International Urogynecology Journal最新文献

Introduction and hypothesis: Research on female patients with bladder pain syndrome/interstitial cystitis (BPS/IC) who have urethral, vaginal, perineal, or anal pain (pelvic-perineal pain, PPP) remains limited. This retrospective study characterized their clinical features and treatment outcomes.

Methods: From 2013 to 2023, a total of 130 female patients with BPS/IC were enrolled. Treatments included hydrodistension with Hunner lesion resection (when present), oral/intravesical medications, and pudendal nerve block for significant PPP. Recurrences were managed with repeat therapy or advanced options (platelet-rich plasma, botulinum toxin, sacral neuromodulation), with urinary diversion as the last resort.

Results: Among the cohort, 24 patients (18.46%) were identified as having PPP. These patients were significantly older and had higher symptom scores than those without PPP (all p < 0.05). The PPP group exhibited a higher prevalence of cystoscopic grade 4 lesions and a smaller anesthetic bladder capacity. Furthermore, within the PPP cohort, the presence of grade 4 lesions and a bladder capacity ≤ 400 ml were significant predictors of poor treatment outcome. Over a median follow-up of 74.8 months, although overall improvement was not statistically different from a severity-matched control group, treatment failure necessitating urinary diversion occurred exclusively in the PPP group (12.5% vs 0%, p = 0.013). Furthermore, the PPP group required significantly more therapeutic interventions per patient (1.96 vs 1.17, p = 0.001).

Conclusions: A subset of female patients with BPS/IC presents who had concomitant PPP, which identifies a more severe disease phenotype characterized by objective markers of severity and a higher risk of treatment failure. The assessment of PPP serves as a straightforward and valuable prognostic marker in clinical practice.

Introduction and hypothesis: Access to gender-affirming care has improved for transgender individuals, yet significant barriers to surgical interventions persist. Bilateral orchiectomy is a straightforward, same-day procedure that plays a crucial role in gender affirming care. This article and accompanying video outline the indications for this procedure and provide a step-by-step demonstration of the surgical technique.

Methods: We describe the surgical steps of gender-affirming bilateral orchiectomy, highlighting its similarities to vaginal gynecologic procedures. We also discuss indications for gender-affirming bilateral orchiectomy, review testicular anatomy and its parallels to ovarian anatomy, surgical technique, and postoperative care.

Results: The senior author, a board-certified urogynecologist, has performed over 100 bilateral orchiectomies with excellent outcomes. Given the political and systemic challenges transgender patients face in accessing surgical care, this video underscores the role of urogynecologists and gynecologists in providing this essential service.

Conclusions: This video illustrates indications and technique for bilateral orchiectomy in gender-affirming care, emphasizing its overlap with vaginal surgical skills. Increased exposure to this procedure may encourage urogynecologists and gynecologists to incorporate it into their practice with minimal additional training.

Introduction and hypothesis: Sacrospinous ligament suspension (SSLS) is a common native-tissue prolapse repair procedure. Although effective, 5-year failure rates can approach 70%. Permanent sutures offer durability but carry risks such as erosion and bleeding. Absorbable sutures may reduce these complications, but their efficacy remains uncertain. We hypothesized that absorbable sutures would be non-inferior to permanent sutures in maintaining apical support at 12 months.

Methods: We conducted a randomized controlled trial from January 2023 to January 2025 at a tertiary center. Patients undergoing SSLS were randomized 1:1 to absorbable or permanent sutures. Blinded assessors evaluated outcomes. The primary outcome was POP-Q point C at 12 months. A non-inferiority margin of 2 points in POP-Q point C and standard deviation of 2 were used. Secondary outcomes included composite prolapse recurrence, suture-related complications, and Patient Global Impression of Improvement (PGI-I). To achieve 90% power with α = 0.05, 18 patients per group were required. Fisher's exact, Mann-Whitney U, and Chi-squared tests were used where appropriate.

Results: Forty-nine patients were randomized; 41 completed follow-up (23 absorbable, 18 permanent). Median point C was -5 in both groups (p = 0.98). Composite recurrence rates were similar (43.5% absorbable vs 50% permanent, p = 0.68). No suture erosion or granulation was observed. PGI-I improvement in 82.6% of the absorbable and 100% of the permanent group (p = 0.12).

Conclusions: Absorbable sutures were non-inferior to permanent sutures in supporting apical prolapse at 12 months. Both groups demonstrated high rates of patient-reported improvement with low complication rates.

Introduction and hypothesis: Urinary incontinence (UI) is a common chronic condition in middle-aged and older women, linked to various physical and psychological health issues. High psychological need frustration (PNF) may compromise UI patients' autonomy and motivation in pursuing health goals, preventing effective self-management. This study aimed to explore the determinants of PNF among UI patients amid global aging.

Methods: A convenience sample of 170 middle-aged and older women was recruited from a tertiary hospital in Shenzhen between January and April 2025. Participants completed standardized questionnaires, including a general information questionnaire, psychological need frustration scale for physical activity (PNFS-PA), the International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Satisfaction with Life Scale (SWLS). Data were analyzed using t-tests, analysis of variance (ANOVA), Pearson correlation coefficients, and multiple linear regression.

Results: Findings revealed that most patients exhibited mild-to-moderate UI severity and moderate levels of PNF. PNF demonstrated a positive association with UI severity and negative correlations with physical activity and life satisfaction; however, the effect sizes associated with physical activity was relatively small. Multiple linear regression analysis identified educational level, family residence, UI severity, physical activity levels, and life satisfaction as statistically significant predictors of PNF.

Conclusions: The PNF of middle-aged and older women with UI is at a moderate level. Educational level, family residence, UI severity, physical activity levels, and life satisfaction are the factors influencing the PNF of UI patients.

Introduction and hypothesis: Individuals experiencing anorectal symptoms may report a history of sexual violence (SV) and conversely, survivors of SV may later report anorectal symptoms. However, the nature of the relationship between SV and these symptoms remains insufficiently understood. This review aims to systematically assess the reported prevalence and severity of anorectal symptoms, as well as their association with sexual violence, among adult survivors of both sexes.

Material and methods: Following the PRISMA guidelines, a systematic search of three databases, CINAHL, Embase, and MEDLINE/PubMed, was performed for quantitative observational studies concerning SV (rape, sexual harassment, childhood sexual abuse, female genital mutilation) as well as reported anorectal symptoms among adults. Cross-sectional, cohort, case-control, and case series studies published in English and French were included. The Mixed Methods Appraisal Tool (MMAT) was used for assessing the quality of included studies.

Results: Thirteen studies met the inclusion criteria for data extraction. Most studies (12/13) were conducted in a medical setting with a cross-sectional design. Two cross-sectional studies assessed the prevalence of reported anorectal symptoms among SV survivors and 11 studies evaluated the prevalence of SV among patients with anorectal disorders. SV prevalence ranged from 4.1% to 62%. Constipation was the main studied symptom (9/13) followed by fecal incontinence (7/13), anorectal pain (2/13), and recto-vaginal fistula (1/13). Assessments for both SV and anorectal disorders lacked standardization, involving heterogeneous findings.

Conclusion: This review highlights the need for more specific research using standardized assessment of SV and anorectal disorders to better understand their association to improve trauma-informed care pathways.

Introduction: Pelvic organ prolapse (POP) is a common condition in women, often associated with substantial morbidity. Robotic-assisted sacrocolpopexy (RASC) has been developed as a minimally invasive option for POP repair, potentially improving outcomes compared with conventional techniques. This study aimed to assess long-term anatomical and functional results of RASC in a single-institution cohort.

Methods: A retrospective cohort study was conducted including women aged ≥18 years with symptomatic POP stages II-IV who underwent RASC between 2016 and 2021. Patients with a minimum follow-up of 4 years were analyzed. The primary endpoint was anatomical and subjective correction of POP. Secondary outcomes included perioperative complications, functional outcomes, and patient satisfaction. Data were obtained from clinical interviews, physical examinations, and validated questionnaires.

Results: Forty-five patients were included, with a mean age of 64.7 years and a median follow-up of 55 months. Most patients had advanced prolapse, with 73.3% presenting grade III and 22.3% grade IV according to the Baden-Walker classification. Anatomical and subjective correction was achieved in 88.9% of cases, with only one patient requiring reintervention for recurrence. Early complications occurred in 6.7% of patients, all Clavien-Dindo grade I-II. Late complications included de novo constipation (15.6%) and urinary symptoms (22.2%). Overall, 95.6% of patients reported improvement and high satisfaction postoperatively.

Conclusion: RASC is a safe and effective option for the treatment of POP, providing durable anatomical and functional improvements with high patient satisfaction at long-term follow-up.

Introduction and hypothesis: This systematic review and meta-analysis aims to synthesize existing evidence on the effectiveness of alternative exercise regimens for managing stress urinary incontinence in women, compared to pelvic floor muscle training or usual care/placebo.

Methods: A comprehensive search of MEDLINE, Cochrane Library, CINAHL, Embase, PubMed, and Scopus, was conducted up to April 26, 2025. Randomized controlled trials investigating alternative exercises, including Pilates, lumbopelvic stabilization, breathing exercises, resisted hip rotation, yoga, and the Paula method, were included. A random-effects model was applied in the meta-analysis to compute standardized mean differences (SMDs) for urinary incontinence severity and quality of life.

Results: Fourteen RCTs involving 797 women were included. Among them, nine studies were evaluated as good quality, and five as fair. Meta-analysis showed no significant difference between the effectiveness of alternative exercises and pelvic floor muscle training on urinary incontinence severity (SMD 0.04, 95% CI -0.15 to 0.23, p = 0.68) and quality of life (SMD -0.11, 95% CI -0.26 to 0.04, p = 0.14). Alternative exercises significantly outperformed usual care/placebo in improving symptom severity (SMD -1.34, 95% CI -1.85 to -0.83, p < 0.001) and quality of life (SMD -1.03, 95% CI -1.52 to -0.54, p < 0.001). No adverse events were reported.

Conclusions: Alternative exercise regimens provide comparable benefits to pelvic floor muscle training and significantly outperform usual care/placebo, making them viable, evidence-based options for stress urinary incontinence management.

Introduction and hypothesis: This study aimed to adapt the original instrument titled Genitourinary Syndrome of Menopause Symptoms and Vaginal Treatments Acceptability Questionnaire into Turkish and to evaluate the validity and reliability of the obtained Turkish version.

Methods: This methodological study was conducted with 505 postmenopausal women receiving care at the women's health clinic of a public hospital in Türkiye. The adaptation process included forward-backward translation, expert review, pilot testing, and statistical analyses. Construct validity was assessed using confirmatory factor analysis, and internal consistency was evaluated using Cronbach's alpha coefficient. Additionally, discriminant validity analysis was performed.

Results: The results of the confirmatory factor analysis supported the original three-factor structure of the questionnaire in the Turkish sample (CFI 0.973, TLI 0.976, RMSEA 0.027). The overall Cronbach's alpha coefficient of the scale was 0.853, with subscale values ranging from 0.787 to 0.930. Significant differences were found between the upper and lower 27% groups, indicating strong discriminative power. Negatively worded items in domain C adversely affected internal consistency, and their revision is recommended.

Conclusion: The Turkish version of the Genitourinary Syndrome of Menopause Symptoms and Vaginal Treatments Acceptability Questionnaire is a valid and reliable self-report instrument for assessing symptom burden, quality of life, and treatment acceptability in postmenopausal women. It can be used in clinical practice for diagnosis and follow-up, and as a culturally sensitive data collection tool in scientific research.

Background: Perineal trauma during childbirth is a common complication with significant short- and long-term maternal consequences. Perineal protection devices (PPDs) have been developed as a potential preventive strategy, yet their clinical effectiveness remains under evaluation.

Aim: To assess the effectiveness of perineal protection devices in reducing the incidence and severity of birth-related perineal trauma.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Eligible studies were identified from PubMed, Scopus, Web of Science, and Embase. Primary outcomes included rates of intact perineum, perineal tears (grade ≥ 2), labial tears, episiotomy, and Apgar scores. Secondary outcomes included adverse effects and feasibility. The Cochrane Risk of Bias tool 2 and GRADE assessment were used to evaluate study quality.

Results: Five RCTs involving 2331 participants were included. PPD use was associated with a significantly increased rate of intact perineum (RR 1.41; 95% CI 1.18-1.69; p < 0.001). No significant differences were found for grade 1 (RR 1.05; p = 0.48), grade 2 (RR 0.92; p = 0.32), or grade 3-4 perineal tears (RR 0.76; p = 0.26). Labial tears showed no significant reduction overall (RR 0.90; p = 0.64), but sensitivity analysis revealed a benefit after excluding one study (RR 0.72; p = 0.02). No significant differences were found in episiotomy rates (RR 0.96; p = 0.62) or Apgar scores < 7 at 5 min (RR 0.99; p = 0.93).

Conclusion: PPDs appear safe and effective in increasing intact perineum rates without adverse neonatal outcomes. Further large-scale, standardized trials are needed to confirm their role in obstetric practice.