International Urogynecology Journal最新文献

Tethered vagina syndrome is an iatrogenic, but poorly defined condition that usually develops after surgical procedures performed on the anterior vaginal wall. Loss of elasticity as a result of scarring in the bladder neck-urethra is blamed for its pathogenesis. Patients often present with typical, massive uncontrollable urine loss and have specific examination findings. Having awareness about the diagnosis is important for its management. Surgical restoration and maintenance of bladder neck elasticity are essential for treatment. In our case, we presented the surgical approach we applied to tethered vagina syndrome that developed after the single-incision mini-sling operation. We demonstrated the surgical technique of Martius flap transposition and showed that this flap can be used to maintain the elasticity of the bladder neck area of the vagina.

Introduction and hypothesis: This study is aimed at characterizing patients seen at a new combined pelvic floor clinic (CPFC) established at a tertiary women's hospital in Singapore. Study goals include identifying patterns of symptom clusters and reviewing management strategies compared with international care standards, improving understanding of complex female pelvic floor dysfunction, and guiding future development of clinical and ancillary support.

Methods: This is a single-center, retrospective cohort study of medical case record review for all patients seen at the CPFC between 1 September 2020 and 31 August 2021. All patients seen at CPFC during this study period were included for analysis. Data were deidentified and aggregated, with analysis performed for descriptive and summary statistics. Institutional Review Board approval was obtained with waiver of informed consent.

Results: Sixty-six referrals were made to the CPFC, with 57 patients seen in 11 clinic sessions across the 12-month period. The most common reasons for referral were fecal or flatus incontinence (30, 52.6%), severe constipation or defecatory dysfunction (21.1%), and rectal prolapse (17.5%). Most patients (78.9%) had multiple symptoms.

Conclusions: Our patient demographic profile aligns with known risk factors for pelvic floor dysfunction, presenting with gastrointestinal symptoms-similar to PFCs worldwide. The new workflow and services were well positioned to address patients' needs, including those left previously untreated, or received uncoordinated care. Conservative approaches were first employed, like with other global PFCs. The combined multidisciplinary model of care resulted in good outcomes for patients managed both conservatively and surgically. Future studies to analyze patient satisfaction are planned.

Introduction and hypotheses: Few studies have investigated the relationship between work productivity (WP) and overactive bladder syndrome (OABS). The majority of those that do use generic productivity questionnaires or only include WP as a secondary outcome. We evaluated the impact of OABS on specific domains of WP, with the hypothesis that OABS has an impact on the domains of efficiency, concentration, vigor, and irritability, lost working hours, interruptions, and impairment to the work schedule.

Methods: An observational, cross-sectional study with 576 female employees (without SBH 447, dry OABS 63, wet OABS 66) was carried out. The 8-item Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and a WP questionnaire developed by the authors were used. Non-parametric tests were adopted to associate OABS with productivity. The correlation between the instruments was performed using the Spearman test, adopting a value of p = 0.05.

Results: There was a significant impact of urinary symptoms on WP (p = 0.03) in the domains of productivity/efficiency (p = 0.03), restlessness (p < 0.05), and interruptions to go to the bathroom (p = 0.03), which was higher among employees with wet OABS. Urgency and urge urinary incontinence (UUI) were the symptoms with the greatest productive impact (p = 0.01, p < 0.001). A significant correlation was found between WP scores and OAB-V8 and ICIQ-AOB scores in both groups (p < 0.05).

Conclusion: OABS impacted WP, in the domains of efficiency, restlessness, and interruptions to go to the bathroom, with urgency and UUI being the symptoms with the greatest impact on productivity.

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: Lifetime physiological or pathological events, such as vaginal delivery and menopause, may change vaginal structure and appearance, owing to local tissue expansion and separation of the pelvic floor muscles, which can affect a woman's sexual relationships. This systematic review was aimed at exploring the effect of vaginal tightening surgery on female sexual function.

Methods: Articles that had measured female sexual function after vaginal tightening were considered eligible. Articles on vaginal tightening surgeries conducted only for cosmetic and/or sexual and/or functional reasons (not for medical indications) and which evaluated postoperative sexual function by a quantitative tool were included. A literature review was conducted by searching databases such as PubMed, Web of Science, Scopus, PsycINFO, Embase, the Cochrane Library, and ClinicalTrials.gov from the beginning of 2000 until 1 February 2024.

Results: The authors identified 11 studies that had evaluated sexual function after vaginal reconstructive procedures designed to adjudicate sexual issues involving loss of friction, orgasmic, and aesthetic concerns. Although most of the studies implied that vaginal tightening could improve sexual function, more meticulous assessment of the studies' methodology challenged the robustness of these findings in clinical decision making.

Conclusions: Although on the surface, it can be concluded that vaginal tightening surgery improves women's sexual function, the conclusion is severely restricted owing to the absence of the precise measurement of vaginal laxity, as well as the inconsistency in surgical techniques, methods, and tools employed in the research.

Introduction and hypothesis: The incidence of obstetric anal sphincter injuries (OASI) has increased in recent years, which may be due to improved recognition and documentation. There is limited evidence regarding the effects of thorough documentation of obstetric anal sphincter injury repairs on postpartum clinical outcomes. Our objectives were to (1) compare the incidence of perineal wound complications between documentation groups, (2) compare other adverse events, and (3) to describe factors associated with adequate documentation. We hypothesized that better documentation would be associated with improved clinical outcomes.

Methods: This was a retrospective cohort study of 599 patients with OASI at a tertiary care referral center between January 2015 and December 2020. A priori definitions of documentation adequacy were utilized to stratify delivery notes. On the basis of these criteria, there were preferred, adequate, and inadequate documentation groups. Maternal characteristics, outcomes, and peripartum factors were compared between the groups.

Results: There were no significant differences in clinical outcomes between the groups. A higher degree of perineal laceration (p < 0.001), greater blood loss (p = 0.002), and the need for repairs in the operating room (p = 0.019) were significant factors associated with adequate documentation. Clinicians who were comprehensive in their documentation were more likely to refer patients to Urogynecology (p < 0.001) and to add OASI to the electronic medical record problem list (p = 0.005).

Conclusions: While certain factors are associated with adequate documentation, this did not improve clinical outcomes for OASI and further research is warranted to explore the importance of medical documentation surrounding OASI.

Introduction and hypothesis: Sacrospinous hysteropexy is one of the preeminent uterus-preserving surgical techniques for treating pelvic organ prolapse supported by level one evidence. As training on models greatly improves surgical skills and outcomes, we developed a simple and inexpensive model to simulate sacrospinous hysteropexy.

Methods: A step-by-step instruction for the production of the model is available to be viewed online. To keep production costs low, readily available materials were used, with a total cost per model of about 2 EUR (Austria, August 2023). All important anatomical landmarks (prolapsing uterus, vagina, ischial spine and sacrospinous ligament) were all represented. We present a detailed instructional video on how to construct the model and the practical training, detailing the individual steps of a successful sacrospinous hysteropexy, available online. Thus, trainees are able to practice the individual movements of the entire surgical procedure on this simulator model guided by the tutorial video. In this way, trainees will be able to practice the entire surgical procedure.

Results: An introduction to the model with explanation of all anatomical landmarks and a standardised explanation of the surgery with its individual steps (handout distributed).

Conclusion: The presented video showcases the feasibility of the easy construction and application of a model for the surgical skill training of sacrospinous hysteropexy. Easily accessible, inexpensive material and its simple build make this a reproducible model regardless of geographic or socioeconomic resources.

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: Transvaginal tape is currently a stress urinary incontinence (SUI) treatment with recommendation grade A in accordance with the 7th International Consultation on Incontinence. The main aim of the present study was to evaluate objective and subjective outcomes of tension-free vaginal tape (TVT) 20 years after our medical group started to use it. A second aim was to describe the voiding phase and the immediate, medium-term, and late complications of TVT procedures.

Methods: This is a retrospective cohort study that included patients diagnosed with SUI who received TVT treatment in a tertiary care hospital in Argentina from 1999 to 2003. Objective outcomes were recorded in a medical visit by means of urogynecological examination, which included a cough stress test with a comfortably full bladder and uroflowmetry. Subjective outcomes were assessed using quality-of-life questionnaires and questions addressed to the patient, regarding whether the patient felt cured and would recommend surgery.

Results: A total of 74 patients with an average follow-up of 18 years were evaluated. Most of the patients evaluated (96.8%) were objectively continent in the long term, 95.3% reported feeling cured, and 97.6% would recommend surgery. The complications were similar to those reported in the literature. No cases of voiding disorder were found in the long-term follow-up.

Conclusions: Tension-free vaginal tape is a minimally invasive, safe, and effective surgical technique, with a high objective and subjective cure rate, a low rate of complications related to the mesh or aging, and good results in long-term follow-up.