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Lau HH, Lai CY, Hsieh MC, Peng HY, Chou D, Su TH, Lee JJ, Lin TB. Thermodynamic Work of High-Grade Uterine Prolapse Patients Undergoing Transvaginal Mesh Repair with Total Hysterectomy. Bioengineering (Basel) 2024; 11:875. [PMID: 39329617 PMCID: PMC11428840 DOI: 10.3390/bioengineering11090875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/09/2024] [Indexed: 09/28/2024] Open
Abstract
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.
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Affiliation(s)
- Hui-Hsuan Lau
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
| | - Cheng-Yuan Lai
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25245, Taiwan
| | - Ming-Chun Hsieh
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
| | - Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
| | - Dylan Chou
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
| | - Tsung-Hsien Su
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104217, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
| | - Jie-Jen Lee
- Department of Medicine, Mackay Medical College, New Taipei 25245, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Tzer-Bin Lin
- Institute of Translational Medicine and New Drug Development, College of Medicine, China Medical University, Taichung 404328, Taiwan
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan
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Lau HH, Lai CY, Hsieh MC, Peng HY, Chou D, Su TH, Lee JJ, Lin TB. Pressure-Volume Loop Analysis of Voiding Workload: An Application in Trans-Vaginal Mesh-Repaired Pelvic Organ Prolapse Patients. Bioengineering (Basel) 2023; 10:853. [PMID: 37508880 PMCID: PMC10376103 DOI: 10.3390/bioengineering10070853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
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.
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Affiliation(s)
- Hui-Hsuan Lau
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 11031, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei 11031, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
| | - Cheng-Yuan Lai
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei 25244, Taiwan
| | - Ming-Chun Hsieh
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
| | - Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
| | - Dylan Chou
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
| | - Tsung-Hsien Su
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 11031, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei 11031, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
| | - Jie-Jen Lee
- Department of Medicine, Mackay Medical College, New Taipei 25244, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Tzer-Bin Lin
- Institute of Translational Medicine and New Drug Development, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11689, Taiwan
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Shin Street, Taipei 11031, Taiwan
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Lau HH, Lai CY, Peng HY, Hsieh MC, Su TH, Lee JJ, Lin TB. Modification of bladder thermodynamics in stress urinary incontinence patients submitted to trans-obturator tape: A retrospective study based on urodynamic assessment. Front Bioeng Biotechnol 2022; 10:912602. [PMID: 36061421 PMCID: PMC9437260 DOI: 10.3389/fbioe.2022.912602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
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)
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Affiliation(s)
- Hui-Hsuan Lau
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Cheng-Yuan Lai
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan
| | - Hsien-Yu Peng
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Ming-Chun Hsieh
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Tsung-Hsien Su
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tzer-Bin Lin
- Institute of New Drug Development, College of Medicine, China Medical University, Taichung, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Tzer-Bin Lin,
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