Risk factors of surgical failure following transvaginal mesh repair for the treatment of pelvic organ prolapse.

OBJECTIVE: To identify the factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair. STUDY DESIGN: One hundred and thirteen women with symptomatic POP stage II to IV were scheduled for TVM procedures. All subjects underwent urinalyses and pelvic examination using the POP quantification (POP-Q) staging system before and after surgery. RESULTS: Seven (6.2%) of 113 women reported POP recurrence after a mean follow-up time of 30 months. We performed a univariate analysis of patients' characteristics to identify the predictors of surgical failure after TVM. There was no difference between two groups as to body mass index, POP stage, mesh type, and preoperative urinary symptoms and urodynamic parameters (P>0.05). However, we found that uterine prolapse (P=0.016) and surgical experience (P=0.043) were two significant predictors of surgical failure. Multivariate logistic regression showed similar results. CONCLUSION: Advanced uterine prolapse and lack of surgical experience were two significant predictors of failure following TVM. POP recurrence after mesh repair appears to be unlikely beyond the learning curve.

The positive correlation between cord serum retinol-binding protein 4 concentrations and fetal growth.

BACKGROUND/AIMS: Retinol-binding protein 4 (RBP4) has been shown to be associated with insulin resistance and fatty acid metabolism. We hypothesize that RBP4 might play a role in fetal growth and that cord serum RBP4 may act as a marker of fetal growth, independent of fetal insulin levels. METHODS: Twenty-one women having fetuses in the top quartile (>75th percentile) of birth weights for gestational age were enrolled into the trial, along with 21 women having fetuses in the bottom quartile (<25th percentile) of birth weights for gestational age. Serum RBP4 and insulin levels were analyzed. RESULTS: Cord serum RBP4 and insulin concentrations were significantly higher in the top quartile group (14.3 ± 3.7 ng/ml, 3.8 ± 5.2 µIU/ml) than in the bottom quartile group (11.3 ± 2.6 ng/ml, 0.9 ± 1.4 µIU/ml; p = 0.004, p = 0.017). Cord serum RBP4 and insulin as well as gestational age (r = 0.744, r(2) = 0.553, p < 0.001) were significantly correlated with fetal birth weights. CONCLUSION: Cord serum RBP4 concentrations were higher in subjects with top quartile fetuses than in those with bottom quartile fetuses. Cord serum RBP4 concentrations were significantly correlated with fetal birth weight. These findings may indicate that cord serum RBP4 plays a regulatory role in fetal growth.

Lower serum apelin levels in women with polycystic ovary syndrome.

We tested differences in serum apelin levels between women with polycystic ovary syndrome (PCOS) and those with a healthy regular menstrual cycle, finding that apelin levels were higher in normal women and that apelin was positively correlated with apolipoprotein A levels.

Effect of ovariectomy on the gene expression of detrusor muscarinic receptors in female rats.

Eight rats served as control subjects with sham surgeries and eight rats underwent ovariectomy. Two months later, the expression of muscarinic receptors, neuronal nitric oxide synthase (nNOS), and estrogen receptor (R) at the mRNA level were assessed by reverse-transcription polymerase chain reaction. The results showed that performing an ovariectomy in a virgin rat appears to have little effect on the gene expression of detrusor muscarinic receptors and urethral nNOS despite the menopausal events that occurred.

The clinical and urodynamic effects of the tension free bladder neck sling procedure.

This study evaluated the clinical and urodynamic findings before and after tension-free bladder neck sling (TBS) procedure with Prolene tape. We enrolled 32 women who underwent TBS for genuine stress incontinence without intrinsic sphincter deficiency or severe uterovaginal prolapse. All subjects received 1-h pad test, Q-tip test, multichannel urodynamic testing, introital ultrasonography, and the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 1 year after surgery. Of the 32 subjects 27 were cured of stress incontinence, two improved, and three failed. The incidence of irritative symptoms and incomplete bladder emptying were significantly lower after surgery. The mean urethral straining angle showed a significant decrease from 73.8 degrees preoperatively to 30.1 degrees postoperatively. At rest the postsurgical position of the bladder neck (BN) was localized more cranially. During straining both ventral and caudal mobility of the BN decreased significantly following TBS, causing a more cranial and dorsal position of the BN. Urodynamic parameters including functional urethral length, maximal urethral closure pressure, and pressure transmission ratio showed significant increases after surgery. TBS could decrease the hypermobility of the BN and restore the BN support to prevent urinary leakage during straining, instead of urethral obstruction. The subjective and objective cure rate of stress incontinence is 84%, similar to those results reported after retropubic urethropexy and tension-free vaginal tape procedure. It is also worth emphasizing that no postoperative urinary retention occurred, although the limited number of cases makes it hard to confirm the significance of findings over the retention rate of tension-free vaginal tape.

Urodynamic comparison of continent and incontinent women with severe uterovaginal prolapse.

OBJECTIVE: To compare the clinical and urodynamic characteristics of continent and incontinent women with severe uterovaginal prolapse. STUDY DESIGN: Fifty-eight consecutive women with stage III or IV pelvic organ prolapse between June 1998 and December 2001 were enrolled. Each woman had a urinalysis, pelvic examination and urodynamic study and answered a urinary questionnaire. They were divided into clinically continent (n = 20) and incontinent (n = 38) groups. The clinical symptoms and urodynamic results in the 2 groups were compared statistically with the chi 2 test, Fisher's exact test and Mann-Whitney U test. RESULTS: Incontinent women with severe genital prolapse were more likely to report urinary frequency, urgency and nocturia than were continent women (P < .05). However, the incidence of voiding hesitancy was significantly higher for members of the continent group as compared to the incontinent group (P = .002). With respect to urodynamic variables, including detrusor pressure at peak flow, maximal urethral closure pressure and pressure transmission ratio, significantly higher values occurred in the continent group as compared with the incontinent group; they were 38 (range, 12-66) vs. 24 cm H2O (range, 10-49) (P < .01), 84 (range, 39-117) vs. 63 cm H2O (range, 45-84) (P = .033) and 102% (range, 66-135) vs. 66% (range, 14-98) (P = .019), respectively. All other parameters and the incidence of bladder outlet obstruction and detrusor instability did not differ significantly between the 2 groups (P > .05). CONCLUSION: The results of this study suggest that severe uterovaginal prolapse could produce obstructive symptoms and prevent or reduce urinary leakage, but whether urethral kinking or external urethral compression causes the obstruction remains unclear. More studies on different types of isolated pelvic organ prolapse are needed to elucidate the mechanism, and specific strategies can be developed to aid urogynecologists in their goal of restoring normal anatomy.

Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse.

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.