The incidence and risk factors of occult malignancy in patients receiving vaginal hysterectomy for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the incidence and risk factors for premalignant and malignant pathology in patients receiving vaginal hysterectomy (VH) and pelvic floor repair (PFR) for pelvic organ prolapse (POP). METHODS: We performed a retrospective cohort study of pathological results after VH and PFR of 569 women at our institution from January 2011 through December 2020. Age, body mass index (BMI), POP-Q stage, and preoperative ultrasound results were evaluated as risk factors for occult malignancy. RESULTS: Six of the 569 patients (1.1%) had unanticipated premalignant uterine pathology and 2 (0.4%) had unanticipated malignant uterine pathology (endometrial cancer). There was no significant difference in the incidence of premalignant or malignant uterine pathology according to age, BMI, and POP-Q stage. However, if endometrial pathology is confirmed on preoperative ultrasonography, the probability of confirming malignant pathology increases (OR 4.63; 95% CI 1.84-51.4; p=0.016). CONCLUSION: The incidence of occult malignancy during VH for POP was significantly lower than that found in hysterectomy owing to benign disease. In the case of POP patients, for whom uterine-conserving surgery is not absolutely contraindicated, it can be performed. However, if endometrial pathology is confirmed by preoperative ultrasonography, uterine-conserving surgery is not recommended.

Impact of Body Mass Index on Postoperative Urinary Symptoms after Miduretheral Sling Surgery in Female Patients.

OBJECTIVES: This study aims to examine the clinical outcomes of women who underwent a midurethral sling surgery for stress urinary incontinence and compare postoperative urinary symptoms among different body mass index (BMI) groups. METHODS: A retrospective cohort study on results after midurethral sling surgery according to BMI was conducted at the institution of the current study from January 2010 to December 2019. The study population was classified into three groups according to patients' BMI (in kg/m²) during surgery: normal weight (BMI < 23.0 kg/m²), overweight (BMI, 23.0-24.9 kg/m²), and obese (BMI ≥ 25.0 kg/m²). The primary outcome was the recurrence of urinary symptoms after surgery. The secondary outcomes were operation time, estimated blood loss, length of hospital stay, and postoperative complications. RESULTS: This study included 376 patients (normal weight, 148; overweight, 74; and obese women, 154) who underwent midurethral sling surgery. No significant difference was noted in urinary symptom recurrence after midurethral sling surgery. Of the patients, 6.8% (n = 10), 9.5% (n = 7), and 7.8% (n = 12) were normal weight, overweight, and obese women, respectively (P = 0.775). Moreover, operation time (P = 0.589), blood loss (P = 0.138), and complication rate (P = 0.865) showed no significant difference. CONCLUSIONS: Midurethral sling surgery is effective regardless of BMI. Even when midurethral sling surgery was performed as a concomitant surgery, no significant difference in urinary symptom recurrence, operation time, intraoperative blood loss, and complication rate was noted among different BMI groups.

Impact of age on outcomes of midurethral sling procedures in women.

INTRODUCTION AND HYPOTHESIS: Trans-obturator tape (TOT) and tension-free vaginal tape (TVT) comprise minimally invasive surgical management for stress urinary incontinence (SUI). The aim of this retrospective cohort study was to investigate outcomes of TOT and TVT among different age groups of women. METHODS: Medical records of patients who underwent TOT and TVT from January 2010 to December 2015 were reviewed. Patients were stratified into three groups according to age. All patients were interviewed routinely before and after surgery. The primary outcome was cure rate after surgery. Secondary outcomes included hospital stay, operative time, blood loss in surgery, and complication rate. A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. RESULTS: A total of 616 patients diagnosed with SUI and 262 patients who had not undergone any concurrent surgery were eligible for study inclusion. There were 81 patients in group 1 (≤ 50 years), 97 patients in group 2 (51-59 years), and 84 patients in group 3 (≥ 60 years). After surgery, there were no significant differences in cure rates among the three groups (96.3% vs. 94.8% vs. 97.6%, P = 0.623). There were also no significant differences in operation time, blood loss, hospital stay, and complication rate among the three groups. When analyzing the TOT group (217 patients) and TVT group (45 patients) separately, primary and secondary outcomes did not differ significantly according to age group. CONCLUSIONS: As surgical management for SUI, midurethral sling procedures, both TOT and TVT, were found to be safe and effective among different age groups.

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation.

PURPOSE: Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by "true cervical elongation," compared with vaginal hysterectomy (VH). MATERIALS AND METHODS: Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤-4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS: During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08-2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01-0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION: The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.

Postoperative urinary symptoms after transobturator tape in normal-weight compared with overweight and obese woman.

OBJECTIVES: To examine the clinical outcome of obesity in women who underwent the transobturator tape procedure for stress urinary incontinence and to compare postoperative urinary symptoms after transobturator tape surgery between normal-weight women and overweight and obese women. METHODS: We performed a retrospective cohort study of the risk of postoperative urinary symptoms, including recurrence after transobturator tape surgery, in normal-weight women compared with overweight and obese women at our institution from January 2009 through October 2011. We compared the body mass index (BMI) among the four groups. The primary outcome was the occurrence of postoperative urinary symptoms. RESULTS: Three hundred ten patients who underwent transobturator tape surgery were reviewed. At the 1-year follow-up, 281 women were analyzed: 89 (34%) normal-weight women, 78 (25%) overweight women, 101 (37%) obese 1 women, and 13 (3%) obese 2 women. There was a significant difference in the occurrence of postoperative urinary symptoms. They occurred in 3.4% (n=3) of normal-weight women, 5.1% (n=4) of overweight women, and 12.9% (n=13) of obese 1 women (P=0.038). The most common postoperative urinary symptom was frequent urination (n=14). There was a significant difference in leakage; it occurred in 1.1% (n=1) of normal-weight women, 3.9% (n=3) of overweight women, and 7.9% (n=8) of obese 1 women (P=0.139). Postoperative urinary symptoms were almost four times more likely to occur in obese 1 women than in normal-weight women. CONCLUSION: Transobturator tape surgery seems effective regardless of BMI, but obese women had a higher occurrence of postoperative urinary symptoms than did normal-weight women.

Surgical treatments for vaginal apical prolapse.

Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits.

MicroRNA-30d and microRNA-181a regulate HOXA11 expression in the uterosacral ligaments and are overexpressed in pelvic organ prolapse.

The balanced turnover of collagen is necessary to maintain the mechanical strength of pelvic supportive connective tissues. Homeobox (HOX) A11 is a key transcriptional factor that controls collagen metabolism and homoeostasis in the uterosacral ligaments (USLs), and the deficient HOXA11 signalling may contribute to alterations in the biochemical strength of the USLs, leading to pelvic organ prolapse (POP). However, it is unknown how HOXA11 transcripts are regulated in the USLs. In this study, we found that microRNA (miRNA)-30d and 181a were overexpressed in women with POP, and their expression was inversely correlated with HOXA11 mRNA levels. The overexpression of miR-30d or 181a suppressed HOXA11 mRNA and protein levels in 293T cells, whereas the knockdown of these miRNAs enhanced HOXA11 levels and collagen production. Cotransfection of a luciferase reporter plasmid containing the 3'-untranslated region of HOXA11 with miR-30d or 181a mimic resulted in decreased relative luciferase activity. Conversely, cotransfection with anti-miR-30d or 181a increased luciferase activity. Taken together, these results indicate that both miR-30d and 181a are important posttranscriptional regulators of HOXA11 in the USLs and could be a potential therapeutic target for POP.

NGF and HB-EGF: potential biomarkers that reflect the effects of fesoterodine in patients with overactive bladder syndrome.

PURPOSE: To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. MATERIALS AND METHODS: This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. RESULTS: Urinary levels of NGF/Cr (OAB: 1.13±0.9 pg/mg; control: 0.5±0.29 pg/mg) and HB-EGF/Cr (OAB: 8.73±6.55 pg/mg; control: 4.45±2.93 pg/mg) were significantly higher in subjects with OAB than in controls (p<0.001). After 16 weeks of fixed-dose fesoterodine treatment, urinary NGF/Cr levels (baseline: 1.13±0.08 pg/mg; 16 weeks: 0.60±0.4 pg/mg; p=0.02) and HB-EGF/Cr levels significantly decreased (baseline: 8.73±6.55 pg/mg; 16 weeks: 4.72±2.69 pg/mg; p=0.03, respectively). Both the OABSS and OAB q scores improved (p<0.001). However, there were no a statistically significant correlations between these urinary markers and symptomatic scores. CONCLUSION: Urinary levels of NGF and HB-EGF may be potential biomarkers for evaluating outcome of OAB treatment. Fixed-dose fesoterodine improved OAB symptoms. Future studies are needed to further examine the significance of urinary NGF and HB-EGF levels as therapeutic markers for OAB.

Two-year urinary outcomes of sacrocolpopexy with or without transobturator tape: results of a prolapse-reduction stress test-based approach.

INTRODUCTION AND HYPOTHESIS: Women undergoing sacrocolpopexy (SCP) are at risk for postoperative stress urinary incontinence (SUI). However, the optimal management for this condition remains debatable. The aim of this study was to evaluate urinary outcomes 2 years after SCP with or without transobturator tape (TOT) based on the results of a prolapse-reduction stress test. METHODS: A prospective, observational study was conducted assessing a cohort of women undergoing SCP. Patients were assigned to the TOT or non-TOT group based on results of a prolapse-reduction stress test. The primary outcome was SUI (defined as a positive cough stress test or bothersome symptoms) or additional surgery for this condition. RESULTS: Among the 247 women enrolled, 223 (90 %) received surgery per assignment and completed the follow-up. Two years after surgery, 5.4 % of women in the TOT group and 28.6 % in the non-TOT group had SUI or received additional anti-incontinence surgery (p < 0.01). In the non-TOT group, more women with symptoms of SUI prior to surgery had postoperative SUI or received additional anti-incontinence surgery than those without symptoms (42.9 % vs. 20.0 %, p = 0.01). CONCLUSIONS: A preoperative prolapse-reduction stress test alone is not sufficient to determine the need for anti-incontinence surgery at the time of SCP. In particular, women with symptoms of SUI despite a negative prolapse-reduction stress test are more likely to experience postoperative SUI or additional anti-incontinence surgery.

Comparison of midurethral sling outcomes with and without concomitant prolapse repair.

OBJECTIVE: We compared the outcomes of the midurethral sling (MUS) with and without concomitant prolapse repair. METHODS: We retrospectively reviewed the outcomes of 203 women who underwent MUS at Severance Hospital from January 2009 to April 2012 with and without concomitant prolapse repair. Patients completed the urogenital distress inventory questionnaire preoperatively and postoperatively. The outcomes were assessed by using validated questionnaires and reviewing medical records. McNemar's test, t-test, and multiple logistic regression were used for analysis. RESULTS: We noted that women who underwent MUS alone were more likely to experience urinary frequency (12% vs. 25%, P = 0.045), urgency (6% vs. 24%, P < 0.001), and bladder emptying difficulty (2% vs. 10%, P = 0.029) compared to those who underwent concomitant repair. Women who only MUS were more likely to experience discomfort in the lower abdominal or genital region compared to those who than those who underwent concomitant repair; however, the difference was not significant (5% vs. 11%, P = 0.181). In the MUS only group, maximal cystometric capacity (MCC) was a significant parameter of preoperative and postoperative urinary frequency (P = 0.042; odds ratio, 0.994; P = 0.020; odds ratio, 0.993), whereas the Valsalva leak point pressure (VLPP) was a significant factor of postoperative bladder emptying difficulty (P = 0.047; odds ratio, 0.970). CONCLUSION: The outcomes did not differ between patients who underwent MUS alone and those with concomitant repair. In the MUS only group, MCC and VLPP were significant urodynamics study parameters related to urinary outcome.

The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study.

OBJECTIVE: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). METHODS: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. RESULTS: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. CONCLUSION: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

Changes in sexual function and comparison of questionnaires following surgery for pelvic organ prolapse.

PURPOSE: The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. MATERIALS AND METHODS: From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. RESULTS: Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99±0.18 vs. 7.56±1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width. CONCLUSION: In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function.

Association between the poly(ADP-ribose) polymerase-1 gene polymorphism and advanced pelvic organ prolapse.

OBJECTIVE: Apoptotic cell death, probably induced by oxidative stress, contributes to the development of pelvic organ prolapse. Because poly(ADP-ribose) polymerase-1 is an important mediator of cellular response to oxidative stress, genetic variations in the poly(ADP-ribose) polymerase-1 gene may play a role in the pathogenesis of pelvic organ prolapse. This study aimed to determine the association between advanced pelvic organ prolapse and Val762Ala polymorphism in the poly(ADP-ribose) polymerase-1 gene. METHODS: A total of 340 women were enrolled in the study. The pelvic organ prolapse group consisted of 185 women with stage III or IV pelvic organ prolapse, whereas the control group consisted of 155 postmenopausal women with stage 0 or I pelvic organ prolapse who visited the hospital for treatment of benign gynecologic disease or routine gynecologic checkup. Genotyping of the poly(ADP-ribose) polymerase-1 Val762Ala polymorphism was performed by real-time polymerase chain reaction analysis using a TaqMan assay. RESULTS: Genotype distribution in the pelvic organ prolapse group was different from that in the control group (P = 0.024). Furthermore, C-allele frequency was lower in the pelvic organ prolapse group than in the control group (P = 0.029). Women with the CC genotype had a 0.461-fold lower risk of developing advanced pelvic organ prolapse than women with the TT genotype (95% CI, 0.245-0.870; P = 0.017), and women with the C-allele had a 0.716-fold lower risk of developing advanced pelvic organ prolapse than women with the T-allele (95% CI, 0.527-0.973; P = 0.033). CONCLUSIONS: These findings suggest that the poly(ADP-ribose) polymerase-1 Val762Ala polymorphism is associated with a decreased risk of advanced pelvic organ prolapse.

Translation and linguistic validation of Korean version of short form of pelvic floor distress inventory-20, pelvic floor impact questionnaire-7.

The short forms of pelvic floor distress inventory (PFDI) and pelvic floor impact questionnaire (PFIQ) are useful disease specific questionnaires evaluating symptoms, quality of life for pelvic floor disorders. The purpose is to develop linguistic validation of the PFDI-20 and PFIQ-7 questionnaires. Three types of Korean version of questionnaires have been used in four locations of University Hospitals in Korea. Each version of questionnaires was developed by forward translation and back-translation by bilingual translators and was verified by the patients with pelvic floor disorder and healthy persons. For harmonization of 3 types of questionnaires, four authors reviewed, discussed all discrepancies, incorporated and produced a new version. The multi-step processes of translation and linguistic validation of the Korean version of PFDI-20 and PFIQ-7 questionnaire were completed. Further process of validation of Korean version of these questionnaires is required.

Estrogen-related genome-based expression profiling study of uterosacral ligaments in women with pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to identify the differential expression of estrogen-related genes that may be involved in the menopause and pelvic organ prolapse (POP) using microarray analysis. METHODS: An age, parity, and menopausal status-matched case-control study with 12 POP patients and 5 non-POP patients was carried out. The study was conducted from January to December 2010 at Yonsei University, Severance Hospital. We examined microarray gene expression profiles in uterosacral ligaments (USLs) from POP and non-POP patients. Total RNA was extracted from USL samples to generate labeled cDNA, which was hybridized to microarrays and analyzed for the expression of 44,049 genes. We identified differentially expressed genes and performed functional clustering. After clustering, we focused on transcriptional response and signal transduction gene clusters, which are associated with estrogen, and then validated the changes of gene expression levels observed with the microarray analysis using quantitative polymerase chain reaction (qPCR). RESULTS: The data from the microarray analysis using more than a 1.5-fold change with p value <0.05 resulted in 143 upregulated genes and 87 downregulated genes. Of 59 genes identified to be associated with signal transduction and transcription, 4 genes were chosen for qPCR that have been classified to be associated with estrogen. We found that estrogen receptor-related receptor-α (ERRα) was downregulated and that the expression of death-associated protein kinase 2 (DAPK 2), signal-transducing adaptor protein-2 (STAP-2), and interleukin (IL)-15 were upregulated. CONCLUSIONS: We found four differentially expressed genes by microarray analysis that may account for the way in which changes in estrogen level affect POP pathophysiology.

Involvement of oxidative stress and mitochondrial apoptosis in the pathogenesis of pelvic organ prolapse.

PURPOSE: Biomechanical weakness of the pelvic supportive structures has been proposed to be a cause of pelvic organ prolapse. However, the molecular mechanism involved in these changes is not completely understood. In this investigation we evaluated oxidative stress biomarkers in the uterosacral ligaments of women with pelvic organ prolapse and compared them with those of women with normal support. In addition, mitochondrial apoptosis was examined. MATERIALS AND METHODS: Samples were collected from 26 women with advanced stage pelvic organ prolapse and 29 age matched controls. The expression levels of 8-OHdG and 4-hydroxy-2-nonenal in the uterosacral ligaments were measured using immunohistochemistry. To assess mitochondrial apoptosis we performed TUNEL assay, immunohistochemistry for cleaved caspase-3 and cytochrome c, and Western blot analyses for cleaved caspase-3 and caspase-9. RESULTS: The mean percentage of cells immunopositive for 8-OHdG, 4-hydroxy-2-nonenal, TUNEL, cleaved caspase-3 and cytochrome c in the uterosacral ligaments was significantly higher in patients with pelvic organ prolapse than in controls. Similarly, Western blot analysis revealed increased expression of cleaved caspase-3 and caspase-9 in patients with pelvic organ prolapse. Correlation analyses revealed significant positive correlations between the percentage of cells immunopositive for 8-OHdG or 4-hydroxy-2-nonenal and markers of mitochondrial apoptosis. Analyzing by pelvic organ prolapse quantification system stage according to C point, the mean percentage of cells immunopositive for 8-OHdG, 4-hydroxy-2-nonenal and cytochrome c was significantly higher in patients with pelvic organ prolapse compared to controls, regardless of stage. However, the mean percentage of TUNEL and cleaved caspase-3 positive cells was significantly higher only in patients with stage III or IV pelvic organ prolapse. CONCLUSIONS: Oxidative stress and increased mitochondrial apoptosis may contribute to the pathological process of pelvic organ prolapse.

Alteration of elastin metabolism in women with pelvic organ prolapse.

PURPOSE: Although there are many studies about the effects of vaginal birth, the effects of menopause on pelvic floor support have not been identified. We compared elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse, and defined the menopausal regulation of this process. MATERIALS AND METHODS: The study group consisted of 35 women who underwent hysterectomy for pelvic organ prolapse. The control group consisted of 39 women without pelvic organ prolapse. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of mRNA, and protein for neutrophil elastase, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by real-time quantitative polymerase chain reaction and ELISA, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin, an inhibitor of neutrophil elastase, was also determined. ANOVA, the Kruskal-Wallis test and multivariate linear regression were used for statistical analysis. RESULTS: Expression of neutrophil elastase and matrix metalloproteinase-2 mRNA was higher in women with pelvic organ prolapse than in those without pelvic organ prolapse. Compared to before menopause, neutrophil elastase and matrix metalloproteinase-2 showed a significant decrease in postmenopausal women without pelvic organ prolapse, although these remained increased in postmenopausal women with pelvic organ prolapse. Alpha-1-antitrypsin was significantly less in postmenopausal women with pelvic organ prolapse than in postmenopausal women without pelvic organ prolapse. The activities of neutrophil elastase, matrix metalloproteinase-2 and matrix metalloproteinase-9 were increased in women with pelvic organ prolapse, and these trends were similar to neutrophil elastase and matrix metalloproteinase-2 expression even after adjustment for age, parity and menopausal status. CONCLUSIONS: After menopause increased elastolytic protease has a significant role in the development of pelvic organ prolapse.

Comparison of Burch colposuspension and transobturator tape when combined with abdominal sacrocolpopexy.

OBJECTIVE: To compare the treatment outcomes of Burch colposuspension and transobturator tape (TOT) when each is combined with abdominal sacrocolpopexy (ASC) to treat stress urinary incontinence (SUI) with pelvic organ prolapse (POP). METHODS: Consecutive cases of Burch colposuspension and TOT combined with ASC were retrospectively reviewed. Patients with SUI and POP beyond stage III--according to the POP-quantification system--were included. RESULTS: Mean hospital stay was longer in the Burch group (n=49) than in the TOT group (n=60) (11.3 vs 7.8 days; P<0.001), as was operation time (202.7 vs 170.1 minutes; P<0.001); furthermore, there were higher rates of urinary retention (53.1% vs 11.7%; P<0.001), de novo urgency (18.4% vs 3.3%; P=0.01), and recurrent SUI (18.4% vs 1.7%; P=0.003) in the Burch group. The cure rate was significantly higher in the TOT group than in the Burch group (98.3% vs 69.7%; P<0.001). CONCLUSION: The use of TOT with ASC resulted in higher cure rates and better functional outcomes than did Burch colposuspension with ASC.