A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse.

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.

Efficacy and safety of solifenacin succinate tablets versus solifenacin succinate tablets with local estrogen for the treatment of overactive bladder in postmenopausal women--a multicenter, randomized, open-label, controlled comparison study.

OBJECTIVE: The aim of the study was to compare the effectiveness and safety of solifenacin succinate tablets alone or combined with local estrogen for overactive bladder treatment in postmenopausal women. METHODS: This multicenter, randomized, open, parallel-controlled clinical trial enrolled 104 women between January 2012 and August 2013. Participants meeting the inclusion criteria were randomized 1:1 to 12 weeks of treatment with group A (solifenacin 5 mg qd + promestriene vaginal capsules intravaginally) or group B (solifenacin 5 mg qd). Before and after 12 weeks of treatment, symptoms (urinary urgency, frequency, and urge incontinence) were analyzed. Our primary outcome was the change from baseline to the end of treatment in the mean number of voids in 24 hours. Quality of life (QoL) was assessed using International Prostate Symptom Score and Overactive Bladder Symptom Score questionnaires and safety according to the incidence of adverse events. The t test or the Mann-Whitney U test was used to compare continuous variables, and the χ(2) test or Fisher's exact test was used to compare categorical variables. RESULTS: The median decreases in the mean number of voids in 24 hours in groups A and B were 5.2. and 4.3, respectively, which were not significantly different. The median decreases in urgency episodes in groups A and B were 2.0 and 2.5, respectively. In addition, the QoL scores significantly changed in both groups (both P < 0.05). The most common adverse event was dry mouth (19.2% in both groups). CONCLUSIONS: Solifenacin with or without local estrogen was effective and safe for overactive bladder treatment in postmenopausal women. The addition of local estrogen improved subjective feelings and QoL.

Laparoscopy versus laparotomy for the management of early stage cervical cancer.

BACKGROUND: The possible advantages of laparoscopic radical hysterectomy (LRH) versus open radical hysterectomy (RH) have not been well reviewed systematically. The aim of this study was to systematically review the comparative effectiveness between LRH and RH in the treatment of cervical cancer based on the evaluation of the Perioperative outcomes, oncological clearance, complications and long-term outcomes. METHODS: The systematic review was conducted by searching PubMed, MEDLINE, EMBASE, the Cochrane Library and BIOSIS databases. All original studies that compared LRH with RH were included for critical appraisal. Data were pooled and analyzed. RESULTS: A total of twelve original studies that compared LRH (n = 754) with RH (n = 785) in patients with cervical cancer fulfilled quality criteria were selected for review and meta-analysis. LRH compared with RH was associated with a significant reduction of intraoperative blood loss (weighted mean difference = -268.4 mL (95 % CI -361.6, -175.1; p < 0.01), a reduced risk of postoperative complications (OR = 0.46; 95 % CI 0.34-0.63) and shorter hospital stay (weighted mean difference = -3.22 days; 95 % CI-4.21, -2.23 days; p < 0.01). These benefits were at the cost of longer operative time (weighted mean difference = 26.9 min (95 % CI 8.08-45.82). The rate of intraoperative complications was similar in the two groups. Lymph nodes yield and positive resection margins were similar between the two groups. There were no significant differences in 5-year overall survival (HR 0.91, 95 % CI 0.48-1.71; p = 0.76) and 5-year disease-free survival (hazard ratio [HR] 0.97, 95 % CI 0.56-1.68; p = 0.91). CONCLUSIONS: LRH shows better short term outcomes compared with RH in patients with cervical cancer. The oncologic outcome and 5-year survival were similar between the two groups.

[Laparoscopic anatomical nerve sparing radical hysterectomy for cervical cancer: a clinical analysis of 37 cases].

OBJECTIVE: To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. METHODS: From October 2006 to September 2007, 37 cervical cancer patients with stage Ib1 to II a underwent LANSRH (LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH, LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. RESULTS: The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175 +/- 41) min vs. (178 +/- 30) min, P = 0.72], blood loss [(233 +/- 104) ml vs. (218 +/- 77) ml, P = 0.06], numbers of lymph nodes (13 +/- 4 vs. 15 +/- 6, P = 0.16), resected length of paracervix tissue [(3.6 +/- 0.5) cm vs. (3.7 +/- 0.6) cm, P = 0.43], resected length of vaginal tissue [(3.5 +/- 1.0)cm vs. (3.5 +/- 0.8) cm, P = 0.80]. (2) The mean time of the Foley catheter removed was (10.6 +/- 2.7) days (7 - 17 days) in LANSRH group and (17.2 +/- 4.2) days (9 - 25 days) in LRH group (P = 0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class II in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class II in LRH group, it reached statistical difference (P < 0.05). In the mean time, there was no significant difference in Class I bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. CONCLUSION: LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.

[Complication of laparoscopic radical hysterectomy and lymphadenectomy: an analysis of 23 cases].

OBJECTIVE: To explore complications of laparoscopic radical hysterectomy and lymphadenectomy in patients with cervical and endometrial carcinoma, and its prevention. METHODS: From July 2000 to December 2004 at our institution, a total of 278 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed in 242 patients with cervical carcinoma and 36 patients with endometrial carcinoma. We reviewed the clinical data of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to check their complications and other factors related to this open surgical procedure. RESULTS: All but 4 surgical procedures were completed laparoscopically. Paraaortic lymphadenectomy was performed in 108 patients and pelvic lymphadenectomy was performed in all of 278 patients. Major and minor intraoperative complications occurred in 4.7% (13/278) of patients. The overall conversion rate was 1.4% (4/278), consisting of 3 emergency and 1 elective conversions. Vascular injuries occurred in 7 patients, five of them were repaired or treated laparoscopically and one left external iliac vein injury required laparotomy, another patient underwent laparotomy to control bleeding. Operative cystotomies occurred in 4 patients and all were repaired laparoscopically. One patient underwent laparotomy because of hypercapnia. Another patient underwent laparotomy because of ascending colon injury. Postoperative surgery complications occurred in 3.6% (10/278) of patients. Three patients had a ureterovaginal fistula and three patients had a vesicovaginal fistula after the operation that required reoperation. There was one patient with ureterostenosis while three patients with urinary retention. CONCLUSIONS: Laparoscopic radical hysterectomy in combination with lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications that are unique to laparoscopy exist but they decrease with more practice and experience.

[Effect of warming needle moxibustion on pain threshold in the patient of sciatica].

OBJECTIVE: To observe effect of warming needle moxibustion on pain threshold in the patient of sciatica. METHODS: Ninety cases were randomly divided into 3 groups, 30 cases in each group. The warming needle moxibustion group were treated with warming needle moxibustion at Shenshu (BL 23), Dachangshu (BL 25), Huantiao (GB 30), etc; the western medicine group with oral administration of Nimeisulide; and the acupoint-injection group with injection of 654-2 into the same acupoints as those in the warming needle moxibustion group. RESULTS: The cured rates were 56.67%, 26.67% and 20.00% in the 3 groups, and the total effective rate were 90.00%, 73.33% and 63.33%, respectively, the therapeutic effect of the warming needle moxibustion group being better than those of other two groups (both P < 0.01). The amplitude of pain threshold increase in the warming needle moxibustion group was higher than those of other two groups (both P < 0.01). CONCLUSION: Warming needle moxibustion can increase pain threshold, improve symptoms and raise quality of life for the patient of sciatica.

[Role of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating early cervical carcinoma].

OBJECTIVE: To investigate the possibility and effect of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating women with early cervical cancers who desired to maintain fertility. METHODS: From August 2001 through May 2003, we performed vaginal radical trachelectomy with laparoscopic lymphadenectomy on 12 patients with biopsy-proven early stage cervical carcinomas. Subjects were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. Pelvic lymphadenectomies were performed in all patients. Vaginal radical trachelectomy was performed immediately if lymph nodes were negative. RESULTS: Twelve women underwent this procedure. The median age was 27.6 years (range 24 - 31 years); 10 were nulligravid and 2 were multipara. Mean operative time was 142 min (115 - 178 min), with a mean blood loss of 180 ml (120 - 230 ml), and an average hospital stay of 6.7 days. There was no intra- or post-operative complication. With an average follow-up of 21.5 months, there have been no recurrences. One woman has become pregnant. CONCLUSIONS: Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy permits preservation of fertility in selected patients. It is mini-invasive, and needs shorter recovery time.

[Diagnostic value of laparoscopy for pelvic masses in perimenopausal and postmenopausal women].

OBJECTIVE: To evaluate the value of laparoscopy in the diagnosis of pelvic masses in perimenopausal and postmenopausal women. METHODS: The results of laparoscopic examination performed in 117 perimenopausal and postmenopausal women with pelvic masses were retrospectively analyzed. RESULTS: Malignant tumors in 19 cases (16.2%) and benign tumors were identified in 98 cases, and all of them managed laparoscopically. CONCLUSION: Laparoscopy is safe and accurate in diagnosing pelvic masses in perimenopausal and postmenopausal women, and may help define the quality of the masse and provides means for early detection and treatment of malignant tumors.

[Laparoscopic suture uterosacral ligament hysteropexy for uterine prolapse].

OBJECTIVE: To investigate possibility and effect of laparoscopic suture uterosacral ligament hysteropexy or colpopexy for women with uterine prolapse. METHODS: Thirty-two women with symptomatic uterine prolapse underwent laparoscopic suture uterosacral ligament hysteropexy. At the laparoscopic suture hysteropexy or colpopexy, the pouch of Douglas was closed and the uterosacral ligaments were plicated and reattached to the cervix. All patients were multipara and menopausal with prolapse of anterior wall of vagina. Additionally, 4 patients were with prolapse of posterior wall of vagina, 15 with stress urinary incontinence, and 4 with myomas. RESULTS: All procedures were successfully completed laparoscopically. The mean operating time for the laparoscopic suture hysteropexy or colpopexy alone was (32 +/- 11) min (range 20 approximately 80 min), and the mean blood loss was less than 50 ml. After a mean follow-up of (12 +/- 6) months (range 4 approximately 28 months), 23 women had no symptoms of uterine prolapse and seven had no objective evidence of uterine prolapse. Two women presented recurrence of uterine prolapse 3 months after operation. CONCLUSIONS: The laparoscopy suture hysteropexy or colpopexy is effective and safe in the management of symptomatic uterine prolapse. It may be an appropriate procedure for women with uterine prolapse hoping for uterine preservation.

[Clinical evaluation of laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy in patients with cervical cancer].

OBJECTIVE: To evaluate the effective, results and complications in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy and retroperitoneal lymphadenectomy. METHODS: In 57 consecutive patients with stage Ia to IIb cervical cancer, laparoscopic radical hysterectomy and lymphadenectomy were performed. Forty-eight patients had squamous cell carcinomas, 7 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. RESULTS: All but 2 surgical procedures were completed laparoscopically. The average operative time was 186 min (150 - 320 min). The average blood loss was 168 ml (120 - 700 ml). Average numbers of pelvic and paraaortic lymph nodes removed were 18.6 (12 - 23) and 8.2 (6 - 12), respectively. Eight patients (14.0%) had positive lymph nodes. All surgical margins were macroscopically negative. Operative cystotomies occurred in 2 patients and one patient with venous injuries were repaired laparoscopically. Two other patients underwent laparotomy to control bleeding or repair ascending colon. After surgery, patients passed gas in 2.3 days and self-voided in 10.2 days on average. Follow-up has been provided every 3 months. There have been 3 cases of recurrences, one patient uncontrolled, and one patient ureteral constriction. Three patients have retention of urine. CONCLUSIONS: Laparoscopic radical hysterectomy and lymphadenectomy can be successfully completed in patients with cervical cancer with acceptable operation complications, a less injury and recovery time, and may become preferred for treating early cervical cancer.