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Abstract Overactive bladder (OAB) is a prevalent condition that substantially impairs quality of life. Obesity and overweight status are recognized as significant risk factors for OAB, but their influence on treatment efficacy is not well understood. This cross-sectional study was conducted from January 2023 to October 2024 at a tertiary care hospital. Women diagnosed with refractory OAB were classified into normal weight, overweight, and obese groups according to their body mass index (BMI). Treatment options included combination pharmaceutical therapy and Botulinum toxin injections. Outcomes were assessed using the Overactive Bladder Symptom Score (OABSS) and quality of life questionnaires, administered before and 12 weeks after treatment. A total of 197 women were included in the study. Normal weight women demonstrated significant improvements in OAB symptoms and quality of life following both combination therapy and Botulinum toxin injection. Conversely, overweight and obese women showed limited improvement with pharmaceutical therapy but responded better to Botulinum toxin injections. The findings suggest that Botulinum toxin injection may be a more effective treatment modality for overweight or obese women with refractory OAB compared to pharmaceutical therapy. Normal weight women might benefit from initiating treatment with combination medication therapy.

Abstracts: Mid urethral sling (MUS) surgery is a widely accepted and safe procedure performed for stress urinary incontinence (SUI) with excellent cure rate besides its minimal complications. There are various types of MUS which can be offered. In this review we collated published data on MUS surgery performed among Taiwanese women with SUI in search for the best techniques and its outcome. We reviewed 77 articles, searched using PubMed platform related to MUS in USI among Taiwanese women from 1998 to 2023.24 articles, total 2733 participants with at least 12 months follow up after MUS. Objective cure rate for trans-obturator tape (TOT), retropubic sling (TVT, tension vaginal tape), single incision sling (SIS) (Solyx) and SIS (MiniArc) are 80%–92%, 88%–94%, 87%–90% and 87%–91% respectively, while subjective cure is 60%–90% in TOT, 86% in SIS (Solyx) and almost 90% in SIS (MiniArc), Predictors for surgical failure analyzed in 5 papers of 1006 women. Identifiable risk includes low maximal urethral closure pressure, intrinsic sphincter deficiency, previous anti SUI or prolapse surgery, presence of neurogenic disease, constipation, decreased bladder sensation, age >65 years, high pad test, Diabetes, detrusor overactivity, post-menopausal, reduced postoperative urethral mobility and tape percentile. Subsequently we dwell into complications of each type of MUS. This review showed the evolution of MUS and its comparable therapeutic efficacy. However, with certain complication rates and predictors for failure. This will add value in preoperative counselling while taking into accounts patients’ factors in choosing the appropriate types of MUS. Future research is needed on long term effectiveness and risk of future recurrence.

ObjectiveIn addition to the well-established advantage that strengthened pelvic musculature increases urethral resistance in stress urinary incontinence (SUI) patients, intra-vaginal electrical stimulation (iVES) has been shown in preclinical studies to improve bladder capacity via the pudendal-hypogastric mechanism. This study investigated whether iVES also benefits bladder storage in SUI patients by focusing on compliance, a viscoelastic parameter critically defining the bladder’s storage function, in a clinical study. Moreover, the potential involvement of stimulation-induced neuromodulation in iVES-modified compliance was investigated by comparing the therapeutic outcomes of SUI patients treated with iVES to those who underwent a trans-obturator tape (TOT) implantation surgery, where a mid-urethral sling was implanted without electric stimulation.Patients and methodsUrodynamic and viscoelastic data were collected from 21 SUI patients treated with a regimen combining iVES and biofeedback-assisted pelvic floor muscle training (iVES-bPFMT; 20-min iVES and 20-min bPFMT sessions, twice per week, for 3 months). This regimen complied with ethical standards. Data from 21 SUI patients who received TOT implantation were retrospectively analyzed. Mean compliance (Cm), infused volume (Vinf), and threshold pressure (Pthr) from the pressure-flow/volume investigations were assessed.ResultsCompared with the pretreatment control, iVES-bPFMT consistently and significantly increased Cm (18/21; 85%, p = 0.017, N = 21) and Vinf (16/21; 76%, p = 0.046; N = 21) but decreased Pthr (16/21; 76%, p = 0.026, N = 21). In contrast, TOT implantation did not result in consistent or significant changes in Cm, Vinf, or Pthr (p = 0.744, p = 0.295, p = 0.651, respectively; all N = 21).ConclusionOur results provide viscoelastic and thermodynamic evidence supporting an additional benefit of iVES-bPFMT to bladder storage in SUI patients by modifying bladder compliance, possibly due to the potentiated hypogastric tone, which did not occur in TOT-treated SUI patients.Clinical trial registration:ClinicalTrials.gov, NCT02185235 and NCT05977231.

Objective: This study is aimed to compare the impact on bladder function and symptoms between robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM) in women with pelvic organ prolapse. Materials and methods: This prospective controlled study enrolled patients who received RSC or TVM at our hospital between March 2020 and June 2022. We compared preoperative and postoperative bladder function between two groups by using a questionnaire of lower urinary tract symptom (LUTs) for subjective assessment and urodynamic study for objective assessment. Results: A total of 60 patients were enrolled, of whom 30 received RSC and 30 received TVM. In LUTs analysis, the RSC group had a higher risk of de novo stress urinary incontinence than the TVM group (33.3% vs. 3.3%, p = .007). Urodynamic studies showed that both groups had a deterioration in maximal urethral closure pressure postoperatively (RSC: 56.9 ± 17.1 vs. 44.2 ± 15.5 cmH2O; and TVM: 61.2 ± 29.4 vs. 47.6 ± 19.7 cmH2O, p

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure–flow and pressure–volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019–December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure–volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder’s workload.

Objective: To investigate the current knowledge and practice patterns of obstetrics and gynecology (obs/gyn) physicians regarding the diagnosis, evaluation, and management of pelvic floor disorders (PFD) including stress urinary incontinence (SUI), pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS). The knowledge related to urodynamic study (UDS) is also evaluated. Materials and methods: A 25-item questionnaire was developed and sent for the physician members who participated in the annual congress of Taiwan Association of Obstetrics and Gynecology (TAOG). Response to the questionnaire was voluntary and anonymous. The questionnaires were collected prior to the ending of the congress. Results: 2000 copies of the questionnaire were sent and 1443 TAOG members responded. 86 poor respondents and 45 copies from urogynecologists were excluded. 1312 copies of the completed questionnaires were analyzed. 77.7% of the respondents were male physicians and 50.6% were over 55 years old. Up to 53.7% of the physicians had completed their residency training for over twenty years. Generally, around half of the respondents didn't reach well a level of well understanding regarding the various PFD. Most of the physicians would like to have further knowledge in urogynecological field for their daily practice. Regular delivery of updated information about various urogynecological diseases is mandatory. Conclusion: With the aging population worldwide, the need for management of PFD is increasing. The obs/gyn physician plays an important role in the primary evaluation and management of PFD. This study offered important information related to the current investigation, management, practice patterns and future expectation from obs/gyn physicians as references for the future continuing medical education programs.

Objective: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the “Childbirth Accident Emergency Relief Act” was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system. Materials and methods: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation. Results: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor–patient relationship by immediate care and assistance from medical institutions. Conclusion: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

Although trans-vaginal mesh (TVM) offers a successful anatomical reconstruction and can subjectively relieve symptoms/signs in pelvic organ prolapse (POP) patients, its objective benefits to the voiding function of the bladder have not been well established. In this study, we investigated the therapeutic advantage of TVM on bladder function by focusing on the thermodynamic workload of voiding. The histories of 31 POP patients who underwent TVM repair were retrospectively reviewed. Cystometry and pressure volume analysis (PVA) of the patients performed before and after the operation were analyzed. TVM postoperatively decreased the mean voiding resistance (mRv, p < 0.05, N = 31), reduced the mean and peak voiding pressure (mPv, p < 0.05 and pPv, p < 0.01, both N = 31), and elevated the mean flow rate (mFv, p < 0.05, N = 31) of voiding. While displaying an insignificant effect on the voided volume (Vv, p < 0.05, N = 31), TVM significantly shortened the voiding time (Tv, p < 0.05, N = 31). TVM postoperatively decreased the loop-enclosed area (Apv, p < 0.05, N = 31) in the PVA, indicating that TVM lessened the workload of voiding. Moreover, in 21 patients who displayed postvoiding urine retention before the operation, TVM decreased the residual volume (Vr, p < 0.01, N = 21). Collectively, our results reveal that TVM postoperatively lessened the workload of bladder voiding by diminishing voiding resistance, which reduced the pressure gradient required for driving urine flow.

Importance: It needs to be clarified whether trans-obturator tape (TOT)-enhanced urethral resistance could impact the voiding function.Objective: Although TOT has been well-recognized for enhancing urethral resistance to restore continence in stress urinary incontinence (SUI) patients, whether the bladder’s voiding functions adapt to the TOT-enhanced resistance has not been adequately investigated. This study thereby aimed to investigate whether TOT impacts the bladder’s thermodynamic efficacy during the voiding phase.Design: A retrospective analysis of urodynamics performed before and after TOT was assessed.Setting: A tertiary referral hospital in Taiwan.Participants: A total of 26 female SUI patients who underwent urodynamic investigations before and after TOT.Main outcomes and measures: The area enclosed by the pressure-volume loop (Apv), which represents the work performed by the bladder during voiding, in a pressure-volume analysis established by plotting the detrusor pressure versus intra-vesical volume was retrospectively analyzed. Paired Student’s t-tests were employed to assess the difference in values before and after the operation. Significance in difference was set at p < 0.05.Results: TOT increased Apv in 20 of 26 (77%) patients and significantly increased the mean Apv compared to the preoperative control (2.17 ± 0.18 and 1.51 ± 0.13 × 103 cmH2O-ml, respectively p < 0.01). TOT also increased the mean urethral resistance (1.03 ± 0.30 vs. 0.29 ± 0.05 cmH2O-sec/ml, p < 0.01) and mean voiding pressure (25.87 ± 1.72 and 19.30 ± 1.98 cmH2O p < 0.01) but did not affect the voided volume and voiding time. Moreover, the TOT-induced Apv increment showed a moderate correlation with the changes in urethral resistance and voiding pressure (both r > 0.5) but no correlation with changes in voided volume or voiding time. It is remarkable that the TOT-induced urethral resistance increment showed a strong correlation with changes in voiding pressure (r > 0.7).Conclusion and Relevance: The bladder enhances thermodynamic efficacy by adapting the voiding mechanism to increased urethral resistance caused by TOT. Further studies with higher case series and longer follow-ups should assess whether this effect could be maintained over time or expire in a functional detrusor decompensation, to define diagnostic criteria that allow therapeutic interventions aimed at its prevention during the follow-up.Clinical Trial Registration: (clinicaltrials.gov), identifier (NCT05255289)

Objective: Lower urinary tract symptoms (LUTS) are common in women. However, due to multifactorial etiologies, it is difficult to determine the prevalence, and functional changes with age. The aim of this study is to assess the effect of age on female LUTS, urethral and bladder function after their midlife. Materials and methods: This was an observational cohort study conducted at a tertiary referral medical center. Women who visited for bothersome LUTS, valid quality of life questionnaires, and urodynamic tests were recruited into the this study. Patients The patients were divided into four groups (69 years). All LUTS, and urodynamic parameters were reviewed, and compared between groups. Results: A total of 364 women were enrolled and analyzed. The urodynamic tests showed the that maximal cystometric bladder capacity, the average and maximal urine flow rate, and pressure of detrusor contractility at maximal urine flow rate were all significantly decreased with age. Besides, the voiding time, and post-voiding residual urine volume significantly increased with age. For urethral competence, the maximal urethral closure pressure deteriorated with age. All storage symptoms did not change with age, except for nocturnal enuresis. However, the effect of age on some voiding symptoms significantly increased with age, including straining to void, hesitancy, and intermittency. Conclusions: Lower urinary tract symptoms, bladder and urethral functions change with age, particularly voiding function. Physicians should be aware of the aging process when counseling and before implementing management strategies, particularly for older people.

Transvaginal mesh (TVM) insertion for the treatment of pelvic organ prolapse (POP) is significantly associated with lower failure rates, although its use remains controversial due to the potential risk of mesh-related complications. In this review, we collected the published literature regarding the use of TVM to treat POP in an attempt to assess both the efficacy and complications related to TVM usage in Taiwan.We searched 25 English language articles using PubMed related to TVM in Taiwan from 2010 to 2019. The present article focuses on the efficacy and complications of TVM and analyzes the data.There were 25 studies on TVM selected for this review. Regarding their success rate, 21 out of the 22 studies (95.5%) had more than a 90% objective success rate. Twenty studies (90.9%) had less than 10% major complications of TVM. Twenty out of the 25 studies (80.0%) had 5% or less mesh exposure. For self-cut TVM and the later single-incision TVM, both the complication rates and exposure rates decreased. The rate of de novo dyspareunia ranged from 2.6% to 14.3%, and the incidence decreased yearly from 2011 to 2019.This review showed both the high treatment efficacy and low complication rate of TVM usage for the short-term treatment of POP in Taiwan. However, a longer-term study is needed to draw a conclusion regarding the safety of this treatment.

Objective: The short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a condition-specific instrument used to evaluate sexual function in women with pelvic floor disorders. The traditional Chinese version of the PISQ-12 (CVPISQ-12) has been validated, however the cutoff score has yet to be determined. The aim of this study is to establish the cutoff score for the CVPISQ-12 and analyze the risk factors for female sexual dysfunction. Material and methods: A sub-analysis of data involving sexually active women who sought consultation for pelvic floor disorders at a medical center in 2016. Based on the known cutoff value of Female Sexual Function Index, the cutoff score of the CVPISQ-12 was analyzed using receiver operating characteristic (ROC) curve analysis. Other assessments included 1-h pad test and incontinence-related questionnaires using the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Results: ROC curve analysis showed a cutoff score of 32.5, with a sensitivity of 87% and specificity of 88%. The area under the ROC curve was 0.937 (p

Coronavirus disease 2019 (COVID-19) is highly contagious, and thus has become an emerging health crisis worldwide. The optimal strategies to prevent the spread of this disease are inconclusive, and therefore, the adopted measurements to combat COVID-19 varies in different countries. In mid-March and late-August 2020, we performed internet searches to collect relevant information, from sources such as the website of the World Health Organization. The epidemiological data of COVID-19 from several countries were collected and we found that Taiwan had a comparably successful story for combating the pandemic. As of mid-March, Taiwan had high rates of diagnostic testing (688.5 tests per million citizens) with a lower infection rate (49 cases, 2.1 cases per million people). As of late-August, there were 488 cases (20 cases per million people). Furthermore, Taiwanese government-guided strategies and hospital data were also reviewed. We summarized some important strategies to combat COVID-19, which include: (1) border control; (2) official media channel and press conferences; (3) name-based rationing system for medical masks; (4) TOCC-based rapid triage, outdoor clinics, and protective sampling devices; and (5) social distancing, delaying the start of new semesters, and religious assembly restriction. In conclusion, Taiwan had lower rates of COVID-19 compared with other countries, and Taiwan government-guided strategies contributed to the control of the disease's spread.

Background Coronavirus disease 19 (COVID-19) is a global health threat with significant medical, economic, social and political implications. The optimal strategies for combating COVID-19 have not been fully determined and vary across countries. Methods By the end of February 2020 in Taiwan, 2,150 patients received diagnostic COVID-19 testing and 39 confirmed cases were detected. This is a relatively lower rate of infection compared to other Asian countries. In this article, we summarize the epidemiological characteristics of the 39 infected patients as well as public and hospital responses to COVID-19. Results Thirty-nine COVID-19 cases and one death have been confirmed in Taiwan. Seventeen of these patients were infected by family members or in hospital wards, emphasizing how COVID-19 is mostly spread by close contact. We examined how hospital have responded to COVID-19, including their implementation of patient route control, outdoor clinics, hospital visit restrictions and ward and staff modifications. We also studied the public’s use of face masks in response to COVID-19. These strategies may reduce the spread of COVID-19 in other countries. Conclusion The emergence and spread of COVID-19 is a threat to health worldwide. Taiwan has reported lower infected cases and its strategies may contribute to further disease prevention and control.

Objective: A midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and Methods: We enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Results: We included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p

Objective: To report the objective outcome, subjective measurement of incontinence-related quality of life (QoL) for female urodynamic stress incontinence (USI) after transobturator sling surgery (TVT-O) and to evaluate the effects of surgical failure and complications on QoL. Materials and methods: We analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. Results: A total of 78 women were followed for a median of 13.5 months (range 12–15 months) after surgery. Within this group, 75 (96%) were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. Conclusions: TVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL. Keywords: Complication, Quality of life, Stress urinary incontinence, Transobturator tape, Urodynamic stress incontinence

Objective: Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient’s comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion. Materials and Methods: All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients’ characteristics, presenting symptoms, treatment and outcomes were collected from their medical records. Results: A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3–84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35–58.82; p

Coital incontinence is an under-reported disorder among women with urinary incontinence. Women seldom voluntarily report this condition, and as such, related data remains limited and is at times conflicting.To investigate the incidence and quality of life in women with coital incontinence and to determine associated predictors.This observational study involved 505 sexually active women attending the urogynecologic clinic for symptomatic urinary incontinence at a tertiary medical center. All of the patients were consulted about the experience of coital incontinence and completed evaluations including urodynamics, and valid questionnaires including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.Of these women, 281 (56%) had coital incontinence, while 224 (44%) did not. Among women with coital incontinence, 181 (64%) had urodynamic-proven stress incontinence, 29 (10%) had mixed incontinence, and 15 (5%) had detrusor overactivity. Only 25 (9%) sought consultation for this disorder before direct questioning. Fifty percent (84/281) of the women rarely or sometimes had incontinence during coitus, while 33% (92/281) often had incontinence, and 17% (48/281) always had incontinence. The frequency of coital incontinence was not different regarding the types of incontinence (p = 0.153). Women with mixed incontinence had the worst sexual quality of life and incontinence-related symptom distress. Based on univariate analysis, higher body mass index (OR 2.47, p = 0.027), and lower maximal urethral closure pressure (≤ 30 cmH2O) (OR 4.56, p = 0.007) were possible predictors for coital incontinence. Multivariate analysis showed lower MUCP was independently significant predictors (OR3.93, p = 0.042).The prevalence of coital intercourse in urinary incontinence women was high. Coital incontinence in these women was associated with abnormal urodynamic diagnosis and urethral dysfunction.

Objective: The aim of this study was to evaluate the feasibility and efficacy of laparoscopic surgery for patients with ectopic pregnancies in unusual locations. Materials and methods: This is a retrospective case series of 31 patients from 6 weeks to 10 weeks postmenstrual who were referred for diagnosis and treatment and suspected of having an unruptured cesarean scar pregnancy (CSP) or cornual pregnancy (CP). The diagnosis was confirmed with transvaginal ultrasound, and all of the patients underwent laparoscopic management. Results: A diagnosis of CSP or CP was confirmed in all of the patients during the laparoscopic procedure. None of the patients required conversion to laparotomy. The total operative time ranged from 40 minutes to 120 minutes. The total blood loss was limited, ranging from 30 mL to 200 mL. All of the women tolerated the operation well and had uneventful recoveries. Conclusion: When performed by a well-trained gynecologist, laparoscopy appears to be a reasonable alternative for the treatment of unruptured CSP or CP.

Objective: Prosima (Ethicon, Somerville, NJ, USA) is a novel procedure for treating pelvic organ prolapse (POP) that uses nonanchored vaginal mesh. However, nonfixation of the mesh may limit effectiveness. The aim of this study was to evaluate the safety, efficacy, and limitations of this procedure. Materials and methods: From January 2011 through to December 2011, 52 patients with symptomatic POP ≥ Stage 2 undergoing the Prosima procedure at a tertiary hospital were enrolled consecutively in this prospective study. A Data and Safety Monitoring Plan (DSMP) was developed to assess the results. Results: Fifty of the 52 patients (96%) attended the 3–6-month postoperative assessment. Symptom and quality-of-life scores were found to have improved significantly after surgery (p

Objective: The goal of this study is to assess the feasibility of simple extrafascial hysterectomy for patients with clinical stage IA1 cervical squamous cell carcinoma (SCC) after once conization regardless of any pathologic risk factor. Materials and Methods: All cases with T1a1, SCC lesion in their cervical cone specimen were retrospectively collected after chart and pathology review for the period between January 2002 and December 2009. All cases underwent subsequent hysterectomies within a month of diagnosis. Pathologic risk factors of conization, surgical scale of hysterectomy, residual lesion of the uterus, necessity of adjuvant radiation therapy, complications, and survival were analyzed in this study. Results: Eighty-one cases were identified from the registry. Most were managed by simple hysterectomy (SH; 60/81, 74%), and the remaining 21 cases underwent modified radical hysterectomy (MRH). All cases without any risk factors in their cone specimens demonstrated residual lesion ≤T1a1 in both SH and MRH groups, whereas those with existing risk factor were confirmed positive for residual lesions ≤T1a1 [SH, 95.8% (46/48) vs. MRH, 75% (15/20)]. Only two cases in the SH group received adjuvant radiation for residual lesions >T1a1. On the contrary, 15 cases in the MRH group can receive smaller scale surgery than MRH. All cases were recurrence-free without any permanent treatment-related complication by the end of the study. Conclusion: Extrafascial simple hysterectomy may be recommended for clinical T1a1 cervical SCC regardless of the pathologic risk factor.

Objective: To estimate the safety and effectiveness of unidirectional knotless barbed suture compared to the traditional suture for repair of uterine wall defects through myomectomy via mini-laparotomy. Materials and Methods: This was a prospective clinical study performed by a single surgeon in a medical center. Sixty-eight women with symptomatic myoma were enrolled. Their uterine wall defects were repaired either by unidirectional knotless barbed suture (Group A) or by traditional suture (Group B). The surgical time, intraoperative blood loss, and number of myomas in the two groups were analyzed by two-sample t test. Results: Surgical time required from skin incision to complete closure was significantly lower in Group A than in Group B (50.2 ± 16.49 vs. 69.1 ± 25.33 min) (p = 0.0008). The intraoperative blood loss was also lower in Group A (mean, 260.9 mL; range, 20–850 mL) than in Group B (mean, 394.7 mL; range, 50–2200 mL) but not statistically significant. Conclusion: The unidirectional knotless barbed suture may facilitate the repair of uterine defects during mini-laparotomy myomectomy by significantly lowering operative time. It may also reduce the intraoperative blood loss.

Objective: To assess the efficacy of hydrodistention (HD) followed by bladder training (BT) versus HD alone in patients with interstitial cystitis (IC). Methods: A total of 70 patients with IC were included and randomly assigned to two groups: one treated with HD (HD group) and the other treated with HD plus BT (HD plus BT group). Each patient was followed up using a weekly diary for 8 weeks after HD and monthly thereafter for 6 months after HD. Evaluation parameters included age, duration of IC in years, how many doctors visited before treatment, urgency, bladder pain, daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day. Results: Age, duration of IC in years, doctors visited before treatment, and voiding profiles of patients before treatments between the two groups did not show statistical significance. However, at 24 weeks after HD, the proportions of urgency, and bladder pain of the HD group versus the HD plus BT group were 43.48% versus 10.71% (p = 0.008), and 34.78% versus 14.29% (p = 0.086), respectively. Concurrently, the mean ± standard deviation of daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day of the HD group and HD plus BT group are 212.2 ± 114.2 mL and 300.1 ± 90.2 mL (p = 0.005), 276.8 ± 113.0 mL and 360.0 ± 129.6 mL (p = 0.018), 8.2 ± 3.2 and 6.2 ± 1.4 (p = 0.010), and 2.2 ± 1.2 and 1.5 ± 0.7 (p = 0.019), respectively. Conclusion: HD followed by BT produced a statistically significantly better effect than HD alone in the treatment of patients with IC.

Objective: Coexistence of Klinefelter syndrome and holoprosencephaly (HPE) is rare. We report alobar HPE, cebocephaly, and micropenis in a Klinefelter fetus of a mother with type 2 diabetes mellitus with obesity and poor metabolic control. Case Report: A 38-year-old woman was referred for therapy of type 2 diabetes mellitus with poor glycemic control at 24 weeks of gestation. On examination, she had a body height of 162 cm and a body weight of 105 kg. She had been treated with oral medication for diabetes mellitus for 4 years with poor maternal metabolic control. She had prominent glucosuria and glycemia. Her hemoglobin A1c was 7.5% (normal range: 3.4–6.1%), and the fasting glucose level was 141 mg/mL (normal range: 70–99 mg/mL) during this visit. Her husband was 46 years old. Prenatal ultrasound revealed a singleton fetus with fetal biometry equivalent to 24 weeks, alobar HPE, cebocephaly, and micropenis. As a result of poor maternal heath and fetal anomaly, the parents elected to terminate the pregnancy, and a 986-g male fetus was delivered with hypotelorism, HPE, cebocephaly, micropenis, and cryptorchidism. Cytogenetic analysis of the cord blood revealed a karyotype of 47,XXY. The parental karyotypes were normal. Polymorphic DNA analysis revealed a paternal origin of the extra X chromosome. Molecular analysis of the HPE genes of SHH, ZIC2, SIX3, and TGIF revealed no mutations. Conclusion: Prenatal diagnosis of HPE should include a biochemical examination to identify metabolic factors such as maternal diabetes, and preventive management should be considered in subsequent pregnancies to achieve good control of maternal diabetes.

Interstitial cystitis (IC) has been described as a chronic debilitating sterile inflammatory multifactorial bladder syndrome of unknown etiology. IC is characterized by bladder pain (or suprapubic pain) associated with urgency, urinary frequency, and nocturia. Because the pathogenesis of IC remains unclear, it is still an enigma and represents a diagnostic and therapeutic challenge. The diagnosis of IC remains unclear and is based on exclusion of other diseases. Consequently, IC has usually been underdiagnosed, and the consensus on best available treatment for the disease is lacking. The current goal for the treatment of IC is usually symptomatic relief, and treatment protocols are based on empiricism. Multiple forms of therapy are available, and most patients can be managed conservatively. Nevertheless, the efficacy of most treatments is short term. This review article gives an overview of the available treatments for IC.

Background: Surgical staging using transperitoneal laparoscopic para-aortic lymph node dissection is an option for the pretreatment evaluation of locally advanced cervical cancer; however, its role for elderly patients (≥ 65 years) remains unclear. Methods: Elderly patients with stage IIB–IVA cervical squamous cell carcinoma who underwent transperitoneal laparoscopic para-aortic lymph node dissection (TLSPAD) before radiation therapy (RT) or concurrent chemoradiation therapy (CCRT) during 1993–2001 were included in this retrospective study. The control group included elderly patients with the same clinical conditions, except they did not undergo TLSPAD. Survival and major bowel complications were compared between these two groups. Results: The TLSPAD group consisted of 19 patients (median age: 72 years; range: 65–78 years), and the control group consisted of 37 patients (median age: 73 years; range: 65–86 years). In the TLSPAD group, para-aortic lymph node metastasis was noted in 15.8% of patients and another 15.8% were unable to have their lymph node laparoscopically retrieved. Although patients in the TLSPAD group demonstrated a higher rate of receiving CCRT than the control group, neither failure-free survival nor overall survival were statistically different between these two groups. Subsequent major bowel complications (e.g., fistula, bowel obstruction) were more frequent in the TLSPAD group (36.8%) than the control group (10.8%; p=0.032). Conclusion: In elderly patients with locally advanced cervical squamous cell carcinoma, pretreatment TLSPAD might not improve survival and might be associated with an increased risk of subsequent major bowel complications. Extraperitoneal laparoscopic para-aortic lymphadenectomy might be a better method for the pretreatment surgical staging of elderly patients because it could potentially result in fewer bowel complications.

Objective: To investigate the effect of hysterectomy on urinary incontinence (UI) in Taiwanese women aged 60 or older. Materials and Methods: A nationwide epidemiologic study was conducted and a total of 2410 women were selected by a multistage random sampling method. Face-to-face interviews with 1517 women were completed. The prevalence of UI by hysterectomy, route of hysterectomy, medical reasons for hysterectomy, and years after hysterectomy were assessed by frequency and Pearson’s χ2 test using a significance level of less than 0.05. Results: The prevalence of hysterectomy in Taiwanese women aged 60 or older was 8.83% (134/1,517). Hysterectomy is a risk factor of UI (p=0.003) with the prevalence of UI estimated to be 42.38% (59/134) and that of nonhysterectomy group to be 27.96% (425/1380). Route of hysterectomy (p=0.825), reason for hysterectomy (p=0.060), and how many years after hysterectomy has been performed (p=0.562) were not associated with deteriorating symptoms of UI. Conclusion: There is a high prevalence of UI among women who have performed hysterectomy, but there is no significant relationship between UI and route of hysterectomy, reason for hysterectomy, including cervical cancer and uterine prolapsed, or year after hysterectomy.

Background: Villoglandular adenocarcinoma (VGA) of the uterine cervix is a relatively rare subtype of endocervical adenocarcinomas that often occurs in early reproductive women. Methods: Clinical cases were retrospectively collected from the cancer registry systems at Mackay Memorial Hospital (Taipei, Taiwan). Clinical histories on the subjects were extracted directly from chart review of records of clinic visits. Results: The mean age of 12 subjects was 42 years, with 10 and 2 subjects clinically staged as IB1 (10 of 12) and IA2 (2 of 12), respectively, for the period between January 1, 1996, and December 31, 2007. Eleven subjects had classical Type III radical hysterectomy with or without bilateral salpingo-oophorectomy plus bilateral pelvic lymphadenectomy, and one received pelvic and para-aortic lymphadenectomy plus postoperative adjuvant treatment of weekly cisplatin concurrent with radiotherapy. Only one subject had confirmed pelvic lymph nodes metastases. Nine subjects had pure histologic type and others had mixed histologic type of VGA. Only one subject had a recurrence but was still alive. Most subjects were long-term survivors (greater than 5 years) (10 of 12). Conclusion: In conclusion, this study confirms the young age of subjects with VGA and reemphasizes the difficulties in the diagnosis of VGA. Because the current management strategy renders good tumor control in young subjects with early-stage VGA, we would suggest that similar treatment should be considered for elder subjects with this rare category of cervical malignancy. Our experience shows that the primary management of subjects with early-stage VGA (International Federation of Gynecology and Obstetrics Stages IA2 to IIA1) is classical Type III radical hysterectomy plus salpingo-oophorectomy with bilateral pelvic lymphadenectomy at MMH. We hope our 12-case experience may contribute to the clinical decision making for subjects with this disease.

Objective: To assess the associated risk factors for daytime urinary frequency among Taiwanese women aged = 60 years. Materials and Methods: Daytime urinary frequency, defined by the International Continence Society, and its associated problems were evaluated, and medical history and sociodemographic variables were recorded. A total of 2,410 women were selected by a multistage random sampling method. The factors were assessed by frequency and Pearson's ?2 test using a significance level of < 0.05. Results: A total of 621 women of those initially selected in the study died before completion of this study. Face-to-face interviews with 1,521 women were completed, producing a response rate of 85.0% (1,521/1,789 women). The prevalence of daytime urinary frequency was significantly related to body mass index (p = 0.018), diabetes mellitus (p = 0.017), hypertension (p = 0.015), previous drug allergy (p = 0.003), smoking (p = 0.005), hormone therapy (p = 0.019), parity (p = 0.019), and urinary incontinence (p = 0.000). However, there was no association between urinary frequency and previous gynecologic surgery, hysterectomy, alcohol consumption, marital status, childbirth, and age of menopause. Conclusion: The results of this study showed a relatively high risk of urinary frequency development in patients with urinary incontinence, diabetes mellitus, hypertension, obesity, and smoking that are preventable, modifiable, or controllable. Better quality of health education for these women, drawing their attention to the associated factors, may have an impact on the prevalence of urinary frequency.

Objective: To evaluate the demographics, clinical presentations, laboratory findings, and maternal and fetal outcomes in patients with acute fatty liver of pregnancy. Materials and Methods: A retrospective review was conducted of the records of pregnant patients with a diagnosis of acute fatty liver in a tertiary medical center over a 22-year period. Results: Eighteen patients with acute fatty liver of pregnancy were recruited, all of whom developed the disease in the third trimester. Eleven women (61%) were primigravid and four (22%) had twin pregnancies; six (33%) were diagnosed antepartum, and the other 12 (67%) were diagnosed postpartum. There were two maternal deaths (11%) and four fetal deaths (18%). The most common complications apart from severe liver dysfunction were acute renal failure (83%), hypoglycemia (61%), and disseminated intravascular coagulation (61%). Conclusion: Women who become acutely ill during the third trimester of pregnancy should undergo tests for acute fatty liver of pregnancy, including laboratory tests for assessing liver function and coagulation profile.

Objective: To evaluate the prevalence of daytime urinary frequency among Taiwanese women aged 60 years and older. Materials and Methods: There were an estimated 1.25 million female residents aged 60 years and over in Taiwan in 2000. A sample of 2,410 women was selected using a multistage random sampling method. Face- to-face visits with 1,523 women were completed by trained professional interviewers within 3 months of the subjects' selection. Questions about urinary frequency and other lower urinary tract symptoms, sociodemo-graphics, reproduction, and medical and surgical histories were recorded. The factors were assessed by frequency and Pearson's χ2 test using a significance level of < 0.05. Results: The prevalence of urinary frequency in Taiwanese women aged 60 years and over was 18.8% (286/1,521). The response rate was 85.0% (1,521/1,789). For those who complained of frequency, 45.8% voided 8–15 times a day, 37.8% voided 16–23 times a day, 1.7% voided 24–31 times and a day, and 14.7% voided more than 31 times a day. The prevalence of urinary frequency was significantly associated with age (p < 0.001). Conclusion: Urinary frequency is a common symptom in menopausal women and is significantly related to age. More than half of the women interviewed experienced intervals of < 1 hour between visits to the restroom during the day.

Objective: To evaluate the safety and efficacy of a microwave endometrial ablation (MEA) procedure to treat patients with menorrhagia after endometrial curettage but without medical pretreatment. Materials and Methods: From February to September 2001, 19 eligible and consenting premenopausal women with menorrhagia underwent endometrial curettage, immediately followed by MEA. No medical pretreatment with gonadotropin-releasing hormone (GnRH) analogues or danazol was given for endometrial preparation. The severity of menorrhagia was assessed using the menstrual score. The patients were followed up for at least 3 years. Results: Of the 19 women, 17 had completed at least 3 years' follow-up. Fourteen patients (82%) were satisfied with the posttreatment menstrual status, comparable with those patients receiving medical pretreatment of other studies (78–94%). The mean menstrual score was 11.8 before treatment and 1.95, 2.25, 2.2, 2.1 and 2.1 at 3, 6, 12, 24 and 36 months posttreatment, respectively. Of the 12 patients who complained of dysmenorrhea before surgery, six (50%) showed improvement. Three patients had hysterectomy; they all had adenomyosis and dysmenorrhea which did not respond to medical analgesics. Conclusion: MEA preceded by endometrial curettage instead of hormonal pretreatment had results comparable to those of other studies in which the patients received hormones for 4–6 weeks before MEA. Endometrial curettage is an alternative to drug pretreatment.

Objective: To evaluate the clinical value of human papillomavirus (HPV) DNA testing (Hybrid Capture II) in predicting which women with mild cervical cytologic abnormality (atypical squamous cells of undetermined significance [ASCUS] or low-grade squamous intraepithelial lesions [LSIL]) are most likely to have high-grade cervical intraepithelial neoplasia (CIN). Materials and Methods: A total of 266 women with mildly abnormal Papanicolaou (Pap) smear results (160 with ASCUS and 106 with LSIL) concurrently underwent Hybrid Capture II testing, repeat Pap smear, and colposcopy-directed biopsies. Results: Overall, the underlying prevalence of histologically confirmed CIN2/3 was 16.9% (27/160) in women with ASCUS and 29.2% (31/106) in those with LSIL. High-risk HPV DNA was detected in 55% and 88.7%, respectively. The sensitivity of CIN2/3 detection by HPV DNA was 96.3% (26/27) and 100% (31/31) among women with ASCUS and LSIL, respectively. Conclusion: A positive baseline HPV test in women with ASCUS or LSIL is clinically equivalent, requiring colposcopic examination and denoting an approximately one-third chance of having CIN2/3. Among women with ASCUS, a negative HPV test strongly indicates that the patient is free of CIN2/3, which should minimize a patient's anxiety and unnecessary colposcopic examinations.

Objective: To analyze the obstetric and gynecologic history of women with uterine rupture during pregnancy, and examine maternal and perinatal morbidity and mortality outcomes after uterine rupture. Materials and Methods: A retrospective review of patients with rupture of the gravid uterus at Mackay Memorial Hospital, for the period between January 1984 and September 2003, was undertaken. The records of these patients were studied with regard to previous cesarean section, the use of uterine stimulants, the use of instruments in delivery, clinical features, treatment modality, and maternal and fetal morbidity and mortality. Results: A total of 21 cases of rupture of the gravid uterus were found. The prevalence of uterine rupture was 1 in 6,056 deliveries. The most common risk factor was previous cesarean section scar (48%). Fetal distress (43%) and postpartum hemorrhage (24%) were the two most common manifestations of ruptured uterus. Fourteen cases were term pregnancies. However, seven cases presented before term, including one in the first trimester, two in the second trimester, and four in the early third trimester. There was only one maternal death (5%), but five cases (24%) presented with intrauterine fetal demise. Conclusion: Physicians should be alert to the possibility of uterine rupture at all stages of pregnancy. The ability to recognize the various signs of a possible rupture event, such as fetal distress, maternal pain, or hypotension, and then to address the situation immediately, is critical to a good outcome.

Objective: Lower urinary tract symptoms (LUTS) are highly prevalent, and increase significantly as age advances. However, whether LUTS predispose women to more admissions and/or operations has not been well reported. We studied the risks of admissions among women with or without LUTS. Materials and Methods: Based on a nationwide population-based database, the risks of admissions among women of National Health Insurance enrollees with at least one outpatient service claim, with the coding of LUTS during 2001–2004, were compared with those without LUTS for the following 2 years. Results: Total admission rates (per 1000 person-years) were significantly higher in women with LUTS, as compared with the controls; 309.7 versus 173.6, respectively. The adjusted incidence rate ratio (IRR)=1.79 and 95% confidence interval (CI)=1.63–1.95. The adjusted IRRs=1.78 (95% CI=1.56–2.03), 2.02 (95% CI=1.75–2.33), 1.53 (95% CI=1.29–1.81), 2.09 (95% CI=1.13–3.86), 1.40 (95% CI=1.21–1.63), and 4.48 (95% CI=3.37–5.96) in the departments of internal medicine, gynecology, surgery, psychiatry, orthopedics and urology, respectively; all p values < 0.05. Meanwhile, the operation rates were also higher in women with LUTS, as compared with controls, in total and in the departments of gynecology, orthopedics, and surgery; all p values < 0.05. Conclusions: The preliminary data showed a higher risk of admissions and operations among women with LUTS. The possible explanations included: more co-morbidities, a poorer quality of life, a lower threshold of admission, or potential early symptoms of either medical or surgical conditions. This highlights a broad understanding of multiple and overlapping systems in LUTS.

Objective: Angiomyxoma is a rare tumor of the umbilical cord and is associated with increased perinatal morbidity and mortality. However, the management of these pregnancies in the third trimester is not clearly defined. We present a case of an angiomyxoma of the umbilical cord diagnosed in the second trimester, and highlight the contribution of color Doppler imaging to the early diagnosis of cord anomalies. Case Report: A 29 year-old, gravida 3, para 1, woman had elevated maternal serum a-fetoprotein at 17 weeks of gestation. Ultrasonography at 19 weeks showed a placental mass measuring 2 × 1.5 cm over the insertion site of the umbilical cord. The mass slowly enlarged in size, from 2.72 × 1.09 cm at 21 weeks to 3.9 × 3.9 cm at 33 weeks. Beyond the cord lesion, the development of the fetus was unremarkable. At 38 weeks, a normal female infant was delivered by cesarean section due to previous history of cesarean section. A mass measuring 3.2 cm was found near the insertion site of the umbilical cord to the placenta. Pathologic examination showed proliferation of thin-walled vessels embedded in a myxoid stroma, and the endothelial cells were positive for factor VIII-related antigen. Conclusion: Angiomyxoma is a rare tumor of the umbilical cord and should be considered when using prenatal ultrasound for detection of cystic lesion. Color Doppler imaging can easily and instantly detect perfusion through the umbilical vessels and assess cardiac function. In our case, application of color Doppler imaging for monitoring the relationship between the tumor and the adjacent vessels allowed the fetus to be delivered at term with a favorable outcome.

Objective: We present a case of bladder calculus formation and recurrent urinary stress incontinence following Stamey's operation. Case Report: A 59-year-old woman had stress urinary incontinence and underwent Stamey's operation (needle suspension of the bladder neck). However, there was no significant postoperative improvement. Ten years later, a bladder calculus and a non-absorbable suture stitch were found incidentally during cystocopy prior to surgical tension-free vaginal taping. The calculus and the suture stitch were removed during the procedure. The patient's urinary incontinence improved significantly and she had no further events after discharge. Conclusion: The present report demonstrates that recurrent urinary stress incontinence may be associated with injury to the lower urinary tract during anti-incontinence surgery.

Objective: In roughly 50% of all patients with meconium peritonitis, there is no evidence of primary obstruction of the bowel. We report a case of maternal methamphetamine and heroin abuse complicated by fetal meconium pseudocyst without a definite intestinal obstructive lesion. We discuss the correlation between the presence of meconium peritonitis and prenatal exposure to methamphetamine. Case Report: A 19-year-old, gravida 2, para 0, abortus 1, woman had abused illegal drugs, including methamphetamine and intravenous heroin. Suffering from withdrawal symptoms, she was taken to a shelter where she was diagnosed with a pregnancy of 26 weeks' gestation. The patient underwent cesarean section at 34 weeks due to preterm labor and fetal malpresentation. A boy weighing 2,474 g was born, but had to be intubated and admitted to the intensive care unit because of a distended abdomen and respiratory distress. A laparotomy performed on the second day of life revealed a large calcified pseudocyst associated with two perforations of the distal jejunum. A segmental resection of the jejunum with primary anastomosis was performed. The infant recovered well after the operation and was discharged 65 days after birth. Conclusion: Since methamphetamine is a powerful α-adrenergic stimulant and induces the release of catecholamines from adrenergic synapses, it can cause powerful vessel constriction. Prenatal exposure to methamphetamine can cause disruption of mesenteric blood flow with transmural necrosis of the bowel, resulting in bowel perforation and meconium peritonitis.