European journal of obstetrics, gynecology, and reproductive biology最新文献

英文中文

Gestational diabetes mellitus and group B streptococcus maternal colonization 妊娠糖尿病与 B 组链球菌母体定植。

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-22 DOI: 10.1016/j.ejogrb.2025.02.043

Yong-Shan Chen , Dong-Zhi Li

引用次数: 0

Letter to Editor

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-22 DOI: 10.1016/j.ejogrb.2025.02.042

Aashima Arora , Pradip Kumar Saha

引用次数: 0

The association of intrapartum IV fluid rates during labor with birth weight

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-22 DOI: 10.1016/j.ejogrb.2025.02.040

Emma Anisman , Robert M. Ehsanipoor , Gabriele Saccone , Vincenzo Berghella

Purpose

Since discovering that intravenous (IV) fluid infusion rate of 250 mL/hr during labor decreases incidence of cesarean delivery and decreases time in labor when compared to infusion rate of 125 mL/hr, patients and midwives have expressed concern that increased fluid rates may lead to increased birth weights. Thus, our objectives were to determine the impact, if any, of increased IV fluid infusion rates on birth weight.

Methods

This was a meta-analysis of all randomized controlled trials (RCTs) of low-risk, nulliparous women with gestations ≥ 36 weeks comparing IV fluid rates of 125 vs. 250 mL/hr. We conducted a comprehensive literature search to identify studies published since the meta-analysis by Ehsanipoor et al. (2017) that assessed the impact of IV fluid rate on birth weight. For our analysis, we included the articles published since 2017 as well as articles from the original meta-analysis that included birth weight (6/7 studies).

Results

Eight trials, with an overall low risk of bias, including 1727 women were analyzed. 913 were in the 125 ml/hr group and 876 were in the 250 ml/hr group. The vast majority of the included trials used Ringer’s solution or normal saline. Overall, there was no significant difference in birth weights between the two treatment groups (mean difference –22.69 g; 95 % CI −75.52 to + 27.14).

Conclusions

We conclude that in addition to the previously demonstrated decreased incidence of cesarean delivery and length of labor demonstrated in Ehsanipoor et al. afforded by increased rate of IV fluid intake, there is no significant impact on birth weight.

{"title":"The association of intrapartum IV fluid rates during labor with birth weight","authors":"Emma Anisman , Robert M. Ehsanipoor , Gabriele Saccone , Vincenzo Berghella","doi":"10.1016/j.ejogrb.2025.02.040","DOIUrl":"10.1016/j.ejogrb.2025.02.040","url":null,"abstract":"<div><h3>Purpose</h3><div>Since discovering that intravenous (IV) fluid infusion rate of 250 mL/hr during labor decreases incidence of cesarean delivery and decreases time in labor when compared to infusion rate of 125 mL/hr, patients and midwives have expressed concern that increased fluid rates may lead to increased birth weights. Thus, our objectives were to determine the impact, if any, of increased IV fluid infusion rates on birth weight.</div></div><div><h3>Methods</h3><div>This was a <em>meta</em>-analysis of all randomized controlled trials (RCTs) of low-risk, nulliparous women with gestations ≥ 36 weeks comparing IV fluid rates of 125 vs. 250 mL/hr. We conducted a comprehensive literature search to identify studies published since the <em>meta</em>-analysis by Ehsanipoor et al. (2017) that assessed the impact of IV fluid rate on birth weight. For our analysis, we included the articles published since 2017 as well as articles from the original <em>meta</em>-analysis that included birth weight (6/7 studies).</div></div><div><h3>Results</h3><div>Eight trials, with an overall low risk of bias, including 1727 women were analyzed. 913 were in the 125 ml/hr group and 876 were in the 250 ml/hr group. The vast majority of the included trials used Ringer’s solution or normal saline. Overall, there was no significant difference in birth weights between the two treatment groups (mean difference –22.69 g; 95 % CI −75.52 to + 27.14).</div></div><div><h3>Conclusions</h3><div>We conclude that in addition to the previously demonstrated decreased incidence of cesarean delivery and length of labor demonstrated in Ehsanipoor et al. afforded by increased rate of IV fluid intake, there is no significant impact on birth weight.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 268-270"},"PeriodicalIF":2.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Safety and efficacy of transvaginal natural orifice endoscopic surgery (vNOTES) for gynecologic procedures in the elderly: A case series of 119 consecutive patients

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-21 DOI: 10.1016/j.ejogrb.2025.02.039

James Nef , Yannick Hurni , Colin Simonson , Ian Fournier , Marcello Di Serio , Régine Lachat , Pauline Bodenmann , Stéphanie Seidler , Daniela Huber

Introduction

This study evaluates the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in patients aged ≥ 65, focusing on early surgical outcomes for benign and malignant gynecological conditions.

Methods

A total of 119 patients aged 65 and older who underwent vNOTES procedures at Valais Hospital from May 2020 to November 2024 were included. Data collected encompassed demographic characteristics, intraoperative details (e.g., complications, operative time), and postoperative outcomes (e.g., pain scores, complications, length of hospital stay).

Results

The mean age was 72.5 years; 59.7 % underwent total hysterectomies, and 30.3 % had adnexal procedures. Mean operative time was 81.6 min (range: 15–221), and mean blood loss was 66.5 ml (range: 0–500). Conversion to conventional laparoscopy occurred in four cases (3.4 %). Intraoperative complications occurred in 14 cases (11.8 %), with higher rates in patients with BMI > 30 (p = 0.01). ASA III and IV patients experienced higher complications rates both intraoperatively (17.1 % vs. 9.5 %, p = 0.24) and postoperatively (28.6 % vs. 11.9 %, p = 0.03) compared to ASA I and II patients. Complication rates increased with surgical complexity, reaching 33.3 % for three or more concomitant procedures. The mean hospital stay was 2.8 days. Patients 75 years of age or older did not have significantly higher complication rates, operating times, or longer hospital stays.

Conclusion

Our study confirms the feasibility and safety of vNOTES in elderly patients. However, increased number of concomitant procedures seems to correlate with higher complication rates, especially in patients with a high ASA score and high BMI. These findings offer valuable data for preoperative discussions with elderly patients.

{"title":"Safety and efficacy of transvaginal natural orifice endoscopic surgery (vNOTES) for gynecologic procedures in the elderly: A case series of 119 consecutive patients","authors":"James Nef , Yannick Hurni , Colin Simonson , Ian Fournier , Marcello Di Serio , Régine Lachat , Pauline Bodenmann , Stéphanie Seidler , Daniela Huber","doi":"10.1016/j.ejogrb.2025.02.039","DOIUrl":"10.1016/j.ejogrb.2025.02.039","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluates the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in patients aged ≥ 65, focusing on early surgical outcomes for benign and malignant gynecological conditions.</div></div><div><h3>Methods</h3><div>A total of 119 patients aged 65 and older who underwent vNOTES procedures at Valais Hospital from May 2020 to November 2024 were included. Data collected encompassed demographic characteristics, intraoperative details (e.g., complications, operative time), and postoperative outcomes (e.g., pain scores, complications, length of hospital stay).</div></div><div><h3>Results</h3><div>The mean age was 72.5 years; 59.7 % underwent total hysterectomies, and 30.3 % had adnexal procedures. Mean operative time was 81.6 min (range: 15–221), and mean blood loss was 66.5 ml (range: 0–500). Conversion to conventional laparoscopy occurred in four cases (3.4 %). Intraoperative complications occurred in 14 cases (11.8 %), with higher rates in patients with BMI > 30 (p = 0.01). ASA III and IV patients experienced higher complications rates both intraoperatively (17.1 % vs. 9.5 %, p = 0.24) and postoperatively (28.6 % vs. 11.9 %, p = 0.03) compared to ASA I and II patients. Complication rates increased with surgical complexity, reaching 33.3 % for three or more concomitant procedures. The mean hospital stay was 2.8 days. Patients 75 years of age or older did not have significantly higher complication rates, operating times, or longer hospital stays.</div></div><div><h3>Conclusion</h3><div>Our study confirms the feasibility and safety of vNOTES in elderly patients. However, increased number of concomitant procedures seems to correlate with higher complication rates, especially in patients with a high ASA score and high BMI. These findings offer valuable data for preoperative discussions with elderly patients.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"308 ","pages":"Pages 23-28"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic accuracy of available methylation assays in advanced cervical intraepithelial neoplasia from high-risk HPV-positive women: A systematic review and network meta-analysis 现有甲基化检测对高危 HPV 阳性女性晚期宫颈上皮内瘤变的诊断准确性：系统综述和网络荟萃分析

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-21 DOI: 10.1016/j.ejogrb.2025.02.038

Xiang Yue , Yuqing Duan , Dingjie Guo , Yixian Wang , Chunpeng Wang , Xin Liu

Over the past decade, methylation has developed rapidly for the detection of multiple diseases, and several methylation assays have been studied and even applied in clinical practice. This study undertook diagnostic test accuracy (DTA) and network meta-analysis (NMA) to investigate the value of extensively validated methylation assays for use in clinical practice or research for triage of advanced cervical intraepithelial neoplasia (CIN) among high-risk human papillomavirus (HPV)-positive women. PubMed, Web of Science, the Cochrane Library and Scopus were searched for eligible studies. DTA and NMA were conducted using R Version 4.2.0 with a random-effects model. Twenty-eight studies with 16,256 patients were included. The DTA results showed that the pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of all methylation assays for CIN grade 3+ (CIN3+) were 0.708 [95 % confidence interval (CI) 0.676–0.738], 0.780 (95 % CI 0.736–0.819), 0.436 (95 % CI 0.348–0.528) and 0.920 (95 % CI 0.885–0.945), respectively. The diagnostic odds ratio of CIN3+ was 8.828 (95 % CI 7.109–10.962), which was higher compared with that for CIN2+ (6.115, 95 % CI 4.604–8.123). NMA revealed that most methylation assays included in this study performed similarly to cytology. Among the available methylation assays, S5 classifier has a balanced performance in sensitivity and specificity overall. In conclusion, methylation assays are an effective and accurate triage strategy for advanced CIN among high-risk HPV-positive women. S5 classifier seems to be promising due to its triage performance. Cervi-M and GynTect are suitable for application in developing countries due to their superior specificity and PPV. However, more studies are needed to confirm these conclusions.

{"title":"Diagnostic accuracy of available methylation assays in advanced cervical intraepithelial neoplasia from high-risk HPV-positive women: A systematic review and network meta-analysis","authors":"Xiang Yue , Yuqing Duan , Dingjie Guo , Yixian Wang , Chunpeng Wang , Xin Liu","doi":"10.1016/j.ejogrb.2025.02.038","DOIUrl":"10.1016/j.ejogrb.2025.02.038","url":null,"abstract":"<div><div>Over the past decade, methylation has developed rapidly for the detection of multiple diseases, and several methylation assays have been studied and even applied in clinical practice. This study undertook diagnostic test accuracy (DTA) and network <em>meta</em>-analysis (NMA) to investigate the value of extensively validated methylation assays for use in clinical practice or research for triage of advanced cervical intraepithelial neoplasia (CIN) among high-risk human papillomavirus (HPV)-positive women. PubMed, Web of Science, the Cochrane Library and Scopus were searched for eligible studies. DTA and NMA were conducted using R Version 4.2.0 with a random-effects model. Twenty-eight studies with 16,256 patients were included. The DTA results showed that the pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of all methylation assays for CIN grade 3+ (CIN3+) were 0.708 [95 % confidence interval (CI) 0.676–0.738], 0.780 (95 % CI 0.736–0.819), 0.436 (95 % CI 0.348–0.528) and 0.920 (95 % CI 0.885–0.945), respectively. The diagnostic odds ratio of CIN3+ was 8.828 (95 % CI 7.109–10.962), which was higher compared with that for CIN2+ (6.115, 95 % CI 4.604–8.123). NMA revealed that most methylation assays included in this study performed similarly to cytology. Among the available methylation assays, S5 classifier has a balanced performance in sensitivity and specificity overall. In conclusion, methylation assays are an effective and accurate triage strategy for advanced CIN among high-risk HPV-positive women. S5 classifier seems to be promising due to its triage performance. Cervi-M and GynTect are suitable for application in developing countries due to their superior specificity and PPV. However, more studies are needed to confirm these conclusions.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"308 ","pages":"Pages 54-65"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of epidural analgesia on postpartum bladder sensation

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-21 DOI: 10.1016/j.ejogrb.2025.02.037

G. Linfield-Brown , V. Khullar , L. Cardozo

Introduction

This study investigates the effects of epidural analgesia on postpartum urinary bladder sensation. Urinary retention and inability to void are well known side effects of epidural analgesia but the causes are unknown. The incidence of postpartum hypotonic bladder injury is increased in women receiving epidural analgesia during labour. We hypothesise that long-acting local anaesthetics used in epidural analgesia can impair bladder sensation and can lead to an increased risk of asymptomatic overdistension.

Method

Primiparous women between 38–42 weeks gestation who had received epidural analgesia prior to being in labour were recruited. The women were catheterised prior to insertion of the epidural to obtain baseline bladder sensation measurements of first sensation to void and maximum bladder capacity from cystometry. Women who delivered by spontaneous vaginal delivery were followed up. Postnatally, cystometry was repeated until bladder sensation returned to within 10 % of the pre-delivery volumes, bladders were not filled beyond 600 ml.

Results

Sixty women were recruited prior to insertion of the epidural but only eighteen were studied postpartum as they had a spontaneous vaginal delivery. The mean time for cystometry values to return to pre-delivery levels was 6.6 h with a maximum duration of 8 h. The mean volume of urine produced before bladder sensation returned was 1054 ml.

Conclusion

Epidural analgesia delays the return of bladder sensation by up to 8-hours post-delivery. The volume of urine passed during this time can be as much as 1400 ml. Bladder catheterisation should be performed following epidural analgesia to minimise the possibility of bladder overdistension.

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引用次数: 0

Inside Back Cover - Editors with images

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-21 DOI: 10.1016/S0301-2115(25)00090-9

引用次数: 0

Corrigendum to “Impact of the type of vaginal assisted delivery on the pelvic floor and OASI – Ultrasound study” [Eur. J. Obstetr. Gynecol. Reprod. Biol. 305, 142–146]

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-21 DOI: 10.1016/j.ejogrb.2025.02.027

Jan Dvorak , Renata Poncova , Tomas Fucik , Hans Peter Dietz , Jaromir Masata , Alois Martan , Kamil Svabik

引用次数: 0

Next birth after caesarean − Why are women not choosing to trial labour?

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-20 DOI: 10.1016/j.ejogrb.2025.02.009

Sarah J. Murphy , Mize Omar , Charlotte Madden , James Postle

Background

Vaginal birth after Caesarean section (VBAC) is a safe and appropriate choice for the majority of women after a previous lower segment caesarean section (LSCS) (1,2). The overall reported VBAC success rates are 72–75%. However, despite the safety and high success rates, VBAC rates in Ireland remain low, with rates of 18.9% and 20.7% in 2019 and 2020 respectively (3).

Methods

This was a retrospective, cross-sectional study of all eligible women attending a regional obstetric unit in Ireland between January and December 2022. Data was accessed via accessed through the Hospital In-Patient Enquiry (HIPE) system.

Results

210 women were identified from the 12 month period. At booking, over half of these women, 112 (53 %) chose to have a planned, repeat LSCS. Of those who choose a VBAC (n = 98) only 41.8 % had a trial of labour after caesarean. In total, this gives a total of 169 or 80 % of women who chose to have a repeat caesarean.

Conclusion

While VBAC success rates are high, our study shows that the majority of women in our unit did not wish to attempt a VBAC. This data is important, because as the rate of primary LSCS increases internationally, so too will rates of repeat caesareans. Women’s concerns and barriers to choosing VBAC should be explored in order to reduce morbidity associated with repeat LSCS.

{"title":"Next birth after caesarean − Why are women not choosing to trial labour?","authors":"Sarah J. Murphy , Mize Omar , Charlotte Madden , James Postle","doi":"10.1016/j.ejogrb.2025.02.009","DOIUrl":"10.1016/j.ejogrb.2025.02.009","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal birth after Caesarean section (VBAC) is a safe and appropriate choice for the majority of women after a previous lower segment caesarean section (LSCS) (1,2). The overall reported VBAC success rates are 72–75%. However, despite the safety and high success rates, VBAC rates in Ireland remain low, with rates of 18.9% and 20.7% in 2019 and 2020 respectively (3).</div></div><div><h3>Methods</h3><div>This was a retrospective, cross-sectional study of all eligible women attending a regional obstetric unit in Ireland between January and December 2022. Data was accessed via accessed through the Hospital In-Patient Enquiry (HIPE) system.</div></div><div><h3>Results</h3><div>210 women were identified from the 12 month period. At booking, over half of these women, 112 (53 %) chose to have a planned, repeat LSCS. Of those who choose a VBAC (n = 98) only 41.8 % had a trial of labour after caesarean. In total, this gives a total of 169 or 80 % of women who chose to have a repeat caesarean.</div></div><div><h3>Conclusion</h3><div>While VBAC success rates are high, our study shows that the majority of women in our unit did not wish to attempt a VBAC. This data is important, because as the rate of primary LSCS increases internationally, so too will rates of repeat caesareans. Women’s concerns and barriers to choosing VBAC should be explored in order to reduce morbidity associated with repeat LSCS.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"307 ","pages":"Pages 265-266"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of repeated synthetic mid-urethral sling for recurrent stress urinary incontinence: A systematic review and metanalysis

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology

Pub Date : 2025-02-18 DOI: 10.1016/j.ejogrb.2025.02.034

Alessandro Ferdinando Ruffolo , Tomaso Melocchi , Matteo Frigerio , Chrystele Rubod , Yohan Kerbage , Xavier Deffieux , Marine Lallemant , Michel Cosson

Introduction

There is no clinical consensus concerning the best surgical procedure for recurrent stress urinary incontinence (rSUI) after primary mid-urethral sling (pMUS). The aim of this meta-analysis was to evaluate efficacy and safety of repeated MUS (rMUS) in women previously submitted to pMUS.

Methods

We performed systematic research and meta-analysis from PubMed/MEDLINE and EMBASE, according to PRISMA 2020 guidelines, until 11th of November 2024. Women with rSUI after pMUS, submitted to rMUS were included. Primary- versus repeated-MUS and retropubic (RP) versus transobturator (TO) approach were compared. rSUI cure and re-operation rates were evaluated. Seventeen articles were included.

Key findings and limitations

rMUS subjective and objective success rates were 68 % (95 %CI: 62 %-74 %; I²-test 70.3 %, p < 0.001) and 74 % (95 %CI: 66 %-82 %; I²-test 61.4 %, p = 0.003) respectively. No difference emerged between RP and TO approach subjectively [OR 0.92, 95 %CI 0.52–1.64; p = 0.78 (I²-test 34 %, p = 0.18)] and objectively [OR 0.80, 95 %CI 0.03–23.62; p = 0.90 (I²-test 79 %, p = 0.03)]. No difference was highlighted between pMUS and rMUS [OR 0.42, 95 %CI 0.16–1.09; p = 0.08 (I²-test 78 %, p = 0.03)] in subjective cure. No severe adverse events were reported. Reoperation rate for any indication was 5 % (95 %CI: 1 %-9%; I²-test 56.9 %, p = 0.04). Reoperation rate for rSUI was 1 % (95 %CI: 0 %-2%; I²-test 0.24 %, p = 0.37). Reoperation rate for other indications was 3 % (95 %CI: 1 %-4%; I²-test 10.9 %, p = 0.34).

Conclusion

rMUS is a highly effective and safe option for women with rSUI. Its excellent effectiveness, comparable to that of pMUS, and the lack of significant differences between RP and TO techniques underscore the flexibility and validity of this approach.

{"title":"Efficacy and safety of repeated synthetic mid-urethral sling for recurrent stress urinary incontinence: A systematic review and metanalysis","authors":"Alessandro Ferdinando Ruffolo , Tomaso Melocchi , Matteo Frigerio , Chrystele Rubod , Yohan Kerbage , Xavier Deffieux , Marine Lallemant , Michel Cosson","doi":"10.1016/j.ejogrb.2025.02.034","DOIUrl":"10.1016/j.ejogrb.2025.02.034","url":null,"abstract":"<div><h3>Introduction</h3><div>There is no clinical consensus concerning the best surgical procedure for recurrent stress urinary incontinence (rSUI) after primary mid-urethral sling (pMUS). The aim of this <em>meta</em>-analysis was to evaluate efficacy and safety of repeated MUS (rMUS) in women previously submitted to pMUS.</div></div><div><h3>Methods</h3><div>We performed systematic research and <em>meta</em>-analysis from PubMed/MEDLINE and EMBASE, according to PRISMA 2020 guidelines, until 11th of November 2024. Women with rSUI after pMUS, submitted to rMUS were included. Primary- versus repeated-MUS and retropubic (RP) versus transobturator (TO) approach were compared. rSUI cure and re-operation rates were evaluated. Seventeen articles were included.</div></div><div><h3>Key findings and limitations</h3><div>rMUS subjective and objective success rates were 68 % (95 %CI: 62 %-74 %; I<sup>2</sup>-test 70.3 %, <em>p</em> < 0.001) and 74 % (95 %CI: 66 %-82 %; I<sup>2</sup>-test 61.4 %, <em>p</em> = 0.003) respectively. No difference emerged between RP and TO approach subjectively [OR 0.92, 95 %CI 0.52–1.64; <em>p</em> = 0.78 (I<sup>2</sup>-test 34 %, <em>p</em> = 0.18)] and objectively [OR 0.80, 95 %CI 0.03–23.62; <em>p</em> = 0.90 (I<sup>2</sup>-test 79 %, <em>p</em> = 0.03)]. No difference was highlighted between pMUS and rMUS [OR 0.42, 95 %CI 0.16–1.09; <em>p</em> = 0.08 (I<sup>2</sup>-test 78 %, <em>p</em> = 0.03)] in subjective cure. No severe adverse events were reported. Reoperation rate for any indication was 5 % (95 %CI: 1 %-9%; I<sup>2</sup>-test 56.9 %, <em>p</em> = 0.04). Reoperation rate for rSUI was 1 % (95 %CI: 0 %-2%; I<sup>2</sup>-test 0.24 %, <em>p</em> = 0.37). Reoperation rate for other indications was 3 % (95 %CI: 1 %-4%; I<sup>2</sup>-test 10.9 %, <em>p</em> = 0.34).</div></div><div><h3>Conclusion</h3><div>rMUS is a highly effective and safe option for women with rSUI. Its excellent effectiveness, comparable to that of pMUS, and the lack of significant differences between RP and TO techniques underscore the flexibility and validity of this approach.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"308 ","pages":"Pages 34-46"},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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