International Urogynecology Journal最新文献

Introduction and hypothesis: Pelvic floor muscle exercises are widely recommended as an evidence-based, noninvasive, and cost-effective approach, particularly for the prevention and management of urinary incontinence. This study was conducted to compare the knowledge levels, application habits and recommendation behaviors of Physiotherapy and Rehabilitation and Nursing department students regarding Kegel exercises.

Methods: This cross-sectional study included 250 undergraduate students (150 from Physiotherapy and Rehabilitation, 100 from Nursing) at a Turkish university. Data were collected via a structured questionnaire evaluating students' sociodemographic characteristics, knowledge, practice frequency, recommendation behaviors, and perceived effectiveness of Kegel exercises. Group comparisons were analyzed using independent t-tests and chi-square tests, with statistical significance set at p < 0.05.

Results: Physiotherapy and Rehabilitation students showed significantly higher scores in knowledge (p = 0.032), more frequent application (p = 0.008), and greater likelihood of recommending Kegel exercises (p = 0.001). They also reported higher effectiveness and overall engagement (p < 0.001).

Conclusions: The findings indicate that Physiotherapy and Rehabilitation students possess higher levels of knowledge, are more likely to apply Kegel exercises themselves, and more frequently recommend them to others compared to Nursing students. This disparity may be attributed to curriculum differences, particularly the greater emphasis on musculoskeletal and pelvic health training within physiotherapy education. Integrating structured pelvic floor muscle training modules into nursing curricula may enhance students' competence and confidence, ultimately contributing to improved pelvic health awareness and patient care outcomes.

Introduction and hypothesis: Sacrospinous ligament fixation (SSLF) is an established procedure for pelvic organ prolapse (POP) repair, yet the suture placement involves risks of neurovascular injury. The Tissue Anchoring System (TAS^®; Promedon) was developed to standardize SSLF and reduce associated risks. This study presents the assessment of anatomical safety margins of the TAS^® following fixation by both expert and novice operators, as well as its mechanical fixation strength.

Methods: Two POP surgeons with different experience levels placed TAS^® anchors bilaterally in the anterior portion of the SSL in 10 female cadavers (20 fixation points). A blinded assessor measured SSL dimensions and distances to the ischial spine (IS), inferior gluteal artery (IGA), internal pudendal artery (IPA), pudendal nerve (PN), and levator ani nerve (LAN). Fixations ≥ 0.10 cm from all structures were defined as safe. Pull-out strength was tested after anatomical measurements, with 10 N as the safety threshold.

Results: Median anchor-to-structure distances were IS 2.4 cm (2.0-3.1), IGA 2.8 cm (2.3-3.0), IPA 2.9 cm (2.5-3.3), PN 3.0 cm (2.7-3.4), and LAN 1.1 cm (0.7-1.5). Nineteen of the 20 TAS^® were ≥ 0.10 cm from all structures; one TAS^® placed by the novice was 0.7 cm from LAN. No appreciable differences were seen between right and left sacrospinous ligament sides or operators. Mean pull-out force was 54.3 N.

Conclusions: Fixation of TAS^® achieved safe, reproducible placement within the SSL and provided great mechanical strength. Results were consistent across sides and operators, although anatomical and surgical training remains essential for safe clinical use.

Introduction and hypothesis: To explore the association between dysfunctional toileting behaviors (TB) and recurrent urinary tract infections (RUTI) in premenopausal women using a validated behavioral assessment scale.

Methods: We conducted a case-control study at the American University of Beirut Medical Center between 2020 and 2023. A total of 294 premenopausal women were recruited, comparing 98 women with RUTI and 196 controls without RUTI. Participants completed a structured questionnaire, including demographic data and responses to the Toileting Behaviors-Women's Elimination Behavior (TB-WEB) scale, assessing five behavioral domains: place preference, premature voiding, delayed voiding, straining, and position preference. Statistical analysis involved t-tests, chi-square tests, and multivariable logistic regression adjusting for potential confounders.

Results: Women with RUTI were more likely to prefer crouching rather than sitting on toilet seat during micturition, both at home and in public restrooms. Women with RUTI showed significantly higher mean scores for dysfunctional TB when compared to those without RUTI in the following domains: place preference for voiding, premature voiding, delayed voiding, and straining. At least 62.5% of women with RUTI reported that these behaviors had been habitual prior to their diagnosis suggesting that these practices could have contributed to the development of RUTI.

Conclusions: This study identifies a significant association between "dysfunctional" TB and RUTI in premenopausal women. The findings underscore the importance of further research to explore the causal mechanisms underlying this relationship and to develop targeted interventions aimed at modifying TB to try to curb the incidence of RUTI.

Introduction and hypothesis: Urogenital fistulas are rare but severe complications of gynecological surgery, mainly hysterectomy, with a major impact on quality of life. This study aimed to evaluate the management and outcomes of urogenital fistulas treated in a tertiary referral center, with a focus on vesicovaginal fistulas (VVF) and prognostic factors for surgical success.

Methods: We retrospectively reviewed all patients managed for urogenital fistula in our institution between January 2010 and December 2024 in a French university hospital. Clinical, etiological, surgical, and functional outcomes were analyzed. Subgroup analysis was performed on patients with VVF to identify predictors of surgical success.

Results: Among 131 patients identified, 67 were confirmed with urogenital fistulas: 39 VVF (58.2%), 12 urethrovaginal (17.9%), 11 ureterovaginal (16.4%), and five vesicouterine fistulas (7.5%). Median age at diagnosis was 49 years [IQR 43-62] and median BMI 27 kg/m² [IQR 24-31]. Most cases followed hysterectomy (58%) or other pelvic surgery (26.1%), while 11.6% were obstetric. Primary success after the index repair was 80.6%, while definitive closure was ultimately achieved in 92.5% of patients. In vesicovaginal fistulas, primary success was 89.7%. Predictors of failure included prior radiotherapy (75% vs 10.8%, p = 0.012), oncological etiology (p = 0.013), and longer surgical delay (12 months vs 6 months, p = 0.027). Major complications (Clavien ≥ III) occurred only in failures (50% vs 0%, p = 0.007).

Conclusions: VVF repair achieves high success rates in specialized centers. Radiotherapy, oncological etiology, and prolonged delay are significant risk factors for failure, underlining the importance of early referral and multidisciplinary management.

Introduction and hypothesis: The route of vaginal cuff closure after laparoscopic hysterectomy has not been standardized. This study was designed to compare pelvic floor support after vaginal or laparoscopic cuff closure. The authors hypothesized that laparoscopic closure would be superior.

Methods: This randomized controlled trial included women undergoing a benign total laparoscopic hysterectomy. Exclusion criteria included concurrent prolapse procedure, malignancy, and a pelvic organ prolapse quantitation system (POPQ) point C greater than -4. Preoperative POPQ exams were performed by blinded Urogynecologists. Patients were randomized to vaginal or laparoscopic cuff closure on the day of surgery. POPQ exams were repeated by blinded Urogynecologists at 6-8 weeks and 1 year postoperatively. Using a corrected alpha of 0.05 and power 0.8 to detect a 1.75 cm difference, the required sample size was 62 with 31 patients per group. Categorical variables were compared using the chi-squared or Fisher exact tests. Continuous variables were compared using a two-tailed t-test.

Results: Fifty-seven patients were enrolled. Forty-four patients completed 6-8 week follow-up, and 33 patients were evaluated at 1 year. The calculated sample size was not obtained as patient enrollment and retention were impacted by the COVID-19 pandemic. The mean difference of point C between laparoscopic and vaginal closure was 0.98 cm and 1.24 cm, respectively, at 6-8 weeks (p = .55), and 1.22 cm and 1.63 cm, respectively, at 1 year (p = .48). Mean differences for all other POPQ exam points and complication rates were nonsignificant.

Conclusions: For up to 1 year postop, there is no significant difference in apical support when comparing laparoscopic to vaginal cuff closure.

Introduction and hypothesis: To evaluate the long-term effectiveness of fractional CO₂ laser in the treatment of stress urinary incontinence (SUI), the permanence of symptom control, and additional session requirements over a 2-year follow-up period.

Methods: This retrospective cohort study included 215 women with clinically diagnosed SUI who underwent a standardized course of fractional CO₂ laser therapy. Assessments were conducted at baseline, 4-6 weeks, 1 year, and 2 years. Primary outcome measures included patient-reported satisfaction and Michigan Incontinence Symptom Index (MISI) scores. Secondary outcomes were changes in sexual function determined using the Female Sexual Function Index (FSFI), vaginal symptom severity using the Vaginal Symptom Questionnaire (VSQ), and genital self-image using the Female Genital Self-Image Scale (FGSIS). Data distribution was evaluated using the Shapiro-Wilk test. Repeated measures were analyzed using Friedman or repeated-measures ANOVA, followed by the Dunn or Newman-Keuls post hoc tests. Statistical significance was set at p < 0.05.

Results: Significant improvement was observed throughout follow-up in all primary and secondary outcomes (p = 0.0001). Satisfaction scores increased significantly at 4-6 weeks compared to baseline and still exhibited a high level at 1 year. Although a partial decrease occurred in the second year, values still remained significantly above baseline (from median 2 to 4; p = 0.0001). MISI decreased from 19.51 ± 4.41 at baseline to 1.96 ± 1.38 at 4-6 weeks. Although values rose to 6.31 ± 4.01 in the second year, significant improvement compared to baseline was maintained (p = 0.0001). Significant improvement was observed in all FSFI subdomains (including desire, arousal, lubrication, orgasm, satisfaction, pain, and total score) in the early period (p = 0.0001), and despite a slight decrease in the second year, the gains were largely maintained. Similar marked improvements were also observed in VSQ and FGSIS scores, with no return to baseline values despite a partial decline in the second year (p = 0.0001). Supportive additional session requirements were determined in association with subjective worsening in symptoms in the second year in approximately 20% of the participants.

Conclusions: Fractional CO₂ laser therapy produces significant and clinically important improvement in SUI symptoms, sexual function, vaginal symptoms, sexual function, vaginal comfort, and genital self-image. All effects peak at 4-6 weeks, are largely preserved at 1 year, and despite a partial decline in the second year, remain markedly superior to baseline. These findings show that fractional CO₂ laser is an effective, minimally invasive, nonsurgical option in the management of SUI.

Introduction and hypothesis: Transobturator mid-urethral sling (TVT-O), a surgical treatment for stress urinary incontinence, has been shown to be highly effective in the short and medium term. However, long-term outcomes with larger sample sizes are lacking. The study is aimed at assessing the efficacy and safety of TVT-O over a 10-year follow-up period in Chinese women.

Methods: This prospective observational study included Chinese women who underwent TVT-O for urodynamic stress incontinence. Objective cure was defined as the absence of urodynamic stress incontinence on a urodynamic study, whereas a subjective cure was defined as the patient's perception of their condition. Quality of life (QOL) was assessed using the validated Urogenital Distress Inventory-6 questionnaire and the Incontinence Impact Questionnaire-7, along with the visual analogue scale (VAS).

Results: A total of 326 Chinese women were included in the study. The objective and subjective cure rates at the 10-year follow-up were 75.2% and 73.6% respectively. Significant improvements were observed across all QOL domains. The mean VAS satisfaction score was 8.5 out of 10 after 10 years. Complications were uncommon; 2 women (0.6%) experienced tape erosion, one of whom required local excision. No patients reported persistent thigh pain after 10 years. The cumulative rate of repeating the mid-urethral sling procedure was 2.5%.

Conclusions: The TVT-O is a highly effective and safe surgical treatment for women with stress urinary incontinence at the 10-year follow-up. Thigh pain after TVT-O is rare and should not prevent women from considering this beneficial treatment.