International Urogynecology Journal最新文献

Introduction and hypothesis: Women undergoing a vacuum-assisted (VA) delivery are at an increased risk of experiencing an obstetric anal sphincter injury (OASI). Studies using three-dimensional-endoanal ultrasound (3D-EAUS) have shown that not all OASIs are recognized immediately postpartum. In primipara with VA deliveries, the presence of and the potential clinical implications of undetected OASIs are undetermined and consequently, we examined prospectively a 1-year cohort of this population. We hypothesized that the total rate of OASIs would be higher than the clinically reported rates and wanted to identify potential associated predictors.

Methods: The participants were examined 10-14 days postpartum with 3D-EAUS. Two experienced examiners, blinded to the clinical data, rated the results. The primary outcome was the combined rate of clinically recognized OASIs and clinically unrecognized ultrasound anal sphincter injuries. Logistic regression analysis was used to calculate the odds ratios for selected variables.

Results: Of 334 eligible women, 271 (81%) were included. The total rate of OASIs was 19% (95% CI 14-24; 14% clinically recognized and 5% clinically unrecognized). Prolonged second-stage/maternal exhaustion, occiput posterior presentation, and birthweight ≥ 4000g were significant and independent risk factors, increasing the odds two- to three-fold. The indication fetal distress alone or in combination with others significantly reduced the odds.

Conclusions: About 1 in 5 primipara undergoing a VA delivery experienced an OASI and about one quarter of them were not recognized clinically. The VA procedure is a modifiable intervention, and the identified risk and protective factors may help clinicians to decide whether it should be performed.

Introduction and hypothesis: Knowledge regarding rates of improvement of fecal incontinence (FI) after repair of posterior compartment prolapse is limited. We aimed to estimate the rate of resolution or improvement of fecal incontinence postoperatively following transvaginal posterior compartment repair.

Methods: This was a retrospective cohort study including patients with diagnosis of fecal incontinence who underwent transvaginal posterior repair at a single academic institution between 1/2016 and 1/2022. Patients who underwent concomitant anal sphincteroplasty served as controls. The primary outcome was resolution of FI symptoms within 6-weeks postoperatively. Secondary outcomes included improvement of FI symptoms and preoperative anorectal manometry characteristics. Univariate and bivariate analysis were performed to describe and compare outcomes between groups with multivariable regression performed to address potential confounders.

Results: Of 179 patients included, 91 had posterior repair alone, while 88 had concomitant anal sphincteroplasty. Demographic and clinical characteristics were similar between groups. Overall, 143 (80%) patients did not report any FI symptoms at their 6-week postoperative visit. An additional 28 (16%) reported improvement in FI symptoms. Among patients who underwent posterior repair alone, 76 (84%) had resolution of their FI compared to 67 (76%) in patients with concomitant anal sphincteroplasty (P = 0.6); 71 patients underwent anorectal manometry preoperatively. There were no significant differences in mean average resting pressures or mean maximum squeeze pressures between groups.

Conclusions: Posterior compartment repair resulted in resolution or improvement of fecal incontinence symptoms within 6-weeks postoperatively. The mechanism for FI symptoms in women with rectoceles may be independent of the anal sphincter complex.

Introduction and hypothesis: The aim of this study was to evaluate the effectiveness of core stabilization exercises combined with pelvic floor muscle training (PFMT, Kegel exercises) in women with stress urinary incontinence (SUI) on pelvic floor muscle strength, incontinence parameters, and quality of life scores.

Methods: This prospective, randomized controlled study included 60 women diagnosed with SUI or stress-dominant mixed urinary incontinence (MUI). Participants were randomly assigned to two groups: the intervention group, which performed both core and Kegel exercises, and the control group, which engaged only in Kegel exercises. Evaluations were conducted immediately after the intervention and at the 10-week follow-up using digital palpation, perineometer, bladder diaries, pad tests, and quality of life assessments, including UDI-6, IIQ-7, ISI, and the King's Health Questionnaire (KHQ).

Results: Both groups demonstrated significant reductions in the frequency and severity of incontinence, as well as improvements in quality of life scores. However, while the intervention group exhibited sustained benefits at the 10th-week follow-up, improvements in the control group regressed over time.

Conclusions: The addition of core stabilization exercises to Kegel exercises did not yield significant short-term differences; however, at follow-up, the core exercise group maintained significantly better outcomes compared to the control group. These findings suggest that, in women diagnosed with SUI, core stabilization exercises enhance pelvic floor muscle strength and endurance more sustainably than Kegel exercises alone.

Introduction: Pad tests have been used to assess urinary incontinence (UI) during exercise, but they do not account for confounding factors such as perspiration. The objectives of this study were to describe pad weight gain among runners with and without running-induced stress UI (RI-SUI), who complete a standardized treadmill-based pad test, and to investigate the sensitivity and specificity of pad weight gain as a measure of urine leakage.

Methods: This was an observational cohort study. We recruited adult female runners with and without RI-SUI. Participants performed a 38-min treadmill-based running protocol while wearing a pre-weighted incontinence pad. Pad weight gain was described by group, then compared between groups using the Mann-Whitney U test. A receiver-operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of different cutoff values for pad weight gain.

Results: Data from 74 runners (20 with and 54 without RI-SUI) were included. The median pad weight gain was significantly higher in the incontinent group (24.20 g; range 3.90-166.30 g) than in the continent group (3.80 g; range 0.20-19.96 g; p < 0.001). When using a 9.35 g cutoff, the ROC curve predicted urine leakage with 70% sensitivity and 88% specificity, while a 0.25 g cutoff would achieve 100% sensitivity and 19.98 g would achieve 100% specificity.

Conclusion: Pad weight gain during a treadmill-based pad test should be interpreted cautiously, as values up to 19.96 g may result from perspiration or other fluids.

Introduction and hypothesis: The treatment of pelvic organ prolapse (POP) presents significant challenges. It is important to explore safer and more effective treatment modalities. Recombinant humanized collagen (rhCol) is a promising biomaterial with excellent biocompatibility and pro-regenerative properties. Therefore, this study aims to evaluate the potential applications of rhCol in POP treatment.

Methods: Vaginal wall tissues were collected from three non-POP and five POP patients to analyze extracellular matrix (ECM) changes via histological staining. Primary fibroblasts isolated from POP vaginal tissues were treated with rhCol III. Cell proliferation, migration, senescence, and ECM synthesis were assessed. A simulated birth injury (SBI) rat model was used to evaluate ECM remodeling following rhCol injection into the vaginal wall. Additionally, the angiogenic potential of rhCol III was examined in vivo and in vitro.

Results: POP patient tissues and fibroblasts exhibited lower expression levels of type I and III collagen compared to non-POP samples. At a 1 mg/ml concentration, rhCol III promoted fibroblast proliferation and migration, reduced cellular senescence, and enhanced ECM synthesis. In the vaginal wall, the expression of COL1A1 and COL3A1 in the rhCol group was significantly higher than that in the SBI group, with a marked increase in the levels of CD31, CD34, and VEGFA. Furthermore, rhCol III improved the proliferation, migration, and tubule formation capacities of HUVECs.

Conclusions: rhCol III may promote ECM remodeling in an injured vaginal wall by restoring fibroblast function and stimulating angiogenesis, offering a novel biomaterial-based strategy for POP treatment.

Introduction and hypothesis: To date, levator ani muscle (LAM) morphometry has been classified descriptively and semi-quantitatively. New MRI techniques enabling detailed visualization with the 3D pelvic inclination correction system (3D PICS) could offer a one-stop-shop diagnostic modality for quantitative assessment of LAM subdivisions. The aim of this controlled MRI study was to assess morphometric LAM subdivision characteristics in two distinct groups of premenopausal women, namely nulliparous asymptomatic controls and symptomatic patients (Pelvic Organ Prolapse Quantification [POP-Q] ≥ II).

Methods: Magnetic resonance imaging scans of the 22 women in each group were analyzed applying the 3D PICS coordinate system. A second reading of MRI was used to calculate interrater reliability (IRR). Origins and insertions were expressed in the 3D-Cartesian coordinate system in relation to point 0/0/0 (inferior pubic point). Distances and angles between muscles and planes were described using mean and standard deviation or median with first and third quartiles for all LAM subdivisions.

Results: Moderate to good IRR was reported except for points close to point 0/0/0. Origins showed no difference between groups. Insertions differed notably in the vertically oriented pubovaginal, puboperineal, and puboanal muscles, with patients exhibiting lower positions along the superior-inferior axis by 6.1-7.7, 8.8, and 8.0-8.2 mm respectively. In contrast, the insertions of the horizontally oriented puborectal muscle showed a smaller difference of 1.8 mm. Muscle lengths were also 4% to 24% longer in cases.

Conclusions: This in vivo MRI study reveals first geometric 3D data on LAM morphology in 3D PICS for both cases and controls. Exact 3D coordinates of origin/insertion points, lengths, and angles could serve as a basis for future imaging-based POP diagnostics.

Introduction: To evaluate and compare 30-day perioperative outcomes of those undergoing gender-affirming vaginectomy with a hysterectomy and those with vaginectomy alone.

Methods: This was a retrospective cohort study of patients who underwent gender-affirming transvaginal vaginectomy with or without concurrent minimally invasive hysterectomy at an academic institution from 2020 to 2023 by surgeons in the division of Urogynecology and Reconstructive Pelvic Surgery. The primary outcome was a composite of clinically significant surgical complications within 30 days of the procedure, including Emergency Department (ED) visits, readmissions, re-operations, and surgical and urinary tract infections.

Results: Sixty-eight patients underwent gender-affirming transvaginal vaginectomy during the study period. Thirty-one patients had vaginectomy at the time of concurrent hysterectomy, while 37 patients had staged vaginectomy following hysterectomy. The median age was 32.8 years (27.6-38.8), and the mean body mass index (BMI) was 28.5 (SD 0.7). All concurrent hysterectomies were performed laparoscopically. Most demographic characteristics were similar between the two groups, except that the staged vaginectomy group had a longer duration of hormone therapy and higher parity. No significant differences were observed in the 30-day perioperative complications between those who underwent combined procedure transvaginal vaginectomy with or without minimally invasive hysterectomy. The only notable differences were an increase in the median estimated blood loss and a longer operative time in the concurrent hysterectomy and vaginectomy group. However, no patients in the cohort required a blood transfusion, and there was no difference in the total length of hospital stay.

Conclusions: Concurrently performing hysterectomy and vaginectomy adds no significant clinical morbidity to those undergoing vaginectomy as an interval procedure following hysterectomy.

Introduction and hypothesis: Pessary self-management (PSM) may increase patient autonomy and minimize the number of doctor consultations. However, little is known about the implementation and patient perception of PSM. This study aims to explore patients' experiences, opinions, and needs regarding PSM and how this was taught. Furthermore, to develop a standardized instruction manual.

Methods: A qualitative study with semi-structured interviews was conducted among patients with pessary therapy for pelvic organ prolapse (POP). A preliminary framework was conducted for thematic content analysis. Three main themes were described: initial opinion, motivation and suggestions for healthcare workers and other patients regarding PSM.

Results: Seventeen patients were interviewed of which 11 performed PSM, five women refused PSM, and one woman was not able to perform PSM. The initial opinion of patients varied. Half of patients were confident in succeeding to perform PSM, and in the other half, nervousness and lack of confidence in being able to perform PSM predominated. Autonomy, hygiene and fewer doctor consultations were named as the main motivating factors to perform PSM. Reasons for not performing PSM were anxiety and existing comorbidities. Patients were generally satisfied with the way PSM was explained and named videos and information leaflets as tips.

Conclusions: This explorative qualitative study revealed the motivators and barriers to learning PSM. Our findings highlight the importance of addressing patients' concerns and providing adequate information. In doing so, it is important to create a supportive environment to increase patient engagement and confidence in managing their condition through PSM. These results can help to successfully implement PSM in future healthcare.

Introduction: The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA revised (PISQ-IR) measures sexual function in women with pelvic floor dysfunctions (PFD). The aim of this study was to translate the PISQ-IR to Norwegian and to assess its psychometric properties.

Methods: The instrument was translated and reviewed through cognitive interviews with women from the target group and multidisciplinary clinical experts to establish face/content validity and cultural equivalence. Thereafter, a cross-sectional study of women with PFD from two Norwegian University hospitals was conducted. Floor and ceiling effects and internal consistency were calculated for all subscales. Construct validity was assessed through exploratory factor analysis (EFA) and by testing 19 theoretically derived hypotheses.

Results: Of 157 respondents, 111 (71%) women considered themselves sexually active (SA) and 46 (29%) non-sexually active (NSA). Item nonresponse rate varied from 4 to 36% in the subscales. For the NSA subscales, both floor and ceiling effect was detected. EFA mainly supported the original structure for both the SA and NSA subscales, although not completely consistent and with many cross-loadings. Unidimensional factors were assessed and confirmed the presence of one factor within all subscales for SA women and three for NSA women (except NSA-PR). Construct validity confirmed 16 of the 19 predefined hypotheses (84%). All subscales exhibited good internal consistency.

Conclusions: The Norwegian PISQ-IR demonstrated good face/content validity, internal consistency and construct validity, and can be used to assess sexual function among sexually active women with PFD. A small sample size of NSA women precludes drawing firm conclusions regarding structural validity for NSA subscales.

Introduction and hypothesis: Pelvic organ prolapse (POP) significantly affects women's quality of life, making the availability of validated, culturally adapted tools for reliable symptom evaluation essential. In this study, the Pelvic Organ Prolapse Symptom Score (POP-SS) was translated into Hungarian and validated, with the assessment of its psychometric properties for clinical and research use.

Methods: In total, 125 women diagnosed with symptomatic POP (Pelvic Organ Prolapse Quantification Score-POP-Q stage ≥ 2) completed the Hungarian POP-SS (POP-SS-H), the Hungarian version of the Australian Pelvic Floor Questionnaire (AFPQ-H), and the short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). Exploratory factor analysis was performed, McDonald's ω was used to assess internal consistency, and intraclass correlation coefficients (ICCs) were used to examine test-retest reliability over a 2-week interval.

Results: The POP-SS-H demonstrated strong psychometric properties (overall ICC = 0.96, p < 0.001). Item ICCs were 0.69-0.99, with "difficulty in emptying the bladder" being the most stable. The scale has a two-factor ("prolapse and urinary distress" and "abdominal strain and bowel discomfort") structure. McDonald's ω was 0.75, confirming its good internal consistency. The scale's convergent validity was demonstrated through correlations with AFPQ-H and WHOQOL-BREF subscale scores.

Conclusions: The POP-SS-H is a reliable and valid instrument for the assessment of prolapse-related symptoms. Its high degrees of test-retest reliability and internal consistency make it suitable for clinical follow-up and research. The tool addresses a significant gap in pelvic-floor disorder management in Hungary, although further research is recommended to assess its sensitivity in the tracking of symptom changes after treatment.