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Objective: Previous studies have shown that anterior vaginal wall prolapse (AVWP) results in reduction of pressure in the proximal urethra. However, the effect of severity of AVWP on urethral pressure is controversial. This study aimed to evaluate parameters of the urethral pressure profile in different stages of AVWP. Materials and methods: From 2016 to 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were enrolled in this study to analyze their urethral pressure profiles. Stages of AVWP were regrouped into three groups ranging from mild to severe stages (groups 1‐3). Maximal urethral pressure, urethral closure pressure, functional urethral length, length of continence zone, as well as area of continence zone were compared among these three groups. Results: Distribution of age, parity, and menopausal women were significantly different among these three groups. Maximal urethral pressure (pressures for groups 1, 2, and 3 were 74.6∼75.9cmH2O, 69.7∼73.4cmH2O, and 58.3∼60.5cmH2O, respectively; all P<.05) and stress urethral closure pressure (pressures for groups 1, 2, and 3 were 69.3cmH2O, 62.3cmH2O, and 52.2cmH2O, respectively; all P<.05) gradually and significantly decreased, consistent with the severity of AVWP. However, the attenuated maximal urethral pressure and stress urethral closure pressure in accordance with severity did not show any significant difference after controlling for age, body mass index, parity, menopause, and stress urinary incontinence symptoms. Conclusion: Our results showed that AVWP significantly attenuated urethral pressure. However, patient age, menopausal status, and number of parities seem to be more influential in compromising urethral function than just AVWP alone. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term subjective outcomes in women who underwent sacrospinous ligament fixation with and without uterine preservation for treatment of uterovaginal prolapse.Study Design: Two hundred and ten women with POP-Q≧stage III uterovaginal prolapse, who underwent sacrospinous ligament fixation from January 1994 to December 2007 were included. Patient Global Impression of Improvement was used to assess the surgical outcome in July 2016. Primary outcome measures were subjective success rate and current satisfaction. Kaplan-Meier method and Cox proportional hazard model were used for analysis.Results: The mean follow-up was 13.3 years (range 8.5-22.6 years). One hundred and thirty-nine patients were successfully interviewed and analyzed. The cumulative subjective success rate was 88.5% and current satisfaction was 77.7%. The repeat surgery rate was 2.9%. There were no significant differences in subjective success (89% vs. 88%) or current satisfaction (78.1% vs. 77.3%) between uterine preservation (n = 64) and concomitant hysterectomy (n = 75). Kaplan-Meier analysis showed that sacrospinous ligament fixation with uterine preservation had a better subjective outcome at mid-term follow-up but was not significantly different compared with concomitant hysterectomy after long-term follow-up (P = 0.63). The adjusted HR of uterine preservation was 0.75 (95%CI: 0.22-2.12, P = 0.59).Conclusion: Sacrospinous ligament fixation with or without uterine preservation in the treatment of women with uterovaginal prolapse has no significant difference in long-term subjective outcomes and patient satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: Prevalence studies show that nocturia is a very common condition, affecting older age groups in particular. In this study, we evaluate (1) the community-based prevalence of nocturia and its associated overactive bladder according to the patient’s perception and disturbance to sleep and (2) whether age or menopausal (MP) transition has a greater effect on the occurrence of nocturia. Methods: The questions regarding nocturia were part of the Bristol female lower urinary tract symptoms questionnaire (translated into Mandarin, the correlation coefficient r=0.91). A total of 1253 (79.1% response rate) women were randomly sampled from a community-based female population, aged 20 years or older. Samples were subdivided into reproductive age, perimenopausal stage and elderly. If the participants reported having nocturia, they were further questioned with, “Does it interfere with your sleep or bother your daily life?” The chi-square test and the Cochran–Armitage trend test were used to analyze the data. Results: Nocturia in older age groups was significantly higher than that of the younger age groups. The occurrence of nocturia was significantly associated with the elderly (compared with the reproductive age, P<0.05). There were no significant differences in the prevalence of nocturia between the perimenopausal stage and the reproductive age (P>0.05). Conclusions: Our data implies that the increasing occurrence of nocturia is age-related and is not affected by the transition from pre- to postmenopause. Large-scale prospective longitudinal studies need to be conducted to clarify the effects of the aging process and estrogen deficiency. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the prevalence and associated risk factors of pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) among women seeking healthcare services in 3 discrete rural areas in Nepal. Methods: A cross-sectional study was conducted using a Nepalese-specific questionnaire to obtain demographic and personal information. Urinary symptoms were examined using the Urogenital Distress Inventory Short form questionnaire, while POP severity was staged according to the POP-Q system. The χ2 test and multivariate logistic regression analysis were used to determine POP risk factors. Results: Of the 174 women included in the analysis, 106 (60.9%) had stage II POP or greater. In all, 93 women (53.4%) had cystocele, 63 (36.2%) had rectocele, and 37 (21.3%) had uterine prolapse. Univariate analysis identified high parity; young age at first delivery; menopause; squatting or standing position during delivery; and early return to work after delivery as risk factors for POP. Multivariate logistic regression revealed that delivery in a lying position presented a lower risk for cystocele than squatting or standing (odds ratio 0.34; P <0.01). Conclusion: Both LUTS and POP are common among women in rural Nepal. Cystocele is the most frequent, advanced, and symptomatic form of POP observed in this population. [Copyright &y& Elsevier]

Objectives: To evaluate the short‐term evolution and risk factors of overactive bladder (OAB) in community‐dwelling male residents aged 40 years and above in central Taiwan. Methods: This was a 3‐year longitudinal cohort study. From January 2012 to December 2012, community residents aged 40 years and above, living in central Taiwan, were invited to participate in this study. A yearly Overactive Bladder Symptom Score (OABSS) questionnaire was used to assess the prevalence, incidence, remission, persistence, and relapse of OAB for three consecutive years. OAB was defined as total OABSS ≧4 and urgency score ≧2. Results: Nine hundred forty‐one male residents aged ≧40 years were recruited. The prevalence of OAB was 15%. The male residents with OAB were older, had a history of urological surgery, were unemployed, had lower educational levels, and lower yearly incomes compared with male residents without OAB. The prevalence increased with age when stratified into different age cohorts (40‐49, 7%; 50‐59, 12.7%; 60‐69, 18.2%; ≧70, 32%; P <.001). Age ≧60 (odds ratio [OR] 2.58; 95% CI, 1.62‐4.11) and history of urological surgery (OR 2.85; 95% CI, 1.29‐6.30) were the major risk factors after multivariable logistic regression analysis. Eight hundred participants completed all the 3 years' questionnaires. The second‐ and third‐year incidence rates of OAB were 10% (69/691) and 6.2% (42/674), respectively. The remission rates were 47.7% (52/109) and 46% (58/126), respectively. The two‐year OAB persistence rate was 30.3% (33/109). Conclusions: The prevalence and yearly incidence of OAB are high in community‐dwelling male residents aged ≧40 years in central Taiwan. Age is an important risk factor. [ABSTRACT FROM AUTHOR]

Abstract: Mixed lineage leukemia 1 (MLL1)-mediated histone H3 lysine 4 trimethylation (H3K4me3) of a subset of genes has been linked to the transcriptional activation critical for synaptic plasticity, but its potential contribution to neuropathic allodynia development remains poorly explored. Here, we show that MLL1, which is induced in dorsal horn neuron after spinal nerve ligation (SNL), is responsible for mechanical allodynia and increased H3K4me3 at metabotropic glutamate receptor subtype 5 (mGluR5) promoter. Moreover, SNL induced WD (Trp-Asp) repeat domain 5 subunit (WDR5) expression as well as the MLL1-WDR5 interaction accompany with H3K4me3 enrichment and transcription of mGluR5 gene in the dorsal horn in neuropathic allodynia progression. Conversely, WDR5-0103, a novel inhibitor of the MLL1-WDR5 interaction, reversed SNL-induced allodynia and inhibited SNL-enhanced mGluR5 transcription/expression as well as MLL1, WDR5, and H3K4me3 at the mGluR5 promoter in the dorsal horn. Furthermore, disrupting the expression of MLL1 or WDR5 using small interfering RNA attenuated mechanical allodynia and reversed protein transcription/expression and complex localizing at mGluR5 promoter in the dorsal horn induced by SNL. This finding revealed that MLL1-WDR5 complex integrity regulates MLL1 and WDR5 recruitment to H3K4me3 enrichment at mGluR5 promoter in the dorsal horn underlying neuropathic allodynia. Collectively, our findings indicated that SNL enhances the MLL1-WDR5 complex, which facilitates MLL1 and WDR5 recruitment to H3K4me3 enrichment at mGluR5 promoter in spinal plasticity contributing to neuropathic allodynia pathogenesis. [ABSTRACT FROM AUTHOR]