International Urogynecology Journal最新文献

Introduction and hypothesis: Midurethral slings (MUS) are among the most commonly performed surgical treatments for stress urinary incontinence (SUI) worldwide, but mesh erosion remains a concerning complication. This systematic review and meta-analysis aimed to identify patient-related risk factors associated with mesh erosion following MUS procedures.

Methods: We conducted a comprehensive literature search in MEDLINE via PubMed, ScienceDirect, and Scopus from January 2010 to March 2025. Studies reporting risk factors for mesh erosion following synthetic MUS procedures for SUI were included. Two independent reviewers assessed study quality using the Newcastle-Ottawa Scale. Evidence certainty was evaluated using the GRADE approach. Fixed-effects meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Six high-quality studies (n = 3068 patients) were included. The prevalence of mesh erosion ranged from 1.3% to 13.7% across studies. Significant risk factors for mesh erosion included prior pelvic surgery (OR 10.37; 95% CI 6.70-16.07), diabetes mellitus (OR 4.63; 95% CI 3.44-6.25), smoking (OR 3.38; 95% CI 2.54-4.48), obesity (BMI ≥ 30 kg/m²) (OR 2.79; 95% CI 1.69-4.62), and postmenopausal status (OR 2.34; 95% CI 1.67-3.27). GRADE assessment indicated moderate-certainty evidence for prior pelvic surgery, diabetes mellitus, smoking, and postmenopausal status.

Conclusions: This meta-analysis identifies prior pelvic surgery, postmenopausal status, diabetes mellitus, smoking, and obesity (BMI ≥ 30 kg/m²) as significant risk factors for mesh erosion following MUS procedures. These findings provide an evidence-based foundation for preoperative risk stratification and patient counseling.

Trial registartion: Prospero CRD420251026364.

Introduction and hypothesis: Pelvic organ prolapse (POP) is a common condition among aging women, whereas rectal prolapse (RP) is uncommon. The change of anatomy and vector of downward force after surgical repair of POP may be a risk factor for RP. The objective of this study is to examine the occurrence of RP after surgical repair of POP and associated clinical factors.

Methods: A retrospective chart review was performed from 2013 to 2024 for women who had undergone surgery for POP at a single institution. Demographic variables were analyzed. Correct diagnoses were validated, and clinical courses were extracted. Appropriate statistical analysis was performed.

Results: A total of 2381 surgeries for POP were performed (2150 reconstructive, 231 obliterative). Seven patients developed RP, 0.14% of patients who had undergone reconstructive surgery, and 1.7% in whom obliterative vaginal surgery had been performed. In univariate analysis, the odds of a patient being diagnosed with RP after reconstructive repair were 12 times lower than after an obliterative repair (OR 0.08, CI 0.012-0.48, p < 0.05). After adjusting for age, parity, and BMI, patients who had undergone obliterative surgical repair still showed higher odds of developing RP than those who had undergone reconstructive repair, although this finding did not reach statistical significance (OR 6.15, 95% CI 0.76-44.84, p = 0.09).

Conclusions: This exploratory description of the finding of RP in patients who had undergone surgical repair of POP generates the hypothesis that there is a higher likelihood of the developing RP in patients who undergo obliterative vaginal repairs than in those who undergo reconstructive vaginal repairs. Further research is needed to elucidate this relationship.

Introduction and hypothesis: Strengthening the diaphragm muscle, the roof of the pelvic floor muscles (PFMs), may be a potential complementary approach in women suffering from stress urinary incontinence (SUI). This pilot randomized controlled study was aimed at investigating the effects of home-based telerehabilitation-assisted high-intensity inspiratory muscle training (IMT) on PFM function and urinary symptoms in women with SUI.

Methods: Twenty-two women aged 25-50 years with SUI were randomly assigned to either the intervention group (n = 11) or the control group (n = 11). Inspiratory muscle strength (maximal inspiratory pressure [MIP]), PFM function (assessed via pressure biofeedback), and urinary symptoms (evaluated using the Urogenital Distress Inventory Short Form, the International Consultation on Incontinence Questionnaire Short Form, and the Incontinence Severity Index) were evaluated. Participants performed IMT twice daily, 7 days a week, over 8 weeks. The intervention group underwent IMT at 60% of their baseline MIP, whereas the control group performed a sham-IMT.

Results: Function of the PFMs showed significant improvement in the intervention group compared with the control group, as demonstrated by increases in peak maximum voluntary contraction (p = 0.024, η2 effect size = 0.24), average maximum voluntary contraction (p = 0.027, η2 effect size = 0.23), and PFM endurance (p = 0.006, η2 effect size = 0.36). Additionally, the intervention group showed a significant increase in MIP (p = 0.018, η2 effect size = 0.26) compared with the control group. There were no statistically significant differences between the groups in urinary symptom scores (p > 0.05).

Conclusions: This pilot study demonstrates that home-based high-intensity IMT may enhance inspiratory muscle strength and potentially contribute to improved PFM function in women with SUI.

Introduction and hypothesis: Patient satisfaction is a key indicator of the quality of care after urogynecological surgery. The aim of this study was to adapt and validate the Polish version of the International Consultation on Incontinence Questionnaire-Satisfaction (ICIQ-S) among women after urinary incontinence (UI) and/or pelvic organ prolapse (POP) surgery.

Methods: This was a multicenter, cross-sectional study including 283 women 6-12 months after surgery. Translation was performed according to ICIQ guidelines. Participants completed the ICIQ-S twice via telephone interviews to assess test-retest reliability. Construct validity was analyzed using confirmatory factor analysis (CFA) and group comparisons. Concurrent validity was assessed through correlations with ICIQ lower urinary tract symptoms (LUTS), ICIQ female lower urinary tract symptoms (FLUTS), and the Pelvic Floor Distress Inventory (PFDI-20). Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients (ICC).

Results: The six-item ICIQ-S core showed strong internal consistency (Cronbach's α = 0.913) and excellent test-retest reliability (ICC = 0.958). CFA confirmed good construct validity (Comparative Fit Index = 0.985, Tucker-Lewis Index = 0.967, Standardized Root Mean Squared Residual = 0.021). The ICIQ-S total score demonstrated a very strong negative correlation with PFDI-20 total score (r = -0.764) and moderate negative correlations with ICIQ-LUTS and ICIQ-FLUTS. Group comparisons showed significant differences in satisfaction between UI, POP, and POP + UI groups.

Conclusions: The Polish version of the ICIQ-S is a valid and reliable tool for assessing patient satisfaction after surgical treatment of UI and POP. It can be recommended for clinical practice and research to evaluate patient-centered outcomes in urogynecology.

Introduction and hypothesis: This systematic review synthesizes current evidence on the prevalence, risk factors, pathophysiology, clinical manifestations, and management of pelvic floor disorders (PFD) following gynecologic cancer surgery and adjuvant therapy, with an emphasis on rehabilitation, multidisciplinary care, and quality of life.

Methods: Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and Web of Science were searched for English-language studies published between January 2000 and May 2025. Eligible studies included adult women with gynecologic malignancies reporting outcomes related to urinary or fecal incontinence, pelvic organ prolapse, chronic pelvic pain, or sexual dysfunction. Data were extracted using a standardized form, qualitatively synthesized, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results: Thirty studies met the inclusion criteria. PFD were highly prevalent, particularly after radical surgery and adjuvant therapies. Stress urinary incontinence and prolapse were more frequent after radical surgery, while urgency incontinence, vaginal stenosis, and chronic pelvic pain were linked to radiotherapy. Chemotherapy was associated with neurogenic bladder and bowel dysfunction. Independent risk factors included advanced age, obesity, and postmenopausal status. PFD significantly impaired physical, psychological, sexual, and social quality of life. Nerve-sparing and minimally invasive techniques showed promise in reducing dysfunction. Conservative measures-pelvic floor muscle training, biofeedback, vaginal dilators, and lifestyle modification-were effective for many patients, while surgical procedures such as slings and sacrocolpopexy were reserved for severe cases. Emerging options include local estrogen or DHEA after radiotherapy and onabotulinumtoxinA for refractory urge incontinence.

Conclusions: PFD are underrecognized yet common and disabling complications in women treated for gynecologic cancers. Multidisciplinary management integrating pelvic floor rehabilitation and individualized survivorship care is essential to improve outcomes and quality of life. Further research should establish standardized screening, preventive strategies, and evidence-based rehabilitation protocols for this high-risk population.

Introduction and hypothesis: To evaluate the clinical efficacy and safety of combined sacral magnetic stimulation (SMS) and bladder electrical stimulation (ES) in treating post-stroke urgency urinary incontinence (UUI).

Methods: We retrospectively enrolled 90 patients with post-stroke UUI, divided into ES, SMS, and SMS + ES groups (n = 30 each). Urodynamic parameters, voiding diaries, quality of life scales (ICIQ-SF, ICIQ-QoL, SAS), Patient Global Impression of Improvement (PGI-I), urinary tract infection (UTI) incidence, and overall response rates were compared before and 1 month after treatment.

Results: The SMS + ES group demonstrated comprehensive therapeutic advantages. Urodynamically, this group showed significantly greater maximum bladder capacity (408.5 ± 70.1 mL), lower postvoid residual urine volume (75.2 ± 53.4 mL), and lower detrusor pressure at maximum flow (28.4 ± 6.5 cmH₂O) compared to single-therapy groups (all P < 0.01). Clinically, the combined group showed the most significant improvements in 24-h incontinence episodes, ICIQ-SF, ICIQ-QoL, and SAS scores (all P < 0.01), along with the best PGI-I scores. The UTI incidence was 3.3% in the SMS + ES group, significantly lower than the 13.3% in the ES group (P < 0.05). The overall response rate was 93.3% in the SMS + ES group, significantly higher than in the ES (66.7%) and SMS (73.3%) groups (P < 0.05).

Conclusion: Combined SMS and ES therapy synergistically improves storage and voiding function, alleviates anxiety, reduces UTI risk, and significantly enhances quality of life in post-stroke UUI patients, demonstrating superior efficacy over either therapy alone.

Introduction and hypothesis: Urethral diverticulum (UD) is a complex condition with significant implications for patient quality of life. Despite increasing interest, gaps remain in understanding its etiology, optimal diagnosis, and long-term outcomes. This bibliometric analysis examines global research trends in UD to identify key themes and knowledge gaps.

Methods: A literature search was conducted in the Web of Science Core Collection on January 8, 2025, using the terms "urethral diverticulum" OR "urethral diverticula" OR ("urethra" AND "diverticulum"). English-language original and review articles published between 1970 and 2024 were included. Articles were manually screened for relevance. Bibliometric analysis was performed using Bibliometrix and VOSviewer to assess publication trends, citation impact, collaboration networks, and keyword co-occurrence.

Results: A total of 357 articles met inclusion criteria, with a slow annual publication growth rate (0.95%). The United States, China, and the United Kingdom were the top contributors, with low international co-authorship rates (5.6%). Most research focused on surgical management, especially diverticulectomy, with limited studies on conservative treatments or minimally invasive approaches. Key research themes included imaging techniques, surgical outcomes, and UD management in women, while gaps persisted in long-term patient-reported outcomes and standardized diagnostic protocols.

Conclusions: UD research remains underdeveloped with a predominance of surgical studies. Increased international collaboration and research on nonsurgical management, minimally invasive techniques, and long-term outcomes are needed to refine clinical guidelines and improve patient care.

Introduction and hypothesis: Several epidemiological studies estimate the prevalence of incontinence, urinary (UI), fecal (FI), and dual (DI) in US women; however, none has specifically examined the prevalence of UI, FI, and DI in a large cohort of self-identified Black women. The primary objective was to estimate the prevalence of the incontinence types in the Black Women's Health Study (BWHS) and extrapolate these findings to Black women in the USA by integrating BWHS prevalence with the 2020 US Census data.

Methods: Among BWHS participants responding to the biennial follow-up questionnaire administered in 2011, we assessed the prevalence of UI in all women (N = 38,100) and the prevalence of FI and DI in post-menopausal women (N = 19,244). We then standardized age-specific prevalences from BWHS using the 2020 US Census weights to extrapolate findings to self-identified Black women in the USA. All analyses were conducted using R version 4.3.

Results: Approximately one in two participants reported having UI at least once a year (50.6%). Among post-menopausal women, 14% reported any FI, and 10% reported DI. Extrapolating estimates from BWHS data to the 2020 US Census data for US Black women aged 35 years or older, approximately 5.6 million Black women (95% CI = 5.42-5.80 million) had UI, 784,529 women had FI (95% CI = 0.70-0.91 million), and 608,710 women had DI (95% CI = 0.53-0.72 million).

Conclusions: In this large study among community dwelling Black women, prevalence estimates of UI, FI, and DI are higher than previously reported, translating to over five million affected US Black women.

Introduction and hypothesis: This study aims to systematically compare the efficacy of dorsal onlay buccal mucosal graft urethroplasty (BMGU) and ventral onlay BMGU in the treatment of female urethral stricture (FUS), evaluating key outcomes such as success rate, postoperative maximum urinary flow rate (Qmax), postoperative post-void residual volume (PVR), and postoperative American Urological Association (AUA) score.

Methods: A literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases. Statistical analysis was performed using Review Manager 5.3 software and Stata version 18.0, and a random-effects model was applied to analyze data with significant heterogeneity.

Results: Five studies met the inclusion criteria, involving a total of 319 patients (112 with dorsal onlay and 207 with ventral onlay). The pooled analysis showed no significant difference between the two surgical approaches in terms of success rate (relative risk [RR] 1.00; 95% confidence interval [CI] 0.91, 1.10; p = 0.95). At 6 months postoperatively, Qmax (mean difference [MD] -0.88; 95% CI -2.21, 0.46; p = 0.20), PVR (MD 0.74; 95% CI -3.04, 4.52; p = 0.70), and AUA score (MD -0.54; 95% CI -1.24, 0.15; p = 0.13) were similar between the dorsal and ventral groups.

Conclusions: Dorsal onlay BMGU and ventral onlay BMGU show similar efficacy in treating FUS. The choice of surgical approach should be based on individual patient factors, such as the location, severity of stricture, and history of prior treatments.