International Urogynecology Journal最新文献

Introduction and hypothesis: Current research on pelvic floor disorders is constrained by fragmented disciplinary approaches, static anatomical views, and insufficient attention to biomechanical balance. This paper is aimed at constructing a novel theoretical framework for pelvic floor stress dysfunction disorders (PFSDs) by integrating philosophical and scientific methodologies.

Methods: Using First Principles thinking, we redefine PFSD as a disruption of dynamic biomechanical equilibrium centered on the concept of "force." Inductive and deductive reasoning are applied to critically evaluate existing theories (e.g., Three-Compartment, Hammock), while verification and falsification principles are employed to expose logical inconsistencies between etiology and treatment.

Results: The analysis reveals fundamental limitations in current theories, which fail to account for the dynamic and integrated nature of pelvic floor function. We propose physiological biomechanical reconstruction-rather than symptom-based repair-as the core therapeutic objective. Boundary-breaking innovation promotes a holistic understanding of pelvic floor synergy across disciplines.

Conclusions: This philosophically grounded framework shifts the focus from static anatomy to dynamic biomechanical balance, offering a logical basis for evidence-based PFSD management. It supports a transition from empirical to mechanism-driven approaches in both research and clinical practice.

Introduction and hypothesis: Episiotomy is among the most performed obstetrical procedure globally. While restrictive episiotomy is recommended, patients may be reluctant to consent. TikTok, a rapidly growing video platform, is a popular patient resource to obtain health information on episiotomy. This study aimed to evaluate the information quality and degree of misinformation contained in TikTok videos about episiotomy and examine the relationship between user engagement and misinformation.

Methods: In this cross-sectional study, we identified the top videos with keyword "episiotomy" on the Canadian TikTok app. Three reviewers scored videos using the DISCERN instrument for health information quality and a 5-point Likert scale for misinformation. We evaluated correlation between user engagement and misinformation and narrator credentials and misinformation using the Pearson correlation coefficient.

Results: Forty-seven videos met the inclusion criteria. The median video length was 57 s (IQR 15-89). Most videos were oriented towards education (59.6%) and narrated by healthcare providers (36.2%) or patients (25.5%). Many videos (71.74%) contained low quality information (DISCERN score < 3), and 36.17% of videos contained misinformation (misinformation rating Likert score > 3). There was no significant correlation between engagement and misinformation (r = 0.06, p = 0.68) nor between narrator credentials and misinformation (r = 0.17, p = 0.29).

Conclusions: Low-quality health information and misinformation about episiotomy are prevalent on TikTok. Neither user engagement nor narrator credentials showed a significant correlation with misinformation. Patient education about potential misinformation on these platforms and development of evidence-based resources about episiotomy are essential to support informed decision-making.

Introduction and hypothesis: Although the association between the prolonged second stage of labour and obstetrical anal sphincter injury (OASI) risk has been established, the contribution of the duration of the active phase (time spent pushing) remains unclear. This study was aimed at estimating the association between the duration of the active phase of the second stage of labour and OASI risk among nulliparous pregnant persons.

Methods: We conducted a population-based, retrospective cohort study of nulliparous pregnant persons who gave birth to a singleton, non-anomalous, vertex foetus at ≥ 37 weeks' gestational age from 2017 to 2021. Poisson regression models adjusting for confounders were developed to estimate the risk ratio (RR) with 95% confidence intervals (CI) for the association between duration of the active phase, and total duration of the second stage, of labour and OASI.

Results: Of 4963 persons, 471 (9.5%) cohort members sustained an OASI (8.7% third-degree and 0.8% fourth-degree). An active phase ≥ 120 min was associated with a 92% higher risk of OASI compared with 30 to < 60 min (RR 1.92, 95% CI 1.51-2.45). When stratified by mode of delivery, RRs estimated for this association were attenuated (spontaneous: 0.92, 95% CI 0.56-1.53; vacuum: 1.37, 95% CI 0.77-2.45; forceps: 0.85, 95% CI 0.63-1.15). When total duration of the second stage was considered, a duration ≥ 120 min was associated with a 59% increased risk of OASI compared with 30 to < 60 min (1.59, 95% CI 1.17-2.16).

Conclusion: Increasing duration of the active phase of the second stage of labour is associated with an increased risk of OASI.

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.