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Çetinel B, Kırlı EA, Önal B, Kalender G, Demirbilek M, Okur A, Can G. Voiding dynamics of pelvic organ prolapse: Large scale comparative study. Neurourol Urodyn 2023; 42:736-745. [PMID: 36806102 DOI: 10.1002/nau.25156] [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: 09/21/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To determine the voiding dynamics of the patients with pelvic organ prolapse (POP). MATERIALS AND METHODS A retrospective patient file review was performed of 877 female patients with lower urinary tract symptoms. After exclusion criteria 373 female patients were eligible for the study. Two patient groups w/wo prolapse were identified. The symptoms, patient characteristics, patterns of free urine flow, and detrusor voiding pressure curves were compared between two groups. A comparison of the urodynamic findings between the subgroups (mild/moderate, severe, and w/o prolapse) was made and shown on a scatter plot graphics of Pdet Qmax versus Qmax as well. RESULTS A total of 373 patients with median age 54 (18-92), 189 (51%) had varying degrees and forms of POP while 184 (49%) did not have any prolapse (p < 0.003). Logistic regression analysis results showed that older age [p = 0.023, odds ratio (OR) = 1.01, confidence interval (CI): (1.00-1.03)], weaker pelvic floor muscle strength [p = 0.032, OR = 1.67, CI: (1.04-2.69)], more frequent symptom of hesitancy [p = 0.003 OR = 2.15 CI: (1.29-3.58)], prolonged-tailed shaped curve pattern of free urine flow [p = 0.027 OR = 1.97 CI: (1.08-3.58)], and higher Pdet Qmax (22 cmH2 O) values [p = 0.002, OR = 1.02, CI: (1.00-1.03)] were the independent different features of the patients with prolapse. Subgroup urodynamic analysis showed significantly lower free flowmetry Qmax and higher Pdet Qmax values in patients with severe prolapse. Prolonged/tailed-shaped curve pattern of free urine flow was significantly more frequent in patients with prolapse. CONCLUSIONS Voiding dynamics of the patients with prolapse were significantly different from the patients' w/o prolapse. They had higher Pdet Qmax values, more frequent symptom of hesitancy, and prolonged shaped free flow curve pattern. Free flow Qmax values were lower in patients with severe prolapse.
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Affiliation(s)
- Bülent Çetinel
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif A Kırlı
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Göktuğ Kalender
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhammet Demirbilek
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alper Okur
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Defining Bladder Outlet Obstruction in Women. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Urodynamic Curve Patterns may Predict Female Bladder Outlet Obstruction and Detrusor Underactivity. Urology 2022; 165:150-156. [DOI: 10.1016/j.urology.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
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Mai HC, Wu RC, Lin VC, Kuo WWT, Wu CH. External validation of Solomon-Greenwell nomogram for female bladder outlet obstruction. Neurourol Urodyn 2022; 41:626-632. [PMID: 34962312 DOI: 10.1002/nau.24863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022]
Abstract
AIM There is no unified diagnostic standard for female bladder outlet obstruction (BOO) to date. The Solomon-Greenwell (S-G) nomogram was developed to indicate the probability of female BOO by performing a pressure-flow study, and the equation of the BOO Index in females (BOOIf) is PdetQmax - 2.2 × Qmax. We aimed to validate the diagnostic value of the S-G nomogram in female BOO. MATERIALS AND METHODS We retrospectively reviewed a videourodynamic study (VUDS) cohort in our institution. Between 2015 and 2020, 192 female patients underwent VUDS for lower urinary tract dysfunction (LUTD). We excluded patients with neurogenic LUTD (n = 30) and patients with no detrusor contraction and/or no void during VUDS (n = 51). The diagnosis of female BOO was based on the Nitti criteria (radiological evidence of urethral narrowing in the presence of a sustained detrusor pressure). BOOIf was calculated for each enrolled patient. The cutoff values of BOOIf were set at <0, >5, and >18 as the original S-G nomogram proposed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each threshold to diagnose female BOO were calculated. RESULTS Out of the 111 enrolled patients, 43 (38.7%) were diagnosed as having female BOO by VUDS. The most common etiology of female BOO was dysfunctional voiding (19/43, 44.2%), followed by primary bladder neck obstruction (PBNO, 15/43, 34.9%). When the cutoff value was <0 (low probability of obstruction), the sensitivity, specificity, PPV, and NPV were 90%, 91%, 92%, and 87%, respectively; when >5 (likely obstructed), the values were 79%, 96%, 92%, and 88%, respectively; and when >18 (obstruction almost certain), the values were 47%, 100%, 100%, and 75%, respectively. Fourteen of 15 PBNO patients would be classified as non-BOO if the cutoff value was >18. Six PBNO patients would not be diagnosed as female BOO if the threshold was >5. CONCLUSION A BOOIf <0 showed good diagnostic value for excluding female BOO. A BOOIf >18 had perfect specificity and PPV for diagnosing female BOO. However, the sensitivity of the S-G nomogram for detecting female BOO was unsatisfactory, especially for patients with PBNO. VUDS remains the examination of choice for patients with suspected female BOO.
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Affiliation(s)
- Hsing-Chia Mai
- Department of Urology, E-Da Cancer Hospital, Kaohsiung, Taiwan
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Richard C Wu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Victor C Lin
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wade W-T Kuo
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Hsien Wu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
- Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Sharma JB, Thariani K, Deoghare M, Kumari R. Autologous Fascial Slings for Surgical Management of Stress Urinary Incontinence: A Come Back. J Obstet Gynaecol India 2021; 71:106-114. [PMID: 34149210 DOI: 10.1007/s13224-020-01408-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly's plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it's routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.
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Affiliation(s)
- J B Sharma
- Department of Obstetrics, Gynecology and Urogynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Karishma Thariani
- Department of Obstetrics, Gynecology and Urogynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Manasi Deoghare
- Department of Obstetrics, Gynecology and Urogynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Rajesh Kumari
- Department of Obstetrics, Gynecology and Urogynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
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Urodynamics for the “Failed” Midurethral Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: a long-term follow-up study. Int Urogynecol J 2020; 31:2557-2564. [PMID: 32556406 DOI: 10.1007/s00192-020-04333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We report long-term changes in VUDS profiles of women with dysfunctional voiding and investigate potential predictors for treatment response. METHODS Women with dysfunctional voiding and available VUDS data between November 1997 and June 2018 were enrolled for retrospective analysis. The patients were all treated with medication first. In refractory patients, urethral botulinum toxin was provided as an additional option. The primary outcome was the change of VUDS parameters between baseline and follow-up studies. The secondary outcomes were baseline parameters and clinical factors that were associated with the BOOI response (> 10 points of BOOI reduction). RESULTS A total of 195 women with DV were included in this study. The mean age was 54.5 years old. Sixty patients received urethral botulinum toxin injection. For all patients, Pdet decreased from 47.2 to 36.8 cm H2O (p < 0.0001), and BOOI decreased from 26.4 to 17.7 (p = 0.0001). Patients with urethral injection had significantly smaller Qmax, voided volume, and voiding efficiency (VE) and significantly larger PVR and BOOI at baseline, indicating a severer obstruction in this group. The overall BOOI response rate was 44% (85/195). A higher baseline BOOI was associated with the BOOI response in multivariate analysis. CONCLUSIONS In this long-term study of women with dysfunctional voiding, medical treatment with or without urethral botulinum toxin injection both resulted in reduction of Pdet and BOOI. A more prominent obstructive profile at baseline VUDS study was associated with a higher rate of BOOI response at follow-up study.
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Mahdy A, Ghoniem GM. Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature. Neurourol Urodyn 2018; 38 Suppl 4:S51-S58. [PMID: 30525246 DOI: 10.1002/nau.23878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/06/2018] [Indexed: 11/12/2022]
Abstract
AIMS Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid-urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re-emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. This resulted in patients' fear related to vaginal mesh and drop in number of patients seeking surgical treatment of SUI. PVS has re-emerged as an option for treatment of primary SUI. The aim of this review is to familiarize, disseminate information, and share tips for the practicing female pelvic surgeons related to the practice of the autologous fascia sling. METHODS We reviewed the literature related to the autologous sling. We used the following data bases and search engines: GoPubMed (Transinsight), Cochrane reviews (Wiley Interscience), google scholar (google), and Scopus (Elsevier). Because it is the most commonly investigated and utilized, we focused on the autologous rectus fascia sling. We also focused on the retropubic sling approach because the literature on transobturator rectus fascia sling is sparse. RESULTS Out of 307 articles related to the subject found, 22 articles were included and the rest were excluded. CONCLUSION ARFS is a valid primary method of treatment for female SUI. Also, it is used in particular indications such as patients with intrinsic sphincter deficiency (ISD), prior pelvic irradiation, failed and/or complicated synthetic MUS, and violated urethral lumen.
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Affiliation(s)
- Ayman Mahdy
- Department of Urology, University of Cincinnati, Cincinnati, Ohio
| | - Gamal M Ghoniem
- Chief Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology
- UC Irvine Health, Orange, California
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Abstract
PURPOSE OF REVIEW The diagnosis and evaluation of bladder outlet obstruction (BOO) in women remains a challenging topic. The goal of this study is to review recent literature and summarize the diagnosis and management of BOO with special focus on recent progress. RECENT FINDINGS In recent years, numerous advances in the area of female BOO have taken place including a movement towards unified diagnostic criteria, summary of functional and anatomic causes, and exploration of potential diagnostic options. SUMMARY This review discusses the known diagnosis and management of female bladder outlet obstruction, yet highlights specific functional causes, new criteria available for diagnosis, and long-term results of treatment options.
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Kira S, Mitsui T, Kobayashi H, Haneda Y, Sawada N, Takeda M. Detrusor pressures in urodynamic studies during voiding in women. Int Urogynecol J 2016; 28:783-787. [DOI: 10.1007/s00192-016-3203-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
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La disfunción del tracto urinario inferior en el paciente mayor. Med Clin (Barc) 2016; 147:455-460. [DOI: 10.1016/j.medcli.2016.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
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Shen W, Ji H, Yang C, Zhang H, Xiong T, Wu X, Zhang J, Zhou Z. Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction: Description of a novel surgical procedure. Int J Urol 2016; 23:491-5. [PMID: 27037830 DOI: 10.1111/iju.13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the efficacy and complications of controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction. METHODS A total of 59 patients who were diagnosed with female primary bladder neck obstruction by urodynamic examination underwent surgical procedures at Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China, between March 2010 and March 2014. For all patients, neurogenic, anatomical and dysfunctional voiding causes of bladder outlet obstruction had been excluded. Perioperative and follow-up data, including operative time, maximum urine flow rate, residual urine volume, International Prostate Symptom Score and Quality of Life Score, were prospectively investigated. RESULTS All of the operations were completed uneventful. The median operative time was 15 ± 8 min (range 10-22 min). No massive hemorrhage or infection was reported. Follow-up data were available for 59, 59, and 57 of the patients at 1, 6 and 12 months postoperatively, respectively. The mean maximum urine flow rate increased from 7.2 ± 3.9 mL/s preoperatively to 26.1 ± 5.2 mL/s postoperatively. The mean residual urine volume decreased from 162 ± 75 to 20 ± 7 mL. The mean International Prostate Symptom Score decreased from 24.5 ± 7.2 to 5.5 ± 3.6. The mean Quality of Life Score decreased from 5.4 ± 1.7 to 1.9 ± 1.1. All of the differences between the preoperative and postoperative values were significant (P < 0.001). CONCLUSIONS The novel technique described here shortens the length of the urethra to 2.5 cm, which both released the obstruction and maintained continence. The results of the present preliminary study show that this method represents a safe and effective treatment for female primary bladder neck obstruction.
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Affiliation(s)
- Wenhao Shen
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Huixiang Ji
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Chao Yang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Heng Zhang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Tailing Xiong
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Xiaojun Wu
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Jiahua Zhang
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Zhansong Zhou
- Urological Institute of the People's Liberation Army, First Affiliated Hospital of Third Military Medical University, Chongqing, China
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