International Urogynecology Journal最新文献

Context: Stress and urgency urinary incontinence (UI) significantly impact the quality of life of women worldwide. The complexity of treatment options calls for robust decision support tools to guide informed, patient-centered care.

Aim: This scoping review maps best practices in the development, implementation, use, evaluation, and reported outcomes of patient decision aids (PDAs) for adult women with stress and/or urgency urinary incontinence.

Method: Complementary literature searches (2000-2024) were conducted between March 2023 and May 2024 using scientific databases and gray literature. The first focused on general PDA, the second on PDAs specific for women with stress and/or urgency UI. Selected documents were analyzed using standardized extraction grids; inter-rater agreement ensured validity.

Results: Fourteen literature reviews and six studies specifically about PDAs for women with stress and/or urgency UI were selected. PDAs were reported to improve patient knowledge, reduce decisional conflict, and support shared decision-making. Key facilitators of PDA development and implementation include involving patients and healthcare professionals, adapting tools for diverse needs, clinician training, clear guidelines, regular updates, and multiformat accessibility. Barriers include time constraints, limited access, comprehension difficulties, individual preferences, media influence, and organizational challenges. Addressing these factors through tailored design, improved access, and targeted training is important for successful adoption and implementation of PDAs in this context.

Conclusion: PDAs represent a valuable tool for supporting decision-making for women with stress and/or urgency UI. Future research should address long-term outcomes, cost-effectiveness, and strategies to tailor PDAs to diverse patient needs, ultimately enhancing patient-centered care and adoption in practice.

Introduction and hypothesis: Stress urinary incontinence is a common condition that significantly affects women's quality of life. Minimally invasive mid-urethral slings are the gold standard treatment, offering high cure rates and low complication risks. Although rare, mesh exposure can cause debilitating pain, making prevention essential. Infection may contribute to mesh exposure, but evidence supporting prophylactic antibiotic use is limited. We hypothesized that a single perioperative dose of antibiotics reduces the risk of mesh exposure and that exposure rates differ between retropubic (R-MUS) and transobturator (tO-MUS) sling approaches.

Methods: We included Danish women undergoing primary mid-urethral sling surgery from 2010 to 2018 using nationwide registry data. Cox's regressions were used to assess the risk of mesh exposure by perioperative antibiotic use and sling type.

Results: Among 6706 women, 3991 underwent R-MUS and 2715 tO-MUS, hereof 34 (0.9%) and 53 (2.0%), respectively, experienced mesh exposures; 5178 (77.2%) received perioperative antibiotics, 82% in the R-MUS and 70% in the tO-MUS group. Mesh exposure occurred in 30 (1.6%) patients with antibiotics vs. 23 (2.9%) without. Perioperative antibiotics reduced mesh exposure in the tO-MUS group (adjusted hazard ratio (aHR) 0.5 [95% confidence interval (CI) 0.3-0.9])), whereas the pooled R-MUS/tO-MUS analysis was nonsignificant (aHR 0.77 [95% CI 0.45-1.32]). In the R-MUS group, the effect remained inconclusive due to low precision. R-MUS was associated with a significantly lower risk of mesh exposure compared to tO-MUS (aHR 0.5 [95% CI 0.3-0.7]).

Conclusion: Perioperative antibiotics were linked to reduced mesh exposure after tO-MUS. R-MUS had a lower mesh exposure risk than tO-MUS.

Introduction and hypothesis: This study is aimed at identifying the risk factors for de novo urinary incontinence (UI) during pregnancy.

Methods: This cross-sectional study included 350 pregnant women attending prenatal clinics at a tertiary care center. Women with a history of UI or lower urinary tract disorders were excluded. Data collection included demographics, obstetric history, ultrasound assessments (detrusor thickness, uterocervical angle), and laboratory parameters. UI was diagnosed using the International Consultation on Incontinence Questionnaire Short Form questionnaire. Logistic regression analysis was performed to identify independent risk factors.

Results: De novo UI was reported by 21.4% (n = 75) of participants. Women in the UI group had higher body mass index (28.1 ± 4.0 kg/m² vs 26.8 ± 3.9 kg/m², p = 0.048) and detrusor thickness (3.3 ± 0.6 mm vs 3.0 ± 0.5 mm, p = 0.041), and a lower uterocervical angle (95.6 ± 15.3° vs 101.3 ± 14.6°, p = 0.043) compared with the non-UI group. Multivariate analysis identified increased detrusor thickness (odds ratio [OR] 3.89; 95% confidence interval [CI] 2.19-6.88; p = 0.03) and decreased uterocervical angle (OR 1.31; 95% CI 1.14-1.82; p = 0.04) as independent risk factors for de novo UI.

Conclusions: Increased detrusor thickness and decreased uterocervical angle during pregnancy are associated with the development of de novo UI. Incorporating these anatomical parameters into routine prenatal ultrasound assessments may facilitate early identification of at-risk women and allow for the implementation of preventive strategies.

Introduction and hypothesis: Pelvic organ prolapse (POP) may result from anatomical disruption, including fascial rupture during pregnancy and childbirth, and impaired pelvic floor support. Emerging evidence suggests that POP might be associated with weakened core and lower-limb muscles. We hypothesized that POP is associated with reduced muscle strength and decreased muscle cross-sectional area (CSA).

Methods: This cross-sectional study included 55 women aged 50-70 years. Muscle strength was measured by handgrip, sit-ups, and one-leg standing with eyes open. Pelvic magnetic resonance imaging assessed the CSA of the iliopsoas, rectus abdominis, and iliac muscles, adjusted for height. Participants were grouped as 50-59 years (n = 30) and 60-70 years (n = 25) of age.

Results: Exercise habits were similar in the two groups. In the Activities of Daily Living questionnaire, women with POP reported reduced physical ability in daily activities. Handgrip strength and sit-up repetitions did not vary significantly, but women with POP aged 50-59 years had shorter one-leg standing time (p = 0.02). The iliopsoas CSA was smaller in women with POP in both age groups (50-59 years: p = 0.003; 60-70 years: p = 0.008).

Conclusions: Younger middle-aged women with POP exhibited reduced iliopsoas CSA and impaired lower-limb balance, potentially reflecting a broader musculoskeletal vulnerability associated with aging and sarcopenia. Although this observational study had no interventions, further research should assess if early muscle weakness detection and targeted rehabilitation can improve physical function in this population.

Introduction and hypothesis: Perceived benefits are crucial for maintaining adherence to pelvic floor muscle training (PFMT). However, the timeline for expected responses and the factors influencing PFMT effectiveness remain unclear. Our study aimed to (1) determine when older women with urinary incontinence (UI) can expect a clinically important reduction in leakage from PFMT, and (2) identify factors associated with the time needed to achieve this reduction.

Methods: This is a pooled analysis from a randomized controlled trial supporting the non-inferiority of group-based versus individual PFMT. Participants included 362 older women with stress or mixed UI following a structured 12-week PFMT program, delivered in group sessions or individually. Primary Outcomes: Time to achieve minimal (50%) and incremental (70%) clinically important differences in weekly incontinence episodes were assessed using Kaplan-Meier estimates.

Secondary outcomes: Factors that potentially influenced treatment response, including age, body mass index, parity, comorbidities, UI duration, severity and type, pelvic floor strength, and PFMT delivery mode were analysed using ordinal logistic regression.

Results: A total of 328 (91%) women provided usable leakage report data. Median minimal and incremental clinically important differences were achieved by the 4th and 6th weeks of treatment. Improvements continued until the last treatment session. Age, UI duration, severity, pelvic floor strength, and group-based intervention were related to later treatment response.

Conclusions: In older women with stress or mixed urinary incontinence, a clinically significant reduction in leakage can be achieved by the 4th week of PFMT. Early PFMT intervention and post-treatment exercise adherence favours optimal outcomes.

Trial registration: NCT02039830.

Introduction and hypothesis: Pregnancy and delivery are known risk factors for the development of pelvic floor dysfunction (PFD). An electronic cross-sectional survey was distributed to physicians, midwives, and physiotherapists in Germany, assessing demographics, knowledge, and awareness of postpartum PFD risk/protective factors, and personal or spousal preferences for cesarean section (CS) as a preventive measure. Differences across professional groups were also analyzed.

Methods: An anonymous online survey was conducted via Qualtrics from January 25 to April 15, 2025. The German-language survey targeted healthcare professionals involved in obstetric or postpartum care. Data analysis was performed using SPSS version 28.0 for Mac OS X. Chi-square tests compared binary and categorical variables. P values of < 0.05 were considered statistically significant.

Results: After excluding 129 incomplete or non-consented responses, 228 questionnaires were analyzed. The majority of respondents demonstrated a high level of awareness and knowledge regarding the impact of pregnancy and childbirth on pelvic floor health. However, only 36.8% reported routinely providing postpartum counseling for PFD prevention. While 79.8% regularly asked about PFD symptoms postpartum, counseling rates remained low, consistent with earlier findings. Differences emerged between professional groups: physicians were more likely than midwives to view CS as protective against PFD (28.8% vs. 9.3%) and to consider CS for themselves or their partners (27.2% vs. 8.3%). These findings highlight the need to integrate structured PFD counseling protocols into routine antenatal and postnatal care.

Introduction and hypothesis: Magnetic stimulation is a noninvasive, painless neuromodulatory therapy that has emerged as a promising conservative treatment for urinary incontinence. This study aimed to evaluate its clinical effectiveness and safety in women with urgency urinary incontinence (UUI).

Methods: In this single-centre, prospective randomised controlled trial, 70 women with UUI were randomised in a 2:1 ratio to active MS or sham treatment. Participants received 12 sessions of magnetic stimulation over 6 weeks. The active group received individually adjusted stimulation intensity, while the sham group received minimal stimulation to preserve blinding. The primary outcome was change in symptom severity measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Secondary outcomes included bladder diary parameters (urinary frequency, urgency urinary incontinence episodes, nocturia), symptom-specific quality of life (UDI-6, IIQ-7), and patient-reported improvement (PGI-I). Outcomes were assessed at baseline and 6 months post-treatment.

Results: At 6 months, 40 participants in the active group and 16 in the sham group completed follow-up. The active group demonstrated significantly greater improvement in ICIQ-UI SF scores (mean change -4.05 ± 3.23) compared to sham (-1.19 ± 1.72; p < 0.001). Significant improvements were also observed in urgency incontinence episodes, nocturia, and quality of life measures in the active group. No serious adverse events were reported, confirming the favourable safety profile of MS.

Conclusions: This study provides new controlled evidence supporting MS as an effective, noninvasive, and well-tolerated treatment for women with UUI. These findings contribute important data on mid-term efficacy but highlight the need for further high-quality RCTs with standardised protocols and longer-term follow-up.

Introduction and hypothesis: Vaginal childbirth may cause levator ani muscle (LAM) avulsion and hiatal widening. 3D/4D transperineal ultrasound (TPUS) is widely used to assess the hiatal area and insertion of the LAM. We aimed to assess the quality of TPUS images for assessing the above when acquisitions were done immediately after vaginal childbirth.

Methods: Secondary analysis of images obtained after vaginal birth by experienced sonographers, in 100 randomly selected patients from two prospective cohort studies, was carried out. In those, TPUS volumes were acquired immediately after vaginal delivery at rest, during contraction of the pelvic floor muscles, and during Valsalva. Two investigators independently rated the image quality for visibility of midsagittal landmarks (symphysis, urethra, levator ani; yes/no), quality of visualization using a three-point Likert scale of the LAM in the axial plane and on tomographic ultrasound images (TUI), and visualization of the pubic symphysis and insertion points of the LAM. Sixty random volumes with adequate/ideal image quality were selected for intra- and inter-rater agreement of hiatal dimension measurements.

Results: In the midsagittal plane, all landmarks were visible in over 83% of TPUS volumes. "Ideal" or "adequate" visualization of the LAM in the axial plane was achieved in 50% and 40% respectively. Ideal visualization was highest during contraction of the pelvic floor muscles (63%). In TUI, the symphysis was visualized "ideally" or "adequately" in 71% or 22%, right LAM insertion in 73% or 19%, and left LAM insertion in 72% and 20% respectively. Hiatal dimension measurements showed excellent intra- and inter-rater agreement.

Conclusions: The quality of TPUS images obtained immediately after birth was adequate to ideal in over 90% of acquisitions.

Introduction and hypothesis: Vacuum-assisted vaginal deliveries (VAVD) represent a growing proportion of operative vaginal deliveries. Mediolateral episiotomy in patients undergoing VAVD has been shown to reduce obstetrical anal sphincter injuries (OASIS) in some settings; however, results of Canadian studies have been conflicted, and the practice has not been widely adopted by Canadian providers. The objective of this study was to estimate the association between episiotomy and OASIS among patients undergoing VAVD in a Canadian cohort.

Methods: A population-based, retrospective cohort of patients who underwent VAVD at term of non-anomalous, singleton, vertex fetuses between 2005 and 2023 were identified using the  Nova Scotia Atlee Perinatal Database. Augmented inverse probability weighting analyses were used to estimate risk ratios (RR) with 95% confidence intervals (CI) adjusting for confounding variables, overall and stratified by length of the second stage of labour and parity.

Results: Of 8407 VAVD, OASIS occurred in 970 (10.3%). Episiotomy was performed in 3780 (45.0%) VAVD. Overall, episiotomy was not found to be associated with OASIS risk (RR 0.94, 95% CI 0.83-1.07). Among individuals with a total second stage ≥ 60 min (RR 0.86, 95% CI 0.75-0.99) and an active phase ≥ 60 min (RR 0.60, 95% CI 0.34-1.06), episiotomy was associated with decreased OASIS risk. When stratified by parity, episiotomy was associated with reduced OASIS risk in nulliparous (RR 0.86, 95% CI 0.75-0.99) and increased risk in parous individuals (RR 1.37, 95% CI 0.99-1.90).

Conclusions: Among patients undergoing VAVD, episiotomy was protective against OASIS in certain populations, including nulliparous individuals and those with longer second stage of labour.