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Lo TS, Harun F, Chua S, Shen YH, Tan YL, Hsieh WC. Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up. J Formos Med Assoc 2024; 123:331-339. [PMID: 37996329 DOI: 10.1016/j.jfma.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND PURPOSE We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. METHODS This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. RESULTS Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. CONCLUSION The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC.
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Yu-Hua Shen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, KPJ Healthcare Group, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, ROC; Chang Gung University, School of Medicine, Taoyuan, Taiwan, ROC
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Post WM, Widomska J, Grens H, Coenen MJH, Martens FMJ, Janssen DAW, IntHout J, Poelmans G, Oosterwijk E, Kluivers KB. Molecular Processes in Stress Urinary Incontinence: A Systematic Review of Human and Animal Studies. Int J Mol Sci 2022; 23:ijms23063401. [PMID: 35328824 PMCID: PMC8949972 DOI: 10.3390/ijms23063401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common and burdensome condition. Because of the large knowledge gap around the molecular processes involved in its pathophysiology, the aim of this review was to provide a systematic overview of genetic variants, gene and protein expression changes related to SUI in human and animal studies. On 5 January 2021, a systematic search was performed in Pubmed, Embase, Web of Science, and the Cochrane library. The screening process and quality assessment were performed in duplicate, using predefined inclusion criteria and different quality assessment tools for human and animal studies respectively. The extracted data were grouped in themes per outcome measure, according to their functions in cellular processes, and synthesized in a narrative review. Finally, 107 studies were included, of which 35 used animal models (rats and mice). Resulting from the most examined processes, the evidence suggests that SUI is associated with altered extracellular matrix metabolism, estrogen receptors, oxidative stress, apoptosis, inflammation, neurodegenerative processes, and muscle cell differentiation and contractility. Due to heterogeneity in the studies (e.g., in examined tissues), the precise contribution of the associated genes and proteins in relation to SUI pathophysiology remained unclear. Future research should focus on possible contributors to these alterations.
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Affiliation(s)
- Wilke M. Post
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Joanna Widomska
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Hilde Grens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Marieke J. H. Coenen
- Radboud Institute of Health Sciences, Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Frank M. J. Martens
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Dick A. W. Janssen
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Joanna IntHout
- Department of Health Evidence, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
- Correspondence:
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Immunochemical and urodynamic outcomes after polypropylene mesh explant from the pelvic wall of rats. Int Urogynecol J 2021; 33:1839-1848. [PMID: 34037814 DOI: 10.1007/s00192-021-04842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To analyze the immunochemical and urodynamic outcomes after partial versus complete excision of transvaginal polypropylene mesh (PPM) from pelvic walls of rats. METHODS Forty-eight female Sprague-Dawley (SD) rats were randomly distributed into seven groups: control, mesh total removal 60 days (M-T 60D), mesh total removal 180 days (M-T 180D), mesh partial removal 60 days (M-H 60D), mesh partial removal 180 days (M-H 180D), sham 60 days (Sham 60D), and sham 180 days (Sham 180D). In the mesh groups, PPM was inserted and partially (0.3 × 0.3 cm) or completely removed 30 days later. In the Sham group, the space between the vagina and bladder was dissected without placing or removing the synthetic mesh at day 1 and day 30 later. Urodynamic studies, immunochemical analysis, and Western blot were done at days 60 and 180. RESULTS The M-T 60D voiding pressure was significantly decreased compared to the Sham 60D and M-H 60D. The voiding interval of M-T 60D was significantly shorter than that of M-H 60D. In the M-T 60D and M-T 180D groups, the leak point pressure was significantly less than in their corresponding sham groups. IL-1 and TNF-α were significantly more intense in M-T 60D compared to M-H 60D and Sham 60D. NGF was significantly greater in M-T 60D compared to Sham 60D. There were no significant differences in MMP-2 and CD-31s throughout the group. CONCLUSION Total mesh excision incites a host inflammatory response and transitory lower urinary tract dysfunction. Despite the good outcomes after total excision, the invasiveness and surgical risk associated with repeated procedures should not be underestimateded.
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Lo TS, Lin YH, Chua S, Chu HC, Uy-Patrimonio MC, Ng KL. Immunochemical analysis on polypropylene mesh: does mesh size make a difference? Int Urogynecol J 2020; 32:47-55. [PMID: 32651643 DOI: 10.1007/s00192-020-04399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study is to demonstrate the impact of the size of implanted mesh in relation to its immunohistochemical reaction implanted into animal models. METHODS An experimental study utilizing 54 female Sprague Dawley (SD) rats was divided into five groups: control, sham, and study groups (mesh-small [M-S], mesh-medium [M-M], mesh-large [M-L]). The M-S group used a mesh size of 0.2 × 0.2 cm, the M-M group a mesh size of 0.5 × 0.5 cm, and the M-L a mesh size of 0.7 × 1.0 cm. The sham group underwent vaginal dissection with no mesh implantation. The rats were sacrificed using isoflurane overdose on days 7 and 30. The mesh with the surrounding vaginal and bladder wall tissues were removed and processed for histochemical and western blot analysis. RESULTS There is a significant increase in IL-1 and TNF-α immunoreactivity in the M-M and M-L groups on day 7 when compared with the sham group with p values of 0.001 and < 0.001 respectively. M-L showed significantly higher immunoreactivity to TNF-α persisting until day 30. All study groups presented a significantly higher immunoreactivity to MMP-2 and NGF on day 7. However, reactivity to NGF does not persist to day 30 in all groups. Immunoreactivity to CD 31 on days 7 and 30 appears significantly greater in the M-M and M-L groups, with the reaction in the M-L group continuing until day 30. CONCLUSION Mesh size is directly proportional to the inflammatory reaction in the host tissue. The prolonged inflammatory process leads to delayed tissue remodeling and angiogenesis, which could delay mesh-tissue integration.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Medical Center, Taipei, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Yi-Hao Lin
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Sandy Chua
- Department of Obstetrics and Gynecology, Cebu Institute of Medicine-Cebu Velez General Hospital, Cebu City, Philippines
| | - Hsiao-Chien Chu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsin Street, Kwei-shan, Tao-Yuan City, Taiwan, 333, Republic of China.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China
| | - Ma Clarissa Uy-Patrimonio
- Department of Obstetrics and Gynecology, Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod City, Philippines
| | - Kai Lyn Ng
- Department of Obstetrics and Gynecology, National University Hospital of Singapore, Singapore, Singapore
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Lo TS, Ng KL, Huang TX, Chen YP, Lin YH, Hsieh WC. Anterior-Apical Transvaginal Mesh (Surelift) for Advanced Urogenital Prolapse: Surgical and Functional Outcomes at 1 Year. J Minim Invasive Gynecol 2020; 28:107-116. [PMID: 32416263 DOI: 10.1016/j.jmig.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To determine the objective and subjective outcomes of pelvic organ prolapse (POP) surgery using a modified Surelift system (Neomedic International, Barcelona, Spain) and to evaluate surgical complications and postoperative impact on quality of life (QOL) and lower urinary tract symptoms. DESIGN Retrospective cohort study. SETTING Tertiary-care university hospital. PATIENTS Patients with symptomatic anterior or apical POP stage III and above. INTERVENTIONS All patients underwent pelvic reconstructive surgery with a modified Surelift transvaginal mesh kit. MEASUREMENTS AND MAIN RESULTS Eighty-three women who underwent pelvic reconstructive surgery with a modified Surelift for symptomatic anterior or apical prolapse stage III and above from April 2018 to January 2019 were reviewed retrospectively. All completed a 72-hour voiding diary, urodynamic study, and multiple validated QOL questionnaires at baseline and at between 6 and 12 months postoperatively. Descriptive statistics were used for demographics and perioperative data. Paired-samples t test and the McNemar test were applied for comparison of pre- and postoperative continuous and categoric data, respectively. The primary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure on the basis of negative answers to Pelvic Organ Prolapse Distress Inventory 6. The objective and subjective cure rates at 1 year were 97.6% and 92.8%, respectively. There were significant improvements in QOL scores postoperatively. Although bladder outlet obstruction improved, de novo urodynamic stress incontinence and stress urinary incontinence were increased at 18.9% and 21.6%, respectively, at 1-year follow-up. The mesh extrusion rate was 4.8%. CONCLUSION A modified Surelift has good objective and subjective cure rates at 1 year postoperatively with 4.8% mesh extrusion rate. There was significant improvement in lower urinary tract symptoms and QOL. De novo urodynamic stress incontinence at 6 months to 12 months was increased, but it was not sufficiently bothersome to warrant surgery.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei (Dr. Lo), Taiwan.
| | - Kai Lyn Ng
- Department of Obstetrics and Gynaecology, National University Hospital of Singapore (Dr. Ng), Singapore
| | - Ting-Xuan Huang
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
| | - Yi-Pin Chen
- Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Taiwan (Drs. Lo and Chen)
| | - Yi-Hao Lin
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh); Department of Obstetrics and Gynecology, School of Medicine, Chang Gung University, Taoyuan, Taiwan (Drs. Lo, Chen, and Lin)
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital at Linkou, Taiwan (Drs. Lo, Huang, Lin, and Hsieh)
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