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To describe the results of mesh exposure and prolapse recurrence of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrocolpopexy after more than 24 months of postoperative follow-up.A retrospective cohort study.A university hospital.Women with uterine prolapse who underwent vNOTES sacrocolpopexy with an ultralightweight polypropylene mesh between May 2018 and March 2020.vNOTES sacrocolpopexy.Of 57 women, 55 women (96.5%) were included in the final analysis. The mean follow-up duration was 35.5 ± 7.6 (24-46) months. The total incidence of mesh exposure was 3 of 55 (5.5%). The total incidence of prolapse recurrence was 3 of 55 (5.5%). The changes in the Pelvic Organ Prolapse Quantification System scores, including Aa, Ba, C, Ap, Bp, and total vaginal length values, showed significant improvement after surgery (p.05 for all).The study demonstrates that vNOTES sacrocolpopexy appears to be an effective option with low risks of mesh exposure and prolapse recurrence. Studies including more patients and longer follow-up periods should be performed before a clear conclusion can be reached.

Metastasis of renal tumor leads to poor prognosis of patients and increased therapeutic challenges. Nevertheless, the molecular mechanism underlying this clinical phenomenon remain to be elucidated. In this study, we identified 81 metastasis-related key genes and systematically explored their regulatory axis in renal tumor metastasis. In detail, both copy number variation and DNA methylation can partially affect the expressions of these key genes and showed differential distribution in the metastatic group. Path analysis modeling evaluated the potential overall causal effects from genomic level to phenotype and determined five statistical models. Additionally, the competing endogenous network revealed the post-transcriptional regulation of these key genes. Besides that, immune cell infiltration analyses suggested that some key genes may be involve in the regulation of tumor immunologic microenvironment. Furthermore, we built an effective machine learning model to predict renal tumor metastasis for clinical application. In summary, our research systematically described the potential biological roles and regulatory profiles of renal tumor metastasis-related genes, which may contribute to the improvement of clinical targeted therapy for renal tumor.

Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

To demonstrate the outcomes of pelvic reconstruction using Y-shaped mesh in patients with multiple-compartment pelvic organ prolapse via transvaginal single-port laparoscopy. We conducted a retrospective case series study. Patients diagnosed with severe multiple-compartment prolapse were enrolled between July 1, 2017, and March 31, 2020. Patients underwent transvaginal single-port laparoscopic pelvic reconstruction with Y-shaped mesh. Baseline data and perioperative results were collected. Patients were followed up with the POP-Q score, Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). T-test was used for statistical analysis. Operations were successful in all 93 patients without conversion or serious complications. Mean operative time was 132.70 ± 28.02 min and estimated blood loss was 110.65 ± 56.31 ml. VAS pain score was 2.91 ± 1.16 and cosmetic score was 9.20 ± 0.60. During 1–33 months of follow-up, no recurrence or mesh exposure was observed. Five patients suffered from de novo SUI, six had constipation, two had dyspareunia, and one had persistent pelvic pain. The pre- and postoperative Aa point was +2.13 ± 1.23 vs. −2.91 ± 0.28 (P < 0.05), C point was 2.63 ± 2.41 vs. -6.86 ± 0.69 (P < 0.05), and Ap point was −0.26 ± 1.79 vs. −2.97 ± 0.16 (P < 0.05). The PFDI-20 score was 76.81 ± 32.06 vs. 18.18 ± 20.25 (P < 0.05), while the PISQ-12 score was 34.30 ± 4.17 vs. 37.20 ± 2.60 (P < 0.05), which suggested significant improvements in both physical prolapse and quality of life after surgery. Transvaginal single-port laparoscopic pelvic reconstruction with Y-shaped mesh is a feasible, effective and safe treatment option for severe multiple-compartment prolapse. Patients may benefit from its mild pain level and good cosmetic effect as well as only minor mesh-related complications.

We describe the standard practice of presacral exposure during transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrocolpopexy in women with uterine prolapse. In this video, we demonstrate the key techniques: identifying the right hypogastric nerve (rHN) before opening the pelvic peritoneum; removing the fat and loose connective tissue along the rHN to expose the presacral fascia; incising the presacral fascia to reach the presacral space to expose the middle sacral vasculature and the anterior longitudinal ligament (ALL) of the first sacral vertebra (S1) below the promontory; attaching the mesh to the ALL to avoid vessel injury; and completing the peritonealisation.

The causes of recurrence of pelvic organ prolapse (POP) are sufficiently understood. However, few studies are available evaluating reoperation for recurrence of POP. This study evaluates the efficacy and safety of LeFort colpocleisis for recurrent POP. We reviewed data from patients with recurrent POP who underwent LerFort colpocleisis at a center between March 2012 and April 2017. Quality of life was assessed using the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) scores. The Patient Global Impression of Improvement scale (PGI-I) was used to assess self-perceived success and subjective measures of satisfaction. The Clavien-Dindo classification (CD) was used to assess the safety of the procedure. Chi-square and paired t-tests were used to compare the same patients before and after treatment in the follow-up. Twenty-six patients with recurrent POP after previous prolapse surgery underwent LeFort colpocleisis. Most of these patients had at least one comorbidity. The mean age (years) was 71.8 (7.3). The mean time to recurrent POP was 5.602 (3.643) years. There were no intraoperative bladder lesions or rectal lesions. At mean follow-up of 33.1 months, all patients had no recurrence (< stage 2), significant resolution of awareness of prolapse (P

Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse.Methods This is a retrospective study conducted for patients with severe prolapsed (≥stage 3) who underwent vNOTES USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES USLS.Results A total of 35 patients were included. The mean operative time was 111.7±39.4 minutes. The mean blood loss was 67.9±35.8 ml. Statistically significant differences were observed before and after vNOTES USLS in regard to Aa (+0.6±1.7 versus −2.9±0.2), Ba (+1.9±2.2 versus −2.9±0.3), C (+1.5±2.2 versus -6.9±0.9), Ap (-1.4±1.0 versus −3.0±0.1) and Bp (-1.1±1.4 versus −2.9±0.1) (P < 0.05 for all). The mean pre- and post-operative PFDI-20 score was 19.9±6.7 versus 3.2±5.4, and the PISQ-12 score was 24.8±2.3 versus 38.3±4.1 (P < 0.05 for both). During 1–13 months of follow-up, no severe complications or recurrence.Conclusions vNOTES USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety data. However, a study with a larger number of patients and a longer follow-up period should be conducted.

Objective:To investigate the bladder function recovery and quality of life (QOL) using nerve-sparing radical hysterectomy (NSRH) in treating early invasive cervical carcinoma.Methods:Subjects included patients who underwent radical hysterectomy by laparotomy for early-stage cervical carcinoma. Thirty-one patients were randomly assigned to 2 groups: group A, 15 patients who underwent NSRH; and group B, 16 patients who underwent classical radical hysterectomy. We observed the patients' general clinical information, surgical characteristics, postoperative vital signs, pathological findings, adjuvant therapies, and adverse effects. A urodynamic study was used to assess the bladder function. The patients' QOL was evaluated by Functional Assessment of Cervical Cancer Therapy (FACT-Cx).Results:Twenty-nine patients completed the study. No significant differences were found in age, body mass index, surgery characteristics, pathological findings, adjuvant therapies, and main adverse effects between the 2 groups (P > 0.05). The postoperative time of bladder function recovery in group A was obviously earlier than that in group B (P < 0.05). The urodynamic study showed that the extent of bladder function recovery in group A was better than that in group B (P < 0.05). The QOL in group A evaluated 1 year after operation was improved compared with that in group B (P < 0.05). The QOL analysis showed that group A did much better than group B in social and family life, emotional well-being, working status, and the symptom correlated with the operation (P < 0.05). No significant differences were found in basic bodily functions (P > 0.05).Conclusions:Nerve-sparing radical hysterectomy is a safe and reliable technique for early invasive cervical carcinoma. The postoperative bladder function recovery and the patients' QOL were improved after NSRH compared with the control group. Therefore, NSRH could be an alternative management to modify the classical surgery for cervical carcinoma with International Federation of Gynecology and Obstetrics stages IB1 to IIA.

To evaluate the clinical effects of the four surgical patterns of hysterectomy for uterine without prolapsis.Six hundred and eight patients with different gynecological diseases were operated upon by transvaginal hysterectomy (TVH, 78 cases), laparoscopically assisted vaginal hysterectomy (LAVH, 102 cases), classical intrafascial supracervical hysterectomy (CISH, 228 cases), or transabdominal hysterectomy (TAH, 200 cases). The clinical effects of these surgical patterns were analyzed.The success rate was 100% for TVH, 99.1% for CISH, and 98.0% for LAVH. The bleeding time and bleeding amount were significantly shorter or less in the TVH group than in the other 3 groups (P0.05), without a significant difference among the 3 groups. The percentage of analgesic use and postoperative morbidity were significantly higher in the TAH group than in the other 3 groups (P0.01), without a significant difference among the 3 groups. The days of hospitalization in the TAH group were significantly more than those in the other 3 groups (P0.05), without a significant difference among the 3 groups. The hospitalization expense was greater in the LAVH and CISH groups than in the TVH and TAH groups Except 2 cases of damages to the supravesical artery or ureter occurring during the early stage of CISH group, no surgical damage was found.Highly effective and with less injury, minimally invasive surgery in hysterectomy is worth spreading. LAVH and CISH apply in the cases with severe pelvic adhesion, with adhesive adnexa to be resected, or with adnexal cyst5 cm. CISH and TAH apply in the uterine larger than 16 weeks pregnant size. LAVH and TAH apply in the cases highly suspected as malignant diseases of uterine or endometrium.