Objective To investigate the clinical efficacy and improvement of patients' quality of life in tension-free vaginal tape(TVT)and tension-free vaginal tape obturator(TVT-O)for surgical treatment of severe female stress urinary incontinence.Methods This study was a randomized,singleblinded,controlled trial.Patients were randomized by a computer-generated randomization schedule with allocation to either TVT or TVT-O procedure.TVT procedure was performed in 35 cases and TVT-O in 34 cases.None had received surgery for urinary incontinence or was in pregnancy.Transvaginal hysterectomy and prolapse reparation were done simultaneously in some of the patients.All patients were requested to complete the Urinary Distress Inventory(UDI-6)and Incontinence Impact Questionnaire(ⅡQ-7)as part of their pre-and postoperative assessment.Results All patients were evaluable and the mean follow-up was 14.5 months.The mean operative time was(18±5)min in the TVT-O group,Significantly shorter than in the TVT group(27±5)min(P＜0.01).The two groups did not differ significantly in perioperative blood loss,postoperative complications(including tape erosion,pain in thigh or behind pubis),postvoid residual volume,hospital stays or expenses(all P＞ 0.05).Sixty patients were successfully treated for stress urinary incontinence(88.6%and 85.3%for TVT and TVT-O groups,respectively).There were significant improvements in postoperative scores for both the ⅡQ-7 and the UDI-6(P＜0.01),except in subscale measuring symptoms of voiding dysfunction(P＞0.05).Conclusions Both techniques appear to be equally effective in the surgical treatment of severe stress urinary incontinence in a short term review.Significant improvements could also be seen in patients' quality of life.However.TVT-O has a shorter operative time.No evidence of increasing risk of urethral obstruction after the operation could be found.Long term followups axe necessary to evaluate outcomes of different types of surgery for stress urinary incontinence.

Objective To evaluate the safety and efficacy of ischiospinous ligament fixation in treatment of stage Ⅲ pelvic organ prolapse (POP).Methods Between March 2007 and December 2009,65 patients with stage Ⅲ POP who underwent ischiospinous ligament fixation in Peking Union Medical College Hospital were enrolled in this study.Among 21 cases complicated with stress urinary incontinence (SUI) underwent transobturator tension-free vaginal tape (TVT-O) concomitantly.Clinical parameter associated with perioperation,objective and subjective successful rate and complication were recorded.Results The mean operating time was (71 ±22) min and the mean blood loss was (93 ±40) ml.No intraoperative blood transfusion and viscera injury cases were observed.All patients were able to recover spontaneous micturition.Two cases experienced pelvic hematoma with diameter of 7 cm,after conservative treatment,they all recovered later.The objective success rate was 100％ at 6 weeks follow-up by POP-Q scoring.And 46.2％ (30/65) were followed up at range of 1 -3 years,recurrence rate were 10％ (3/30),and however,no operation were needed.At median of 20 months,all patients were followed up by telephone,the subjective successful rate was 95.4％ (62/65).At 6 weeks after operation,6.2％ (4/65) patients suffered from lower back pain and right thigh pain,visual analogue scale of pain was at range of 3 to 5,which relieved gradually after treatment and disappeared totally within 2 years.The rate of suture exposure was 10％ (3/30),the new urinary incontinence 4.6％ (3/65),and the new dyspareunia 12.5％ (3/24).Conclusions Ischiospinous ligament fixation is a safe and efficacious management.

ObjectiveTo evaluate the safety and efficacy of total pelvic reconstruction surgery with Prosima in treatment of pelvic organ prolapse (POP) stage Ⅲ.Methods From July 2010 to December 2011,31 patients with POP stage Ⅲ undergoing total pelvic reconstruction surgery with Prosima were enrolled in this prospective study.Among two cases complicated with stress urinary incontinence underwent transobturator tension-freevaginaltapeconcomitantlywithtotalpelvicreconstructionsurgerywith Prosima.Clinical parameters during peri-operation were recorded and compared.Pelvic organ prolapse quantitative examiuation(POP-Q)andanatomicimprovementinthesepatientsafter surgery were analyzed.Comparisons of pelvic floor impact questionnaire-short form 7 ( PFIQ-7 ) and pelvic organ prolapse-urinary incontinence sexual questionnaire-short form 12 (PISQ-12) in these patients before and after surgery were used to evaluate quality of life and quality of sexual life.ResultsThe mean operating time was (55 ± 13) minutes,mean blood loss was (66 ± 25 ) ml.No severe intraoperative complications were observed.All patients were able to recover spontaneous mieturation within 5 days.Two cases experienced pelvic hematoma with diameters less than 7 cm,and resolved later.Another case was urinary tract infection.At the median follow-up 6 months ( 1 - 15 months),the rate of anatomic success defined as the leading vaginal edge above the hymen was 94％ (29/31).There were significant improvements in Aa,Ba,Ap,Bp,and C (P ＜0.01 ) by POP-Q.Two patients showed recurrent prolapse at 3 months and 1 year after surgery,without the need of further operation.The median score of post-operative PFIQ-7 was 0 point at 6 months and 0 point at 12 months after operation,respectively,which were significantly lower than that of 50 points pre-operation ( P ＜ 0.01 ).And there was no significant difference in the average score of PISQ-12 before and after surgery [ ( 30 ± 6) points versus (31 ± 4) points ] ( P ＞ 0.05 ).The rate of mesh exposure was 16％ ( 5/31 ),all the 5 cases occurred within 6 months and was cut in clinic.There was no case of de novo urinary incontinence and de novo dyspareunia.Conclusions Pelvic rcconstruction surgery with Prosima is safe and efficacy in treatment of POP stage Ⅲ.It could improve quality of life remarkably without influence on sexual quality of life.

Objective To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital.Methods Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial.The control group including a total of 30 patients,only received 4 weeks pelvic floor electrophysiological treatment in the hospital.Family consolidation treatment group (experimental group) including 30 patients,after 4-week treatment in hospital,received 12-week of pelvic floor neuromnuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors.In post-treatment 6 months and 9 months,1-hour pad test was measured for urine leakage,pelvic floor electrical physiological parameters were assessed,and subjective improvement of symptoms of urinary incontinence were evaluated.All these data were analysed to compare the effect of the two groups.Results In 9 months after treatment,average change of urine leakage,the control group and experiment group were (75±24)％ versus (99±3)％,the difference was statistically significant (P＜0.01).In the experiment group,strength of type Ⅰ muscle (4.4±0.7),strength of type Ⅱ muscle (4.8±0.4) and pelvic floor dynamic pressure [(96± 12) cmH2O,1 cmH2O=0.098 kPa] were better than those of control group [3.2± 1.0,4.3 ± 0.9,(86 ± 10) cmH2O,respectively],the differences were statistically significant (P＜0.01).Subjective outcome,the control group and experiment group were (6.5 ±2.9) versus (1.8 ± 1.7),subjective outcome between the two groups had significant difference (P＜0.01).Conclusion After short-term pelvic floor electrophysiological treatment in hospital,the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.

Objective To evaluate the medium and long term safety and efficacy of sacrospinous ligament fixation (SSLF) performed with conventional instruments in treating stage Ⅲ-Ⅳ pelvic organ prolapse (POP).Methods A prospective cohort analysis was conducted in the Peking Union Medical College Hospital,between May 2007 and June 2015,enrolling 55 women with stage Ⅲ-Ⅳ POP who intended to receive SSLF.Primary end points were objective success rates using pelvic organ prolapse quantitation system (POP-Q) and subjective satisfaction rates with questionnaires after surgery according to vaginal examination and related questionnaires for all patients who received SSLF eventually.Exploratory outcomes included perioperative parameters and complications.Results Of these 55 POP patients enrolled,52 (95％,52/55) received SSLF using conventional surgical instruments,the other 3 cases converted to ischial spinous fascia fixation due to difficulty exposing.Medium blood loss during operation was 100 ml (20-300 ml) and operative time 60 minutes (20-165 minutes).Pelvic hematoma with diameters of 5 cm and 7 cm were observed in two patients,both recovered fully with conservative methods.All patients were able to micturate spontaneously after catheter withdrawal.One patient reported right thigh pain after operation which remained till 3-month follow-up and relieved after physiotherapy.The objective success rate was 100％ (52/52) at 3 months.With a medium follow-up time of 23.7 months,the objective success rate was 98％ (51/52),the recurrence rate was 2％ (1/52) and the satisfactory rate was 94％ (49/52).De novo urinary incontinence occurred in 6％ (3/52) of patients.Conclusion Most POP could be corrected with SSLF using conventional instruments which is a feasible,economic and effective procedure for Asian patients with medium compartment prolapse.

Objective To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the Xiehe pelvic floor reconstruction surgery. Methods From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage Ⅲ to Ⅳ from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life. Results With a median follow-up of 14. 0 months (6 -28 months),twenty-three patients showed recurrent prolapse (8. 3%, 23/277), and anatomical success ( ＜ stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6. 9% (19/277). The postoperative de novo stress incontinence rate was 6. 5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P ＜0. 01 ). And there was no significant difference in the average score of PISQ before and after the surgery (76. 6 ± 15.4 versus 75.5 ± 14. 5 versus 73.6 ± 12. 6, P ＞0. 05 ), but the rate of de novo dyspareunia was 11% (9/80). Conclusions Xiehe pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

Objective To compare the efficacy and safety of zoledronic acid and alendronate in the treatment of postmenopausal osteoporosis and to provide a clinical basis for the safe use of zoledronic acid.Methods Two hundred and ten female patients with postmenopausal osteoporosiswomen in Xuanwu Hospital Capital Medical University from January 2013 to January 2014 were selected as research objects,they were randomly divided into zoledronic acid group(105 cases)and alendronate group(105 cases),patients in the zoledronic acid group were given intravenous infusion of zoledronic acid injection 5 mg one time a year,the alendronate group were given alendronate 70 mg one week,both group had been treated for 24 months.The bone mineral density of the lumbar spine and hip was measured by dual energy X-ray absorptiometry before and after treatment,and the VAS score of the pain status was measured.The chest and lumbar spine were examined by X-ray,and the adverse reactions were recorded.Results After treatment,the BMD of the lumbar spine and hip of the zoledronic acid group and alendronate group were(-1.56 ± 0.35)g/ cm2and(-2.21 ± 0.54)g/ cm2, (-1.91±0.32)g/ cm2 and(-2.16 ± 0.26)g/ cm2,which were higher than those before treatment.The differences were statistically significant(t=6.253,3.633,5.834,3.251,P<0.05).But the BMD of the lumbar spine and hip in the zoledronic acid group was significantly higher than that in the alendronate group,the difference was statistically significant(t=4.421,5.262,P<0.05).The VAS scores of the alendronate group and the zoledronic acid group at 12 months,24 months after treatment were(4.02±0.50)points and(3.01±0.44) points,(2.95 ± 0.36)points and(1.82 ± 0.24)points,which were significantly lower than those before the treatment,the differences were statistically significant(P<0.05).The VAS score of zoledronic acid group at 12 months,24 months after treatment were significantly lower than those of the alendronate group,the differences were statistically significant(t=3.513,3.647,P<0.05).The fever incidence of the alendronate group was 2.86%(3/105),lower than that of the zoledronic acid group(30.48%(32/105)),the difference was statistically significant(χ2=32.901,P<0.01).Conclusion Zoledronic acid injection and alendronate are effective in the treatment of PMOP,but zoledronic acid has better effect on increasing bone density,reducing the degree of bone pain,with better compliance.Although it has increased the incidence of adverse reactions,it is well tolerated.

Objective: To investigate the clinical and pathological features, diagnosis and treatment of primary vulvar Paget disease (VPD) , and analyze the related factors that may affect the recurrence. Methods: A retrospective study was carried out on 36 patients diagnosed as VPD pathologically from January 1983 to December 2017 at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. The clinical and pathological features, diagnosis, treatment and prognosis and the factors influencing recurrence rate of VPD were analyzed. Results: (1) Totally 94% (34/36) of VPD occurred in postmenopausal women. Pruritus was counted 86% (31/36) of the main complaint. Lesions of vulvar were main symptom which had no specificity, acting as ulcer (67%, 24/36) , erythema (50%, 18/36) , depigmentation (42%, 15/36) , sclerosis (31%, 11/36) , and pigmentation (17%, 6/36) . The lesions invaded labium majus (97%, 35/36) , sometimes labium minus (53%, 19/36) , clitoris (28%, 10/36) , perianal (25%, 9/36) , orificium vaginae (3%, 1/36) , and meatus urinarius (3%, 1/36) . Approximately 19% (7/36) of VPD coexisted with intraepithelial neoplasia or adenocarcinoma of vulvar or other part of body. (2) Diagnosis and treatment: diagnosis was confirmed histologically by biopsy or pathologies after surgery, and immunohistochemical results were helpful for differential diagnosis. Surgery was the mean treatment method, 34 of all the 36 patients (94%, 34/36) underwent surgery for at least once, while 2 patients (6%, 2/36) were performed non-operative treatment. The surgical treatment included excision of focus, wide local excision, simple vulvectomy, and extensive vulvectomy. The non-operative treatment included radiotherapy, chemotherapy, laser, photodynamic therapy, and so on. (3) Prognosis: among 36 VPD patients, 4 were lost to follow-up with a 89% (32/36) follow-up rate. Median follow-up was 35.3 months (range,1 month to 31 years) . During the follow-up period, 2 patients were unable to judge whether they will relapse for the follow-up time did not reach half a year, 8 cases were unsuccessful operation, 20 cases succeeded, the achievement ratio was 71% (20/28) . Nine of twenty cases relapsed, the recurrence rate was 45% (9/20) . The median recurrence time was 14 months after operation. One patient of the 32 followed-up patients died, the mortality rate was 3% (1/32) . (4) The related factors affected the recurrence of VPD: t test was applied to the analysis of patients′ age, rank test was used in the statistics of the time of confirmed diagnosis, the length and thickness of the resection focus. Fisher test was used to calculate whether the focus were limited to the epidermis, type of surgical procedures, distance between the margin and the focus, whether tumor cells infiltrated the margin. The results showed that none of the above terms in the first operation had significant contribution to recurrence (all P>0.05) . Conclusions VPD may be a low potential malignancy, which could slowly progress into deep invasive disease. VPD is often associated with intraepithelial neoplasia or primary tumors of the vulva or somewhere else. Operations is the first choice for VPD, but consider for its high recurrence rate after operation, close follow-up should be strongly suggested.

Objective:To investigate the clinical features, etiology, and prognosis of sepsis during pregnancy and the postpartum period.Methods:Sixty-eight pregnant women with maternal sepsis treated in Peking Union Medical College Hospital from January 1997 to December 2019 were collected, and divided into obstetric infection group (30 cases) and non-obstetric infection group (38 cases) according to different infection sources. Clinical manifestations, types of infection sources, microbiological characteristics, treatment and outcomes were studied and analyzed.Results:(1) General conditions and clinical features: sepsis occurrence rate was 57% (39/68) and 43% (29/68) in prenatal and postpartum period, repectively. Statistical analysis showed that incidence of respiratory, renal, liver and coagulation dysfunction in non-obstetric infection group were significantly higher than those in obstetric infection group, and multiple organ dysfunction, cardiac arrest and blood lactate≥4 mmol/L were more common (all P<0.05). Sequential organ failure score in non-obstetric infection group was also significantly higher than that in obstetric infection group ( P<0.05). (2) Types of infection sources and microbiological characteristics: the most common maternal sepsis was genital tract sepsis (37%, 25/68). Chorioamnionitis was the most common cause in obstetric sepsis (40%, 12/30), while intra-abdominal infection was the most common cause in non-obstetric sepsis (34%, 13/38). Thirty-seven patients (54%, 37/68) were diagnosed as bloodstream infection (BSI). Gram-negative bacteremia accounted for 70% (26/37), the most common pathogen of which was Escherichia coli. BSI was most commonly secondary to a genital tract infection (65%, 17/26). (3) Treatment: the ICU hospitalization rates and the utilization rate of mechanical ventilation and vasoactive agents in non-obstetric group were higher than those in obstetric group with significant differences (all P<0.05). Thirty-two patients (47%, 32/68) underwent surgery to remove the infection sources, including 5 cases of hysterectomy. (4) Prognosis: the case fatality rate of maternal sepsis was 19% (13/68), which was significantly higher in the non-obstetric infection group (29%,11/38) compared with the obstetric infection group (7%,2/30; P=0.020). The time from diagnosis of sepsis to termination of pregnancy was (5.5±8.6) days in prenatal women, and time in obstetric infection group [(1.9±2.2) days] was significantly less than that of non-obstetric infection group [(7.7±10.3) days, P=0.029]. Adverse pregnancy outcomes were higher in the first and second trimester (72%, 18/25) than in the third trimester (21%, 3/14), and the difference was statistically significant ( P=0.002). Conclusions:Sepsis during pregnancy and the postpartum period is a potentially life-threatening disease. Pregnant women with non-obstetric sepsis have more complications, more serious condition and worse prognosis than those with obstetric infection. Timely detection of risk factors, early identification and active treatment are helpful to improve maternal and fetal prognosis.

Objective:To study the relationship between vitamin D level and muscle mass and grip strength in elderly patients with type 2 diabetes mellitus (T2DM).Methods:From May 2016 to January 2018, 201 patients with type 2 diabetes mellitus aged ≥ 60 who were admitted to the Department of endocrinology of Xuanwu Hospital were selected for prospective study. According to 25-hydroxyvitamin D level(25(OH)D), the patients were divided into the vitamin D deficiency group (25(OH)D<20 μg/L, 140 cases) and the non-deficiency group (20 μg/L≤25(OH)D<70 μg/L, 61 cases). The grip strength, walking speed and muscle mass of upper and lower limbs were measured.Physical examination and laboratory examination were carried out.Results:There was no significant difference between the two groups ( P>0.05). The grip strength, upper limb and lower limb muscle contents in the non deficiency group were significantly higher than those in the deficiency group ((33.49±9.43) kg vs.(29.59±10.30) kg, (4.99±1.09) kg vs.(4.57±1.11) kg, (15.69±3.10) kg vs.(14.54±3.03) kg, P=0.01, 0.015, 0.017). Multivariate logistic regression analysis showed that vitamin D deficiency was independently related to grip strength and lower limb muscle mass( OR=1.286, 95% CI: 1.197-1.346, P<0.01; OR=1.231, 95% CI: 1.102-1.283, P<0.05). Conclusion:Vitamin D deficiency is a risk factor for the decrease of grip strength and lower extremity muscle mass in elderly patients with type 2 diabetes.