International Urogynecology Journal最新文献

Introduction and hypothesis: Urinary tract infections (UTIs) are one of the most common reasons for seeking medical review worldwide. Women are disproportionately affected, with a life-time incidence of 50%. Women presenting with clinical symptoms of UTI such as dysuria and urinary frequency can often have negative urine culture results, especially if they have been taking multiple courses of antibiotics. This can make the diagnosis and management of recurrent or chronic UTI challenging. In this study we compared the culture results of urine and bladder tissue in women undergoing rigid cystoscopy presenting with lower urinary tract symptoms. We hypothesise that a biopsy of the bladder wall might be more likely to reveal a causative uropathogen on culture than urine.

Methods: Women had clean-catheter urine samples sent for urine culture and then bladder biopsies taken at cystoscopy cultured for uropathogens. Culture results from urine and bladder tissue were analysed and compared.

Results: We found that under 10% of urine cultures were positive (n = 30), whereas 51% of bladder tissues cultures grew a uropathogen (n = 155). Analysis showed that the culture results of urine and bladder tissue did have a statistically significant relationship (p = 0.008). Culture of bladder tissue revealed a wider variety of uropathogens.

Conclusions: This study proposes that cystoscopy with a bladder biopsy for culture might be a useful adjunctive tool in selected women with refractory symptoms of urine infection.

Background: Metabolomics reflects the molecular communications within biological systems. Urine is a noninvasive biofluid, rich in metabolites that serve as potential biomarkers for human health and disease. The impact of storage conditions and DNA stabilizers for urine samples in metabolomic studies remain unclear.

Objective: To evaluate the impact of common storage conditions and the presence of a DNA stabilizer, AssayAssure® (Thermo Scientific), on the metabolite content of voided human urine.

Methods: We assessed the urinary metabolite composition under different storage conditions and with the addition of AssayAssure® to determine its effect on metabolomic analysis.

Results: Urinary metabolite composition remained consistent across different storage conditions. However, the addition of AssayAssure® significantly altered the metabolic profile due to adduct formation. Despite these alterations, the identification of parent metabolites was not compromised, and biological differences were still distinguishable.

Conclusion: These findings suggest that urine biobanked under the tested storage conditions is suitable for metabolomic analysis. The addition of AssayAssure® does not hinder the detection of parent metabolites, although it may affect the overall metabolic profile.

Introduction and hypothesis: The incidence of obstetric anal sphincter injury (OASI) is 3.6-6% of women with vaginal deliveries. Complications to OASI are common, and secondary repair is needed in 2.6-3%. Traditionally, secondary repair has been postponed until wound healing, but studies have shown that early secondary repair within 21 days can be safely performed.

Methods: The aim of this cohort study and literature review was to investigate the long-term outcomes after early secondary repair with focus on anal incontinence, quality of life and impact on sexual function with the use of International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B).

Results: A total of 17 patients underwent early secondary repair after OASI within the study period and 11 answered and returned the long-term follow-up questionnaire. Seven had no postoperative complications, nine had infection and two developed recto-vaginal fistulas that needed subsequent surgical treatment. Median follow-up period was 5 years (2.3-5.7). At long-term, ten women (91%) reported fecal urgency, nine (82%) flatal and liquid incontinence, six (55%) problems with soiling and six (55%) unpredictable bowel accidents. Five women (45%) planned daily activities to accommodate their anal incontinence and three (27%) stayed at home because of anal incontinence. Seven women (64%) reported restrictions in their sexual relations due to anal incontinence.

Conclusions: In conclusion, early secondary repair of OASI in women with severe wound dehiscence involving the anal sphincter may be necessary. However, this group have a high risk of anal incontinence, negative impact on quality of life, and risk of sexual dysfunction at long-term follow-up.

Introduction and hypothesis: Intrasphincteric injection of autologous skeletal muscle-derived cells (aSMDCs) is a minimally invasive treatment for stress urinary incontinence (SUI). This study investigated two cell counts (high/low dose) for functional urethral sphincter regeneration in combination with electrical stimulation, treatment safety and efficacy, and its potential superiority to duloxetine-placebo or duloxetine.

Methods: This phase II, placebo-controlled trial randomised women with SUI to cell implantation (low or high cell number) and to control groups (duloxetine-placebo or duloxetine), each treatment combined with electrical stimulation. The primary efficacy endpoint was the mean reduction of incontinence episode frequency (IEF) at 12 weeks post-treatment compared with baseline. Secondary efficacy parameters included 1-h pad test, visual analogue scale (VAS), Incontinence Quality of Life questionnaire, clinical global impression score and frequency of responders based on IEF. Adverse events were analysed for safety evaluation. Additional follow-up data on IEF and selected secondary efficacy variables were obtained in a sub-population of patients after 12 and 48 months.

Results: The mean reduction ± SD in IEF after 12 weeks was: low cells: -16.4 ± 13.3 (61 patients), high cells: -18.5 ± 18.7 (56), placebo: -9.7 ± 13.7 (68), duloxetine -11.2 ± 19.6 (32). Cell treatments were significantly superior over placebo regarding IEF reduction and all secondary endpoints except for VAS. No safety issues were observed following cell implantation. Improvements were sustained over 12 and 48 months, with no difference between low and high cell implantation groups.

Conclusions: Therapy for SUI with aSMDCs in combination with electrical stimulation is safe, effective and sustained over at least 48 months.

Introduction and hypothesis: This study aims to systematically estimate the global prevalence of overactive bladder (OAB), identify demographic and regional factors contributing to prevalence variations, and assess trends in prevalence over the past two decades.

Methods: This cross-sectional study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. From inception to April 2024, computerized searches for OAB prevalence-related literature were conducted on PubMed, Embase, Web of Science, and Cochrane. Studies of OAB prevalence in the general population were included. Two independent researchers conducted the screening, data extraction, and quality assessment of the included studies.

Results: A total of 53 studies, encompassing 610,438 participants, were ultimately included in the analysis. The meta-analysis determined the global prevalence of OAB to be 20% (95% CI 0.18-0.21). Over the past 20 years, there has been an increase in OAB prevalence, rising from 18.1% (95% CI 0.13-0.23) to 23.9% (95% CI 0.19-0.29). Among women, the prevalence of OAB was 21.9% (95% CI 0.20-0.24), indicating higher rates compared to men (OR = 16.1, 95% CI 0.15-0.18). The study also found higher prevalence rates among overweight and obese individuals (OR = 18.6, 95% CI 0.13-0.24) and those aged 60 years and above (OR = 28.3, 95% CI 0.24-0.33). Middle-income countries exhibited higher prevalence rates compared to high-income countries.

Conclusions: The study highlights higher risks of OAB among obese individuals, women, and the elderly. OAB prevalence has shown an increasing trend over the past 20 years.

Purpose: Bladder pain syndrome (BPS) is associated with heightened inflammatory responses. We hypothesize that reduced A2A adenosine receptor (A2AR) expression exacerbates inflammation and pain, while A2AR activation mitigates these effects. In this study, we aimed to investigate the therapeutic potential of A2AR modulation in an autoimmune cystitis model.

Methods: URO-OVA mice, a transgenic model that expresses ovalbumin (OVA) in the bladder urothelium leading to autoimmune-driven cystitis, were randomly divided into four groups (n = 6 per group): (1) control, (2) inflammation-induced (cystitis), (3) inflammation-induced treated with the A2AR agonist regadenoson (a selective A2AR agonist commonly used in cardiac stress tests), and (4) inflammation-induced treated with the A2AR antagonist ZM241385. Bladder inflammation was assessed via histological analysis, western blot, and RT-PCR of inflammatory markers (IL-6, TNF-α, CD11b, GFAP, HMGB1). Bladder pain was measured using bladder distention-evoked visceromotor responses (VMR) and von Frey filament-based pelvic nociception tests.

Results: Inflammation-induced mice showed significantly reduced A2AR expression (~50% lower vs. controls, p < 0.001), while other inhibitory factors (e.g., IL-10R, TGF-βR, PD-1) remained largely unchanged. Regadenoson treatment reduced IL-6 and TNF-α expression by ~60% compared to cystitis-induced mice and alleviated pain, whereas ZM241385 worsened inflammation and increased pain responses.

Conclusion: A2AR downregulation correlates with increased inflammation in the URO-OVA model of BPS. Activation of A2AR via regadenoson significantly suppresses inflammatory responses and bladder pain, suggesting A2AR is a promising therapeutic target for BPS.

Introduction and hypothesis: CO₂ laser (LS) and microablative radiofrequency (RF) are outpatient options for stress urinary incontinence (SUI) treatment. The aim of this study was to evaluate the lasting effects of SUI treatment using intravaginal CO₂ LS and microablative RF.

Methods: This is a long-term follow-up of a prospective double-blind multi-arm randomized controlled trial, involving women with pure or predominant SUI. Participants received three monthly sessions of LS, RF, or were part of a sham control group (SCT) and were followed up, every 6 months, for 48 months to assess continence rates, defined by the composed outcome: no symptoms, negative stress test, and negative 7-day voiding diary.

Results: One hundred and thirty-nine women were eligible and randomized into the three groups. One hundred and fourteen participants concluded the treatment protocol. The women's mean age was 50.4 (± 9.5) years. The results showed that both LS and RF treatments led to a mean duration of urinary continence of 26.7 months and 24.58 months respectively, compared with 8.21 months in the SCT group. No major complications were observed.

Conclusion: Although the continence rates declined over the time, more than 50% of women in perimenopause, with mild to moderate SUI, pure or predominant SUI, remained without complaints of SUI for at least 24 months after LS or RF application sessions, with no major complications reported.

Introduction and hypothesis: This study was aimed at comparing the efficacy of different modes of transvaginal temperature-controlled radiofrequency (TTCRF) in improving female stress urinary incontinence (SUI).

Methods: A randomized trial with a nested prospective cohort included 89 women with SUI, who were randomized into a unipolar group (n = 35) and a comprehensive group (n = 54). The comprehensive mode group was treated with unipolar and bipolar combination therapy. The 1-h pad test (1-h PWT) was used as the primary metric by which to gauge improvement of SUI. The effective rate was defined as (cure + improvement cases/total cases) × 100%. Daily leakage episodes and urinary incontinence questionnaires were also documented to compliment this metric in assessing treatment efficacy. Patient satisfaction was assessed and adverse reactions were monitored.

Results: No significant difference in the effective rate between the unipolar and comprehensive groups was observed at 1, 3, 6, and 12 months after the end of treatment (62.9% vs 66.7%, 68.6% vs 68.5%, 80.0% vs 71.7%, 74.3% vs 62.5% respectively). Objective improvement of SUI symptoms and subjective satisfaction for all SUI patients were achieved after TTCRF treatment. Ten-course treatment of TTCRF achieved significantly greater treatment effects than five-course treatment as measured by 1-h PWT, daily leakage episodes, International Consultation on Incontinent Questionnaire-Short Form, and Pelvic Organ Prolapsed-Urinary Incontinence Sexual Questionnaire-12. No significant side effects occurred in any patients during treatment.

Conclusions: We consider TTCRF treatment to be a viable outpatient option for SUI, with unipolar and comprehensive modes both showing similar efficacy for SUI.

Introduction and hypothesis: Treatment options for female stress urinary incontinence (SUI) are often offered in a stepped-care approach. However, the shift towards patient-centred care and shared decision making (SDM) has prompted an increased interest in patients' perceptions of treatment decision making. This scoping review maps the available qualitative research on women's perceptions of the treatment decision-making process for SUI and identifies knowledge gaps.

Methods: This scoping review was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Three databases were searched using a systematic search strategy, without restriction in publication date or language. After thorough screening, 19 of the initial 3,473 publications were included.

Results: Four themes were identified; pre-existing experiences and notions that women bring to the consultations (things women consider before their consultation); treatment and patient characteristics (treatment aspects and personal values patients deem important); aspects of the consulting health care professional and facilities (availability of treatment options and counselling styles of physicians); ways of reaching a decision (three different ways that women used to make their decision. There were gaps in the literature on aspects affecting women's treatment preferences, their preferred decision-making style and how they want to be involved in this decision-making process.

Conclusions: This scoping review provides a global overview of women's perceptions on and preferences for treatment for SUI, and highlights a lack of knowledge on women's ideas of the treatment decision process. To provide clinicians with better guidance for their counselling and decision-making approaches, studies on women's perceptions of the decision-making process and the different decision-making styles are needed.