Mode of delivery influences the regression of abnormal cervical cytology.

AIMS: The purpose was to investigate the influence of delivery mode on the postpartum regression of abnormal cervical cytology. METHODS: A retrospective review was conducted of 64 pregnant women with abnormal cervical cytology at Yonsei University Health System in Korea between 2001 and 2008. A Papanicolaou smear and pathological data were categorized into three groups by cervical intraepithelial neoplasia classification. Postpartum evaluation was taken 3-6 months after delivery. The regression rates of cervical cytologic findings were compared between the vaginal delivery group and Cesarean section group. p < 0.05 was considered significant. RESULTS: Of the 64 women, 45 (70.3%) were delivered vaginally and 19 (29.7%) by cesarean section. No significant difference was found between the two groups with respect to age, gestational age, parity, smoking, and HPV (human papilloma virus) screening. Postpartum regression was shown in 39 (92.9%) women who delivered vaginally and in 12 (63.2%) women who underwent cesarean section (p = 0.016). In the cesarean section group, 1 patient had progressed from CIN2 to microinvasive cancer and 2 patients from carcinoma in situ to invasive cancer. CONCLUSION: The rate of spontaneous regression of antepartum abnormal cervical cytology was higher after vaginal delivery.

Risk factors associated with voiding dysfunction after anti-incontinence surgery.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to investigate the risk factors of voiding dysfunction occurring within 1 month after surgical treatment of urinary incontinence. METHODS: Medical records of 903 women who underwent anti-incontinence surgery at Yonsei Medical Health System from January 1999 to April 2007 were reviewed. The patient demographics, urodynamic parameters, pelvic organ prolapse stage, surgical procedures, and concomitant surgery were retrospectively evaluated. Postoperative voiding dysfunction was defined as post-void residual urine measuring greater than 100 cc at two or more successive trials. RESULTS: Age, menopausal status, maximum flow rate, average flow rate, post-void residual, anti-incontinence surgery type, stage of pelvic organ prolapse, and concomitant prolapse surgery were associated predictors of voiding dysfunction after anti-incontinence surgery. In multivariate analysis, concomitant anterior colporrhaphy (OR 2.4; 95% CI 1.38-4.11) was the only independent risk factor. CONCLUSIONS: The most important risk factor associated with voiding dysfunction was concomitant anterior colporrhaphy.

The relationship between COL3A1 exon 31 polymorphism and pelvic organ prolapse.

PURPOSE: We investigated the role of COL3A1 exon 31 polymorphism (a single base substitution from guanine to adenine at +2092), resulting in the replacement of alanine with threonine at the 698th amino acid of COL3A1, in the pathogenesis of pelvic organ prolapse. MATERIALS AND METHODS: A total of 72 postmenopausal Korean women who were not on hormonal replacement therapy and who had a history of vaginal childbirth were enrolled in this study. The patient group consisted of 36 women diagnosed with stage II or greater pelvic organ prolapse irrespective of urodynamic stress incontinence. The control group consisted of 36 healthy volunteers with pelvic organ prolapse quantification system stage 0 or I disease without urodynamic stress incontinence. After extracting the genomic DNA from peripheral blood leukocytes the polymorphism of exon 31 of COL3A1 was typed by restriction fragment length polymorphism (Alu I restriction fragment length polymorphism) and confirmed by direct sequencing. RESULTS: Frequency of the G allele was significantly higher in patients with pelvic organ prolapse than in controls (0.8 vs 0.6, p = 0.002). In women with the G allele the OR for pelvic organ prolapse was 3.2 (95% CI 1.4-7.3). CONCLUSIONS: COL3A1 exon 31 polymorphism may have a role in determining the risk of pelvic organ prolapse in women with risk factors such as aging, vaginal childbirth and hypoestrogenism.

Risk factors for the recurrence of pelvic organ prolapse.

BACKGROUND/AIMS: To investigate the risk factors for the recurrence of prolapse after traditional pelvic reconstructive surgery. METHODS: The medical records of 212 patients who received traditional restorative reconstructive surgeries for symptomatic pelvic organ prolapse from March 1999 to April 2006 were retrospectively analyzed. Recurrence was defined as any prolapse of stage II or greater according to the Pelvic Organ Prolapse Quantification system. The log-rank test and Cox regression of the Kaplan-Meier survival analysis were used in univariate analysis, and the Cox proportional hazard model was used in multivariate analysis. RESULTS: The median follow-up period was 24 (range 1-84) months and the number of patients suffering from recurrence was 36 (17.0%). Age, parity, repetitive heavy lifting/chronic constipation, family history, hormone replacement therapy status, and preoperative stage all had an influence on the outcome, although preoperative stage IV was the only independent risk factor (hazard ratio (HR) 5.6, 95% CI 1.1-29.3, p = 0.044). Analyzing by compartments, preoperative stage IV (HR 18.6, 95% CI 2.1-162.3, p = 0.018) was an independent risk factor for the recurrence in anterior compartment, not for posterior or apical. CONCLUSIONS: Patients with a far advanced preoperative stage (stage IV), especially in cases of anterior prolapse, are more likely to experience a recurrence after traditional reconstructive surgery.

Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency.

OBJECTIVE: The aim of this study was to compare the treatment outcome of 3 sling procedures for stress urinary incontinence with intrinsic sphincter deficiency. STUDY DESIGN: This retrospective study included 253 patients who underwent incontinence surgery (pubovaginal sling [PVS] = 87, tension-free vaginal tape [TVT] = 94, and transobturator tape [TOT] = 72) for urodynamic stress incontinence with intrinsic sphincter deficiency. Analysis of variance, chi(2) test, Fisher's exact test, Kaplan-Meier survival analysis, and Cox proportional hazard regression were used for statistical analysis. RESULTS: Overall complication rates were not significantly different. At 2 years postoperatively, the cumulative cure rates of the PVS, TVT, and TOT groups were significantly different (87.25%, 86.94%, and 34.89%, respectively; P < .0001). The risk of treatment failure in women who received TOT was 4.6 times higher than in women who underwent PVS. The 7-year cumulative cure rates of PVS and TVT groups were 59.10% and 55.09%, respectively. CONCLUSION: PVS and TVT were more efficacious, but the long-term cure rates were low.