International Urogynecology Journal最新文献

Introduction and hypothesis: The ongoing pelvic mesh controversy, coupled with a regulatory pause in using pelvic mesh in some countries, has created a need for mesh-free alternatives for sacrocolpopexy (SCP). This article provides an overview of mesh-free alternatives for SCP.

Methods: MEDLINE and PubMed searches were conducted to identify studies reporting on autologous and non-autologous biologic grafts for SCP. Identified studies were reviewed by two of the authors (CY and MR).

Results: Emerging evidence on autologous fascia lata (AFL) and rectus sheath (ARS) for SCP is promising, with low donor site morbidity. Non-autologous biologic grafts for SCP are mostly reported to be inferior to mesh.

Conclusions: Emerging evidence suggests that AFL and ARS might be safe and effective alternative options to mesh SCP. The main advantages of AFL for SCP over ARS are laparoscopy or robot-assisted laparoscopy approaches, and that a larger graft can be safely harvested. The benefits of utilising allografts and xenografts are limited by their reduced durability compared with mesh and patient acceptability.

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 vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms.

Materials and methods: This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS).

Results: The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group. Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001).

Conclusion: Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.

Introduction and hypothesis: This study examines the effectiveness of yoga intervention on the early postpartum recovery of pelvic organ positions.

Methods: A prospective study was conducted from May to November 2020, involving women who had vaginal deliveries and underwent pelvic floor ultrasound examinations. The control group received no intervention, whereas the experimental group participated in weekly 60-min yoga sessions from 1 week to 3 months postpartum. Pelvic organ positions, including the bladder neck, uterus, and rectal ampulla, were measured via ultrasound at rest and during the Valsalva maneuver at 42 days and 3 months postpartum. The effectiveness of yoga was assessed using t tests.

Results: A total of 128 women participated, with 66 in the control group and 62 in the experimental group. There were no significant differences between groups in age, parity, BMI, or fetal weight (p > 0.05). At 42 days postpartum, there were no significant changes in bladder neck and uterine positions at rest, except for a significant decrease in rectal ampulla position in the control group (p < 0.01). During the Valsalva maneuver, the experimental group showed significant improvement in all pelvic organ positions at 3 months compared with 42 days (p < 0.001), with better outcomes than the control group (p < 0.001).

Conclusion: Yoga intervention supports early postpartum recovery of pelvic organ positions.

Introduction and hypothesis: High birth weight increases the risk of obstetric anal sphincter injury. Macrosomia is a well-known complication in pregnancies complicated by gestational diabetes mellitus. The aim of this study was to investigate whether gestational diabetes is a risk factor for obstetric anal sphincter injury. We hypothesized that women with gestational diabetes have an increased risk of obstetric anal sphincter injury.

Methods: We performed a systematic review and meta-analysis using the PubMed and Embase databases. Studies including numbers on women with and without gestational diabetes and with and without obstetric anal sphincter injury were included. Studies were assessed using the SIGN-methodology checklist to evaluate the quality and risk of bias. Extracted data was analyzed using RevMan 5.4 and the statistical software R.

Results: Twelve cohort studies were included for the meta-analyses. Overall, we found a slightly increased prevalence of obstetric anal sphincter injury among the women with gestational diabetes of 2.40% (95% CI; 2.37-2.43) compared to 2.31% (95% CI; 2.30-2.32) in women without diabetes. The meta-analysis revealed increased risk of obstetric anal sphincter injury in the gestational diabetes-group (RR 1.24 [95% CI; 1.12-1.37]) with a high level of heterogeneity (I² = 94%). Primiparous women with gestational diabetes had an increased risk of obstetric anal sphincter injury 6.65% (95% CI; 6.18-7.14) compared to 4.98% (95% CI; 4.89-5.08) in the control group, whereas the risk was not significantly increased in multiparous women.

Conclusions: The risk of obstetric anal sphincter injury is increased in primiparous women with gestational diabetes mellitus compared to women without gestational diabetes.

Introduction and hypothesis: Identifying patient-reported outcome measures allows management of urogenital prolapse to be tailored to reflect symptom bother and expectations of treatment. We devised a new single-item questionnaire, the Patient Perception of Prolapse Condition (PPPC), based on the Patient Perception of Bladder Condition (PPBC). The aim was to evaluate the criterion validity, test/re-test reliability and responsiveness of the PPPC.

Methods: Women attending a tertiary urogynaecology clinic were recruited. At visit 1, patients completed the Prolapse Quality of Life (P-QOL) and PPPC questionnaires, and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. This allowed assessment of criterion validity using Spearman's rank correlation (rho) of the PPPC against validated subjective and objective outcomes. At visit 2, within the next 6 weeks, PPPC was repeated to assess test/re-test reliability using Cronbach's alpha (α). In those undergoing pelvic floor surgery, responsiveness of the PPPC was assessed at visit 3 by correlating PPPC and P-QOL scores 6 weeks post-operatively.

Results: A total of 178 patients attended visit 1, 60 attended visit 2 and 58 attended visit 3. At visit 1, there were moderate correlations between the PPPC and both objective (POP-Q: rho = 0.385, p < 0.01, CI 0.192-0.549) and subjective (P-QOL: rho = 0.635, p < 0.01, CI 0.493-0.744) measures confirming criterion validity. Test/re-test reliability was high (α = 0.89). Correlation with post-operative PPPC and P-QOL confirmed moderate responsiveness (rho = 0.54, p < 0.01).

Conclusion: The PPPC, a novel single-item patient-reported measure of prolapse condition, demonstrated good criterion validity, test/re-test reliability and responsiveness. These findings support the use of the PPPC as a global assessment of prolapse condition.

Introduction and hypothesis: We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC.

Methods: This was a retrospective cohort of women, who had their first BTX-A treatment for symptoms of overactive bladder (OAB) syndrome, with a pretreatment urodynamic study (UDS). We reviewed demographic, medical and gynecological history, UDS, pretreatment bladder diaries, objective examinations, BTX-A treatment details, and post-void residual (PVR) reports in the electronic medical record. Botox® Allergan 100 International Units were injected into the detrusor at 10-20 sites. Statistical analyses included univariate and multivariate logistic regression analyses.

Results: We included 397 women. Median age was 68 (Q1-Q3: 54-76) years. CIC rate was 8.6% (n = 34) following the first BTX-A treatment. Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.09-0.97). A bladder capacity of 500 ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.06-5.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.10-0.57). Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.52-9.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.00-1.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.07-0.79).

Conclusions: A history of anterior colporrhaphy, large bladder capacity, and absence of incontinence episodes in bladder diary or UDS were risk factors for CIC after the first BTX-A treatment.

Introduction and hypothesis: Obstetric anal sphincter injuries (OASIs), third- and fourth-degree lacerations, represent a severe obstetric complication. Previous studies reported a higher incidence of OASIs in Asian women in non-Asian countries. This study was aimed at establishing a different OASIs prevalence among the racial/ethnic groups in Southern European centers.

Methods: A multicenter retrospective study that included pregnant women who had vaginal singleton delivery between January 2019 and September 2022 in two Italian University hospitals, Naples and Novara, was conducted. We excluded cesarean sections, nonvertex presentation, preterm delivery, multiple pregnancies, congenital malformations, or stillbirths. Statistical analysis with an independent association of ethnicity to the risk of OASIs using clinical characteristics-adjusted multivariate logistic regression was performed.

Results: A total of 3,049 pregnant women were included. 2.33% (71 patients) had an OASI. The median age was 31 years (IQR 7.00) and median gestational age was 39 weeks (IQR 1.40). Mean birth weight was 3,300 g (IQR 580.00). 1' and 5' Apgar scores were 9 and 9. The univariate logistic regression was not statistically significant. Multivariate logistic regression model adjusted for baseline clinical characteristics showed an OR 2.540 (p value 0.01) for OASIs in Asian women. Primiparous and secondiparous were protective factors for OASIs with OR 0.224 (p value < 0.001) and OR 0.209 (p value 0.01).

Conclusions: Our results confirm racial/ethnic disparities regarding OASIs, with an elevated risk for Asian women in Southern Europe. Prevention strategies and obstetric care in developed countries should be modulated to offset the risk of OASIs in this population. Additional research is needed to explain the specific mechanisms of these disparities.

Introduction and hypothesis: The objective was to assess the sonographic tension-free vaginal tape-obturator (TVT-O) position and the outcome in Asian Chinese women.

Methods: A prospective cohort study of 254 patients who underwent TVT-O surgery between 2013 and 2022. The sonographic position of the TVT-O was recorded and correlated with the outcomes, including the subjective cure rates, Incontinence Impact Questionnaire 7 (IIQ-7), and retention of urine.

Results: A total of 92.9% reported no stress urinary incontinence after the operation. The IIQ-7 score significantly improved after TVT-O surgery. 88.2% of patients had the TVT-O placed at 50-70% of the urethral length and half of the TVT-O were placed 3-5 mm from the urethra. The cure rate was higher when the tape was in the middle third of the urethra, but the tape position was not associated with postoperative retention of urine in our study.

Conclusions: Most TVT-Os can be placed in the target zone in a blind procedure in Asian Chinese women. The tape position was related to the outcomes. Early postoperative ultrasound of the tape position may predict the outcome of the surgery.

Introduction and hypothesis: The objective was to compare the functional assessment of the pelvic floor (PERFECT [P = power; E = endurance; R = repetitions; F = fast contractions; ECT = every contraction timed] scheme), vaginal manometry and transperineal ultrasound in women with and in those without stress urinary incontinence (SUI) and to evaluate the correlation among the variables of the three modalities of assessment in both groups.

Methods: This was a cross-sectional study involving nonpregnant women with and those without SUI aged between 18 and 60 years. Women with sphincter deficiency, Oxford scale = 0, and prolapse grade ≥ 2 were excluded. Women were evaluated using the PERFECT scheme, vaginal manometry, and transperineal ultrasound. Groups were compared using the Student's t test, the chi-square test and general linear models. The Spearman correlation test was also performed.

Results: Fifty-one women with SUI (aged 48.5 ± 9.5 years) and 47 women without SUI (aged 47.2 ± 9.2 years) were evaluated. In women with SUI, there was a correlation between vaginal manometry and power (r = 0.87), endurance (r = 0.47) and fast (r = 0.69); between power and endurance (r = 0.53) and fast (r = 0.67); and between endurance and fast (r = 0.61). For the ultrasound variables, there was correlation between the bladder neck and H height, both at rest (r = 0.44) and under stress (r = -0.62); between the ureteric angle at stress and H height at rest (r = 0.49); the ureteric angle at rest (r = 0.74); and the levator anterior area (r = 0.40; p = 0.05 for all measures). None of the ultrasound variables correlated with the PERFECT scheme or the vaginal manometry.

Conclusion: There was no correlation between the ultrasound variables and vaginal manometry or the PERFECT scheme. There was correlation between specific measurements of the PERFECT scheme and vaginal manometry and among some of the ultrasound variables.