Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(S...Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.展开更多
Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more...Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.展开更多
Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to ...Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to improve quality of life in these patients.Methods:Cross-sectional surveys addressing SUI cognition and coping techniques of 520 elderly women patients with SUI were administered between July 2013 and February 2014.Results:Elderly women with SUI had significantly higher avoidance and acceptanceresignation scores than the normal population(p<0.05).Age,marital status,education level and stress urinary incontinence cognitive level all influenced the medical coping style of these patients.Conclusions:Elderly female patients with SUI differ in the factors that influence their coping styles;therefore,clinical and community medical staff should include a comprehensive analysis that takes these factors into consideration when working with patients with SUI to guide them in adopting a positive coping style.展开更多
BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless s...BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.展开更多
<strong>Objectives</strong>: <span style="font-family:;" "=""><span>The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of ...<strong>Objectives</strong>: <span style="font-family:;" "=""><span>The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of Single Incision needleless Mini-Slings compared with tension-free Standard Mid-urethral Sling in the surgical management of female stress urinary incontinence, but with less side effects. </span><b><span>Methods:</span></b><span> The study will be conducted in Zagazig University Hospitals. From 2018 to Sept. 2019, 40 cases were enrolled in the study and were randomized by envelope technique at the time of surgery to either a trans-obturator vaginal tape (TOT) or Needleless anti-incontinence procedure. The patients will be divided into 2 groups: Group 1 patient treated by standard sling (TOT). Group 2 those treated by mini-sling. Parameters in perioperative period such as operating time, intraoperative hemorrhage volume, length of stay in hospital, intraoperative complications, and postoperative pain of each patient were recorded. The sample size was calculated to be 40 cases (20 cases will be treated by standard slings, 20 case will be treated by mini-sling). </span><b><span>Results: </span></b><span>A total of 40 patients assessed for eligibility were randomized into Needleless groups. There were no significant differences in age, body mass index, process, parity, pad test or the assessment of preoperative quality of life between the two groups. In the perioperative period, statistically significant differences between the two groups were found in operating time, intraoperative hemorrhage volume, groin pain scores at 24 h after operation and length of stay in hospital (P < 0.001). After two weeks of follow-up, a statistically significant difference between the two groups was found in groin pain/femori-bus internus pain scores, but there were no significant differences in cure rates, pad test, complications or ICIQ-SF. After 1 year, there were no significant differences between the Needleless and TOT groups in cure rates, pad test, groin pain or ICIQ-SF (P > 0.05). Both groups registered a significant improvement in the quality of life (P < 0.001), but there were no significant differences between the two groups (P > 0.05). </span><b><span>Conclusion: </span></b><span>We conclude that compared with the TOT surgery, single-incision Needleless sling in the treatment of female stress urinary incontinence is simpler and quicker and has less hemorrhage during surgery as well as faster recovery and it also can obviously reduce the inguinal region pains after operation and shorten hospital stays. In summary, single-incision Needleless sling is a kind of convenient, safe and effective minimally invasive surgery for urinary incontinence.</span></span>展开更多
Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & M...Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.展开更多
Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web ...Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.展开更多
<strong>Objective</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>: </stron...<strong>Objective</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>: </strong>To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years.</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;">Methods</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: This was a prospective observational study on Chinese women undergoing the insertion of</span><i> </i><span style="font-family:Verdana;">TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form</span></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;">(IIQ-7)) and adverse events were also collected.</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;">: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant difference</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;"> in objective cure rate (84.2% vs</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 90.5%, p = 0.55) and subjective cure rate (78.9% vs</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 83.3%, p = 0.58).</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;">: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.</span></span></span>展开更多
We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from Fe...We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.展开更多
Aims:To evaluate the medium term efficacy and safety of Altis and Solyx single incision slings(SIS)compared with tension-free vaginal tape(TVT)Abbrevo trans-obturator sling.We hypothesize that both SIS show little dif...Aims:To evaluate the medium term efficacy and safety of Altis and Solyx single incision slings(SIS)compared with tension-free vaginal tape(TVT)Abbrevo trans-obturator sling.We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo.Methods:We conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial(RCT).Subjects were identified retrospectively,and prospectively invited for examination and questionnaires>12 months post-operatively.Exclusions included intrinsic sphincter deficiency,previous sling surgery,and others.Primary outcome was subjective cure[negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF)question 6,leakage during coughing/activity].Secondary outcomes include objective cure(negative cough stress test),functional outcomes,and adverse events.Results:Between 2012 and 2018,a total of 113 women received one of two SIS surgeries;Solyx(n=50)followed by the Altis(n=63);104 were available for final efficacy analysis.Mean follow-up was 21.7(Altis),46.0(Solyx),and 29.0(Abbrevo)months.Baseline characteristics were comparable between the groups.There was no significant differences in the subjective or objective cure rates between the groups,and no differences in functional outcomes such as patient global impression of improvement,and post-operative ICIQ-UI SF score.There was a low rate of mesh related complications and no differences seen between the groups.Conclusions:Despite being an underpowered study,Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings(MUS).展开更多
OBJECTIVE:To evaluate the effectiveness of electroacupuncture(EA)for female stress urinary incontinence(SUI).METHODS:We searched 12 databases electronically from inception to November 2018 without language restriction...OBJECTIVE:To evaluate the effectiveness of electroacupuncture(EA)for female stress urinary incontinence(SUI).METHODS:We searched 12 databases electronically from inception to November 2018 without language restrictions.We included randomized controlled trials(RCTs)involving women with SUI,but excluded other types of urinary incontinence or studies that were not RCTs.Two independent reviewers extracted study characteristics,with disagreements resolved by consensus.Data were pooled and expressed as mean difference(MD)for continuous outcomes and relative risk(RR)for dichotomous outcomes,with 95%confidence intervals(CI).This study was registered with the International Prospective Register of Systematic Reviews(number CRD42018089734).RESULTS:We found very low to high level evidence that EA improved the effective rate(RR=2.03,95%CI:1.40,2.95;P=0.0002)and reduced urine leakage as measured by the 1-hour pad test(MD=3.33,95%CI:0.89,5.77;P=0.008),International Consultation on Incontinence Questionnaire Short Form score(MD=3.14,95%CI:2.42,3.85;P<0.00001),and 72-hour incontinence episodes(MD=1.17,95%CI:0.56,1.78;P=0.0002)compared with sham electroacupuncture(SA),pelvic floor muscle training,and medication.CONCLUSION:The effectiveness and safety of EA for key outcomes for women with SUI are statistically significantly better than those of SA,but most available evidence is very low or low quality.More well-designed RCTs are needed to confirm these findings.展开更多
Objective To assess the effect of intra-sphincteric injections of human umbilical cord mesenchymal stem cells(HUMSCs)on leak point pressure(LPP)changes in an animal model of stress urinary incontinence(SUI).Meanwhile,...Objective To assess the effect of intra-sphincteric injections of human umbilical cord mesenchymal stem cells(HUMSCs)on leak point pressure(LPP)changes in an animal model of stress urinary incontinence(SUI).Meanwhile,to investigate in vivo MRI tracking HUMSCs in SUI rats using a clinically available paramagnetic contrast agent(Gd-DTPA)and commercially available effentence transfection reagents..Materials and Methods HUMSCs were dual labeled with Gd-DTPA and PKH26,the labeling efficiency and longevity of Gd-DTPA maintenance were measured and cell viability and proliferation were assessed.39 female Sprague–Dawley SUI rats.12 normal rats and 12 SUI rats received periurethral injection of PBS and 12 SUI rats were given periurethral injection of dual labeled HUMSCs.3 SUI rat sreceived periurethral injection of u nlabeled HUMSCs.Six weeks after injection,LPP was undertaken in animals.All rats were sacrificed and frozen urethra sections were submitted to pathology and immunohistochemistry assessment.Results The labeling efficiency of Gd-DTPA was up to 80%,the labeling procedure did not influence cell viability and proliferation.The signal intensity on T1-weighted imaging and T1 values of labeled cells were significantly higher than those of unlabeled cells.In vitro,differentiated HUMSCs expressed myosin heavy chain(MHC)and desmin,markers of striated muscles.In vivo,immunohistochemistry of rat urethras revealed dual labeled HUMSCs in situ and at the injection site.LPP was significantly improved in animals injected with HUMSCs.Atrophic urethras with implanted HUMSCs were positively stained for MHC and desmin.The distribution and migration of labeled cells could be tracked by MRI more than 14 days after t ransplantation.Conclusion HUMSCs have the ability to differentiate striated muscles,as demonstrated by MHC and desmin expression.Periurethral injection of HUMSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved LPP.MRI can track Gd-DTPA–labled HUMSCs in an animal model of SUI in vivo.展开更多
This study aimed to induce the differentiation of isolated and purified adipose-derived stromal cells(ADSCs) into myoblasts,which may provide a new strategy for tissue engineering in patients with stress urinary incon...This study aimed to induce the differentiation of isolated and purified adipose-derived stromal cells(ADSCs) into myoblasts,which may provide a new strategy for tissue engineering in patients with stress urinary incontinence(SUI).ADSCs,isolated and cultured ex vivo,were identified by flow cytometry and induced to differentiate into myoblasts in the presence of an induction solution consisting of DMEM supplemented with 5-azacytidine(5-aza),5% FBS,and 5% horse serum.Cellular morphology was observed under an inverted microscope.Ultrastructural changes occurring during the differentiation were observed by transmission electron microscopy and confocal laser scanning microscopy.Cellular immunohistochemical staining was applied to determine the expression of desmin protein in cells with and without induced differentiation.Reverse transcription-polymerase chain reaction(RT-PCR) and Western blotting were used to detect mRNA and protein expression,respectively,of sarcomeric and desmin smooth muscle proteins.The results showed that ADSCs were mainly of a spindle or polygon shape.Flow cytometry analysis revealed that ADSCs did not express CD34,CD45,and CD106 but high levels of CD44 and CD90,which confirmed that the cultured cells were indeed ADSCs.After induction with a 5-aza-containing solution,morphological changes in ADSCs,including irregular cell size,were observed.Cells gradually changed from long spindles to polygons and star-shaped cells with microvilli on the cell surface.Many organelles were observed and the cytoplasm was found to contain many mitochondria,rough endoplasmic reticulum(rER),and myofilament-like structures.Cell immunohistochemical staining revealed different levels of desmin expression in each phase of the induction process,with the highest expression level found on day 28 of induction.RT-PCR and Western blot results confirmed significantly higher desmin gene expression in induced cells compared with control cells,but no significant difference between the two groups of cells in sarcomeric protein expression.It was concluded that under specific induction setting,ADSCs can be induced to differentiate into myoblasts,providing a potential new option in stem cell transplantation therapy for SUI.展开更多
Background:Stress urinary incontinence(SUI),is the most common type of urinary incontinence affecting women.SUI has a significant impact on psychosocial functioning and quality of life.Biomedical treatments,such as su...Background:Stress urinary incontinence(SUI),is the most common type of urinary incontinence affecting women.SUI has a significant impact on psychosocial functioning and quality of life.Biomedical treatments,such as surgery,often result in post-operative complications.In China,traditional Chinese medicine tends to be the treatment of choice for SUI.Case presentation:We present a 35-year-old patient who developed SUI following forceps delivery and was treated successfully with acupuncture and Chinese herbs.Traditional Chinese diagnosis,including channel and acupoint palpation revealed the patient had a syndrome pattern of liver/kidney deficiency,disordered bladder qi transformation,all of which lead to enuresis.Acupuncture,both body and scalp needling,were performed.Herbs were prescribed adjunctively.Conclusion:Traditional Chinese medicine modalities may be considered for treatment of SUI based on appropriate syndrome pattern assessment.展开更多
Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinar...Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension-free vaginal tape(TVT-O) and TVT-O (Group B).Then,we compared these two groups by whole recovery rate,recovery rate of patients with urge incontinence,charge of treatment and complication,respectively.Results Group B's recovery rate for stress urinary incontinence was 100%.Ⅰ degree stress urinary incontinence in Group A's recovery rate was higher;Ⅱ degree patients' recovery rate for stress urinary incontinence was lower;Ⅲ degree patients' recovery rate was 0%.Only 1 case showed abnormal urine stream;2 cases showed urinary retention,but the symptoms disappeared after the treatment.No significant complication in Group A.There were huge differences of the expense between the two groups.The effect in Group A for patients with urge incontinence was good,but there was no effect shown in Group B.Conclusions The two treatments are safe and effective for stress urinary incontinence,but there are existed prominent differences of the therapeutic efficacy between the two groups.展开更多
基金supported by the Natural Science Foundation of Zhejiang Province(Nos.LQ22H040003,LQ20H270019)Medical Science and Technology Project of Zhejiang Province(No.2021KY767).
文摘Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.
基金supported by an unrestricted grant from Urogyn BV,Nijmegen,The Netherlands.
文摘Stress urinary incontinence is not a deadly disease,but for the large population of women suffering from it,it is a very important issue.Especially in the continuously aging population all over the world,there is more and more need for treatment of this serious medical condition.Treatment of female stress urinary incontinence exists already for ages.In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments.The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers.Luckily there are many options available and the field is developing quickly.In recent years many new medical devices have been developed,that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications.This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.
文摘Objective:The aim of this study was to survey the coping style and related factors of elderly women with stress urinary incontinence(SUI)and provide a strong theoretical basis for promoting a positive coping style to improve quality of life in these patients.Methods:Cross-sectional surveys addressing SUI cognition and coping techniques of 520 elderly women patients with SUI were administered between July 2013 and February 2014.Results:Elderly women with SUI had significantly higher avoidance and acceptanceresignation scores than the normal population(p<0.05).Age,marital status,education level and stress urinary incontinence cognitive level all influenced the medical coping style of these patients.Conclusions:Elderly female patients with SUI differ in the factors that influence their coping styles;therefore,clinical and community medical staff should include a comprehensive analysis that takes these factors into consideration when working with patients with SUI to guide them in adopting a positive coping style.
文摘BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.
文摘<strong>Objectives</strong>: <span style="font-family:;" "=""><span>The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of Single Incision needleless Mini-Slings compared with tension-free Standard Mid-urethral Sling in the surgical management of female stress urinary incontinence, but with less side effects. </span><b><span>Methods:</span></b><span> The study will be conducted in Zagazig University Hospitals. From 2018 to Sept. 2019, 40 cases were enrolled in the study and were randomized by envelope technique at the time of surgery to either a trans-obturator vaginal tape (TOT) or Needleless anti-incontinence procedure. The patients will be divided into 2 groups: Group 1 patient treated by standard sling (TOT). Group 2 those treated by mini-sling. Parameters in perioperative period such as operating time, intraoperative hemorrhage volume, length of stay in hospital, intraoperative complications, and postoperative pain of each patient were recorded. The sample size was calculated to be 40 cases (20 cases will be treated by standard slings, 20 case will be treated by mini-sling). </span><b><span>Results: </span></b><span>A total of 40 patients assessed for eligibility were randomized into Needleless groups. There were no significant differences in age, body mass index, process, parity, pad test or the assessment of preoperative quality of life between the two groups. In the perioperative period, statistically significant differences between the two groups were found in operating time, intraoperative hemorrhage volume, groin pain scores at 24 h after operation and length of stay in hospital (P < 0.001). After two weeks of follow-up, a statistically significant difference between the two groups was found in groin pain/femori-bus internus pain scores, but there were no significant differences in cure rates, pad test, complications or ICIQ-SF. After 1 year, there were no significant differences between the Needleless and TOT groups in cure rates, pad test, groin pain or ICIQ-SF (P > 0.05). Both groups registered a significant improvement in the quality of life (P < 0.001), but there were no significant differences between the two groups (P > 0.05). </span><b><span>Conclusion: </span></b><span>We conclude that compared with the TOT surgery, single-incision Needleless sling in the treatment of female stress urinary incontinence is simpler and quicker and has less hemorrhage during surgery as well as faster recovery and it also can obviously reduce the inguinal region pains after operation and shorten hospital stays. In summary, single-incision Needleless sling is a kind of convenient, safe and effective minimally invasive surgery for urinary incontinence.</span></span>
文摘Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.
文摘Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.
文摘<strong>Objective</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>: </strong>To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years.</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;">Methods</span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">: This was a prospective observational study on Chinese women undergoing the insertion of</span><i> </i><span style="font-family:Verdana;">TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form</span></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;">(IIQ-7)) and adverse events were also collected.</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;">: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant difference</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;"> in objective cure rate (84.2% vs</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 90.5%, p = 0.55) and subjective cure rate (78.9% vs</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 83.3%, p = 0.58).</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;">: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.</span></span></span>
基金supported by the National Natural Science Foundation of China (81830043 and 81771561)the National Key Research and Development Program of China (2018YFC2002201)。
文摘We aimed to evaluate the long-term effectiveness and safety of Burch colposuspension(BC) for stress urinary incontinence(SUI). In this prospective cohort study, 84 patients with SUI undergoing BC were enrolled from February 2004 to January 2010.Data on long-term subjective success and postoperative complications were collected at clinic visits and by telephone follow-up.During a mean follow-up period of 14.2 years, 68%(57/84) patients completed the follow-up. A total of 68.4% of patients(39/57) reported absence of SUI symptoms, 73.6%(42/57) were subjectively satisfied according to the Patient Global Impression of Improvement, and 68.4%(39/57) reported subjective success regarding urinary symptoms via the Urinary Distress Inventory Short Form. However, 28.1%(16/57) suffered at least one long-term postoperative complication and incident. Specifically, 1 in25(4.0%) sexually active patients reported dyspareunia, 3 patients(5.3%) had de novo overactive bladder, and 6 patients(10.5%)reported voiding dysfunction. Four patients(7.0%) reported new onset prolapse symptoms, and 3 patients(5.3%) underwent secondary urinary incontinence surgery. Our study indicated that Burch colposuspension is an effective procedure for SUI, and the cure effect was largely maintained for the 14-year follow-up period, with relatively low complication rates. BC should be considered a surgical option for SUI.
文摘Aims:To evaluate the medium term efficacy and safety of Altis and Solyx single incision slings(SIS)compared with tension-free vaginal tape(TVT)Abbrevo trans-obturator sling.We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo.Methods:We conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial(RCT).Subjects were identified retrospectively,and prospectively invited for examination and questionnaires>12 months post-operatively.Exclusions included intrinsic sphincter deficiency,previous sling surgery,and others.Primary outcome was subjective cure[negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF)question 6,leakage during coughing/activity].Secondary outcomes include objective cure(negative cough stress test),functional outcomes,and adverse events.Results:Between 2012 and 2018,a total of 113 women received one of two SIS surgeries;Solyx(n=50)followed by the Altis(n=63);104 were available for final efficacy analysis.Mean follow-up was 21.7(Altis),46.0(Solyx),and 29.0(Abbrevo)months.Baseline characteristics were comparable between the groups.There was no significant differences in the subjective or objective cure rates between the groups,and no differences in functional outcomes such as patient global impression of improvement,and post-operative ICIQ-UI SF score.There was a low rate of mesh related complications and no differences seen between the groups.Conclusions:Despite being an underpowered study,Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings(MUS).
文摘OBJECTIVE:To evaluate the effectiveness of electroacupuncture(EA)for female stress urinary incontinence(SUI).METHODS:We searched 12 databases electronically from inception to November 2018 without language restrictions.We included randomized controlled trials(RCTs)involving women with SUI,but excluded other types of urinary incontinence or studies that were not RCTs.Two independent reviewers extracted study characteristics,with disagreements resolved by consensus.Data were pooled and expressed as mean difference(MD)for continuous outcomes and relative risk(RR)for dichotomous outcomes,with 95%confidence intervals(CI).This study was registered with the International Prospective Register of Systematic Reviews(number CRD42018089734).RESULTS:We found very low to high level evidence that EA improved the effective rate(RR=2.03,95%CI:1.40,2.95;P=0.0002)and reduced urine leakage as measured by the 1-hour pad test(MD=3.33,95%CI:0.89,5.77;P=0.008),International Consultation on Incontinence Questionnaire Short Form score(MD=3.14,95%CI:2.42,3.85;P<0.00001),and 72-hour incontinence episodes(MD=1.17,95%CI:0.56,1.78;P=0.0002)compared with sham electroacupuncture(SA),pelvic floor muscle training,and medication.CONCLUSION:The effectiveness and safety of EA for key outcomes for women with SUI are statistically significantly better than those of SA,but most available evidence is very low or low quality.More well-designed RCTs are needed to confirm these findings.
文摘Objective To assess the effect of intra-sphincteric injections of human umbilical cord mesenchymal stem cells(HUMSCs)on leak point pressure(LPP)changes in an animal model of stress urinary incontinence(SUI).Meanwhile,to investigate in vivo MRI tracking HUMSCs in SUI rats using a clinically available paramagnetic contrast agent(Gd-DTPA)and commercially available effentence transfection reagents..Materials and Methods HUMSCs were dual labeled with Gd-DTPA and PKH26,the labeling efficiency and longevity of Gd-DTPA maintenance were measured and cell viability and proliferation were assessed.39 female Sprague–Dawley SUI rats.12 normal rats and 12 SUI rats received periurethral injection of PBS and 12 SUI rats were given periurethral injection of dual labeled HUMSCs.3 SUI rat sreceived periurethral injection of u nlabeled HUMSCs.Six weeks after injection,LPP was undertaken in animals.All rats were sacrificed and frozen urethra sections were submitted to pathology and immunohistochemistry assessment.Results The labeling efficiency of Gd-DTPA was up to 80%,the labeling procedure did not influence cell viability and proliferation.The signal intensity on T1-weighted imaging and T1 values of labeled cells were significantly higher than those of unlabeled cells.In vitro,differentiated HUMSCs expressed myosin heavy chain(MHC)and desmin,markers of striated muscles.In vivo,immunohistochemistry of rat urethras revealed dual labeled HUMSCs in situ and at the injection site.LPP was significantly improved in animals injected with HUMSCs.Atrophic urethras with implanted HUMSCs were positively stained for MHC and desmin.The distribution and migration of labeled cells could be tracked by MRI more than 14 days after t ransplantation.Conclusion HUMSCs have the ability to differentiate striated muscles,as demonstrated by MHC and desmin expression.Periurethral injection of HUMSCs in an animal model of SUI restored the damaged external urethral sphincter and significantly improved LPP.MRI can track Gd-DTPA–labled HUMSCs in an animal model of SUI in vivo.
基金supported by grants from Research Foundations for Young Scholars,Health Department of Fujian Province,China(No.2008-1-27)Research Foundations of the Health Department of the Nanjing Military Zone of the People's Liberation Army,China(No.08MA099)Nursery Scientific Research Foundation for Youth of Fujian Medical University,China(No.2010MP004)
文摘This study aimed to induce the differentiation of isolated and purified adipose-derived stromal cells(ADSCs) into myoblasts,which may provide a new strategy for tissue engineering in patients with stress urinary incontinence(SUI).ADSCs,isolated and cultured ex vivo,were identified by flow cytometry and induced to differentiate into myoblasts in the presence of an induction solution consisting of DMEM supplemented with 5-azacytidine(5-aza),5% FBS,and 5% horse serum.Cellular morphology was observed under an inverted microscope.Ultrastructural changes occurring during the differentiation were observed by transmission electron microscopy and confocal laser scanning microscopy.Cellular immunohistochemical staining was applied to determine the expression of desmin protein in cells with and without induced differentiation.Reverse transcription-polymerase chain reaction(RT-PCR) and Western blotting were used to detect mRNA and protein expression,respectively,of sarcomeric and desmin smooth muscle proteins.The results showed that ADSCs were mainly of a spindle or polygon shape.Flow cytometry analysis revealed that ADSCs did not express CD34,CD45,and CD106 but high levels of CD44 and CD90,which confirmed that the cultured cells were indeed ADSCs.After induction with a 5-aza-containing solution,morphological changes in ADSCs,including irregular cell size,were observed.Cells gradually changed from long spindles to polygons and star-shaped cells with microvilli on the cell surface.Many organelles were observed and the cytoplasm was found to contain many mitochondria,rough endoplasmic reticulum(rER),and myofilament-like structures.Cell immunohistochemical staining revealed different levels of desmin expression in each phase of the induction process,with the highest expression level found on day 28 of induction.RT-PCR and Western blot results confirmed significantly higher desmin gene expression in induced cells compared with control cells,but no significant difference between the two groups of cells in sarcomeric protein expression.It was concluded that under specific induction setting,ADSCs can be induced to differentiate into myoblasts,providing a potential new option in stem cell transplantation therapy for SUI.
文摘Background:Stress urinary incontinence(SUI),is the most common type of urinary incontinence affecting women.SUI has a significant impact on psychosocial functioning and quality of life.Biomedical treatments,such as surgery,often result in post-operative complications.In China,traditional Chinese medicine tends to be the treatment of choice for SUI.Case presentation:We present a 35-year-old patient who developed SUI following forceps delivery and was treated successfully with acupuncture and Chinese herbs.Traditional Chinese diagnosis,including channel and acupoint palpation revealed the patient had a syndrome pattern of liver/kidney deficiency,disordered bladder qi transformation,all of which lead to enuresis.Acupuncture,both body and scalp needling,were performed.Herbs were prescribed adjunctively.Conclusion:Traditional Chinese medicine modalities may be considered for treatment of SUI based on appropriate syndrome pattern assessment.
文摘Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence.Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension-free vaginal tape(TVT-O) and TVT-O (Group B).Then,we compared these two groups by whole recovery rate,recovery rate of patients with urge incontinence,charge of treatment and complication,respectively.Results Group B's recovery rate for stress urinary incontinence was 100%.Ⅰ degree stress urinary incontinence in Group A's recovery rate was higher;Ⅱ degree patients' recovery rate for stress urinary incontinence was lower;Ⅲ degree patients' recovery rate was 0%.Only 1 case showed abnormal urine stream;2 cases showed urinary retention,but the symptoms disappeared after the treatment.No significant complication in Group A.There were huge differences of the expense between the two groups.The effect in Group A for patients with urge incontinence was good,but there was no effect shown in Group B.Conclusions The two treatments are safe and effective for stress urinary incontinence,but there are existed prominent differences of the therapeutic efficacy between the two groups.
