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There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

The balanced turnover of collagen is necessary to maintain the mechanical strength of pelvic supportive connective tissues. Homeobox (HOX) A11 is a key transcriptional factor that controls collagen metabolism and homoeostasis in the uterosacral ligaments (USLs), and the deficient HOXA11 signalling may contribute to alterations in the biochemical strength of the USLs, leading to pelvic organ prolapse (POP). However, it is unknown how HOXA11 transcripts are regulated in the USLs. In this study, we found that microRNA (miRNA)-30d and 181a were overexpressed in women with POP, and their expression was inversely correlated with HOXA11 mRNA levels. The overexpression of miR-30d or 181a suppressed HOXA11 mRNA and protein levels in 293T cells, whereas the knockdown of these miRNAs enhanced HOXA11 levels and collagen production. Cotransfection of a luciferase reporter plasmid containing the 3′-untranslated region of HOXA11 with miR-30d or 181a mimic resulted in decreased relative luciferase activity. Conversely, cotransfection with anti-miR-30d or 181a increased luciferase activity. Taken together, these results indicate that both miR-30d and 181a are important posttranscriptional regulators of HOXA11 in the USLs and could be a potential therapeutic target for POP.

Although there are many studies about the effects of vaginal birth, the effects of menopause on pelvic floor support have not been identified. We compared elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse, and defined the menopausal regulation of this process.The study group consisted of 35 women who underwent hysterectomy for pelvic organ prolapse. The control group consisted of 39 women without pelvic organ prolapse. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of mRNA, and protein for neutrophil elastase, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by real-time quantitative polymerase chain reaction and ELISA, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin, an inhibitor of neutrophil elastase, was also determined. ANOVA, the Kruskal-Wallis test and multivariate linear regression were used for statistical analysis.Expression of neutrophil elastase and matrix metalloproteinase-2 mRNA was higher in women with pelvic organ prolapse than in those without pelvic organ prolapse. Compared to before menopause, neutrophil elastase and matrix metalloproteinase-2 showed a significant decrease in postmenopausal women without pelvic organ prolapse, although these remained increased in postmenopausal women with pelvic organ prolapse. Alpha-1-antitrypsin was significantly less in postmenopausal women with pelvic organ prolapse than in postmenopausal women without pelvic organ prolapse. The activities of neutrophil elastase, matrix metalloproteinase-2 and matrix metalloproteinase-9 were increased in women with pelvic organ prolapse, and these trends were similar to neutrophil elastase and matrix metalloproteinase-2 expression even after adjustment for age, parity and menopausal status.After menopause increased elastolytic protease has a significant role in the development 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.

The aim of this study was to evaluate whether hysterectomy or the use of graft is necessary for the reconstructive surgery for uterine prolapse. One hundred sixty-eight patients were categorized into the 3 groups: group I, abdominosacral colpopexy with mesh and hysterectomy (n = 63); group II, abdominosacral uteropexy with mesh (n = 35); group III, abdominal uterosacrocardinal colpopexy and hysterectomy (n = 70). Perioperative and postoperative complications, functional outcomes, and anatomical recurrences were assessed. The median follow-up was 36 months in all surgery groups. In the complication rates and functional outcomes, no difference was noted, except for operation time (longer in group I, p = 0.001) and hemoglobin loss (greater in group II, p = 0.002). There was a significant difference in the cumulative anatomical cure rates (p < 0.0001). The risk of recurrence in group III was 6.2 times higher than in group I. In conclusion, the use of graft, rather than hysterectomy, might be necessary for the reconstructive surgery for uterine prolapse.

Background/Aims: The aim of this study was to obtain the surgical therapeutic index (STI) of tension-free vaginal tape (TVT) and transobturator tape (TOT) and compare it with the previously obtained result of Burch colposuspension. Methods: The study population consisted of 121 patients who were diagnosed as having stress urinary incontinence, underwent TVT or TOT between January 1, 2000 and June 30, 2005 and were followed up for at least 1 year. Patients with detrusor overactivity, urinary tract infection, intrinsic sphincter deficiency and pelvic organ prolapse more than stage II according to the POP-Q system were excluded. The cure and complication rates were investigated, and the STI (median percent cure rate/median percent complication rate) of each operation was calculated. Results: Of the 121 patients, 61 underwent TVT and 60 received TOT. Patient characteristics and the results of preoperative urodynamic studies showed no significant difference between the two groups. The STI of TOT (2.72, 4.08, 4.23, 5.29) was higher than that of Burch colposuspension (1.19, 2.27, 2.89, 3.53) and TVT (2.77, 3.69, 3.23, 3.17) irrespective of follow-up months (at 1, 3, 6, 12 months). Conclusion: TOT seems to be a more suitable surgical procedure for stress urinary incontinence with urethral hypermobility.

Through the experience of five cases of leiomyoma developed in the female bladder and urethra with a review of the literature, we have made an effort to characterize the association of symptom with the size and location of the tumor and demonstrate an appropriate treatment. The study population was composed of patients who underwent surgery for bladder or urethral leiomyoma in our hospital from March 1990 to April 2005. Their medical records were reviewed retrospectively concerning the symptom, size and location of leiomyoma, the result of cystoscope and radiological examination, surgical method, pathologic report, complications, and recurrence. Four cases were diagnosed as urethral leiomyoma and one case as bladder leiomyoma. All patients with urethral leiomyoma were admitted for the chief complaint of a palpable tumor. When the tumor size was small, if it was located on the lateral side of the urethra, it was asymptomatic, but if located in the midline, it presented irritative or obstructive symptom. When it was big, if located on the lateral side, it presented irritative rather than obstructive symptom, and if located in the midline, it presented obstructive symptom. One case of bladder leiomyoma was discovered incidentally during ultrasonic exam. In all five cases, surgical removal was performed and complications or recurrence were not detected afterwards. Bladder and urethral leiomyomas are very rare and cause diverse manifestations from asymptomatic to irritative or obstructive symptom. It is presumed that the location and size of the tumor are associated with symptom. Unless it is the case with severe hemorrhage or obstructive acute renal failure, immediate surgery is not required. However, it is desirable to distinguish leiomyoma from malignant or other benign tumors by surgical biopsy or removal.

We analyzed 12 ovarian epithelial tumors using 2D PAGE-based comparative proteomics to construct intra- and inter-tumoral distance map trees and to discover surrogate biomarkers indicative of an ovarian tumor. The analysis was performed after laser microdissection of 12 fresh-frozen tissue samples, including 4 serous, 5 mucinous, and 3 endometrioid tumors, with correlation with their histopathological characteristics. Ovarian epithelial tumors and normal tissues showed an apparent separation on the distance map tree. Mucinous carcinomas were closest to the normal group, whereas serous carcinomas were located furthest from the normal group. All mucinous tumors with aggressive histology were separated from the low malignant potential (LMP) group. The benign-looking cysts adjacent to the intraepithelial carcinoma (IEC) showed an expression pattern identical to that of the IEC area. The extent of change on the lineages leading to the mucinous and serous carcinoma was 1.98-fold different. The overall gene expression profiles of serous or endometrioid carcinomas appeared to be less affected by grade or stage than by histologic type. The potential candidate biomarkers screened in ovarian tumors and found to be significantly up-regulated in comparison to normal tissues were as follows: NM23, annexin-1, protein phosphatase-1, ferritin light chain, proteasome alpha-6, and NAGK (N-acetyl glucosamine kinase). In conclusion, ovarian mucinous tumors are distinct from other ovarian epithelial tumors. LMP mucinous tumors showing histologically aggressive features belong to mucinous carcinoma on the proteomic basis.

Aims: To evaluate the differences in urodynamic study (UDS) and the perineal ultrasonography parameters between stress urinary incontinence (SUI) patients with or without urethrovesical junction (UVJ) hypermobility. Treatment outcomes following a retropubic urethropexy were also compared. Methods: The records of 164 SUI patients (≤stage II), treated with retropubic urethropexy at our department between January 2001 and February 2004 were reviewed. The patients were categorized into a hypermobility group when the measured Q-tip angle was ≥30, and a non-hypermobility group when

We investigated the objective coexisting rate of stress urinary incontinence and pelvic organ prolapse, and also compared the treatment outcomes in patients who had both conditions, treated by a corrective operation on the basis of a precise preoperative evaluation. We reviewed 97 cases who underwent urodynamic studies and evaluation of the prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system from among patients who were admitted for treatment of either stress urinary incontinence or pelvic organ prolapse. A Burch urethropexy, either alone or with a parvaginal repair, was done to correct the stress urinary incontinence, as well as additional operations to correct prolapse of stage II or more. The patients were evaluated postoperatively for the stress urinary incontinence and the degree of prolapse at every visit. Nineteen of 30 (63.3%) patients who were admitted with stress urinary incontinence had a coexisting pelvic organ prolapse, most often of the anterior wall. In 42 of 67 (62.7%) cases admitted with pelvic organ prolapse there was a coexisting stress urinary incontinence. A total of 61 patients who had both conditions were followed for 12 months postoperatively. The recurrence rate of stress urinary incontinence and prolapse (all of which were stage II) was 3.3% and 18.0%, respectively. It was noted that the greater the preoperative stage, the higher the recurrence rate (stage II 4.35%; stage III 25.0%; stage IV 33.6%). The coexisting rates of pelvic organ prolapse in patients having stress urinary incontinence, and stress urinary incontinence in patients having a pelvic organ prolapse, were both high. Therefore, when a preoperative evaluation that simultaneously considers both conditions and the correcting surgery is based on this evaluation, the recurrence rates of both conditions could be lowered.

To determine whether obesity influenced the risk of perioperative and long-term complications in patients undergoing vaginal surgery.Women diagnosed with pelvic organ prolapse who underwent vaginal surgery between March 1999 and May 2007 were classified into 3 groups: normal weight (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] 18.5-23.0); overweight (BMI 23.0-27.5); and obese (BMIor=27.5). Complications were subdivided into perioperative (1 month) and long-term (or=1 month). Statistical analysis was performed using analysis of variance, chi(2) test, and logistic regression.Demographic information showed no differences among the groups, except for the presence of comorbidity (P=0.03). Blood loss and transfusion as a perioperative complication and urinary retention as a long-term complication were significantly different among the groups: odds ratio (OR) 2.46 (95% confidence interval [CI], 1.38-4.39; P0.01); and OR 2.20 (95% CI, 1.21-4.03; P=0.03), respectively.Major complications were rare, and most were not significantly different among the groups. However, obesity was a protective factor against blood loss and transfusion, and long-term urinary retention.

Purpose The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. Materials and Methods From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. Results Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p

Objective To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). Methods The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. Results In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. Conclusion In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

To compare the treatment outcomes of Burch colposuspension and transobturator tape (TOT) when each is combined with abdominal sacrocolpopexy (ASC) to treat stress urinary incontinence (SUI) with pelvic organ prolapse (POP).Consecutive cases of Burch colposuspension and TOT combined with ASC were retrospectively reviewed. Patients with SUI and POP beyond stage III--according to the POP-quantification system--were included.Mean hospital stay was longer in the Burch group (n=49) than in the TOT group (n=60) (11.3 vs 7.8 days; P0.001), as was operation time (202.7 vs 170.1 minutes; P0.001); furthermore, there were higher rates of urinary retention (53.1% vs 11.7%; P0.001), de novo urgency (18.4% vs 3.3%; P=0.01), and recurrent SUI (18.4% vs 1.7%; P=0.003) in the Burch group. The cure rate was significantly higher in the TOT group than in the Burch group (98.3% vs 69.7%; P0.001).The use of TOT with ASC resulted in higher cure rates and better functional outcomes than did Burch colposuspension with ASC.

The aim of this study is to investigate the risk factors of voiding dysfunction occurring within 1 month after surgical treatment of urinary incontinence.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.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.The most important risk factor associated with voiding dysfunction was concomitant anterior colporrhaphy.

To evaluate the efficacy of tension-free vaginal tape (TVT) and transobturator tape (TOT) according to urethral function based on a preoperative urodynamic study (UDS).Preoperative Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP) were compared with the actual surgical outcome, and patients were followed for1 year. Student's t test, chi2 test, multiple regression analysis and receiver operating character curve analysis were used for statistical analysis. Of the 437 patients, 225 received TVT and 212 patients received TOT.Age, parity, body mass index, menopausal status, hormone replacement therapy and previous surgical history showed no significant difference between the groups. Advanced pelvic organ prolapse, concomitant hysterectomy and vault suspension were more common in the TOT group, whereas concomitant anterior colporrhaphy was more common in the TVT group. The treatment outcome of TVT was not associated with VLPP and MUCP. However, cutoff values of VLPPor = 72.5 cm H2O and MUPCor = 42 cm H2O were most predictive of successful surgical outcomes in TOT group, revealing a sensitivity of 95.7% and a positive predictive value of 98.4%.Preoperative MUCP and VLPP can predict the treatment outcome of TOT but not TVT.

Purpose: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). Materials and Methods: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. Results: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse ≥ stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. Conclusion: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

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.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.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).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.

Objectives Pelvic organ prolapse is associated with defects in connective tissue including elastic fibers. The purpose of this study was to investigate expression of fibulin-5 and lysyl oxidase-like 1, which play an essential role in synthesis and assembly of elastic fibers in the uterosacral ligament, in samples taken from women with advanced pelvic organ prolapse compared with controls. Study design Specimens were obtained prospectively during abdominal hysterectomy from 30 women with advanced pelvic organ prolapse and 30 controls matched to the study group for age and parity among postmenopausal women with benign gynecologic pathology. Expression levels of protein and mRNA of fibulin-5 and lysyl oxidase-like 1 in uterosacral ligaments were measured by Western blot analysis and real-time quantitative polymerase chain reactions. For statistical analyses, Student's t -test, chi-square test, Mann–Whitney U test, Fisher's exact test and Spearman's correlation were used. Results Significant decrease in the expression of mRNA of fibulin-5 was found in patients with prolapse ( P -value = 0.042; 0.743 ± 0.229 and 1.061 ± 0.537). The expression of mRNA of lysyl oxidase-like 1 was increased in the patient group ( P -value = 0.017; 4.099 ± 2.832 and 1.816 ± 1.602). Similar results were shown in Western blot analysis. Differences in expression of fibulin-5 and lysyl oxidase-like 1 were noted according to stage of prolapse ( P -value = 0.037 and 0.009). Conclusions There was decreased expression of fibulin-5 and increased expression of lysyl oxidase-like 1 in uterosacral ligaments in patients with pelvic organ prolapse, which suggests the possibility of defects in elastin synthesis.

The aim of this study was to compare the treatment outcome of 3 sling procedures for stress urinary incontinence with intrinsic sphincter deficiency.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.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.PVS and TVT were more efficacious, but the long-term cure rates were low.

Objectives: To characterize mesenchymal stem cell‐like cells isolated from human amniotic fluid for a new source of therapeutic cells. Materials: Fibroblastoid‐type cells obtained from amniotic fluid at the time of birth. Methods: The ability of ex vivo expansion was investigated until senescence, and stem cell‐like characteristics were analyzed by examining differentiation potential, messenger RNA expression and immunophenotypes. Results and Conclusions: A morphologically homogenous population of fibroblastoid‐type (HAFFTs) cells, similar to mesenchymal stem cells from bone marrow (BM‐MSCs), was obtained at the third passage. The cells became senescent after 27 passages over a period of 8 months while undergoing 66 population doublings. Under appropriate culture conditions, by the 8th passage they differentiated into adipocytes, osteocytes, chondrocytes and neuronal cells, as revealed by oil red O, von Kossa, Alcian blue and anti‐NeuN antibody staining, respectively. Immunophenotype analyses at the 17th passage demonstrated the presence of TRA‐1–60; SSEA‐3 and‐4; collagen types I, II, III, IV and XII; fibronectin; α‐SMA; vimentin; desmin; CK18; CD44; CD54; CD106; FSP; vWF; CD31; and HLA ABC. Reverse transcriptase–polymerase chain reaction analysis of the HAFFTs from passages 6–20 showed consistent expression of Rex‐1, SCF, GATA‐4, vimentin, CK18, FGF‐5 and HLA ABC genes. Oct‐4 gene expression was observed up to the 19th passage but not at the 20th passage. HAFFTs showed telomerase activity at the 5th passage with a decreased level by the 21st passage. Interestingly, BMP‐4, AFP, nestin and HNF‐4α genes showed differential gene expression during ex vivo expansion. Taken together, these observations suggest that HAFFTs are pluripotent stem cells that are less differentiated than BM‐MSCs, and that their gene expression profiles vary with passage number during ex vivo expansion.

Objectives: To evaluate the risk factors for pelvic organ prolapse (POP) and to determine the relationship between these risk factors and stage or other components of POP. Methods: 244 patients with primary POP and 314 women without POP were included. Age, parity, smoking, body mass index (BMI), menopause, and hormone replacement therapy (HRT) were investigated. Result: Independent risk factors for POP included age over 70, parity higher than 3, and menopause. Age, parity, menopause, and HRTwere significantly associated with stage of POP. Genital hiatus (GH) and perineal body (PB) showed a significant positive and negative correlation with age and parity, respectively. Menopause and HRTwere also associated with them. Conclusion: Age, parity and menopause are possible risk factors of POP and associated with the lengths of GH and PB in POP women. Further, these risk factors and HRTare significantly correlated with the severity of the disease. © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Purpose: To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. Materials and Methods: This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. Results: Urinary levels of NGF/Cr (OAB: 1.13±0.9 pg/mg; control: 0.5±0.29 pg/ mg) and HB-EGF/Cr (OAB: 8.73±6.55 pg/mg; control: 4.45±2.93 pg/mg) were significantly higher in subjects with OAB than in controls ( p

The object of this study was to compare the treatment outcomes of tension-free vaginal tape (TVT) for intrinsic sphincter deficiency (ISD) and nonintrinsic sphincter deficiency (NISD) patients in stress urinary incontinence (SUI) and to evaluate whether TVT can be effectively used in both groups of patients. 111 women with SUI treated by TVT procedure from June 2003 to June 2005 with follow-ups for at least 1 year postoperatively were included in this study. The patients were divided into two groups: 31 patients with ISD and 80 patients with NISD. ISD was defined as the cases with low Valsalva leak-point pressure (VLPP) or Maximal urethral closure pressure (MUCP). Patients were followed up at 1, 3, 6, and 12 months postoperatively. There were no significant differences found in demographics between ISD and NISD groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy (p > 0.05). All urodynamic parameters except for VLPP and MUCP showed no significant differences. The cure rates of the two groups at 1 month follow-up (87.0 vs 100%; p = 0.0053) showed a significant difference, but no significant differences were found at 3, 6, and 12 months. There were no differences in postoperative complication rates (voiding difficulty, de novo urgency, urinary tract infection, retropubic hematoma, and vaginal mesh erosion) between the two groups irrelevant of follow-up months. TVT is effective for SUI in both ISD and NISD patients.

To evaluate the differences in urodynamic study (UDS) and the perineal ultrasonography parameters between stress urinary incontinence (SUI) patients with or without urethrovesical junction (UVJ) hypermobility. Treatment outcomes following a retropubic urethropexy were also compared.The records of 164 SUI patients (or=stage II), treated with retropubic urethropexy at our department between January 2001 and February 2004 were reviewed. The patients were categorized into a hypermobility group when the measured Q-tip angle wasor=30, and a non-hypermobility group when30. All patients underwent UDS and perineal ultrasonography (US) preoperatively. A Burch urethropexy was performed regardless of the Q-tip result. All patients were reevaluated at 1 month and 3 months, postoperatively, and every 3 months thereafter.Ninety-eight patients (60%) had an accompanying UVJ hypermobility and 66 (40%) did not. No significant differences regarding age, parity, body mass index (BMI), menopausal status, hormone replacement status, history of previous gynecologic surgery, or other medico-surgical illness were noted. UDS parameters demonstrated a significant difference between the groups, but were in the normal range. The significant difference noted in the perineal US was the bladder neck descent (BND). Following retropubic urethropexy, the success rates after 1 year were 94% and 91% for the hypermobility group and the non-hypermobility group, respectively, showing no statistical significance.The success rates of Burch urethropexy in the two groups were similar. This result suggests that either the Q-tip is an inaccurate method of evaluating UVJ hypermobility or the presence of UVJ hypermobility does not negatively affect the treatment outcome of a Burch urethropexy.

To compare the success rates of Burch colposuspension in relation to a Valsalva leak-point pressure (VLPP) cutoff level of 60 cm H2O and to examine other predictive factors for intrinsic sphincter deficiency, such as maximal urethral closure pressure (MUCP) and functional urethral length (FUL), in an attempt to define the urodynamic contraindications to Burch colposuspension.From March 1999 to February 2001, among patients who had undergone Burch colposuspension after being diagnosed as having stress urinary incontinence at the Yonsei University Medical Center Urogynecology Clinic, 79 patients eligible for continuous postoperative follow-up were enrolled in the study. Patients with past histories of hysterectomy and/or incontinence surgery were excluded from the study, and all patients included in the study had pelvic organ prolapse stage II or less. Urodynamic studies were performed as a preoperative evaluation, and recurrence of stress urinary incontinence after surgery was diagnosed through thorough history and meticulous urodynamic evaluations.The mean age was 57.66 +/- 9.99 years, mean parity was 3.71 +/- 4.38, menopausal rate and mean age at menopause were 81.0% (64 of 79) and 50.31 +/- 4.60 years, respectively, and the proportion of patients receiving hormone replacement therapy was 10.1% (8 of 79). The success rates in 2 groups, VLPPor = 60 cm H2O (n=55) and60 cm H2O (n=24) were 94.55% and 91.67%, respectively, demonstrating no statistical significance (p0.05). The MUCP and FUL values were within normal ranges in both groups (MUCP, 66.98 +/- 24.04 versus 66.23 +/- 22.89 cm H2O, p0.05; and FUL, 36.33 +/- 7.31 versus 38.71 +/- 8.54 mm, p0.05), without a significant difference. The Pearson correlation coefficients for VLPP versus MUCP and VLPP versus FUL were 0.50 (p0.001) and 0.57 (p0.001), respectively, demonstrating a significant positive correlation.A VLPP level60 cm H2O does not represent an absolute contraindication to Burch colposuspension, provided that other parameters, such as MUCP and FUL, are within acceptable ranges. To select appropriate candidates for Burch colposuspension, a comprehensive evaluation of urodynamic parameters is mandatory.

Recent studies have been reported the roles of the estrogen receptor (ER), progesterone receptor (PR) and p53 in the development of a pelvic organ prolapse (POP). The pathogenesis of stress urinary incontinence (SUI) is related to that of POP in the weakness of pelvic support. Therefore, this study was carried out to assess the relationship between ER, PR, p53 and the development of SUI, and to elucidate the biomolecular pathophysiology of SUI. The periurethral fascia was obtained from 6 menopausal patients diagnosed with SUI and 10 menopausal patients without SUI who visited the Department of Obstetrics and Gynecology, Severance Hospital, Seoul, Korea. The relative ER, PR and p53 protein levels in the periurethral fascia were obtained by western blot analysis and densitometry. A Mann-Whitney U test was used for statistical analysis (p < 0.05). The mean age (+/- SD) of the 16 patients was 59.0 +/- 5.5 years (range, 50-74 years). The mean body mass index was 25.2 +/- 2.7 kg/m2 (21.8 - 30.8) and the average number of vaginal deliveries was 2.8 +/- 1.9 (1.0 - 9.0). The ER level (0.33 +/- 0.17 vs. 1.86 +/- 0.83, p= 0.02) and the p53 level (1.25 +/- 0.67 vs. 4.71 +/- 2.40, p= 0.01) were lower in the experimental group. However, the PR level of the two groups were similar (0.64 +/- 0.13 vs. 0.48 +/- 0.33, p=0.56). The p53 and ER levels were significant lower in the study group. This suggests that p53 and ER might be important factors in the development of SUI. Further prospective studies about the association of ER, p53 and SUI will be needed to elucidate the molecular pathogenesis of SUI.

The aim of this study is to compare the levels of estrogen receptor (ER), progesterone receptor (PR), p53 and p21 between pelvic organ prolapse (POP) and control groups in order to evaluate their roles in pathogenesis of POP, and to find out the relationship among these proteins. Through the year of 2002, uterosacral ligaments were obtained from 20 prolapsus and 24 non-prolapsus hysterectomized uteruses. ER, PR, p53, and p21 proteins were extracted by Western blot analysis and relative levels of proteins were compared by Student t-test and Pearson correlation coefficient. P value

The Maximum Urethral Closure Pressure (MUCP) and Functional Urethral Length (FUL) are significant parameters of the Urethral Pressure Profile (UPP), while the Q-tip angle and Bladder Neck Descent (BND) are the significant parameters of urethral hypermobility. We performed a study to evaluate the effects and predictive values of each of these parameters in the diagnosis of Stress Urinary Incontinence (SUI). A retrospective study was done involving 90 SUI patients and 38 non-SUI patients who underwent urodynamic study, Q-tip test and perineal ultrasound at Yonsei Medical Center between January, 1999 and February, 2002. There was no statistical difference between the SUI and non-SUI groups in terms of mean age, delivery history, menopausal age and body mass index. While the FUL and Q-tip angle showed significant differences (33.18 +/- 19.55 vs 33.12 +/- 13.37 mm, p=0.002; 65.94 +/- 21.69 vs 56.45 +/- 26.53 degrees C, p=0.02,respectively) neither the MUCP nor the BND showed any significant difference between the two groups (60.06 +/- 29.92 vs 48.97 +/- 42.95 cmH2O, p > 0.05; 1.09 +/- 0.75 vs 0.85 +/- 0.76 cm, p > 0.05; 0.71 +/- 0.80 vs 0.53 +/- 0.72 cm, p > 0.05). The odds ratios for the FUL and Q-tip angle were 1.038 (1.014, 1.061) and 1.017 (1.001, 1.033), respectively. The FUL and Q-tip angle had cut-off values of 1.36 cm (sensitivity: 68.8%, specificity : 54.1%, PPV : 73.8%, NPV : 48.1%) and 20.47 degrees C (sensitivity : 93.3%, specificity : 18.17%, PPV : 68.2%, NPV : 60%), respectively, in the diagnosis of SUI. The area under the curve (AUC) of the FUL and Q-tip angle were on average 0.625 (p=0.0016) and 0.575 (p=0.0012), respectively. Both the FUL and Q-tip angle showed a significant difference between SUI patients and the normal group. However, their value as a diagnostic tool was trivial, and since their sensitivity, specificity, positive predictive value and negative predictive value showed inconsistent results at each cut-off value, it would be difficult to apply them to clinical use. A further study is required to set-up standard diagnostic values of these variables for clinical use.

To evaluate whether the results of urodynamic tests and the perineal ultrasound were different between grade 1 and 2 stress urinary incontinence.Forty premenopausal women with a diagnosis of stress urinary incontinence according to urodynamic tests were enrolled in this study. Stress urinary incontinence was defined as urine leakage during stress without detrusor contraction. Twenty patients had grade 1 and 20 had grade 2 stress urinary incontinence. We compared the parameters of uroflowmetry, filling cystometry, urethral pressure profile, dynamic urethral function test, perineal ultrasound and stress urethral axis between grade 1 and 2 levels of stress urinary incontinence.There were no significant differences in age, parity or body mass index between the grade 1 and 2 patients. Uroflowmetry results showed that there were no significant differences in maximal flow rate, average flow rate, voided volume or residual urine between grade 1 and 2. As to cystometry results, only the first desire to void was significantly increased in grade 2 over 1 (304 +/- 113.65 vs. 194 +/- 48.24 [mL], P = .04). There were no significant differences in any of the urethral pressure profile parameters. In the dynamic test, the Valsalva leak point pressure and cough leak point pressure were not significantly different between the 2 groups. There were no significant differences in perineal ultrasound parameters or the stress urethral axis.Most stress urinary incontinence-related parameters showed no difference between the grade 1 and 2, and no urodynamic or ultrasonographic evidence for a difference between the grade 1 and 2 was demonstrated.

This study was undertaken to establish a noninvasive prenatal genetic diagnostic method for trisomy 21 using the fetal nRBCs that is rarely present in maternal circulation. Peripheral venous blood samples were collected from 30 women with an advanced maternal age, abnormal triple marker test results, or abnormal ultrasound findings such as an increased nuchal translucency. The blood samples were treated with heparin. The triple density gradient centrifugation, and MACS using CD45 and CD71 were used to isolate the fetal cells. FISH analysis using probe 21 was performed with GPA-immunostaining. The study population consisted of 30 patients from 13 to 25 weeks of gestation, and nRBCs were separated in all cases. In GPA-immuno FISH analysis using probe 21, 3 cases of trisomy 21 were diagnosed and these results were confirmed by the amniocentesis. In conclusion, a prenatal diagnosis of trisomy 21 through GPA- immuno fluorescence in situ hybridization (FISH) analysis using separated fetal nRBCs is a useful, innovative, accurate, rapid and non-invasive diagnostic method.

This study was conducted to investigate the risk factors associated with peripartum hysterectomy in women who had either vaginal or cesarean delivery. The study subjects were women (n = 101) who had a peripartum hysterectomy at the authors' institution from January 1986 to April 2001. Seventy-two of the 101 patients had delivered at Yonsei University Medical Center and 29 were referred from other hospitals. Of the total 31,044 deliveries at Yonsei during this time period, 11,924 were performed by cesarean section. Fifty-four of these women (0.45%) and 28 of the 19,080 who had a vaginal delivery (0.09%) underwent peripartum hysterectomy. Five of the 29 referred patients had a cesarean section and 24 had a vaginal delivery. The average time from delivery to hysterectomy was significantly longer in the vaginal group than in the cesarean section group (169 min vs. 49 min; P

Objective To identify stem cells in uteri from the fetal to the postmenopausal period. Design Descriptive, controlled study. Setting Tertiary academic medical center. Patient(s) Forty archived uterine endometrial samples. Intervention(s) Immunohistochemistry with c-kit/CD117, CD34, bcl-2, and Ki67. Main outcome measure(s) Immunostaining. Result(s) C-kit/CD117, CD34, bcl-2, and Ki67 were consistently expressed in the stroma of the basalis layer. Bcl-2 was restricted to the fetal uterine endometrium. Conclusion(s) By studying the immunolocalization of stem cell markers (i.e., c-kit, CD34, and bcl-2), we found that stem cells are present continuously in the uterine endometrium from the fetal period. The cells seem to be located mainly in the stroma of the basalis and to be independent of hormonal regulation to avoid cyclic shedding. A small number of latent stem cells dormant in the stroma of the basalis were found to have the potential for mesenchymal differentiation.

To apply the new concept of a surgical therapeutic index to patients who suffer from stress urinary incontinence using the cure rate and complication rates of Burch colposuspension and to develop a preoperative counseling tool and objective comparison tool for the many surgical procedures that have been described.We reviewed the case histories of 22 patients between March 1999 and March 2000 who had stress urinary incontinence and underwent Burch colposuspension and in whom the diagnosis of stress urinary incontinence was made using urodynamic studies and the cotton-tipped-swab test. The surgical therapeutic index was then calculated using the median percentage cure rate and complication rate.The surgical cure rates were 81.8%, 81.8%, 90.9%, 90.9%, 95.4% and 95.4% at postoperative 1st, 3rd, 5th, 7th, 9th and 12th month, respectively, and the surgical complication rates were 69%, 36%, 31.5%, 27%, 22.5% and 27%. The surgical therapeutic indices for each postoperative period were 1.19, 2.27, 2.89, 3.37, 4.24 and 3.53, respectively. The surgical cure rate for Burch colposuspension in stress urinary incontinence was 95.4% 1 year after surgery, and the surgical therapeutic index 1 month and 1 year after surgery was 1.19 and 3.53, respectively.Burch colposuspension is a relatively effective and safe surgical procedure for managing stress urinary incontinence.

Pelvic organ prolapse (POP) is a process in which the pelvic contents, including the reproductive organ, bladder, rectum, and/or small intestines become herniated through defects in the vaginal wall. The pelvic organs are closely related to the urinary tract and thus various urinary functions can be affected. The purpose of this study was to evaluate the relationship between pelvic organ prolapse and lower urinary tract function by urodynamic studies. From March 1999 to May 2000, 40 patients with pelvic organ prolapse who underwent urodynamic studies (uroflowmetry, filling cystometry, urethral pressure profile) without barrier reduction of prolapse were analyzed. The majority of the cases of low grade POP involvedpatients with anterior wall prolapse, whereas the higher POP stages were more frequent in women with cervical cuff prolapse. Symptoms of stress urinary incontinence and hesitancy were more frequent in the patients with anterior wall prolapse. The urodynamic study showed a statistically significant increase in MUCP in patients with POP stage IV and the leading point of POP was cervical cuff. The subjective urinary symptoms of patients with POP appear to be less reliable as a diagnostic tool. POP had no adverse effect on the bladder storage function. However, POP affected the voiding function through an increase in MUCP, especially in patients with stage IV prolapse and when the leading point of POP was cervical cuff. Following the surgical correction of POP, an evaluation of the preoperative changes in the urodynamic study parameters should be performed.

To identify whether endogenous steroid hormone metabolism in women with pelvic organ prolapse (POP) is different from that in normal women and the relationship between endogenous steroid hormone metabolites and POP stage.Twenty postmenopausal women who were clinically diagnosed as having POP and 20 volunteer postmenopausal women without prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of endogenous steroids and degree of prolapse. Urinary profiles of endogenous steroids were assayed by gas chromatography/mass spectrometry.The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the body mass index was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and normal subjects, respectively. The number of patients were 4 at stage I, 4 at stage II, 6 at stage III and 6 at stage IV. 5-Androstene-3 beta,16 beta,17 beta-triol (5-AT), 11 beta-hydroxy an and 17 beta-estradiol were significantly increased in the POP group as compared with the control group (0.76 +/- 0.67 vs. 0.06 +/- 0.03 mumol/g creatinine, P = .002, 1.16 +/- 0.83 vs. 0.65 +/- 0.23 mumol/g creatinine, P = .04; and 15.08 +/- 9.81 vs. 8.53 +/- 6.19 mumol/g creatinine, P = .04). However, tetrahydrocortisone (THE) was significantly increased in the control group as compared with the patient group (9.80 +/- 6.21 vs. 5.22 +/- 4.89 mumol/g creatinine, P = .04). Androgen metabolites 5-AT and THE significantly correlated with the pelvic organ prolapse quantitation (POP-Q) stage (R = .418; P = .027; R = .46, P = .016). Among the estrogen metabolites, 17 beta-estradiol correlated with POP-Q stage, but not significantly so (R = .38, P = .05), and the 17 beta-estradiol/estrone ratio weakly correlated with stage (R = .14, P = .49).The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of POP.

To determine whether obesity increases risk of performing laparoscopic gynecologic surgery in Korean women.Retrospective analysis over 35 consecutive months (Canadian Task Force classification II-2).University-affiliated hospital.Two hundred seventy-seven women who underwent gynecologic laparoscopic surgery.Patients were analyzed by chart review.Obesity was defined as body mass index (BMI) 25 kg/m(2) or greater. Patients were categorized on the basis of BMI [weight (kg)/height(2) (m(2))] as obese (BMIor =25, 74 women) or nonobese (BMI25, 203). Each group was further divided into three subgroups according to operation difficulty. No significant differences in patient age, parity, menopausal status, medicosurgical illness, or history of intraabdominal surgery were apparent between groups, except for distribution of operation difficulty and adhesion grade; however, the adhesion grade was evenly distributed in each operation grade subgroup. In the two BMI groups, no significant differences were seen in surgical values (estimated blood loss, operating time, operative complications, postoperative complications, hospital stay, rate of conversion to laparotomy).Obesity had generally been thought to increase the risk of laparoscopic surgery. In our study in obese Korean women, however, it did not seem to increase the risk, and gynecologic laparoscopic surgery was performed safely.

A phenotypically normal couple was referred for cytogenetic evaluation due to three consecutive first-trimester spontaneous abortions. Chromosomal analysis from peripheral blood was performed according to standard cytogenetic methods using G-banding technique. The husband's karyotype was normal. The wife's karyotype showed a balanced complex chromosome rearrangement (CCR) involving chromosomes 9, 14, and 13. There were three breakpoints: 9p21.2, 14q21, and 13q12.2. The karyotype was designated as 46, XX, t (9;14;13)(p21.2;q21;q12.2). Fluorescence in situ hybridization (FISH) analysis with chromosome-specific libraries of chromosomes 9, 14, and 13 was performed to confirm this rare chromosome rearrangement. The result of FISH coincided with that obtained by standard cytogenetic techniques.

A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.

The purpose of this article is to assess the value of maternal serum triple marker screening of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) for the prenatal diagnosis of fetal chromosomal abnormalities in Korean women of advanced maternal age. Maternal sera were collected from 458 pregnant Korean women aged 35 between 15 and 20 weeks gestation before amniocentesis. A patient- specific second trimester risk for fetal Down's syndrome was calculated using the median values for AFP, hCG, uE3 and maternal age. Twelve fetal chromosomal abnormalities were identified. These included six cases of trisomy 21, one case of 46,XY/47,XY,+21, two cases of trisomy 18, one case of trisomy 13, and two cases of 45, X. A cutoff level of 1:200 detected 85.7% (6/7) of the cases of Down's syndrome and 20% (1/5) of the other aneuploidies, with a 27.3% false positive rate. However, a cutoff level of 1:270 did not result in any gains in detecting Down's syndrome or other aneuploidies at the expense of a false positive rate of 34.3%. Second trimester triple marker testing is an effective screening tool for detecting fetal Down's syndrome in Korean women > or = 35 years old. However, it is not an effective screening tool for non-Down's chromosomal abnormalities.

To investigate the relationship between low unconjugated estriol (uE3) levels in the second trimester and adverse perinatal outcomes in pregnancies without increased risk for Down's syndrome, 1,096 women under 35 years of age underwent a mid-trimester AFP-hCG-uE3 screening test between January 1995 and June 1998. Multiple pregnancies, maternal diabetes, smoking and elevation of AFP and hCG levels more than 2.0 multiple of median (MoM) were excluded from our study population. The results were divided into a low-uE3 group with uE3 levels at or below 0.75 MoM and a normal uE3 group with uE3 levels above 0.75 MoM. The risk for adverse pregnancy outcome was compared between the two groups and the role of low uE3 as a predictor of adverse pregnancy outcome was determined. The data were assessed using chi 2 or Fisher exact test and then logistic regression was used for the final analysis. The odds ratio (OR) and corresponding 95% confidence intervals (CI) were also calculated. Unconjugated E3 levels at or below 0.75 MoM was significantly associated with fetal growth restriction after adjustment for maternal age, weight, sampling weeks, AFP and hCG levels (OR 0.413, 95% CI 0.174-0.900; P = 0.035). Low uE3 levels in the second-trimester could help in the detection of fetal growth restriction by a low risk group in Down's syndrome. Careful gestational dating and serial clinical and sonographic assessment of fetal growth may be required for the clinician to manage these parturients.

Results The two groups had no difference with cardiovascular disease, history of cardiovascular disease, age, obesity, smoking, alcohol, hypertension, dyslipidemia, excluding diabetes. In the univariate logistic regression analysis, diabetes was associated with prevalence of overactive bladder than stress urinary incontinence. In the multiple logistic regression analysis, there was no factor which had influence on the status of urinary incontinence.

Copyright © 2012. Korean Society of Obstetrics and Gynecology Pelvic organ prolapse (POP) is a bulge or protrusion into or through the vagina of pelvic organs and associated vaginal segments [1]. With the aging population, POP is an increasingly common condition seen in women with a lifetime prevalence of 30% to 50% [1,2]. Symptomatic urogenital prolapse has been shown to have significant negative impacts such as those relating to the lower urinary tract, fecal incontinence, back pain, pelvic pain, defecatory problems, and dyspareunia. Management options for women with symptomatic POP include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. A patient’s perception of discomfort from POP and subsequent treatment will vary in relation to the stage of the POP and her ethnicity. Currently, many surgical approaches have been introduced to correct POP. The life time risk of undergoing surgery was estimated to be between 11% and 19%. However, none of these techniques is without risks for complications [2-4]. The prevalence of reoperaORIGINAL ARTICLE

목적 본 연구는 골반장기탈출증을 가진 환자들의 수술 전에 시행하는 요역동학 검사에서 수술 후 결과 및 합병증과 관련된 유용한 지표를 알아보고, 골반장기탈출증 교정술과 복압성 요실금교정술을 동시에 시행하는 경우 그 타당성을 입증하기 위한 목적으로 시행되었다. 연구방법 2006년 1월부터 2010년 12월까지 연세대학교 세브란스병원에 등록된 수술 전 요역동학 검사 및 골반장기탈출증 수술을 시행한 308명의 환자를 대상으로 후향적 코호트 연구를 시행하였다. 결과 수술 후 복압성 요실금의 유병률은 수술 전 요역동학 검사상 복압성 요실금을 진단받지 않아 골반장기탈출증 수술만 시행한 그룹 2 (3.1%, 4명)에서 복압성 요실금을 진단받아 요실금교정 수술을 동시에 시행한 그룹 1 (1.7%, 3명)보다 높게 나타났으나 통계적으로 유의한 차이는 없었다. 우리는 valsalva 유발 요누출 시 복압, 최대요도 폐쇄압, 최대요속, 최대요속 시 배뇨근압력, 최대 방광용적의 5가지 요역동학 검사 지표를 비교하였다. 수술 후 복압성 요실금에서는 최대요속 시 배뇨근압력(교차비, 1.029; 95% 신뢰구간, 1.001-1.038)이, 절박성 요실금의 경우 최대요도 폐쇄압(교차비, 0.969; 95% 신뢰구간, 0.942-0.996)이 통계적으로 유의한 지표로 나타났다. 결론 수술 후 합병증의 유병률에 중점을 두면, 동시 수술은 골반장기탈출증 수술만 하는 경우보다 더 나은 결과를 나타내며 수술 전 요역동학 검사에서도 의미 있는 지표가 있어 그 시행이 필요하다.

Gonadoblastoma and dysgerminoma developed in a 24-year-old phenotypic female patient with 46,XY pure gonadal dysgenesis. This patient presented with primary amenorrhea. Clinical characteristics showed a typical stigmata of gonadal dysgenesis: primary amenorrhea, sexual infantilism, a small uterus and bilateral streak gonads. A 46,XY karyotype was made by lymphocyte culture. The patient was counseled to undergo a prophylactic bilateral gonadectomy, but she refused. Three years and three months after the initial diagnosis she felt a growing pelvic mass. Bilateral gonadectomy and total hysterectomy were performed. Histological examination revealed gonadoblastoma and dysgerminoma on both gonads. After surgery the patient received radiation therapy and also was started on hormone replacement therapy. Two years and two months after treatment by surgery the patient is well and free of recurrence.

Purpose To evaluate the possible influence of G-->T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP). Materials and methods The study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer. Results Two groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57 on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p Conclusion The polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea.