International Urogynecology Journal最新文献

Introduction and hypothesis: This study compared the rate of postoperative urinary retention between women undergoing apical prolapse repair via uterosacral ligament suspension (USLS) versus sacrospinous ligament fixation (SSLF). We hypothesized that voiding dysfunction may be higher following SSLF.

Methods: We conducted a retrospective chart review study in a tertiary academic center from January 2015 through February 2025, including all patients undergoing either SSLF or USLS surgery. Voiding trials were generally performed the same day as the surgery. Specifically, the bladder was backfilled with 300 mL of sterile water or saline, the catheter was removed, and patients had to void ≥ 200 mL within 30 min to be discharged without a catheter. Univariate and multivariable logistic regression analyses were performed with a threshold of statistical significance set at p < 0.05 to examine the association between surgical approach and voiding trial outcome while controlling for relevant clinical and demographic factors.

Results: The study included two patient groups (USLS 577; SSLF 186) who underwent surgery with mean ages of 63 and 67 years, respectively (p < 0.001). Race distribution differed between subgroups, with "White, non-Hispanic" being the most frequent category in both (84.1%; 71%; p = 0.003). Alcohol use (p = 0.015) and baseline pelvic organ prolapse stage also varied between the two surgical cohorts (USLS 50.1% stages I and II; SSLF: 61.8% stages III and IV; p = 0.006). Most patients in both groups experienced preoperative urinary incontinence (72.1%; 60.2%; p = 0.003) and underwent concomitant surgical procedures including mid-urethral slings (p < 0.001). In univariate analysis, there was no difference in voiding trial outcomes between both groups (p = 1). After controlling for confounders, the overall voiding trial outcomes did not differ in a statistically significant manner between the USLS and SSLF groups (OR 2.53, 95% CI 0.23-61.01, p = 0.48). This was also true even when slings were excluded (p = 0.3).

Conclusions: There was no observed difference in postoperative voiding dysfunction between the two surgical approaches. Future studies with larger sample sizes may garner different results.

Pelvic floor disorders (PFDs) - which include pelvic organ prolapse, urinary incontinence, perineal trauma, fecal incontinence, and sexual dysfunction - affect one in four women globally. There is compelling epidemiological and pathophysiological evidence that these conditions result from childbirth trauma. Yet chronic maternal pelvic morbidity remains a neglected issue within the maternal health agenda worldwide. Current health systems limit public health approaches to maternal health to just 6 weeks after birth, overlooking the long-term pelvic floor consequences of childbirth trauma. In many countries, women suffering from PFDs often face stigma, cultural isolation, and economic hardship yet have little access to care owing to cultural taboos, policy-based neglect, systemic under-reporting and underinvestment, and limited preventive and cost-effective care frameworks within the public health system. This white paper advocates for the extension of the paradigm of maternal health beyond 6 weeks postpartum to encompass all the repercussions of childbirth pelvic floor trauma, irrespective of the timeframe of their development. It concludes with a call to action urging multilateral agencies, national health ministries, policymakers, urogynecologists, public health professionals, and the social sector to join forces in a coordinated multisectoral response. Addressing chronic maternal pelvic morbidity requires the inclusion of pelvic health services within existing maternal and reproductive health programs, the development of global public health guidelines that prioritize prevention and timely management, and the training of health care providers at all levels of the health system. This white paper asks for sustained policy support, greater investment in research and the development of cost-effective therapies, stronger advocacy, and integration with existing programs such as fistula care.

Introduction and hypothesis: The objective was to investigate morphological differences in the superficial perineal muscles-bulbocavernosus muscle (BCM), superficial transverse perineal muscle (STPM), and perineal body (PB)-in women with pelvic organ prolapse (POP) compared with parous and nulliparous controls, and their correlation with symptoms.

Methods: This observational study included 99 women: 66 with POP, 14 parous controls, and 19 nulliparous controls. Participants completed Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) questionnaires and underwent 3.0 T MRI at rest and during Valsalva. High-resolution T2-weighted images were used for 3D reconstruction and volumetric analysis. The analysis incorporated relevant metrics of the BCM, STPM, and PB, including the assessment of BCM integrity with a particular emphasis on identifying ruptures. Receiver operating characteristic curve analysis was applied to explore the normal reference value for STPM volume.

Results: The BCM volume was significantly smaller in the POP group versus nulliparous controls (469.0 mm³ vs 1000.5 mm³, p < 0.001), but not compared with parous controls. Within the POP group, patients with BCM disruption (36.4%, 24 out of 66) had significantly worse quality-of-life scores (PFIQ-7, CRAIQ-7, POPIQ-7; p < 0.05). STPM volume was significantly reduced in the POP group (396.1 mm³) compared with both the parous group (639.9 mm³) and the nulliparous group (807.1 mm³). A STPM volume of less than 705 mm³ was relevant with POP in parous women (area under the curve = 0.75, 63.6% sensitivity, 81.8% specificity, p < 0.001). No significant differences were found in PB volume among three groups.

Conclusion: Superficial perineal muscles, particularly the BCM and STPM, show significant morphological differences in women with POP. These differences include a reduction in the volume of BCM, as well as decreases in the length, width, and volume of the STPM. Rupture of the BCM is associated with colorectal-anal and prolapse symptom severity. Quantitative MRI assessment of these structures could serve as a valuable biomarker for evaluating pelvic floor support and POP risk.

Introduction and hypothesis: Recent evidence supports the clinical and economic advantages of the Manchester procedure (MP) over sacrospinous hysteropexy (SSH) in women treated for mild to moderate uterine prolapse. However, its use remains inconsistent, resulting in a notable variation in current practice. This study explores gynecologists' barriers and facilitators to adoption of the MP, aiming to guide the development of a targeted implementation strategy.

Methods: From March to June 2025, we conducted semi-structured interviews with gynecologists (n = 12) from the Netherlands in different stages of implementation to identify barriers and facilitators. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis, ensuring a structured assessment of key domains.

Results: A total of 12 barriers and 20 facilitators were identified in 13 constructs across all CFIR domains. Key facilitators for implementation included strong regional collaboration networks, the low complexity of the surgical technique, peer-driven motivation to align with national trends, and overall trust in the evidence, although the latter varied between clinicians. Main barriers were the personal and organizational effort required for training and implementation, particularly in the absence of an experienced colleague, satisfaction with SSH results, and concerns about lower reimbursement for the MP.

Conclusions: This study identified key barriers and facilitators influencing the adoption of the MP from the perspective of gynecologists, emphasizing the clinical, organizational, and financial factors involved. Addressing these barriers and leveraging facilitators could enhance adoption of the MP, potentially improving treatment outcomes and reducing healthcare costs.

Introduction and hypothesis: To compare short-term outcomes of pubourethral ligament plication (PLP) versus transobturator tape (TOT) for stress urinary incontinence (SUI) and evaluate the prognostic value of the preoperative International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Methods: In this prospective, non-randomized cohort study, 140 women underwent PLP (n = 48) or TOT (n = 92). Success was assessed at 6 months using objective (pad count) and subjective criteria. Predictive performance of preoperative ICIQ-SF was analyzed using receiver operating characteristic (ROC) curves.

Results: Preoperative symptoms were more severe in the TOT group (p = 0.003). Objective success rates were 88.0% for TOT and 77.1% for PLP (p > 0.05); subjective satisfaction was high and comparable. PLP had significantly shorter operative duration (p < 0.001) and no mesh-related complications, while TOT had an 8.7% complication rate. Preoperative ICIQ-SF score demonstrated excellent discriminative power for predicting failure (AUC 0.98; 95% CI 0.96-1.00), whereas daily pad count was a poor predictor (AUC 0.48). An ICIQ-SF threshold of ≥ 17 points identified patients at high risk of failure with high sensitivity and specificity.

Conclusions: PLP and TOT provide comparable short-term relief. PLP is a faster, mesh-free alternative avoiding synthetic material-related morbidity. Preoperative ICIQ-SF is a robust tool for individualized risk stratification, though the high AUC warrants external validation.

Introduction and hypothesis: This study is aimed at analyzing global public interest in treatment modalities for stress urinary incontinence (SUI) from 2004 to 2025 using Google Trends, a digital tool that captures real-time search behavior.

Methods: Google Trends data were collected for eight urinary incontinence treatment modalities, including both conservative and surgical options, over a 21-year period. The search terms analyzed were: "pelvic floor exercise" (PFE), "artificial urinary sphincter" (AUS), "transobturator tape", "Burch colposuspension," "midurethral sling" (MUS), "Bulkamid", "tension-free vaginal tape", and "pubovaginal sling" (PVS). Linear regression was used to evaluate the direction and magnitude of trend changes, and Pearson correlation analysis assessed inter-relationships among modalities. Data were retrieved on 2 April 2025, and analyzed using IBM SPSS Statistics.

Results: Pelvic floor exercise demonstrated the strongest and most consistent upward trend among all modalities (R² = 0.664, adjusted R² = 0.663, p < 0.001). MUS also showed a pronounced and statistically significant increase in relative search volume (RSV) over time (R² = 0.535, adjusted R² = 0.533, p < 0.001). Bulkamid demonstrated a strong positive temporal trend (R² = 0.585, adjusted R² = 0.583, p < 0.001). AUS exhibited a statistically significant upward trend over the study period (R² = 0.284, adjusted R² = 0.281, p < 0.001). Burch colposuspension showed a significant but more modest increase in RSV (R² = 0.293, adjusted R² = 0.290, p < 0.001). Sling-based surgical techniques demonstrated statistically significant declines in public interest over time.

Conclusions: Public interest is shifting toward conservative management, especially PFE, whereas interest in certain surgical techniques is declining. These findings highlight evolving treatment preferences and the need for region-specific health strategies. Despite its limitations, Google Trends can help to monitor awareness and inform future public health efforts.

Introduction and hypothesis: This retrospective cohort study examined racial/ethnic differences in time from initial presentation with urinary incontinence (UI) to surgery and number of clinical visits prior to sling surgery for UI.

Methods: Electronic health records were accessed for patients aged 18 years or older who underwent sling procedures for UI over a 134-month period at a single academic institution. The primary outcome was lead time to surgery (LTTS), the number of days between the first clinical visit for UI and the anti-incontinence surgery. The secondary outcome was the number of UI-related clinical visits prior to surgery. ANOVA and multivariable linear regression analyses were used to identify independent predictors.

Results: A total of 4246 patients were analyzed. On univariate analysis, Black patients had the longest LTTS (462.8 ± 735.7 days) compared with white patients (302.2 ± 496.8 days) and "Other" patients (226.4 ± 429.4 days; p < 0.01). However, multivariable regression revealed that racial/ethnic differences in LTTS were not statistically significant after controlling for confounders (β = 11.13, p = 0.41). Instead, age and UI severity were identified as significant predictors of LTTS. Age was inversely associated with LTTS (β = -2.53, p < 0.02), and greater UI severity was associated with shorter LTTS (β = -21.93, p = 0.03). Notably, racial/ethnic differences in preoperative visit frequency remained significant in adjusted models; Asian and Hispanic patients had, on average, 0.90 (p < 0.01) and 0.58 (p < 0.01) more visits respectively than white patients.

Conclusions: Although lead time to UI surgery did not differ by race/ethnicity after adjustment, Asian and Hispanic patients had significantly more preoperative visits prior to surgery.

Introduction and hypothesis: The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories.

Methods: This retrospective study included 636 women (mean age 57.4 ± 10.4 years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25 kg/m²), overweight (25-29.9 kg/m²), and obese (≥ 30 kg/m²). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2 g, while subjective cure was based on patient-reported outcomes using the UDI-6.

Results: Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40 cm H₂O.

Conclusions: BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.