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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.
Subject(s)
Female , Humans , China , Gynecologic Surgical Procedures/adverse effects , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh/adverse effects , Treatment Outcome , VaginaABSTRACT
Transvaginal NOTES surgery,as an emerging minimally invasive surgical technique,is widely used in gynecology disease.However,there are some difficulties in clinical application. This article discusses the indications and contraindications of transvaginal NOTES,the difficulties and countermeasures in the establishment of the access platform,the exposure problems of the surgical visual field,the complications encountered during the operation and their treatment,and infection prevention.
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Cervical cancer is one of the most common gynecological malignancies during pregnancy.The management of cervical cancer during pregnancy depends on the following factors:tumor stage,histological type,gestational age,state of lymph nodes and desire regarding fertility.The treatment for patients who want to preserve pregnancy needs to be individualized and requires a multidisciplinary team.This article reviews the researches about management of cervical cancer during pregnancy.
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The application of microsurgery and immunosuppressive agents have led to remarkable progress in uterus allotransplantation for patients with absolute uterine infertility. At present, more than 40 cases of human uterus transplantation have been successfully carried out worldwide, and 12 healthy newborn babies have been delivered using cesarean section. However, selection of transplant donors and recipient, in vitro uterine perfusion, the immunosuppressive therapy and characteristics of graft rejection after uterus allotransplantation are worthy of attention. This article reviews the research progress in uterus allotransplantation.
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<p><b>Background</b>The effectiveness of an anti-incontinence procedure concomitant with prolapse reconstruction for pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for pelvic reconstructive surgery and evaluate the management of POP associated with UI.</p><p><b>Methods</b>A total of 329 patients who underwent total pelvic reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift reconstruction]: n = 190 and Group B [modified total pelvic reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student's t-tests were used for two independent samples.</p><p><b>Results</b>A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total pelvic reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ= 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ= 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ= 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of reconstructions (P > 0.05).</p><p><b>Conclusions</b>No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions.</p>
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<p><b>OBJECTIVE</b>To investigate the regulatory effect of ligustrazine and Radix Astragalus (Chinese drugs for supplementing qi and activating blood circulation) on uterine mucosa stromal cyto-chemotactic factor RANTES and receptor CCR5 expression.</p><p><b>METHODS</b>The eutopic and ectopic endometrial stromal cells (EMSC) isolated and purified from 10 patients with ovarian endometrial cyst were selected as the experimental group, while those from 10 patients with benign lesion were selected as the control group. After they were intervened by different factors, including astragalus injection (AI), ligustrazine injection (LI), AI + LI, and Danazol, the expression levels of RANTES and CCR5 in the cells were detected by ELISA and RT-PCR.</p><p><b>RESULTS</b>RANTES expressions in eutopic and ectopic EMSC were different insignificantly (P > 0.05). The ectopic EMSC RANTES expression was 13.602 +/- 3.358 ng/L and eutopic EMSC RANTES was 12.850 +/- 7.997 ng/L in the positive control group, which was significantly higher than that in the negative control group (both being 0.027 +/- 0.016 ng/L, P <0.05), and the ectopic EMSC expressions after intervened with Chinese drugs were significantly lower than that in the positive control group (P <0.05). CCR5 expression in ectopic EMSC was 0.759 +/- 0.039 ng/L, which was higher than that in eutopic EMSC (0.249 +/- 0.026 ng/L, P <0.05). Ectopic EMSC CCR5 expression was higher in the positive control group than that in the negative control group (0.759 +/- 0.039 ng/L vs 0.478 +/- 0.094 ng/L, P <0.05). Similar situation also was shown between the positive and negative control groups in terms of eutopic EMSC CCR5 expression (0.249 +/- 0.026 ng/L vs 0.131 +/- 0.021 ng/L, P < 0.01), and the expression was significantly lower in all the Chinese drugs treated EMSC groups as compared with that in the positive control group (P < 0.01).</p><p><b>CONCLUSION</b>CCR5 expression was higher in ectopic EMSC than that in eutopic EMSC. Ligustrazine and Radix Astragalus could down-regulate the auto-secretion of RANTES and CCR5 in patients with endometriosis.</p>