Search

Objective: In this 3-year longitudinal cohort study, we aimed to evaluate the evolution of overactive bladder in female community residents aged 40 years and above in central Taiwan and identify its risk factors., Materials and Methods: Female community residents aged 40 years and above were invited to participate in this study and fill out a yearly Overactive Bladder Symptom Score (OABSS) questionnaire over a 3-year period. A woman was defined to have OAB if the total OABSS was ≧4 and urgency score was ≧2. At the end of the third year, the incidence, remission, persistence, and relapse of OAB in these community residents were calculated. A novel statistical analysis technique, machine learning with data mining, was applied to examine its use in this field. Five machine learning models were used to predict the risk factors associated with persistent OAB and the results were compared with the conventional logistic regression model., Results: In total, 1469 female residents were included in the first year and 1290 (87.8%) women completed the questionnaires for all 3 years. The prevalence of OAB was 20.2% (n = 260). The second- and third-year incidence rates of OAB were 13.5% and 7.1%. The remission rates were 39.6% and 44.3%. Twenty-two percent of the women reported relapse of OAB in the third year. The two-year OAB persistence rate was 43.8%. For the prediction of risk factors for persistent OAB, the multivariable logistic regression model had better predictive accuracy (AUC = 0.664) than the five machine learning models. Age ≧ 60 was associated with persistent OAB (OR 2.8; 95% CI: 1.34-5.89, P = 0.002)., Conclusion: The yearly incidence, remission, and persistence rates of OAB were high in female community residents aged 40 years and above in central Taiwan. Older women had a higher risk of persistent OAB symptoms in this 3-year longitudinal cohort study., Competing Interests: Declaration of competing interest None Declared., (Copyright © 2022. Published by Elsevier B.V.)

Objective: To evaluate the short-term effect of routine early postpartum electromyographic biofeedback assisted pelvic floor muscle training on sexual function and lower urinary tract symptoms., Materials and Methods: From December 2016 to November 2017, primiparous women with vaginal delivery, who experienced non-extended second-degree perineal laceration were invited to participate. Seventy-five participants were assigned into a pelvic floor muscle training (PFMT) group or control group. Women in the PFMT group received supervised biofeedback-assisted pelvic floor muscle training at the 1st week and 4th week postpartum. Exercises were performed at home with the same protocol until 6 weeks postpartum. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Urinary Distress Inventory short form questionnaire (UDI-6) were used to evaluate sexual function and lower urinary tract symptoms respectively at immediate postpartum, 6 weeks, 3 months, and 6 months postpartum., Results: Forty-five women (23 in PFMT group,22 in control group) completed all questionnaires at 6 months postpartum. For overall sexual function and the three sexual functional domains, no statistically significant difference was found in PISQ scores from baseline to 6 weeks, 3 months, and 6 months postpartum between the PFMT and control groups. For postpartum lower urinary tract symptoms, all symptoms gradually improved over time for both groups without a statistically significant difference between groups., Conclusion: Our study showed that supervised biofeedback-assisted pelvic floor muscle training started routinely at one week postpartum did not provide additional improvement in postpartum sexual function and lower urinary tract symptoms., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Relationships between pelvic organ prolapse (POP) staging and lower urinary tract symptoms (LUTS) are controversial. In this study, we evaluated correlations of POP staging with LUTS in different compartments., Materials and Methods: From January 2016 to December 2017, 250 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were recruited into this study. Different stages of different compartments (anterior, central and posterior) of POPs according to IUGA and ICS terminology were re-grouped into four categories as stage 0, 1, 2, and 3 (including stage 4 because of a limited number of patients in stage 4). Pearson correlation coefficient and general linear regression were used for correlations of POP staging in different compartments and LUTS (stress urinary incontinence, overactive bladder and voiding symptoms) as well as their associated factors., Results: Only OAB had a moderate correlation with different compartments of POP (anterior vaginal wall: -0.3116; cervix: -0.2954 and posterior vaginal wall: -0.3779; all p < 0.05). Stage 1 AVWP significantly increased (39.6%) the occurrence of OAB compared to no prolapse. Posterior compartment (stage 1-3) prolapse reduced the occurrence of OAB., Conclusion: Only stage 1 AVWP is associated with an increase in OAB, and posterior compartment prolapse may reduce the occurrence of OAB., Competing Interests: Declaration of competing interest The authors have declared that no competing interests exist., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To evaluate the effect of far-infrared radiation on postpartum perineal pain and sexual function in primiparous women undergoing an episiotomy and 2nd degree perineal laceration., Materials and Methods: From May 2016 to May 2017, primiparous women with term pregnancies and vaginal deliveries with an episiotomy due to obstetric indications and 2nd degree perineal lacerations were invited to participate in this study. Women were randomly assigned into a far-infrared (FIR) group and a control group. Visual Analogue Scale (VAS) was used to evaluate the perineal pain immediately postpartum, and at 1 week and 6 weeks postpartum. Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) was used to evaluate sexual function at 6 weeks, 3 months and 6 months postpartum., Results: The data of the control group (n = 22) and FIR group (n = 18) were analyzed. Most of the women had minor perineal pain one week after delivery (1.1 ± 0.9 in control group vs 1.4 ± 1.5 in FIR group) and there was no significant difference between groups. The FIR group had a higher PISQ-12 total score at 3 months (35.4 ± 6.4 vs 34.7 ± 5.7) and 6 months (36.4 ± 5.6 vs 35.6 ± 5.7) postpartum compared with the control group but there was no statistically significant difference., Conclusion: Our study did not show any additional benefit of postpartum far-infrared radiation on primiparous women undergoing an episiotomy and 2nd degree perineal lacerations., (Copyright © 2018. Published by Elsevier B.V.)

Objective: This is part of a three-year study designed to evaluate the natural history of lower urinary tract symptoms in local community residents aged 40 years and above in central Taiwan. We evaluated the prevalence of overactive bladder (OAB) and voiding dysfunction (VD) in female residents using validated questionnaires., Materials and Methods: A structured questionnaire containing groups of different questionnaires was translated into Chinese and each one was validated separately. A trained research assistant interviewed the participants and assisted in filling in the questionnaires. Residents were recorded to have OAB if the total OABSS score was≧4. Urge urinary incontinence (UUI) was defined as urine leakage preceded by the feeling of urgency which is slightly or more distressful. VD was defined as feeling of difficulty in emptying the bladder which is slightly or more distressful., Results: A total of 2411 community residents aged 40 years and above who completed all the questionnaires in the initial survey were recruited, of which 1469(60.9%) were women. The prevalence of OAB, UUI and VD were 33.1%, 26.8% and 28.3% respectively in the female community residents. Age≧60 (OR, 1.5; 95%CI, 1.1-2.0), menopause (OR1.4; 95% CI, 1.0-1.9) and a history of diabetes mellitus (OR, 1.8; 95% CI, 1.2-2.8) were the risk factors for OAB. Age≧60 (OR, 1.4; 95%CI, 1.0-1.9), BMI ≧25 (OR, 1.3; 95% CI, 1.0-1.7) and instrument deliveries (OR, 1.5; 95% CI, 1.0-2.1) were the risk factors for VD., Conclusion: Our results imply that the prevalence of overactive bladder and voiding difficulty are high in female community residents aged ≧ 40 years in central Taiwan., (Copyright © 2017. Published by Elsevier B.V.)

Objective: Treatment of genital prolapse in elderly women is challenging. The aim of this study was to evaluate the long-term postoperative patient satisfaction and objective improvement in women aged 70 years and over with high stages of pelvic organ prolapse treated with obliterative LeFort colpocleisis., Materials and Methods: From January 2003 to December 2013, female patients aged 70 years and over who underwent colpocleisis surgery were included in this study. We reviewed the charts for preoperative and postoperative medical history, severity of prolapse, urodynamic studies, and early postoperative complications related to this procedure in these patients. Subjective outcomes were assessed by a nursing coordinator who interviewed patients by telephone in June 2014., Results: Colpocleisis was performed in 22 elderly patients and 59% patients were of advanced age (≥ 80 years). The mean postoperative follow-up duration was 48.1 months (range, 7-118) months. Six patients (27.3%) had died of medical problems at the time of the telephone interview. Fourteen patients (87.5%) reported a successful outcome after the operation and two patients (12.5%) reported improvement. For present satisfaction, 93.8% of patients reported that they were satisfied., Conclusion: Colpocleisis should be considered as one of the surgical options for treating advanced pelvic organ prolapse in elderly patients who do not wish to preserve vaginal function for sexual intercourse., (Copyright © 2016. Published by Elsevier B.V.)

Objective: The objective of this study was to demonstrate the diversity of urodynamic findings and temporal effects on bladder dysfunction in diabetes as well as to evaluate the predisposing factors that attenuate the storage and voiding function of diabetic women., Material and Methods: In this prospective study, 181 women with type 2 diabetes mellitus (DM) and lower urinary tract dysfunction underwent complete urogynecological evaluations and urodynamic studies. The patients' histories of DM and the treatment agents used were documented from chart records and interviews. The urodynamic diagnoses were recategorized into two groups for comparison, namely overactive detrusor (detrusor overactivity and/or increased bladder sensation as well as mixed incontinence) and voiding dysfunction (detrusor hyperactivity with insufficient contractility and detrusor underactivity with poor voiding efficiency) in order to evaluate the temporal effect of DM on diabetic bladder dysfunction., Results: The development of bladder dysfunction showed a trend involving time-dependent progression, beginning with storage problems (i.e. advancing from urodynamic stress incontinence to detrusor overactivity and/or increased bladder sensation) and eventually led to impaired voiding function. The duration of DM relative to the urodynamic diagnoses of these women was longer in women with voiding dysfunction (6.8 ± 2.8 years with urodynamic stress incontinence, 7.3 ± 6.5 years with detrusor overactivity and/or increased bladder sensation, and 10.4 ± 8.3 years with women with voiding dysfunction). Notwithstanding these findings, stepwise logistic regression analysis indicated that age and recurrent urinary tract infections were the two independent factors associated with developing voiding dysfunction., Conclusion: The urodynamic study revealed a temporal effect on bladder function, and women with diabetic voiding dysfunction were found to have had a longer duration of DM than women with an overactive detrusor. However, aging and recurrent urinary tract infections are the two independent factors that contribute to impaired voiding function and diabetic bladder dysfunction., (Copyright © 2012. Published by Elsevier B.V.)

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Müllerian duct anomalies consisting of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Patients with HWW syndrome are usually asymptomatic until menarche, when they present with acute lower abdominal pain. Here we report a case of a female newborn with right renal agenesis diagnosed during the pregnancy. The patient presented with a protruding mass over the vaginal introitus that was associated with an obstructed hemivagina and uterine didelphys., (Copyright © 2012. Published by Elsevier B.V.)

Objective: This study was conducted to evaluate the effectiveness of self-fashioned Gynemesh for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse, and the factors involved in mesh erosion., Materials and Methods: From March 2004 to September 2006, 65 women with urinary incontinence, with or without pelvic organ prolapse or prior surgery for prolapse or incontinence, were recruited for this study. A self-fashioned Gynemesh was used for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse. Patients in this study underwent suburethral slingplasty and/or concomitant pelvic reconstructive operations. A general linear model univariate analysis was performed to assess the relationships between mesh erosion and various variables., Results: The mean postoperative follow-up was 33 months. Those patients with anterior wall prolapse presented as completely cured postoperatively. The cure rate for urinary incontinence was 80%, and the improvement rate was 17%. Vaginal mesh erosion was discovered in four patients (6%) during the postoperative follow-up. These four patients remained continent after the removal of the eroded mesh. The interactive effects for mesh erosion by a general linear model analysis were menopausal women with advanced anterior vaginal wall prolapse (p < 0.05) and women with advanced anterior vaginal wall prolapse with concomitant sacrospinous ligament fixation (p < 0.05)., Conclusion: We found that using self-fashioned Gynemesh for tension-free suburethral and anterior vaginal slingplasty provided a high success rate (97%) in the 3 years of follow-up. Mechanical rejection may be one of the causes of vaginal mesh erosion.

Objective: To evaluate the different effects on urethral pressure profilometry (UPP) in pubovaginal slingplasty (PVS) and modified Burch colposuspension (MBC) procedures., Materials and Methods: This was a descriptive study of urodynamic parameters and urethral pressure profilometry. A total of 63 patients with successful anti-incontinence surgery were recruited for this study. Thirty-eight women had received MBC before 1998, to stabilize the bladder neck and the anterior vaginal wall. Twenty-five women had undergone autologous PVS to elevate the backstop effect on the proximal urethra between 1998 and 2000. All patients were followed-up for at least 24 months after surgery., Results: The mean age of patients in the PVS group was 52.5 years (range, 32-70 years), and 45.5 years (range, 31-61 years) in the MBC group. Age and parity were not significantly different between the two groups. The pressure transmission ratio (PTR) of the urethra increased significantly in both groups during the postoperative evaluation. Patients who had the MBC procedure showed an increased PTR at quarter (Q) Q1, Q2, and Q3 of the urethra. However, in the PVS group, the PTR increased only at Q3. The urethral closure pressure elevated significantly after MBC, but there were no significant changes after PVS., Conclusion: Our results indicate that different effects on UPP are evident in the PVS and MBC procedures. These two procedures should be considered in different anti-incontinence effect.

Objective: To investigate early postoperative complications of Burch colposuspension and the risk factors that may be associated with failure., Methods: We retrospectively reviewed the chart records of all patients who underwent Burch colposuspension from October 1997 to September 2002. Indications for colposuspension included urodynamic stress incontinence with bladder neck hypermobility and adequate vaginal capacity. The occurrence of early postoperative complications related to the operation was documented. Subjective failure of the operation was defined as patient dissatisfaction and/or persistent urinary leakage. Chi-square test or Fisher's exact test was used to determine the association among risk factors, early postoperative complications, and the failure rate of Burch colposuspension., Results: A total of 258 patients (92.5%) reported satisfaction with the surgical outcome. The age, parity, menopausal status, use of hormone replacement therapy, previous hysterectomy, and occurrence of early postoperative complications did not significantly influence the failure rate., Conclusion: Our results demonstrate that Burch colposuspension is an effective and, according to our patients, highly satisfactory procedure for the treatment of urodynamic stress incontinence.