Preliminary report of Canal Transobturator Tape for Stress Urinary Incontinence in Women Over 65 Years

PURPOSE: To access the feasibility of Canal transobturator tape (Canal TOT) for stress urinary incontinence (SUI) in women over 65 year old. MATERIALS AND METHODS: From August 2006 to December 2008, we reviewed the medical records of 261 patients underwent Canal TOT in Division of Urogynecology, Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine in Seoul. This study is a retrospective analysis of the clinical characteristics (age, gravida, parity, body mass index), previous operation history, comorbidity, surgical procedure and operation outcomes. We performed stress test, one hour pad test, urodynamic study, postvoid residual assessment to all patients for diagnosis of SUI. All patients answered self assessment questionnaires (IIQ-7, UDI-6) at 6 months and 12 months after operation. RESULTS: 55 women over 65 years were underwent Canal TOT. Mean follow up was 11+/-4.5 months. Mean age of patients was 70.2+/-3.9 years, gravida 5.8+/-2.3 times, parity 3.9+/-1.5 times and body mass index (BMI) 25.6+/-3.1Kg/m2. 8 patients had got hysterectomy (14.5%). 16 patients (29%) had sling operation (Canal TOT alone), and 39 patients (71%) had Canal TOT combined with vaginal surgery for pelvic organ prolapse. The cure rate was 96.4% in 6 months follow up. Leakage after operation were reported by 2 patients (3.6%) and 3 patients (5.5%) transiently suffered from postoperative voiding difficulty. Of whom had incontinence complexed with overactive bladder symptoms (frequency, nocturia, and urgency) 12 patients complained of persistent symptoms after Canal TOT (12/33, 36.4%). The scores from self assessment questionnaires (IIQ-7, UDI-6) at6months after operation were improved significantly. CONCLUSION: Canal TOT is feasible and safe method for SUI in old age. The procedure also shows favorable results when combined with other operations for pelvic organ prolapse.

Laparoscopic management of borderline ovarian tumors; KBSMC experience / 대한산부인과학회지

OBJECTIVE: To evaluate feasibility and efficacy of laparoscopic management for borderline ovarian tumors. METHODS: From May 2005 to October 2007 in our institution, laparoscopic treatments were performed for 16 patients for borderline ovarian tumors. Through clinical records, the patients' age, parity, operating time, tumor diameter, length of hospital stay, change in hemoglobin level, intraoperative and postoperative complications, and recurrence were analyzed. RESULTS: The median age of the patients was 38 years (27-72 years), the median parity was 1 (0-3), and 6 patients were nulliparous., Eight patients were performed conservative surgery, and radical surgery was performed in the remainder. The median operating time was 90 minutes (50-305 minutes), the median hospital stay was 5 days (4-16 days), the median change of the hemoglobin level was 1.5 g/dL (0.2-4.5 g/dL), and the median diameter of the tumors was 8.5 cm. FIGO stage was Ia for 9 patients, Ib for 2, Ic for 4, and IIIc for the last one. Histopathological results showed mucinous tumor for 8 patients, serous tumor for 6, and mixed type and endometrioid tumor for each remaining. Laparoscopic pelvic and paraaortic lymphadenectomy were performed 4 patients. There was no upstaging by intraoperative cystic rupture. Neither laparoconversion nor intraoperative complication was noted. The median duration of follow-up was 20 months (3-53 months) and none showed recurrence. One of 8 patients who were treated conservatively obtained a baby by vaginal delivery in 32th postoperative month. CONCLUSION: This preliminary analysis demonstrated patients with borderline ovarian tumor can feasibly and efficiently undergo laparoscopic management.

Laparoscopic adnexal surgery for posthysterectomy patients / 대한산부인과학회지

OBJECTIVE: To evaluate the feasibility and effectiveness of laparoscopic adnexal surgery in posthysterectomy patients and review clinical characteristics including comparison of the adhesion score of left with that of right adnexal mass. METHODS: From February 2004 to January 2007, we reviewed the medical records of 23 post-hysterectomy patients who received laparoscopic adnexal surgery including age, parity, type of hysterectomy, operative indications, histopathological diagnosis, operating time, size of the adnexal mass, adhesion score, change in the hemoglobin level, hospital stay, and any complications. RESULTS: The median age of patients was 48 years (range 35-69 years), and median parity was 2 (0-3). The median operating time was 100 minutes (range 35-180 minutes), and the median size of the adnexal mass was 7.1 cm (range 4-12 cm). The median change in hemoglobin level was 1.8 g/dL (range 0.6-4.1 g/dL). The median hospital stay was 4 days (range 3-19 days). The adhesion score was significantly higher in the left adnexal mass than in the right adnexal mass. Histopathological diagnosis included 6 cases of mucinous cystadenoma, 6 cases of functional cyst, 4 cases of hydrosalpinx, 3 cases of serous cystadenoma, 1 case of fibrothecoma, 1 case of mucinous adenofibroma, 1 case of endometrioma, and 1 case of tubo-ovarian abscess. There were no intraoperative complications or conversion to laparotomy. One case of postoperative ileus was noted. CONCLUSION: The skilled laparoscopic surgeon is capable of achieving successful result by performing laparoscopic surgery primarily to patients with adnexal mass for posthysterectomy patients who are expected to suffer severe adhesion. In posthysterectomy patients, left adnexal mass has more extensive adhesion than right adnexal mass, and these finding was represented as a high adhesion score of left adnexal mass.

Clinical efficacy of laparoscopic myomectomy for 110 cases of various sized myomas / 대한산부인과학회지

OBJECTIVE: To assess the feasibility and clinical efficacy of laparoscopic myomectomy (LM). METHODS: We analyzed retrospectively the data for 110 LM preformed at Kangbuk Samsung Hospital between July 2003 and July 2006. We reviewed their clinical charts and the operative and anesthetic records, and analyzed data on the patients' age, parity, previous operative history, preoperative indication, the diameter of the largest myoma, operating time, number of the removed myoma, hospital stay, change of the hemoglobin concentration from preoperative to postoperative day 1, concomitant procedures, histopathological reports, and complications. RESULTS: The mean age of the patients was 35.7+/-5.8 years, the mean parity was 0.8+/-0.9, and 26 (23%) patients had a previous operative history. The most common operative indication was a palpable abdominal mass (46 patients, 41.9%), followed by chronic pelvic pain (32 patients, 29.0%), abnormal uterine bleeding (24 patients, 21.8%), urinary frequency (7 patients, 6.4%), and infertility (1 patient, 0.9%). The mean operating time was 82.9+/-30.8 minutes, and the mean diameter of the largest myoma was 7.1+/-2.3 cm. The heaviest of the removed myoma weighed 795 gm. The mean change of the hemoglobin concentration was 2.2+/-1.1 g/dL, and the mean hospital stay was 3.5+/-1.4 days. Postoperatively, transfusions were done 10% (11 cases) of patients, and 2 cases of paralytic ileus and a case of subcutaneous emphysema were noted. Conversion rate to laparotomy was 0.9% (1 case). CONCLUSION: LM for various sized myomas can be performed successfully and effectively by decreasing laparoconversion, if the surgical team and the laparoscopic surgeon are experienced and enhanced equipment is available.

Human chorionic gonadotropin and invasion of trophoblast into the tubal wall in tubal pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between gestational age, tubal ultrasonographic diameter, and serum beta-hCG levels and different stages of trophoblastic infiltration of the tubal wall in tubal pregnancy. METHODS: The 45 cases of fallopian tube containing tubal pregnancy were reviewed. Gestational age, diameter of the tubal mass, and beta-hCG level on the day of surgery were calculated by transvaginal sonography and immunoassay respectively. The tubal pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III). RESULTS: 14 patients (31.1%) had stage I tubal infiltration, 10 patients (22.2%) had stage II infiltration, 21 patients (46.7%) had stage III infiltration. There was no relationship between gestational age, tubal diameter and stage, but there was a predictable correlation between beta-hCG and the depth of trophoblastic invasion. The median beta-hCG level was 1,332.1 mIU/mL (range, 215-2,995 mIU/mL) for patients with stage I infiltration, 9,548.0 mIU/mL (range, 569-43,989 mIU/mL) for stage II infiltration, and 23,087.9 mIU/mL (range, 1,373-98,000 mIU/mL) for stage III infiltration. Cut off level of beta-hCG for each stage were 1,996.5 mIU/mL (stage I vs II, III) and 5,665 mIU/mL (stage I, II vs III) respectively. CONCLUSION: These findings may explain why beta-hCG is a important predicting factor for invasion of trophoblast in tubal pregnancy.

Clinical Evaluation on 30 cases of Laparoscopically Assisted Vaginal Hysterectomy for Uteri Weighing 500 g or more / 대한산부인과학회지

OBJECTIVE: To determine the feasibility and safety of performing laparoscopically assisted vaginal hysterectomy (LAVH) for uteri weighing 500 g or more and evaluate the advantages and complications of LAVH. METHODS: A subpopulation of 30 women with uteri weighing 500 g or more from group of 412 patients undergoing LAVH between Mar, 2003 to Feb, 2005. We reviewed medical records and analyzed these cases about age, parity, history of previous abdominal surgery, preoperative indications, postoperative pathologic diagnosis, mean operation times, weight of extracted uterus, change of hemoglobin, hospital stay, and complications. RESULTS: The mean age was 44.8+/-3.88 years. The mean parity was 1.78+/-0.76. Previous operation history was 16 cases (53.3%). The most common indication of operation was palpable abdominal mass. The most common pathologic diagnosis was leiomyoma. The mean operation time was 126.40+/-39.30 minutes. The mean weight of uterus was 621.23+/-107.28 g. The mean hemoglobin change was 1.57+/-1.14 g/dL. The mean hospital stay was 3.74+/-0.88 days. The only complication of operation was superficial trocar site bleeding (1 case). CONCLUSION: LAVH is a safe and effective alternative to total abdominal hysterectomy of the uteri weighing 500 g or more in selective groups.

A Study on the Improvement of Urinary Incontinence Symptoms and Sexual Function in Patients with Urinary Incontinence before and after Extracorporeal Magnetic Innervation (ExMI) Therapy / 대한산부인과학회잡지

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.

A Study on the Improvement of Urinary Incontinence Symptoms and Sexual Function in Patients with Urinary Incontinence before and after Extracorporeal Magnetic Innervation (ExMI) Therapy / 대한산부인과학회잡지

OBJECTIVE: This study was designed to assess the effect of extracorporeal magnetic innervation (ExMI) therapy for urinary incontinence and sexual function. METHODS: Fifty female patients with urinary incontinence were prospectively studied. Their mean age was 47.2 years, and the mean duration of symptoms was 6.7 years. All they had a history of previous vaginal delivery and mixed urinary incontinence symptoms. Evaluation before treatment included urine analysis and culture for excluding urinary infection, physical examination including neurologic and gynecologic evaluation for structural abnormality, vaginal pressure measurement with perineometer and quality of life survey with questionnaire. For the treatment, the patients were seated fully clothed in a Neocontrol chair with a magnetic field therapy. Treatment sessions were for 20 minutes, twices a week for the average 8 weeks. At one week after ExMI therapy, vaginal pressure measurement and quality of life survey (including questions of patient and patient's husband for satisfaction degree of their sexual life) were repeated. The comparison of incontinence symptoms, qulity of life (including sexual life) and vaginal pressure measurement before and after ExMI therapy were assessed. RESULTS: The results were as follows 1) The mean of urge incontinence symptoms score was increased 3.06 to 4.60 after ExMI (P<0.05). 2) The mean of stress incontinence symptoms score was increased 3.08 to 4.57 after ExMI (P<0.05). 3) The mean of quality of life (QoL) score was increased 3.36 to 4.77 after ExMI (P<0.05). 4) The mean of quality of sexual life (QoSL) score was increased 3.70 to 4.92 after ExMI (P<0.05). 5) The mean of vaginal pressure and duration of pelvic floor muscle contraction after ExMI were increased with startistical significance. CONCLUSION: Our results suggested that ExMI therapy might be effective for not only urinary incontinence but also improvement of sexual function.

Clinical Evaluation on 154 Cases of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) / 대한산부인과학회잡지

OBJECTIVE: To evaluate the indications, advantages and complications of laparoscopically assisted vaginal hysterectomy (LAVH), retrospectively. METHODS: From Mar. 2003 to Feb. 2004, clinical trials of LAVH (n=154) were performed in the Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, School of Medicine, University of Sungkyunkwan, Seoul, Korea. Medical records of patients who underwent LAVH were reviewed. The results were evaluated according to characteristics of patients, history of previous abdominal surgery, preoperative surgical indications, postoperative diagnosis, mean operation times, weight of uterus, change of hemoglobin, hospital stay, associated diseases, concomitant procedures and complications. RESULTS: The mean age was 46.09 +/- 6.67 years. The mean parity was 2.08 +/- 0.94. Tubal ligation, vaginal bleeding, leiomyoma was the most common previous abdominal surgery, preoperative surgical indication, and postoperative diagnosis, respectively. The mean operation time was 130.66 +/- 67.68 minutes. The mean uterine weight was 259.27 +/- 123.48 gm. The mean hemoglobin change was 1.61 +/- 1.12 g/dL. The mean hospital stay was 3.44 +/- 1.83 days. The complication rate was 3.2% (5 cases); bladder injury (3 cases) being the most common complication. CONCLUSION: LAVH appears to be beneficial in many aspects. The further development of laparoscopic instruments and skills will reduce limitations and complications of LAVH and will hopefully allow the utilization of this technique to expand to include other clinical indications and concomitant procedures.

The Study of 5,10-Methylenetetrahydrofolate Reductase Variation (MTHFR C677T) in Infertile Females with Polycystic Ovarian Syndrome (PCOS) in Korea / 대한불임학회지

OBJECTIVE: To investigate the association of genetic background between MTHFR C677T genotype and infertile females with polycystic ovarian syndrome. MATERIALS AND METHODS: We compared 86 infertile females with polycystic ovarian syndrome (PCOS) with 100 healthy fertile females with one or more offspring. Pyrosequencing analysis for MTHFR C677T variation was performed on polymerase chain reaction (PCR) product of study group. To validate pyrosequencing data of C677T variation for randomly selected 50 samples, we compared the pyrosequencing result with the PCR-RFLP (Restriction Fragment Length Polymorphism) result of MTHFR C677T genotype. RESULTS: The prevalence of the C677T mutant homozygous (TT) was significantly lower (p=0.0085) in females with PCOS (8.14%) than in fertile females (21.00%). MTHFR 677 TT genotype had a decreased risk (3.7-fold) of PCOS compared with wild type (MTHFR 677 CC). CONCLUSION: Our data support a role for MTHFR mutant homozygous (677 TT) genotype in reducing risk in Korean infertile females with Polycystic ovarian syndrome.

A Case of Tubo-ovarian Actinomycosis Associated with Fitz-Hugh-Curtis Syndrome / 대한산부인과학회잡지

Actinomycosis is a chronic suppurative and granulomatous disease. Actinomyces is a gram positive, anaerobic and non-acid fast bacterium. Many actinomycotic pelvic infection in women used intrauterine device(IUD) with long duration were reported, in contrast, others suggest that actinomycosis develop opportunistic infection irrespective of intrauterine device. One to ten percents of patients with acute pelvic inflammatory disease(PID) develop perihepatic inflammation and adhesion---the Fitz-Hugh-Curtis syndrome. Although in the past Neisseria gonorrhea was thought to be the only etiological agent, recent data indicate that chlamydia trachomatis produces the majority of cases. We have experienced the case of tubo-ovarian actinomycosis(case with IUD(Cu-T)) associated with Fitz-Hugh-Curtis syndrome in a 29years old woman, and reported that with a review of related literatures.

Two Cases of Cerebrovascular Diseases In The Puerperium / 대한산부인과학회잡지

Cerebrovascular disease refers to disorder of one or more blood vessels of the brain, and the majority of lesions that arise from these are from arterial diseases. The occurrence of cerebral venous thrombosis is clearly linked to the puerperal state, and pregnancy may increase the risk of subarachnoid hemorrhage. The most common cause is rupture of arterial aneurism. Hemodynamic, hormonal or other physiological changes of pregnancy may play a role in aneurysmal rupture. We report two cases of cerebrovascular diseases in the puerperium with a brief review of concerned literatures

Clinical Association of Unexplained Elevated Maternal Serum Alpha-Fetoprotein with Adverse Outcomes in Pregnancies Complicated by Placenta Previa / 대한산부인과학회잡지

OBJECTIVE: To determine whether unexplained elevation of maternal serum alpha-fetoprotein(MSAFP) is associated with adverse outcomes in pregnancies complicated by placenta previa. METHODS: One hundred and five pregnant women with placenta previa between January 1995 and March 1999 were included in this study. They underwent the triple test at 14 to 22 gestational weeks. These 105 pregnant women were stratified into two groups by MSAFP at 2.0MOM. The outcomes of pregnancy in high MSAFP(>or=2.0MOM) group were compared with those in normal MSAFP(or=2.0 MOM). Eleven out of 632 pregnant women with high MSAFP were having placenta previa. 3. The incidence of preterm birth was significantly high in high MSAFP group with placenta previa.(p<0.001) 4. Women with unexplained elevated MSAFP and having placenta previa showed the increased risk for preterm delivery (p<0.05), preeclamsa (p<0.001), and bleeding in third trimester (p<0.001), but not placenta accreta, placenta abruption, cesarean hysterctomy and intrauterine fetal death. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP in complicated placenta previa were associated with the elevated risk of preterm delivery, preeclamsia and bleeding in the early third trimester, but not placenta accreta, placenta abruption, cearean hysterectomy and intrauterine fetal death.

Prenatal Diagnosis of Duchenne Muscular Dystrophy (DMD) by Multiplex Polymerase Chain Reaction (PCR) with Chorionic Villi / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of prenatal multiplex PCR with chorionic villi, in the case of family history of DMD due to exon deletion. METHODS: DNA was extracted when cells' size are 1x 106 on T- flask surface area reach to 25 cm2 after 2 weeks from sex confirmation. Average DNA concentration was 50-100 ng and multiplex PCR test was performed from DNA extraction. RESULT: PCR was done for 17 exons devided into 4 groups. Seventeen exons were all amplified with their right size. CONCLUSIONS: This method is DNA analysis for prenatal diagnosis of DMD with chorionic villi in the family of DMD. This is useful when preimplantation genetic diagnosis is not available.

A Case of Nonimmune Hydrops Fetalis / 대한주산의학회잡지

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.