UG & PFR 說明會 - 奇美醫院

65
婦女泌尿及骨盆重建臨床實務介紹 (疾病分類人員繼續教育) 無張力尿道中段吊帶術(TVTs)(MUS)(MISS) 無張力人工網膜植入術(TVM) 吳銘斌醫師 (Ming-Ping Wu, M.D., Ph.D.) 奇美醫院 婦產部 婦女泌尿暨骨盆醫學科 主任 台北醫學大學醫學院 婦產學科副教授 成大醫學院 臨床醫學所 博士

Transcript of UG & PFR 說明會 - 奇美醫院

婦女泌尿及骨盆重建臨床實務介紹

(疾病分類人員繼續教育)

無張力尿道中段吊帶術(TVTs)(MUS)(MISS)

無張力人工網膜植入術(TVM)

吳銘斌醫師 (Ming-Ping Wu MD PhD)

奇美醫院 婦產部 婦女泌尿暨骨盆醫學科 主任

台北醫學大學醫學院 婦產學科副教授

成大醫學院 臨床醫學所 博士

為什麼我運動時都會漏尿

我咳嗽也會漏尿

應力性尿失禁

Stress urinary incontinence (SUI)

Urodynamic stress incontinence (USI)

8

Urodynamic stress incontinence (USI)

婦女影像尿動力學檢查(Female video-

urodyanmic study)

已施工完成之影像尿動力學檢查室 提昇婦女泌尿的醫療深度

地點第一醫療大樓B2(碎石中心)婦女影像尿流動力檢查室

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

為什麼我運動時都會漏尿

我咳嗽也會漏尿

應力性尿失禁

Stress urinary incontinence (SUI)

Urodynamic stress incontinence (USI)

8

Urodynamic stress incontinence (USI)

婦女影像尿動力學檢查(Female video-

urodyanmic study)

已施工完成之影像尿動力學檢查室 提昇婦女泌尿的醫療深度

地點第一醫療大樓B2(碎石中心)婦女影像尿流動力檢查室

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

應力性尿失禁

Stress urinary incontinence (SUI)

Urodynamic stress incontinence (USI)

8

Urodynamic stress incontinence (USI)

婦女影像尿動力學檢查(Female video-

urodyanmic study)

已施工完成之影像尿動力學檢查室 提昇婦女泌尿的醫療深度

地點第一醫療大樓B2(碎石中心)婦女影像尿流動力檢查室

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

8

Urodynamic stress incontinence (USI)

婦女影像尿動力學檢查(Female video-

urodyanmic study)

已施工完成之影像尿動力學檢查室 提昇婦女泌尿的醫療深度

地點第一醫療大樓B2(碎石中心)婦女影像尿流動力檢查室

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

婦女影像尿動力學檢查(Female video-

urodyanmic study)

已施工完成之影像尿動力學檢查室 提昇婦女泌尿的醫療深度

地點第一醫療大樓B2(碎石中心)婦女影像尿流動力檢查室

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Solar Video-urodynamics

+

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Videourodynamic study

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

手術治療-

應力性尿失禁當藥物物理療法等保守療法都無法控制病情時

傳統膀胱懸吊術-

膀胱頸懸吊術(Burch colposuspension)

需開腹或腹腔鏡以縫線方式將膀胱頸懸吊

恥骨陰道吊帶術(pubo-vaginal sling)

需取自身的腹直肌肌膜或側股骨筋膜做為吊帶手術

無張力尿道中段吊帶術MISS手術-

Minimmally invasive suburethral sling

目前最新手術方法

傷口小恢復快治癒率高

術後膀胱訓練時間短病人接受程度高

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

膀胱頸懸吊術(Burch colposuspension)

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

恥骨陰道吊帶術(pubo-vaginal sling)

Stanton SLTanagho EA 1986 Springer-Verlag

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

尿失禁手術

Burch 膀胱頸懸吊術

恥骨陰道吊帶術 無張力陰道吊帶

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Stress urinary incontinency (SUI) is a prevalent disease esp in women of older age

with a life long risk of 11 to receive surgery

Inpatient Expenditures by Admissions files of the National Health Insurance Research Database (NHIRD) 1996-2005

A descriptive study to analyze the The changing trend of different surgical types

The characteristics of patients eg age

Surgeonsrsquo specialties

The accreditation and ownership of the hospitals Wu MP 2008 Int Urogyn J

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

ICD9 Operation 健保手術計價碼

593 Plication of urethra-vesical junction

eg Kelly-Kennedy operation 78029B

78037B

594 Suprapubic sling operation

eg Goebel-Frangenheim-Stoeck

suspension

77029B

595

(RPU)

Retropubic urethral suspension

eg Marshall-Marchetti-Kranz (MMK)

operation Burch procedure

78017B MMK

78030B Burch

596 Paraurethral suspension

eg Pereyra suspension 78028B () TA-

78029B () TV-

5971 Levator ani muscle suspension

5972 Injection of implant into urethral andor

bladder neck eg Collagen implant 78029B () TV-

5979

(MUS)

repair of stress incontinence NOS

(APUS) (TVTs)(TOTs) 77029B APUS

RPU retropubic urethropexy MUS midurethral sling

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Table 1 Surgical types categorized by chronology Surgery (ICD-9-CM code)

Year Total RPU Sling MUS Kelly Needle LS Injection

ICD-9 (595) (594) (5979) (593) (596) (5971) (5972)

n () n () n () n () n () n () n () n ()

17532 7610 2645 4196 900 1165 853 163

(100) (4341) (1509) (2393) (513) (664) (487) (093)

1996 770 281 82 84 95 196 32 0

1997 948 332 81 168 91 200 76 0

1998 1362 732 105 294 68 100 63 0

1999 1618 786 143 375 105 97 112 0

2000 1710 713 239 461 85 102 110 0

2001 2164 914 413 490 78 146 123 0

2002 2308 974 558 450 106 120 100 0

2003 1959 850 395 451 71 79 87 26

2004 2227 1035 322 604 99 54 66 47

2005 2466 993 307 819 102 71 84 90

Wu MP 2008 Int Urogyn J

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

The trend of different surgical

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 year

n

RPU 595

Sling 594

TVTs 5979

Kelly 593

Needle 596

5971

Injection 5972

RPU

Sling

MUS

Kelly

Needle

LS

Injection

The changing trend of surgical types for stress urinary

incontinence in Taiwan

Wu MP et al 2008 Int Urogyn J

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Tension-free Vaginal Tape (TVT)

at rest under stress

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

1st generation Retropubic經恥骨後系統

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Tension-free vaginal tape (TVT)

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

2nd generation Transobturator經閉孔膜系統

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

閉孔動脈 (前分支)

閉孔膜

閉孔動脈 (前分支)

骨盆底閉孔膜

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Monarc (TOT) TVT-O

SPARC TVT

經閉孔膜系統

經恥骨後系統

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Kelly plication

Tradition bladder-neck sling

1st generation Supra-pubic

TVT SPARC IVS

2nd generation Trans-obturator

TVT-O Monarc

The evolution of midurethral sling (MUS)

3rd generation Single-incision

TVT-secure MiniArc

TVT tension-free vaginal tape

TVT-O tension-free vaginal

tape -obturator

SPARC suprapubic arc

Endoscopic bladder neck

suspension (EBNS)

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

3rd generation 超迷你吊帶術Single

incision midurethral slings (SIS)

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

第三代 TVT-Secure MiniArc迷你手術

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

MiniArc

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

1st

2nd

3rd

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Clinical outcomes in patients undergoing

midurethral sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin Practice Urol

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Clinical outcomes in patients undergoing midurethral

sling placement

Rapp DE amp Kobashi KC 2008 Nat Clin PracticeUrol

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

骨盆重建醫學

尿失禁

應力性尿失禁

陰道前壁脫垂

膀胱膨出

陰道後壁脫垂

直腸膨出

陰道頂端脫垂

子宮脫垂

陰道穹窿脫垂

(子宮切除後)

膀胱 直腸

子宮

膀胱

直腸

子宮

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

子宮脫垂嚴重度

wwwmoondragonorgobgyn

第一度 第二度

第三度

子宮切除後之 陰道穹窿脫垂

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Pelvic organ prolapse- quantitation

(POP-Q)

Bump RC 1996 AJOG

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Surgical intervention for POP

Old

Sacral colpopexy 薦骨陰道懸吊

uterosacral ligament high McCall colpopexy子宮薦骨韌帶懸吊

Sacro-spingous suspension薦骨棘陰道懸吊

New

經陰道骨盆底重建Transvaginal pelvic floor

reconstruction (TV-PFR)

Tension free vaginal mesh (TVM)

Prolift (Gynecare JampJ壯生)

Perigee amp Apogee (AMS艾梅斯)

Elevate (AMS艾梅斯)

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Sacral colpopexy

Sacral promontory

Walters MD amp Karram MM 1999 Mosby Inc

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Vaginal stump

Rectum

Uterosacral vaginal vault suspension

Walters MD amp Karram MM 1999

Mosby Inc

U-S Lig

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

X X A B

骨盆鬆弛與吊床理論

Pelvic organ prolapse (POP)

骨盆脫垂就像吊床鏈條(子宮旁韌帶筋膜)斷裂 造成吊床上的孩子(子宮)落地(脫垂)一樣

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Surgery Codes

TV-PFR no VTH

80027B (11730)

TV-PFR + VTH

80028B (14584)

TAV-PFR + TAH

80026B (12188)

申報組

疾病分類組

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

A

D

B

C

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

The changing trend of various

approaches for UTERINE PROLAPSE in

Taiwan a 12 year nationwide descriptive

study

吳銘斌12 梁景忠3 湯澡薰4

財團法人奇美醫院 婦產部婦女泌尿科1

台北醫學大學醫學院婦產學科2

長庚紀念醫院林口總院 婦產部長庚大學醫學院3

台北醫學大學 醫務管理系4

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Material and methods Data source

Inpatient Expenditures by Admission files of the

National Health Insurance Research Database

(NHIRD)

study periods between 1997-2008 total 12 years

Recruitment criteria

female patient with diagnosis of uterine prolapse ICD-9

code 6181 6182 6183 6184 (but not 6185 vaginal

vault prolapse)

received various surgery were recruited into this study

Uterine suspension group (6922)

Hysterectomy group Hysterectomy with vaginal

suspension and fixation (7099)

withwithout associated anti-incontinence surgery

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Uterine prolapse

No hysterectomy hysterectomy

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

Patientsrsquo age Surgeonsrsquo age

and gender Hospital ownership and

accreditation

w wrsquot anti-incontinence surgery

uterine suspension gr Hysterectomy gr

Study design Flow Chart

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Table I The changing trends of surgical types ie

hysterectomy or uterine suspension the wax-and-wane

during the study period

Year

Surgical types

Total uterine suspension hysterectomy

no no

1997 275 94 2642 906 2917

1998 283 91 2841 909 3124

1999 264 89 2719 912 2983

2000 267 89 2735 911 3002

2001 251 84 2740 916 2991

2002 235 79 2752 921 2987

2003 194 77 2325 923 2519

2004 255 96 2405 904 2660

2005 302 113 2377 887 2679

2006 237 94 2297 907 2534

2007 358 136 2284 865 2642

1997-2007 2921 94 28117 906 31038

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Fig 1 The changing trends of surgical

types for POP

2917

31242983 3002 2991 2987

25192660 2679

25342642

2642

28412719 2735 2740 2752

23252405 2377

2297 2284

275 283 264 267 251 235 194 255 302 237358

0

500

1000

1500

2000

2500

3000

3500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

N

Year

Total hysterectomy uterine suspension

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Table II The patientsrsquo age and associated procedure

were the determinants for the choices of surgical types

Surgical types

Total ChiSQ P uterine suspension hysterectomy

no no Total 2921

94 28117 806 31038

Patient Age lt50 2056 251 6128 749 8184 32883 lt0001

50-59 397 64 5770 936 6167

60-69 263 29 8669 971 8932

lt69 205 26 7550 974 7755

with

anti-incontinence no 2507 88 25923 912 28430 1395 lt0001

yes 414 159 2194 841 2608

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Surgery equipment

OR

Cystoscopy 0o 70o

28019C (1800)

Cystostomy suprapubic catheterization

(Bard)

Cystofix (B Braun)

8-12 Fr

Trocar method

78003C (3285)

Foley catheterization

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

The Perigeetrade System

American Medical System (AMS)

OR

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

The Perigeetrade

System

AMS

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

AMS

The Apogeetrade System

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Gynecare Prolift Pelvic Floor Repair System

(GPS)

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Gynecare Prolift Pelvic Floor Repair System

Anterior Implant Posterior Implant

Total Implant

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Gynecare Prolift Pelvic Floor Repair System

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Prolift

Anterior incision

Gynecare Prolift System

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Anterior implant

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Posterior implant

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Monarc or

TVT-O

Prolift (ant) or

Perigee

Prolift (post) or

Apogee or

post IVS

A B

Preserved uterus Hysterectomized

Gynecare JampJ AMS Tyco

OP record for TVM +- TVT-O

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Single incision TVM迷你人工網膜

Elevate AMS

Prosima J amp J

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

Tension free vaginal mesh (TVM)

JampJ Gynecare Prolift

Anterior Prolift (自費33500)

Posterior Prolift (自費30940)

Total Prolift (自費45240)

American Medical System (AMS)

Perigee (anterior) (自費35100)

Apogee (posterior) (自費31200)

Elevate (anterior) (自費 )

Elevate (posterior) (自費 )

自費耗材

婦產科醫師的辛酸

Father in the delivery room

婦產科醫師的辛酸

Father in the delivery room