In treating women with leiomyoma and who wish to preserve their uterus, laparoscopic uterine artery ligation or uterine artery embolization should be considered as possible options. This study was performed to evaluate the efficacy of laparoscopic uterine artery ligation and uterine artery embolization in treating uterine myoma. The treatment outcomes of 23 patients who underwent uterine artery embolization and 17 laparoscopic uterine artery ligation were evaluated. The uterine volume reduced 3 months after uterine artery embolization, but thereafter no significant changes were observed. On the other hand, the uterine volumes were only slightly reduced 3 months after laparoscopic uterine artery ligation, and slightly more reduced 6 months later. The average reduction in the case of laparoscopic uterine artery ligation was about 58.5%. After laparoscopic uterine artery ligation, 20% of the patients complained of vaginal spotting. Furthermore, the mechanism of volume reduction was evaluated using specimens obtained from a biopsy taken after each procedure. The results suggested that laparoscopic uterine artery ligation results mainly in physiologic cell death, that is apoptosis, whereas, the corresponding result is cell necrosis for uterine artery embolization. Uterine artery embolization and laparoscopic uterine artery ligation are both effective in relieving the symptoms caused by uterine myoma, and therefore both procedures can be used in place of hysterectomy or myomectomy.

The objective of this study was to evaluate characteristics, satisfaction degree, and problems of patients using a pessary for pelvic organ prolapse. A total of 104 patients who had been fitted with a pessary and available for follow-up for pelvic organ prolapse management were enrolled. The patients answered questions on general characteristics, indications for pessary use, complications from pessary use, satisfaction degree, and frequency of removal. The results indicated that 76 (73.0%) patients had at least more than one medical illness and 86 (82.7%) patients complained of lower urinary symptoms such as incontinence, urgency, frequency, or nocturia. Eighty-four (80.7%) patients used pessaries as they were not surgical candidates due to poor medical status or old age. After using a pessary, 76 (73.1%) patients had symptoms such as bleeding, erosion, or foul odor; 70.2% of the women answered that they were satisfied or more than satisfied and 19.1% of the patients removed their pessaries, of whom 80.0% were unable to continue use due to repeated expulsion of the pessary and uncomfortable fitting. These data suggest that the pessary tends to be used for high-risk patients due to medical problems or old age. Despite the high frequency of complications from pessary use, it was seen that the frequency of removing the pessary was low and the satisfaction degree was high. Most of the complications were not thought to be serious. To decrease the frequency of complications, the regular follow-up visit and proper management of pessary use were thought to be needed. Further studies are warranted on tailor-fitting the pessary by variable use and relieving the symptoms associated with the lower urinary tract.

The aim of this study is to compare the levels of estrogen receptor (ER), progesterone receptor (PR), p53 and p21 between pelvic organ prolapse (POP) and control groups in order to evaluate their roles in pathogenesis of POP, and to find out the relationship among these proteins. Through the year of 2002, uterosacral ligaments were obtained from 20 prolapsus and 24 non-prolapsus hysterectomized uteruses. ER, PR, p53, and p21 proteins were extracted by Western blot analysis and relative levels of proteins were compared by Student t-test and Pearson correlation coefficient. P value <0.05 was considered statistically significant. All patients were postmenopausal and had never taken hormone replacement therapy. ER, PR, p53, and p21 were significantly lower in the study than control group (p<0.0001). Positive correlations were found among all proteins in the prolapse group. Further researches are needed to elucidate the interrelationship among these proteins and their precise roles in pathogenesis of POP.

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.

Recent studies have been reported the roles of the estrogen receptor (ER), progesterone receptor (PR) and p53 in the development of a pelvic organ prolapse (POP). The pathogenesis of stress urinary incontinence (SUI) is related to that of POP in the weakness of pelvic support. Therefore, this study was carried out to assess the relationship between ER, PR, p53 and the development of SUI, and to elucidate the biomolecular pathophysiology of SUI. The periurethral fascia was obtained from 6 menopausal patients diagnosed with SUI and 10 menopausal patients without SUI who visited the Department of Obstetrics and Gynecology, Severance Hospital, Seoul, Korea. The relative ER, PR and p53 protein levels in the periurethral fascia were obtained by western blot analysis and densitometry. A Mann-Whitney U test was used for statistical analysis (p < 0.05). The mean age (+/- SD) of the 16 patients was 59.0 +/- 5.5 years (range, 50-74 years). The mean body mass index was 25.2 +/- 2.7 kg/m2 (21.8 - 30.8) and the average number of vaginal deliveries was 2.8 +/- 1.9 (1.0 - 9.0). The ER level (0.33 +/- 0.17 vs. 1.86 +/- 0.83, p= 0.02) and the p53 level (1.25 +/- 0.67 vs. 4.71 +/- 2.40, p= 0.01) were lower in the experimental group. However, the PR level of the two groups were similar (0.64 +/- 0.13 vs. 0.48 +/- 0.33, p=0.56). The p53 and ER levels were significant lower in the study group. This suggests that p53 and ER might be important factors in the development of SUI. Further prospective studies about the association of ER, p53 and SUI will be needed to elucidate the molecular pathogenesis of SUI.