International Urogynecology Journal最新文献

Introduction and hypothesis: To assess early intraoperative and postoperative complications and outcomes in patients with severe obesity undergoing apical prolapse repair compared with patients with normal weight.

Methods: This retrospective cohort study included 315 patients who underwent apical prolapse repair at a tertiary medical center between 2009 and 2024. Fifty-six patients had a BMI greater than 40, and 259 had a normal BMI (18.5-30). Patients with class I and II obesity were excluded from the study. Preoperative data, surgical details, and 30-day postoperative complications were collected and analyzed.

Results: The average age of the patients with severe obesity was significantly lower than that of patients with normal weight (56.6 vs 64.1 years, p < 0.001). Patients with severe obesity had a higher prevalence of diabetes (27.3% vs 9.0%, p < 0.001), hypertension (54.5% vs 25.1%, p < 0.001), and obstructive sleep apnea (21.8% vs 7.4%, p = 0.001). Intraoperatively, the group with severe obesity experienced greater estimated blood loss (233.6 ml vs 115.2 ml, p < 0.001) and were more likely to undergo concurrent incontinence procedures (76.4% vs 51.3%, p = 0.001). However, no significant difference in intraoperative complications was observed between the groups (5.4% vs 5.4%, p = 1.000). Hospitalization duration was longer in patients with morbid obesity. Total complication rate within 30 days was 7.3%, with no statistically significant difference between the groups with severe obesity and normal weight.

Conclusion: Patients with severe obesity undergoing vaginal apical prolapse repair have similar rates of early postoperative complications and health care encounters to patients with normal weight. These findings support offering prolapse surgery to patients with morbid obesity when clinically indicated.

Introduction and hypothesis: The purpose of this study was to develop a maternal health care exercise and pelvic abdominal rehabilitation curriculum for obstetric medical professionals. Maternal health care exercise and pelvic abdominal rehabilitation can effectively prevent and alleviate pelvic-floor-rehabilitation problems in pregnant women and improve their quality of life. However, there is a lack of standardized courses for training obstetric medical professionals.

Methods: This study used the Delphi method to design two rounds of expert consultation. A group of 17 specialists from the fields of gynecology, obstetrics, and rehabilitation, who are involved in clinical teaching and management, participated in the study. Data were collected between October and December 2023.

Results: The effective recovery rates of the two rounds of questionnaires were 85.0% and 94.1%. The expert-authority coefficients were 0.90 and 0.88. The Kendall coordination coefficient was 0.35-0.41. The average importance score for each index ranged from 3.25 to 4.94. The coefficient of variation for each index ranged from 0.07 0.20. Based on the curricular topics, we constructed four first-level indicators, 16 second-level indicators, and 58 third-level indicators of exercise and pelvic and abdominal rehabilitation for obstetric medical professionals.

Conclusion: The training curriculum provides obstetric medical professionals with the basis for obstetric rehabilitation. The training system is clear and coherent, and the content is clear and comprehensive, which enriches global obstetrical rehabilitation education resources. It is helpful to guide and educate on maternal obstetric rehabilitation to improve the quality of life of the women.

Introduction and hypothesis: Urinary tract infection (UTI) is common after onabotulinumtoxin A intradetrusor injections (BTX) but no evidenced-based recommendations exist to guide prophylactic antibiotic regimen. We sought to compare the effect of different oral antibiotic prophylaxis in women with idiopathic and neurogenic overactive bladder (OAB) undergoing BTX.

Methods: This was a single-center retrospective cohort study of women >18 years old who underwent BTX for OAB between June 2018 and June 2023. Duration and type of antibiotic prophylaxis at time of BTX injection were recorded. Primary outcome was treatment for symptomatic UTI within 30 days.

Results: A total of 1250 procedures were included. UTI rate within 30 days of BTX injection was 10% (n = 125). Duration of antibiotics (1 day, 3 days, 5 days, versus ≥7 days of treatment) did not affect 30-day UTI rate (p = 0.42). When comparing antibiotic type, nitrofurantoin had the lowest UTI rate at 8.7% while trimethoprim/sulfamethoxazole (TMP-SMX) had a rate of 12.3% and "other" had highest at 32.4% (p< 0.01). Retreatment rate for UTI was low at 1.9% and urine cultures showed low resistance rates (1.8%) but TMP-SMX had the highest rate of resistance at 4.6% (p < 0.01). There were no differences in retreatment rate or resistance rate between the different durations of prophylactic antibiotics (p>0.05 for both).

Conclusions: The UTI rate after onabotulinumtoxin A injections was similar regardless of the duration of prophylactic antibiotic use. Nitrofurantoin and TMP-SMX had the lowest 30-day UTI rates. These data provide compelling evidence in support of 1-day prophylactic antibiotic treatment regimens with nitrofurantoin (or TMP-SMX) for women with OAB undergoing BTX injection.

Introduction and hypothesis: To confirm the performance and safety of the rechargeable sacral neuromodulation system (InterStim™ Micro) through 2-year follow-up, we report results from the fecal incontinence (FI) cohort through 6-month follow-up.

Methods: Eligible patients were enrolled following successful therapy evaluation and implant. Participants completed bowel diaries and questionnaires at baseline, 3, and 6 months post-implant. The primary objective was improvement in Cleveland Clinic Incontinence Score (CCIS) at 3 months post-implant compared to baseline. Safety was evaluated by collection of reportable adverse events (AE).

Results: Of 53 patients implanted, 90.6% were female and the mean (± SD) age was 58 ± 11 years. There was a statistically significant improvement in CCIS at 3 months vs baseline, with a mean change of -4 ± 3.7 (p < 0.001, n = 52). This improvement was maintained at 6 months, with a mean change of -4.0 ± 3.58 (n = 52). The mean change in Fecal Incontinence Quality of Life (FIQoL) at 3 months was 3.2 ± 2.8 (n = 52) and 3.6 ± 2.9 (n = 53) at 6 months. On the Patient Global Impression of Improvement (PGI-I), 94% (n = 52) and 90.6% (n = 53) of participants reported their condition was better at 3- and 6-month follow-up compared to baseline, respectively. The incidence of device-, procedure-, or therapy-related AEs in enrolled participants was 18.9% (10/53); among these was one serious related AE. There were no unanticipated adverse device effects.

Conclusions: The primary objective of the FI cohort was met, with statistically significant improvement in CCIS and patient-reported outcomes. These data confirm clinical performance and safety through 6 months post-implant.

Clinical trial registration: NCT04506866.

Introduction and hypothesis: Mesh implants were used in Australia until 2018 for managing pelvic organ prolapse. Owing to complications such as dyspareunia, mesh exposure, erosion and vaginal discharge, transvaginal mesh was removed from the market. Regenerative treatments such as transvaginal platelet-rich plasma (PRP) and fractional CO₂ laser therapy may offer relief from mesh complications.

Methods: From 2013 to 2024, women with mesh complications, including dyspareunia, vaginal discharge and/or vaginal mesh exposure (< 2 cm) awaiting surgery, were enrolled in this prospective study. Wilcoxon signed-rank test was used to assess IQR changes in Australian Pelvic Floor Questionnaire (APFQ) and Pelvic Organ Prolapse Quantification symptom severity, whereas a general linear model analysed outcome differences at baseline, 3-6 months and > 9 months. The primary aim was to assess the proportion of patients who avoided surgical intervention after PRP and CO₂ laser treatment.

Results: A cohort of 47 women were eligible. The average age and body mass index were 64 years and 27.94 kg/m² respectively. Thirty-nine received PRP and CO₂ laser combined, whereas 8 underwent CO₂ laser alone. Overall, 40 women (85.0%) avoided surgery over an average 12-month follow-up. APFQ scores improved significantly from baseline to > 9 months (p = 0.02). Treatments also improved bladder, bowel, prolapse and sexual function (p < 0.001) between 3-9 months. Vaginal laxity and prolapse sensation improved at 9 months (p = 0.04, p = 0.005).

Conclusions: Platelet-rich plasma and CO₂ laser treatments allowed most women to avoid surgery, improving bladder, bowel, sexual function and vaginal atrophy. These alternatives may expand treatment options for mesh complications.

Introduction and hypothesis: Long-term outcomes following vaginal (V-USLS) versus laparoscopic (L-USLS) uterosacral ligament suspension have not been reported in the literature. Our objective was to compare long-term outcomes following V-USLS versus L-USLS following hysterectomy.

Methods: This was an ambispective cohort study at a single academic institution comparing patients who underwent a V-USLS following a vaginal hysterectomy or L-USLS following a laparoscopic hysterectomy from 2013 to 2018. The primary outcome was composite prolapse recurrence rate, combining subjective prolapse symptoms and objective failure, including prolapse beyond the hymen on pelvic organ prolapse quantification exam or retreatment. A power calculation determined 68 patients in each group would be required to detect a difference of 15% in recurrence rates. Statistical analysis was performed using Student' t-test, Wilcoxon rank sum test, chi-square test, or Fishers exact test, and multivariable logistic regression where appropriate.

Results: Thirty-six patients in each group presented for a study visit. Preoperative POP-Q measurements were similar between groups. Surgical complication rates were low and similar between groups. Mean follow-up time was 6.8 years, similar between groups. V-USLS had higher rates of recurrent prolapse beyond the hymen on POP-Q (33.2% vs 11.1%, p = 0.016), retreatment (25.0% vs 2.8%, p = 0.006), and composite failure (47.2% vs 22.2%, p = 0.019). Subjective prolapse symptoms were similar between groups. V-USLS was associated with a higher risk of prolapse recurrence (aOR 1.73 (95%CI 1.13-5.78). Anterior prolapse (Aa) was associated with higher recurrence risk, with aOR 2.04 (95%CI 1.15-3.62) per every 1 cm, up to 3 cm beyond the hymen.

Conclusions: On the basis of these results, L-USLS appears to have a decreased association with recurrence compared to V-USLS. Conclusions are limited by a small sample size.

This video details a step-by-step approach to sacrocolpopexy for recurrent anterior vaginal vault prolapse following a sacrocolpopexy at the time of supracervical hysterectomy. An explanation regarding the etiology of increased incidence of recurrent pelvic organ prolapse in supracervical hysterectomy with concomitant sacrocolpopexy as compared to total hysterectomy is provided. Minimally invasive sacrocolpopexy is a feasible and safe option for the treatment of recurrent vaginal vault prolapse. Recurrence of prolapse following pelvic reconstruction most commonly occurs in the anterior compartment. Studies have shown that supracervical hysterectomy at the time of sacrocolpopexy increases the risk of recurrent prolapse compared to total hysterectomy. While supracervical hysterectomy at time of sacrocolpopexy decreases incidence of mesh exposure, careful consideration should be given to patients with redundant anterior vaginal prolapse and patients who have more advanced pelvic organ prolapse preoperatively. This may entail performing a total hysterectomy in lieu of a supracervical hysterectomy or plicating the anterior vaginal wall to decrease redundancy and potentially recurrence of prolapse of the anterior compartment.

Introduction and hypothesis: This video demonstrates the laparoscopic meshless pectopexy with uterine preservation (Salman's modification).

Methods: This study in a single group semi-experimental design was carried out in a secondary center. From May 2022 to April 2024, a total of 40 consecutive symptomatic women with stage 3-4 apical prolapse requesting uterine protection were included in the study. Without using mesh, patients received a laparoscopic pectopexy using monofilament non-absorbable sutures and preserving the uterus. Pelvic organ prolapses quantitative stage 2 or higher, especially in the central compartment (C ≥-1), and anatomical recurrences of genital prolapse were recorded.

Results: In the 1st postoperative year, patients showed a significant improvement in the Pelvic Organ Prolapse Quantification central compartment (C score: mean difference -8.21 ± 3.03, 99% confidence interval -9.20 to -7.21) and in all other landmarks (p < 0.001). Apical prolapse recurrence occurred in 7.9% of cases and stage 3Bp prolapse developed in one patient during the follow-up period. Sexual function and urinary symptom scores (PISQ-12) were significantly improved after surgery.

Conclusions: Laparoscopic meshless pectopexy represents an effective and feasible option for the surgical treatment of uterovaginal prolapse, preserving the uterus and preventing postoperative complications associated with mesh use.

Introduction and hypothesis: Routine preoperative laboratory testing is commonly required prior to minimally invasive hysterectomy (MIH) for pelvic organ prolapse (POP), despite limited evidence for its clinical value. We aim to identify transfusion risk for MIH for POP compared with other benign indications.

Methods: Using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program Gynecology Participant Use Data File, we performed a retrospective cohort study to determine the risk of perioperative blood transfusion following MIH for benign indications. MIH were identified using CPT codes, and surgical indications were classified according to ICD-9 and -10 codes. Gynecological malignancy risk-reducing indications were categorized as prophylactic. Hysterectomy routes included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy, and vaginal hysterectomy. Hysterectomies for malignancy were excluded. Perioperative transfusions were defined as those given intraoperatively or within 30 days postoperatively.

Results: A total of 282,124 patients underwent MIH for benign gynecological indications. Patients undergoing MIH for POP compared with other benign indications were older, had lower BMI, and were less likely to currently smoke (p < 0.001). Overall transfusion rate for benign MIH was 1.2%, and transfusion rates differed significantly by surgical indication (p < 0.001). Patients undergoing MIH for POP had a low rate of transfusion (0.7%) compared with other benign indications such as anemia (15.9%), fibroids (1.8%), and menstrual disorders (1.5%).

Conclusions: Patients undergoing surgery for POP had significantly lower rates of transfusion than those with other benign indications. Aggressive preoperative precautions, including laboratory testing and redundant intravenous access, are likely excessive in this population.