Comparison between tension-free vaginal tape (TVT) and transobturator tape (TOT) with concomitant surgery for pelvic organ prolapse

Objective: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). Methods: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student`s t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. Results: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91±0.93 g/dL; TOT, 1.53±0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. Conclusion: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complicationsope

A Case of Fetal Intestinal Volvulus Diagnosed by Prenatal Ultrasonography in the 3rd Trimester

Fetal intestinal volvulus is a rare congenital disease that causes complications such as intestinal atresia and perforation, leading to ischemic necrosis of the bowel which may be life threatening. Therefore, prompt and accurate prenatal diagnosis is essential for appropriate timing of delivery and surgical correction of the newborn. We report a case of midgut volvulus that was diagnosed accurately by fetal sonography, which exhibited a sonographic ‘whirlpool-like configuration’ in utero.ope

Prognostic factors for predicting spontaneous pregnancy after Laparoscopic surgical treatment of endometriosis

Objective: To identify the prognostic factors for predicting spontaneous pregnancy after laparoscopic surgical treatment of endometriosis. Methods: Retrospective analysis was performed in 82 patients who underwent elective laparoscopic surgery with subsequent pathological confirmation of the endometriosis at Gangnam Severance Hospital from January 2003 to March 2008. We investigated the spontaneous pregnancy rate during the 12 months following surgical treatment and administration of Gonadotropin-Releasing Hormone agonist (GnRH agonist). Factors associated with clinical characteristics, blood tests and operative findings were compared with pregnant and non-pregnant women. Results: The number of patients succeed to spontaneous pregnancy was 32 and failed to pregnancy was 50. Cumulative pregnancy rate was 39.02%. Mean pregnancy duration after surgical treatment was 5.96±3.43 months. r-AFS stage or grouping into two stages (mild/severe) (P=0.018), r-AFS score (P=0.008) and cul-de-sac obliteration (P=0.038) was significantly different between pregnant and non-pregnant group. Complete cul-de-sac obliteration was the independent factor of pregnancy failure in women with endometriosis after laparoscopic surgery. Conclusion: Complete cul-de-sac obliteration may be the important factors for predicting spontaneous pregnancy outcome in women with endometriosis after laparoscopic surgical treatmentope

The roles of thioredoxin and thioredoxin-binding protein-2 in endometriosis

BACKGROUND: Oxidative stress is considered to be involved in the establishment and development of endometriosis. Thioredoxin (TRX) is an endogenous redox regulator that protects cells against oxidative stress, and TRX-binding protein-2 (TBP-2) is a negative regulator of TRX in the biological function and expression. The aim of this study was to investigate the roles of TRX and TBP-2 in the pathophysiology of endometriosis. METHODS: A total of 35 patients with histologically confirmed endometriosis and 31 patients without endometriosis participated in this study. Real-time polymerase chain reaction was used to quantify TRX and TBP-2 mRNA levels, and immunohistochemistry (IHC) was used to assess TRX and TBP-2 protein localization in the endometrium. Serum and peritoneal fluid levels of TRX and TBP-2 were measured using a specific commercial ELISA. RESULTS: There were no significant differences in TRX mRNA levels in the endometrium of patients with endometriosis and the control groups. However, TBP-2 mRNA levels in the endometrium were lower, and the TRX to TBP-2 ratio was higher in patients with endometriosis than in the control group. In particular, the TRX to TBP-2 ratio was significantly higher during late secretory and menstrual phase in patients with endometriosis compared with the control group. IHC studies also showed the decreased TBP-2 immunoreactivity in patients with endometriosis compared with the control group. There was no correlation between TRX and TBP-2 mRNA levels in patients with endometriosis, whereas TRX mRNA levels were positively correlated with TBP-2 mRNA levels in the control group. There were no significant differences between the two groups in TRX and TBP-2 levels in serum or peritoneal fluid. CONCLUSIONS: Aberrant expression of TRX and TBP-2 in the endometrium may be associated with the establishment of endometriosisope

Comparison of Factors Which Influence the Brachial-Ankle Pulse Wave Velocity in Pre- and Postmenopausal Women

Objectives: The aim of this study was to compare the factors which influence the brachial-ankle pulse wave velocity (baPWV) in pre- and post-menopausal women. We also investigated the association of menopause with arterial stiffness measured by baPWV. Methods: We performed a retrospective review of 241 postmenopausal women who attended the health promotion center for a routine checkup. Simple and multiple regression analyses were performed to determine the parameters influencing baPWV in pre- and postmenopausal women. Multiple logistic regression analysis was performed to identify the independent parameters related to increased of arterial stiffness. Results: Multiple regression analysis showed that diastolic blood pressure (DBP; ? = 0.402, P = 0.009) was identified as an independent determinant for baPWV in premenopausal women, and DBP (? = 0.329, P = 0.021) and the neutrophil-to-lymphocyte ratio (NLR; ? = 0.210, P = 0.016) were identified as independent determinants for baPWV in postmenopausal women. The odds ratio (95% CI) of menopause for a high baPWV was 2.666 (1.025∼6.937). Conclusion: The NLR is associated with arterial stiffness in postmenopausal women. Consequently, inflammation is thought to play a crucial role in increased arterial stiffness in postmenopausal women. Menopause is associated with a high baPWV, suggesting that changes in the concentrations of sex hormones during the menopausal transition may influence arterial stiffness in clinically healthy woope

The effect of combined oral contraceptives on metabolic and cardiovascular parameters in patients with polycystic ovary syndrome

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White blood cell differential count and adnexal mass size may predict potential malignancies in laparoscopic surgery

OBJECTIVE: We investigated the clinical value of using preoperative differential white blood cell (WBC) count to predict the potential for malignancy of adnexal masses in laparoscopic surgery. METHODS: The electronic medical records of 1325 patients who underwent laparoscopic surgery for adnexal masses between July 2005 and December 2008 were analyzed retrospectively. RESULTS: Of 1325 patients, 30 (2.3%) had adnexal masses with malignant potential. Analysis of differential WBC count, neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), serum CA 125, mass size showed that only cyst size was significantly different between patients with potentially malignant adnexal masses, those with benign disease (averages of 9.45 cm vs. 6.23 cm, p=0.001). Further analysis was performed using a combination of various markers and multiplication of cyst size and NMR yielded the highest area under the curve, at 0.711(95% confidential interval 0.619~0.806, p<0.001), with a sensitivity and specificity of 86.7% and 48.3% respectively, at a cut off value of 67.23. These values were also significantly different between patients with potentially malignant adnexal masses, and dermoid cyst or endometrioma (p=0.038 and 0.002 respectively, by analysis of variance, post hoc test). CONCLUSION: Preoperative measurement of NMR in conjunction with cyst size may be used as a simple, non invasive marker for predicting the malignant potential of adnexal masses before laparoscopic surgery.ope

Clinical Efficacy of Clomiphene Citrate and Letrozole Combined with Gonadotropins for Superovulation in Patients with Clomiphene-Induced Thin Endometrium

Objective: The aim of this study was to compare the clinical efficacy of clomiphene citrate (CC) and letrozole combined with gonadotropins for controlled ovarian stimulation (COS) in patients with CC-induced thin endometrium Methods: Fifty-one intrauterine insemination cycles performed in patients who previously had a thin endometrium (<8 mm) to ovulation induction using CC were included in this study. A CC 100 mg/day (CC+gonadotropin group, n=26) or letrozole 2.5 or 5 mg/day (letrozole+gonadotropin group, n=25) was administered on day 3~7 of the menstrual cycle, combined with gonadotropins at dose 75~150 IU every other day starting on day 5~7. We compared total dose of gonadotropin used, endometrial thickness, endometrial pattern, number of follicles ${\geq}14\;mm$ on hCG day, pregnancy rate and multiple pregnancy rate between the two groups, which were statistically analyzed using Mann-Whitney U test or Fisher's exact test, where appropriate. Results: There were no significant differences in clinical characteristics such as age, duration of infertility, number of previous IUI cycles, basal serum hormone levels and cause of infertility between the two groups. In both groups, the endometrium was significantly thicker than that of previous ovulation induction cycles using CC. No significant differences were found in the total dose of gonadotropin used, day of hCG administration, the rate of triple endometrium and pregnancy rate. The number of follicles ${\geq}14\;mm$ was significantly lower ($3.7{\pm}1.7$ vs. $2.8{\pm}1.7$, p=0.03) and the endometrium on hCG day was significantly thicker ($7.7{\pm}1.5$ vs. $9.1{\pm}1.7$, p=0.001) in letrozole+gonadotropin group compared to CC+gonadotropin group. Conclusion: The clomiphene citrate and letrozole combined with gonadotropins appear to avoid the undesirable effects on the endometrium frequently seen with CC for ovulation induction. However, in terms of adequate endometrial development or optimal follicular growth, letrozole may be more beneficial than CC for gonadotropin-combined COS in patients with CC-induced thin endometrium. Further prospective randomized controlled studies in a larger scale will be necessary to confirm our findings.ope

The Influence of BMI on Clinical and Metabolic Characteristics in Patients with Polycystic Ovary Syndrome

Objectives: The aim of this study was to investigate the influence of body mass index (BMI) on clinical and metabolic characteristics in patients with polycystic ovary syndrome (PCOS). Methods: A total of 67 patients with PCOS were included in this study. Study subjects were divided into two groups according to BMI: women with BMI ≥23 ㎏/㎡(overweight/obese group, n=24) vs. women with BMI <23 ㎏/㎡ (normal-weight group, n=43). We compared clinical and metabolic characteristics including waist-to-hip ratio, serum lipid profiles, homeostatic model assessment of insulin resistance (HOMA-IR), fasting serum glucose/insulin ratio, postprandial 2 hours (PP2) serum insulin levels, total testosterone, sex hormone-binding globulin (SHBG), high-sensitivity C-reactive protein (hs-CRP) and homocysteine levels between the two groups, which were statistically analyzed using Mann-Whitney U test or Fisher’s exact test, where appropriate. Results: The overweight/obese group has a lower serum SHBG level (37.23±26.74 vs. 66.42±40.16 nmol/l, P= 0.004) and a higher free androgen index (5.83±3.85 vs. 3.57±2.30, P=0.002) than the normal-weight group. Fasting insulin (17.13±8.8 vs. 7.15±4.41 μIU/ml, P<0.001), PP2 insulin (76.81±43.66 vs. 47.98±49.77 uIU/ml, P=0.022) and the HOMA-IR (3.65±1.74 vs. 1.48±1.02, P<0.001) are significantly higher and fasting glucose/insulin ratio (6.59±4.84 vs. 15.18±7.48, P<0.001) are significantly lower in the overweight/obese group compared to those of the normal weight group. Serum triglyceride (125.00±105.34 vs. 77.56±41.69 mg/dl, P=0.036) and hs-CRP levels (3.53±4.23 vs. 0.85±0.70 mg/l, P=0.008) are significantly higher in the overweight/obese group. Conclusion: The overweight and obese women with PCOS are more closely related to hyperandrogenism, insulin resistance and chronic inflammation. These findings may indicate that they have an increased risk of metabolic and cardiovascular diseasesope

Urinary vitamin D-binding protein is elevated in patients with endometriosis.

BACKGROUND: Recently, proteomic technologies have demonstrated that several proteins are differently expressed in various body fluids of patients with endometriosis compared with those without this condition. The aim of this study was to investigate proteins secreted in urine of patients with endometriosis using proteomic techniques in order to identify potential markers for the clinical diagnosis of endometriosis. METHODS: Urine samples were collected from women undergoing laparoscopy for different indications including pelvic masses, pelvic pain, suspicious endometriosis, infertility and diagnostic evaluation. Proteomic techniques and mass spectrometry were used to identify proteins secreted in the urine of the patients with and without endometriosis and quantification of identified protein was performed using western blot and specific commercial sandwich enzyme-linked immunosorbent assays (ELISA). RESULTS: Twenty-two protein spots were differentially expressed in the urine of patients with and without endometriosis, one of which was identified as urinary vitamin D-binding protein (VDBP). ELISA quantification of urinary VDBP corrected for creatinine expression (VDBP-Cr) revealed that urinary VDBP-Cr was significantly greater in patients with endometriosis than in those without (111.96 ± 74.59 versus 69.90 ± 43.76 ng/mg Cr, P = 0.001). VDBP-Cr had limited value as a diagnostic marker for endometriosis (Sensitivity 58%, Specificity 76%). When combined with serum CA-125 levels (the product of serum CA-125 and urinary VDBP-Cr), it did not significantly increase the diagnostic power of serum CA-125 alone. CONCLUSIONS: Urinary VDBP levels are elevated in patients with endometriosis. They have limited value as a potential diagnostic biomarker for endometriosis but suggest it would be worthwhile to investigate other urinary proteins for this purpose.ope