported by the grants from the Beijing Natural Science Foundation(No.Z190021)the National Natural Science Foundation of China(Nos.81830043,81771561,81971366,and 81671442)the Chinese Academy of Medical Sciences(CAMS)Initiative for Innovative Medicine(No.CAMS-2017-I2M-1-002)。
文摘Background:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time.The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse(POP)over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1,2004 and September 30,2018 were included from 22 tertiary academic medical centers.The data were reported voluntarily and obtained from a database.We compared the proportion of each procedure in the 7 years before and 7 years after September 30,2011.The data were analyzed by performing Z test(one-sided).Results:The number of different procedures during October 1,2011-September 30,2018 was more than twice that during October 1,2004-September 30,2011.Regarding pelvic floor surgeries related to POP,the rate of synthetic mesh procedures increased from 38.1%(5298/13,906)during October 1,2004-September 30,2011 to 46.0%(14,107/30,688)during October 1,2011-September 30,2018,whereas the rate of non-mesh procedures decreased from 61.9%(8608/13,906)to 54.0%(16,581/30,688)(Z=15.53,P<0.001).Regarding synthetic mesh surgeries related to POP,the rates of transvaginal placement of surgical mesh(TVM)procedures decreased from 94.1%(4983/5298)to 82.2%(11,603/14,107)(Z=20.79,P<0.001),but the rate of laparoscopic sacrocolpopexy(LSC)procedures increased from 5.9%(315/5298)to 17.8%(2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly.The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565,https://register.clinicaltrials.gov.
文摘Objective:This study aimed to compare the mood state of patients with severe pelvic organ prolapse(POP)before and after surgery.Methods:This prospective study enrolled 100 patients with severe POP who were surgically treated between October 2016 and February 2019.The clinical severity of POP was evaluated using the POP Quantification(POPQ)System.Mood state evaluation,using the Hamilton anxiety(HAMA)and the Hamilton depression(HAMD)scale,was performed preoperatively and at 3 and 6 months postoperatively.Results:The POP-Q stage was significantly improved postoperatively(P<0.05).Preoperatively,the patients had varying degrees of anxiety symptoms(mean HAMA score,11.945.59 points)and depression symptoms(mean HAMD score,5.562.58 points);these scores were significantly decreased at 3 months(mean HAMA score,4.672.02 points;mean HAMD score,3.581.61 points)and 6 months postoperatively(mean HAMA score,4.882.57 points;mean HAMD score,3.381.60 points)(P<0.05).There were no differences in the HAMD and HAMA scores in both traditional prolapse surgery patients and mesh pelvic reconstruction patients preoperatively and at 3 and 6 months postoperatively(P>0.05).Conclusions:Patients with severe POP have different anxiety and depression symptoms preoperatively.Successful individualized surgical treatment is effective for improving the clinical severity of severe POP and might alleviate or improve POP-related anxiety or depression symptoms.
文摘Background:Approximately 7%of all women will require surgery to correct pelvic organ prolapse during their lives.Of these,approximately 10%-13%will require another operation within 5 years due to recurrence of the disease.Increases in life expectancy and elderly individuals with estrogen deficiencies will mean higher rates of pelvic organ prolapse,significantly reducing the quality of life for millions of people.This study introduces technologies that can help treat pelvic prolapse while reducing the rate of recurrence.Methods:This paper outlines how to properly perform sacrospinous ligament fixation using the Miyazaki technique.Results:A needle was used to successfully perform a sacrospinous ligament fixation using Miyazaki's technique.Conclusions:Considering the Food and Drug Administration’s 2019 decision to permit surgeries with native tissue,this method can be used with sacrospinous ligament fixation as the primary treatment option for pelvic organ prolapse.
文摘Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,74 female cases from our hospital who had different defects in pelvic organ prolapse were treated with the entire reconstructive pelvic surgery,in which 38 had uterus retained(observation group) and 36 cases had hysterectomy(control group).The two groups were compared.The patients with combined stress urinary incontinence had transobturator tension-free vaginal tape(TVT-O technique) at the same time.The results of operations were objectively evaluatedaccording to Pelvic Organ Prolapse Quantification sub-degree method(POP-Q) developed by the International Continence Society.Results For observation group,the average operative time was 50 min,and the average amount of bleeding was 100 mL.For control group,the average operative time was 110 min,and the average amount of bleeding was 200 mL.During the postoperative follow-up(8 ~18 months),in the observation group the structures of patients' pelvic floor were normal;stress urinary incontinence was all cured;related symptoms disappeared or were markedly improved;and no postoperative infection appeared.In control group,two cases had postoperative infection;the patients ' pelvic structures were normal during the postoperative follow-up;the related symptoms disappeared or were significantly improved.After 3 months,POP-Q score was significantly elevated in the two groups.Conclusion Full reconstructive pelvic surgery with uterus retained can complete the whole pelvic floor structure and function of all or part of the reconstruction with fast recovery and clear short-term effect.However,the long-term efficacy remains to be revealed.
文摘Introduction and Hypothesis: The Pelvic Floor Dysfunction (PFD) is a common gynecological condition that causes significant morbidity in the affected population, increasing clinical and financial challenge for the Public Health Services. Methods: This study aimed to review the available evidence and interventions to promote the health of women with PFD. We used the following databases to select papers for this review: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consists of seven articles, with evidence levels 1 and 2. Results: The results of the articles point out to a greater number of activities related to the management of Urinary Incontinence (UI) behavioral support to the patient and physical therapy of the pelvic floor muscles. They were both beneficial to UI prevention and treatment. Conclusions: The physical therapy approach, when associated with cognitive and behavioral strategies, leverages UI outcomes in patients.
文摘Vaginal tumors, whether benign or malignant, are rare. They include fibroepithelial polyps (FEPs), which are benign lesions originating in mesenchymal cells, comprised of a core of connective tissue covered by squamous epithelium. They are usually small and asymptomatic. When symptomatic or very large, they may cause bleeding, genital discomfort or the presence of a bulge in the vagina. In the last case, they may be mistaken for a genital prolapse. Although their physiopathology is still not clearly understood, the presence of hormonal receptors and the occurrence of FEPs during the use of hormone therapy or pregnancy suggest that changes in the stroma of these lesions may be induced by hormones. We report on the case of a patient who presented with a vaginal bulge and was referred to the urogynecology outpatient ward with a diagnosis of genital prolapse, which had actually a large fibroepithelial polyp on the posterior vaginal wall.
文摘BACKGROUND After undergoing radical cystectomy combined with hysterectomy,female patients may suffer from pelvic organ prolapse due to the destruction of pelvic structures,which mainly manifests as the prolapse of tissues of the vulva to varying degrees and can be accompanied by symptoms,such as bleeding and inflammation.Once this complication is present,surgical intervention is needed to resolve it.Therefore,preventing and managing this complication is especially important.CASE SUMMARY The postoperative occurrence of acute enterocele is rare,and a case of acute small bowel vaginosis 2 mo after radical cystectomy with hysterectomy is reported.When the patient was admitted,physical examination revealed that the small bowel was displaced approximately 20 cm because of vaginocele.A team of gynecological,general surgery,and urological surgeons was employed to return the small bowel and repair the lacerated vaginal wall during the emergency operation.Eventually,the patient recovered,and no recurrence was seen in the half year of follow-up.CONCLUSION We review the surgical approach for such patients,analyze high-risk factors for the disease and suggest corresponding preventive measures.
文摘Objective: To investigate whether administration of genistein can improve hormonal changes [estradiol and follicle stimulating hormone (FSH)] , heat shock protein 70 (Hsp70) expression, and thickness of vaginal epithelial cells in a rat model of vaginal atrophy. Methods: Twenty-five multiparous female rats were divided into five groups, namely the control group (without ovariectomy), the ovariectomy only group, and the ovariectomy groups 1, 2 and 3 receiving genistein at the doses of 0.045, 0.090 and 0.180 mg/kg body weight/day, respectively. Estradiol, FSH, and Hsp70 expression were analyzed by using the immunoassay technique. Analysis of the thickness of the vaginal epithelium was performed by histology. Results: Ovariectomy significantly decreased estradiol levels compared to the control group (P<0.05). All doses of genistein significantly increased levels of estradiol in rats with vaginal atrophy compared to the ovariectomy only group (P<0.05). Ovariectomy significantly increased FSH levels compared to the control group (P<0.05). All three doses of genistein restored FSH levels comparable to those in the control group (P>0.05). Ovariectomy significantly increased parabasal cell Hsp70 expression compared to the control group (P<0.05). Of all the genistein doses, only the dose at 0.045 mg/kg body weight/day restored the expression of Hsp70 to levels in the control group (P>0.05). Conclusions: Genistein is able to increase the thickness of the vaginal epithelium through hormone modulation and cellular stress suppression. Genistein is beneficial in the form of a herbal or alternative food for improvement of vaginal atrophy due to menopause.
文摘<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of rectocele and cystocele is usually performed in a hospital setting under regional (spinal or epidural) or general anesthesia, and patients commonly have to stay in the hospital for at least one or two days. The possibility of performing the surgery under local anesthesia, as an outpatient procedure with minimal bleeding and pain, no surgical assistants, with immediate discharge and, most importantly, without compromising postoperative results, is appealing. To our knowledge, no studies ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ve</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> evaluated whether performing rectocele and/or cystocele rectocele repair under local infiltration anesthesia and without separation of the vaginal mucosa from the underlying fascia achieves these goals.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The aim of this study is to describe a new surgical technique for outpatient treatment of cystocele and rectocele under local anesthesia, and our initial results. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Forty women underwent outpatient surgical repair of rectocele and/or cystocele between April and September 2020 at the ambulatory procedure room of the authors’ clinics. The technique consists of a triangular-shaped CO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> laser vaporization</span><span style="color:red;"> </span><span style="font-family:Verdana;">or electrocauterization of the posterior and/or anterior vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin suture. A perineorrhaphy was always performed concomitantly with rectocele repair, and a transobturator sling was performed in women presenting with concomitant stress urinary incontinence. Postoperative evaluation included POP-Q measurement for each patient six months after the procedure, and resolution of prolapse was considered when anterior and/or posterior vaginal wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed using Wilcoxon signed-rank test.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The mean operating time was 21 minutes (range: 14</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">38 minutes). All patients tolerated the procedure well and were discharged immediately afterwards. There were no intraoperative or postoperative complications, and all patients had satisfactory healing of the vaginal mucosa. Bleeding from the rectocele and/or cystocele repair was minimal, and nobody required extra-anesthesia or transfer to a hospital surgical theater. At six month follow-up, pre and postoperative POP-Q measurement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of points Ap, Bp, Aa and Ba were all statistical</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">l</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y significant (Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ± 0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactory resolution of both rectocele and cystocele.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Our initial results suggest that rectocele and cystocele may be safely and effectively treated under local anesthesia in an outpatient setting using this new technique.</span></span></span>
文摘Background:Urinary catheterization after vaginal prolapse surgery can cause inconvenience for patients,elevate the risk of urinary tract infections,and potentially prolong the hospitalization.In China,there is no consensus on the optimal time to remove the urinary catheter after vaginal prolapse surgery.Thus,it will be valuable to gain insight into the nationwide catheterization management after the vaginal prolapse surgery.Methods:From March to May 2020,an online questionnaire was shared and purposive non-probabilistic sampling was used to recruit the participants.The urogynecologists currently performing vaginal prolapse surgery and involved nurses were included in this study.Results:1363 urogynecologists and 436 nurses responded and 99.5%of them reported using transurethral indwelling catheters(TIC)for post-operative bladder drainage in their practices.The duration of initial catheterization after vaginal prolapse surgery was generally 1–7 days,with a median duration of 3 days for anterior colporrhaphy(AC)and anterior&posterior colporrhaphy(APC),and 2 days for other procedures.For the same type of surgery,the median duration of catheterization varied by region.For AC,it was shorter by 1 day in West China and South China(P<0.001);for PC,it was 2 days in most regions,while 1 day in East China(P<0.05);and for APC,it was 3 days in most regions,while 4 days in Northeast China(P<0.05).No statistically significant difference was found in duration of catheterization in hospital levels.Conclusions:The findings suggested that duration of catheterization after prolapse surgery varied greatly in China,potentially resulting in unnecessary prolonging of catheterization.Well-designed studies are urgently needed to optimize catheterization management after vaginal prolapse surgery in China.
基金Financial support for this project was provided by the Basic Public Welfare Research Project of Zhejiang Province (Project No:LGF22H040018),a nonprofit organization.
文摘Backgrounds:Pelvic organ prolapse commonly affects the upper two-thirds of the vagina.However,evaluating this region in its normal position presents challenges.This study aimed to assess the anatomical axis of this vaginal segment using pelvic magnetic resonance imaging measurements.Methods:A retrospective study of 614 hospitalized women from two hospitals,who were rigorously screened to exclude those with Pelvic Organ Prolapse or known anatomical variations(median age:43 years,range:17-76 years).Two reference lines were used:the pubococcygeal line(PCL)and a line from the inferior pubic symphysis to the third sacral vertebra(PS3L).Distances between the distal,middle,and apical points of the upper vagina and the reference lines,as well as the angles between the upper vagina and the reference lines,were measured.Comparisons were made among different age groups.Results:The median distances from the distal,middle,and apical vaginal points to the PCL were 0.4 cm(interquartile range[IQR]:0.0-0.7 cm),2.1 cm(IQR:1.7-2.5 cm)and 3.1 cm(IQR:2.5-3.7 cm),respectively.The median PCL-vaginal angle was 29.0°(IQR:23.0-34.0°).The median distances from the distal,middle,and apical vaginal points to the PS3L were-0.5 cm(IQR:-0.9-0.0 cm),0.0 cm(IQR:-0.4-0.6 cm),and-0.2 cm(IQR:-0.9-0.0 cm),respectively.The median PS3L-vaginal angle was 0.0°(IQR:-4.0-7.0°).Women aged 50 years or older had slightly lower vaginal points and slightly larger angles than younger groups in relation to both reference lines(p<.001).The vaginal axis in younger groups appeared parallel to the PS3L.Conclusions:The axis of the upper two-thirds vagina was proximate to a line from the inferior pubic symphysis to the third sacral vertebra,particularly in younger women.It will likely become a simplified method for roughly assessing the vaginal axis in its situ at first glance.
基金supported by the National Natural Science Foundation of China(81830043,81771561)the National High Level Hospital Clinical Research Funding(2022-PUMCH-A-113,2022-PUMCH-C-031)+1 种基金the National Key Research and Development Program of China(2018YFC2002201)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2020-PT320-003)。
文摘Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance globally.However,reports with follow-up>10 years are limited.Thus,this study aimed to report outcomes in a prospective cohort with at least 10 years of follow-up.Women with stageⅢ–Ⅳsymptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary hospital.The main outcome measure was symptomatic failure.Secondary outcomes included anatomic failure,recurrence,patient satisfaction,complications,and reoperation.The Kaplan-Meier curve was used to estimate the cumulative failure rate.Of the 121 patients enrolled in the study,103(85.1%)completed a median follow-up of 11 years.The estimated probability rates of symptomatic and anatomic failure were 17.6%and 8.8%in 11 years,respectively.The estimated incidence of symptomatic failure increased by 8.2%between 5 and 11 years;however,the corresponding rate for anatomic failure was 3.7%.The most common complication was vaginal mesh exposure,and its estimated probability increased from 19.3%to 28.4%from 5 to 11 years,respectively.Office trimming resolved 80.0%of vaginal exposures.These patients did not report decreased overall satisfaction.Patients with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room(5.8%by 11 years)had lower satisfaction rates(P<0.01)and were defined as having severe mesh exposure.The rates of postoperative pain,reoperation,and Patient Global Impression of Improvement≥2 were 2.5%,3.3%,and 94.2%,respectively.The results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal wall.Vaginal mesh exposure was common in women who were largely not sexually active;however,80%of the cases could be managed in the outpatient clinic,which did not affect patient satisfaction.
