Abraham Nicholas Morse

Background: Pelvic organ prolapse (POP) is a common health problem and has significant negative effects on a woman’s quality of life. The transvaginal mesh procedure is a durable reconstructive surgery, but the mesh kits are expensive for underdeveloped countries. Our previous case-series study showed that the use of self-cut mesh had a good success rate (91.8% at 1-year follow-up) and low complication rate. This trial is designed to compare a self-cut titanium-coated polypropylene mesh procedure with a mesh kit for the treatment of symptomatic stage III–IV anterior or apical prolapse in terms of efficacy, safety and cost-effectiveness. Methods: The trial is a randomized controlled multicenter non-inferiority trial. The primary outcome measure is the composite success rate at 1-year follow-up. The secondary outcomes are anatomic outcomes of each vaginal segment (anterior, posterior and apical) using the POP-Q score, subjective improvement of quality of life according to questionnaires, intraoperative parameters, complications and costs. Analysis will be performed according to the intention-to-treat principle. Based on a comparable success rate of 90% and 10% as the margin (β = 0.2 and one-sided α = 0.025), about 312 patients in total from 11 centers will be recruited including 10% dropout. The aims of the research are to demonstrate whether the self-cut mesh procedure is non-inferior to the mesh-kit procedure and to investigate the performance of titanium-coated mesh for vaginal prolapse repair. Discussion: This multicenter non-inferiority trial will evaluate whether the efficacy and safety of self-cut mesh is non-inferior to mesh kits in women with severe symptomatic stage III–IV anterior or apical prolapse. If we are able to show that the self-cut mesh procedure is non-inferior to the mesh-kit procedure in success rates, then the self-cut mesh procedure may be more cost-effective. Trial registration: ClinicalTrials.gov, NCT03283124. Registered on 17 January 2018.

Gestational trophoblastic disease or neoplasia covers a spectrum of benign and malignant conditions arising from pregnancies with highly abnormal development of trophoblastic tissue. In this brief review, we discuss the different features of these different conditions and their origins and risk factors and introduce some of the more novel and controversial treatment options currently being explored.

Purpose: Damage to the uterosacral ligaments is an important contributor to uterine and vaginal prolapse. The aim of this study is to identify differentially expressed proteins (DEPs) in the uterosacral ligaments of women with and without pelvic organ prolapse (POP) and analyze their relationships to cellular mechanisms involved in the pathogenesis of POP.Experimental design: Uterosacral ligament connective tissue from four patients with POP and four control women undergo iTRAQ analysis followed by ingenuity pathway analysis (IPA) of DEPs. DEPs are validated using Western blot analysis.Results: A total of 1789 unique protein sequences are identified in the uterosacral ligament connective tissues. The expression levels of 88 proteins are significantly different between prolapse and control groups (≥1.2‐fold, p < 0.05). IPA demonstrates the association of 14 DEPs with “Connective Tissue Function.” Among them, fibromodulin, collagen alpha‐1 (XIV) chain, calponin‐1, tenascin, and galectin‐1 appear most likely to play a role in the etiology of POP.Conclusions and clinical relevance: At least six proteins not previously associated with the pathogenesis of POP with biologic functions that suggest a plausible relationship to the disorder are identified. These results may be helpful for furthering the understanding of the pathophysiological mechanisms of POP.

INTRODUCTION: Urinary incontinence (UI) affects the quality of life of 15–20% of women in the United States. Pelvic floor muscle training can be effective in alleviating symptoms; however, women need instruction, motivation, and feedback to gain optimal benefit from pelvic rehabilitation. The U.S. Food and Drug Administration–approved FemiScan Pelvic Floor Therapy System uses office electromyography (EMG) and an in-home programmable device to provide training, motivation, and feedback. This study was undertaken to document the outcomes of women who completed a physician-supervised program utilizing the FemiScan Pelvic Floor Therapy System. METHODS: In this chart review, women with de novo, postpartum, or postsurgical stress, urge, or mixed UI, who completed the eight-visit protocol were included in the analysis. We collected patient demographics, EMG measurements and responses to subjective questions about the status of their UI symptoms. Paired t tests were used to analyze the data. RESULTS: Of 202 patients who started treatment with FemiScan, 160 (79%) completed the eight-visit protocol. No adverse events were reported. Mean age was 54±12 years. There was a statistically significant increase (11±16 μV, P<.001) in peak EMG measurements between the first and final visits. Seventy-eight percent considered their symptoms at least 80% improved with 46% reporting complete subjective cure. Women who completed four or more visits but less than eight also demonstrated subjective and objective improvement (data not shown). CONCLUSION: FemiScan is a safe and effective treatment for UI with concomitant increased pelvic floor EMG activity.