UG & PFR 說明會 - 奇美醫院
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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