International Urogynecology Journal最新文献

Introduction and hypothesis: The relationship between depression and overactive bladder (OAB) is unknown. This study aimed to explore the association between depression and OAB in the U.S.

Population:

Methods: A cross-sectional study was performed utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Depression status and severity among participants were assessed via the Patient Health Questionnaire-9 (PHQ-9). The OAB symptoms of the participants were assessed via the OAB symptom score (OABSS) scale. Multivariate logistic regression was conducted to evaluate the association between depression and OAB.

Results: A total of 19,359 participants were enrolled in the study, with 91.01% (N = 17618) exhibiting minimal or mild depression, 7.92% (N = 1533) presenting with moderate or moderately severe depression, and 1.07% (N = 208) identified as severe depression. The overall prevalence of OAB was 21.62%. We found that depression was positively associated with OAB before and after adjustments for all covariates. After adjusting for covariates, individuals with moderate or moderately severe depression presented an elevated risk of OAB (OR = 2.52, 95% CI 2.11-3.01, p < 0.01), while those with severe depression presented a greater risk (OR = 3.74 95% CI 2.37-5.90, p < 0.01) than did participants with minimal or mild depression. Age may modify the correlation between depression and OAB.

Conclusions: Our study highlighted a positive association between depression and OAB in the U.S. population, and the association between depression and OAB was modified by age. However, more studies are needed in the future to verify the associations between depression and OAB and their underlying mechanisms.

Introduction and hypothesis: The objective was to detect subtypes of urinary incontinence (UI) and their effects on quality of life (QoL) and sexual function among women seeking weight loss.

Methods: A cross-sectional study focusing on women seeking weight loss with UI symptoms was carried out. Participants were stratified into three groups: stress UI, urgency UI, and mixed UI groups. The effects of the three groups on QoL and sexual function were compared.

Results: A total of 564 individuals (46.8%) were reported to present with UI symptoms. Among these, 216 (38.3%), 71 (12.6%), and 277 (49.1%) had stress UI, urgency UI, and mixed UI respectively. The severity of UI was greater in the urgency UI and mixed UI groups than in the stress UI group, with varying ratios observed among patients with different severities of UI: stress UI was highest in mild cases, and the mixed UI was highest in moderate or severe cases. Mixed UI had the most detrimental effect on QoL and sexual function. However, after controlling for the severity of UI, mixed UI still had a greater detrimental effect on UI-specific QoL, and no differences were identified among the three groups regarding general QoL or sexual function.

Conclusion: This study revealed variations in the constituent ratios of UI subtypes related to the severity of UI and the effects of various UI subtypes on QoL and sexual function among women seeking weight loss. Notably, the mixed UI demonstrated the most severe symptoms and the most detrimental impact, particularly as assessed by UI-specific QoL questionnaires.

Introduction and hypothesis: Accurate and complete reporting of the Pelvic Organ Prolapse Quantification (POP-Q) system is essential for reporting research outcomes in POP. We aimed to assess the accuracy and completeness of POP-Q reporting in studies published from selected journals in 2023 and evaluate the validity of available POP-Q calculators.

Methods: A systematic search of Medline and Embase was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify eligible studies from selected journals in 2023 that utilised the POP-Q system. An assessment of available POP-Q calculators was also performed.

Results: Of the 134 studies identified, 18 (13.4%) met the inclusion criteria. Twelve studies reported complete quantitative POP-Q data of which 9 (75%) contained identifiable POP-Q reporting errors. These included 5 studies reporting mean Aa > Ba, 2 reporting mean Ap > Bp, 6 reporting C > Bp, 5 reporting mean C > Ba, 1 reporting mean Aa > + 3, and 1 reporting mean D > C. The remaining 6 of the 18 studies reported incomplete POP-Q measurements, which restricted our ability to identify further reporting errors, except for 2 studies reporting C > Ba and C > Bp respectively. The evaluated POP-Q calculator permitted the input of inaccurate POP-Q data.

Conclusions: Erroneous and/or incomplete quantitative POP-Q data were identified in 15 of the 18 studies reviewed (83.3%). Our findings highlight the need for improved POP-Q data reporting. Journal editors and reviewers should ensure that publications provide complete and accurate quantitative POP-Q data. POP-Q calculators should be based on algorithms that ensure complete and accurate data inputs and outputs.

Introduction and hypothesis: This manuscript is a part of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter three, committee three, on the impact of lifestyle modifications (i.e., weight loss, treatment of constipation, activity restriction, etc.) on the prevention and treatment of POP.

Materials and methods: An international group containing ten female pelvic medicine specialists and one university-based medical librarian performed a systematic search of the literature in Medline using the MeSH terms: pelvic organ prolapse (ID: D056887), cystocele (ID: D052858), uterine prolapse (ID: D014596), rectocele (ID: D020047), and women (ID: D014930) to identify studies addressing lifestyle modifications as prevention or treatment for POP on 10/18/21. Relevant studies were included in this review.

Results: A total of 18,483 studies were identified in the initial literature search; 187 full-text articles were deemed pertinent and independently reviewed and double-screened by ten reviewers. After full-text review, information from 86 articles was included in this review.

Conclusion: Women may consider various lifestyle modifications to help prevent and treat POP, even if it is challenging to quantify the efficacy of these interventions.

Introduction and hypothesis: The objective was to compare the effects of pelvic floor muscle exercise (PFME) and spinal stabilization exercise (SSE) on urinary symptoms, pelvic floor muscle strength (PFMS), quality of life (QoL), core stability, balance, spinal posture, and perception of subjective improvement (PSI) in women with stress urinary incontinence (SUI).

Methods: Patients were randomly divided into PFME (n = 25) and SSE (n = 25) groups. The exercises of both groups was applied 3 days a week for 8 weeks. Urinary symptoms, PFMS, QoL, core stability, balance, spinal posture, and PSI were assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and pad test, the Modified Oxford Scale (MOS), the King's Health Questionnaire (KHQ), the Sahrmann test, the Biodex Balance System, a Spinal Mouse device, and a Likert-type scale respectively.

Results: The ICIQ-SF, pad test, KHQ, and static balance scores of both groups decreased, whereas the MOS and Sahrmann scores increased (p < 0.05). All balance scores and sacral angles decreased in the SSE group (p < 0.05). The KHQ-Physical and KHQ-Emotional scores decreased more in the PFME group than in the SSE group, whereas core stability increased more and sacral angle decreased more in the SSE group than in the PFME group (p < 0.05). The PSI were similar (p > 0.05).

Conclusion: Both PFME and SSE were effective in improving urinary symptoms, PFMS, QoL, and PSI in women with SUI. SSE was superior to PFME in improving core stability, balance, and sacral position. SSE may be an alternative method in the treatment of SUI.

Introduction and hypothesis: Although some evidence suggests that Chinese and white women might have different pelvic floor anatomy such as levator complex and connective tissue support for pelvic organs, it is unknown if these differences affect the mechanisms of pelvic organ prolapse. We sought to determine whether differences exist in MRI-based structural failure patterns between Chinese and American white women with prolapse.

Methods: This is a case-control study in different racial cohorts recruited in China and the USA. The Chinese cohort included 19 women with anterior-predominant prolapse and 24 controls with normal pelvic support. The American white cohort included 30 women with anterior-predominant prolapse and 30 controls. Both cohorts underwent the same clinical evaluation and MRI protocol. Three structural support systems were quantified on stress 3D MRI at maximal Valsalva: vaginal factors (length, width); connective tissue attachment (cervix, lateral paravaginal height); and hiatus factors (urogenital hiatus size, major levator ani injury). Abnormal structural support was defined as any measurement outside the normal range defined as the 5th to 95th percentile in controls from the respective cohort. The percentages of the women with abnormal support in the two cohorts were compared.

Results: Among those with prolapse, Chinese women were more likely than white women to have abnormally long vaginal length and width (90% vs 40%, p < 0.001; 53% vs 23%, p = 0.031 respectively). The occurrence of abnormal apical location, paravaginal location, and genital hiatus size ranged from 89 to 100% in Chinese women and from 63 to 80% in white women.

Conclusions: Prolapse in American white women most commonly involves structural failure of connective tissue attachments and hiatus factors and less frequently involves vaginal wall factors, whereas prolapse in Chinese women frequently involves all support structures.

Introduction and hypothesis: Previous work has suggested that refractory detrusor overactivity (DO) was commonly associated with urinary tract infection (UTI), which can lead to inflammatory changes in the bladder. This study aimed to investigate the concentrations of urinary cytokines in a large sample of women with refractory detrusor overactivity (DO) and age matched controls.

Methods: The urinary concentration of 27 cytokines in 140 women (95 with refractory DO and 45 age matched controls (women without urge incontinence)) was determined using the Human Cytokine 27-plex Assay. Cytokine concentrations were correlated with a "UTI score", the presence or absence of bacteriuria or pyuria on the day of sample collection and a previous history of UTI.

Results: Pro-inflammatory cytokines were increased in refractory DO women compared to the controls. In women with refractory DO, the UTI score significantly correlated with urinary cytokine concentrations in 15 of the 22 cytokines detected. A previous history of UTI did not affect urinary cytokine concentrations in refractory DO women with no current UTI. Increasing pyuria was associated with increasing concentrations of urinary cytokines.

Conclusion: Careful comparison of cytokine concentrations in women with refractory DO versus age matched controls has shown that changes in pro-inflammatory cytokines are related to the UTI disease burden, suggesting that an underlying inflammatory response, together with UTI, may be an aetiological contributor to the development of refractory DO.

Introduction and hypothesis: Childhood enuresis may be associated with overactive bladder syndrome (OAB) in adulthood, which may contribute to sleep disorders. The objective was to compare the prevalence of childhood enuresis and sleep quality among women with and without OAB.

Methods: This mixed study included women with and without OAB, who completed an online questionnaire covering sociodemographic, urinary data, and five validated instruments in Portuguese: the Pittsburgh Sleep Quality Index (PSQI-BR), the Epworth Sleepiness Scale, the Berlin Questionnaire (QB-BR), the Modified Fatigue Impact Scale (MFIS-BR), and the Incontinence Questionnaire Overactive Bladder (ICIQ-OAB).

Results: A total of 172 women were included, 86 in each group (OAB and non-OAB). The OAB group showed a higher prevalence of childhood enuresis (52.3% vs 25.6%, p < 0.001), poorer sleep quality on the PSQI-BR (9.6 ± 4.1 vs 5.7 ± 3.1, p < 0.001), more individuals classified as high risk of obstructive sleep apnea by the QB-BR (34.9% vs 15.1%, p < 0.001), higher impact on fatigue assessed by the MFIS-BR (39.3 ± 21.8 vs 17.8 ± 17.2, p < 0.001), and more daytime sleepiness according to the Epworth Sleepiness Scale (10.9 ± 6.1 vs 8.7 ± 4.8, p = 0.014). Women with OAB were associated with poor sleep quality, fatigue, obstructive sleep apnea, and daytime sleepiness. Childhood enuresis was associated with a 2.96 times higher chance of developing OAB (OR = 2.96; 95% CI: 1.41-6.19; p = 0.004).

Conclusions: Overactive bladder was associated with a higher prevalence of childhood enuresis, diminished sleep quality, elevated risk of obstructive sleep apnea, heightened fatigue, and increased daytime sleepiness among women. OAB increases the risk of sleep disorders and childhood enuresis increases the chances of developing OAB.