International Urogynecology Journal最新文献

Aggressive angiomyxoma (AA) is a rare, benign but locally invasive mesenchymal tumor arising from myxoid connective tissue, predominantly affecting women of reproductive age. Its clinical presentation is often nonspecific, frequently mimicking other pelvic or perineal pathologies, which leads to delayed diagnosis. We report an exceptional case of AA presenting as a massive, irreducible pelvic organ prolapse. A healthy multiparous woman in her 40s presented to a Urogynecology Consultation with a 6-year history of a progressively enlarging perineal mass, initially interpreted as a complete pelvic organ prolapse. She reported no pain or systemic symptoms. Clinical examination revealed a large, irreducible perineal mass measuring approximately 30 cm, resembling a fourth-degree uterovaginal prolapse. Pelvic magnetic resonance imaging demonstrated a volumous heterogeneous mass extending from the umbilical region and prolapsing through the perineum. A percutaneous biopsy revealed a mesenchymal neoplasm with smooth-muscle differentiation, initially suggestive of a pelvic leiomyoma. No metastatic lesions were detected on chest computed tomography. The patient underwent wide local excision of the tumor, total hysterectomy, and anterior rectal resection with a temporary colostomy. Histopathological examination confirmed the diagnosis of aggressive angiomyxoma. The postoperative course was uneventful, and intestinal continuity was later restored. The patient remains asymptomatic and disease-free under regular follow-up. This case highlights the diagnostic challenge posed by aggressive angiomyxoma due to its slow growth, deep pelvic location, and clinical resemblance to more common urogynecologic conditions such as pelvic organ prolapse or leiomyoma. MRI remains the imaging modality of choice for preoperative assessment, while complete surgical excision with clear margins is the mainstay of treatment. Given its high recurrence potential, long-term follow-up is essential. Awareness of this rare entity is crucial for early recognition and appropriate multidisciplinary management.

Introduction and hypothesis: Lower urinary tract symptoms (LUTS) are highly prevalent in women. Core instability and physical activity (PA) may be associated with LUTS. The study hypothesized that compared with healthy controls, women with LUTS would have differences in core stability scores, reduced PA levels, and LUTS symptom severity would correlate inversely with core stability.

Methods: This cross-sectional cohort study recruited women aged 18-70 with and without LUTS. Participants completed demographics, Urinary Distress Inventory Short Form (UDI-6), Godin Shephard Leisure Time Exercise Questionnaire (Godin), a novel Resistance Activity Questionnaire (RAQ), and Core Score testing. Summary statistics were provided overall and by LUTS diagnosis. Wilcoxon rank sum tests compared median aerobic physical activity (aPA)/resistance physical activity (rPA) between groups. Regression analyses estimated the effects of LUTS and UDI-6 severity on core stability.

Results: A total of 48 women with LUTS and 49 women without LUTS participated (mean age 46 ± 12, BMI 32 ± 8). Women with LUTS were older (mean, SD 51, 12 vs 43, 13, p < 0.01) with higher parity (2, 1 vs 1, 1, p < 0.01), and higher constipation (n, %: 10, 21 vs 3, 6, p = 0.03), dyspareunia (12, 25 vs 2, 4, p < 0.01), and current formal core exercise instruction (10, 21 vs 3, 6, p = 0.03). After adjusting for age, BMI, and parity, women with LUTS had lower Core Scores (mean difference; 95% CI -1.08; -1.99, -0.18, p < 0.01); PA levels did not differ on Godin (median, IQR 21.5, 10 to 39.5 vs 21, 11 to 46, p = 0.58) or RAQ (0, 0 to 6 vs 2, 0 to 6, p = 0.12), and UDI symptom severity increases of 10 units correlated inversely with Core Scores (mean effect, 95% CI -0.32, -0.53, -0.10, p < 0.01).

Conclusions: Women with LUTS had small, significantly worse core stability scores, but APA and rPA levels did not differ. LUTS severity was associated with worse core stability. Further research may help to determine association versus causation.

Introduction and hypothesis: Urinary incontinence (UI) is a common condition among middle-aged and older women. Despite well-established international guidelines for conservative treatment, patient adherence remains sub-optimal, highlighting a discrepancy between recommendations and practical implementation. This study is aimed at exploring the multidimensional factors influencing the self-management behaviors of patients with UI using the Proactive Health Behavior (PHB) framework.

Methods: A descriptive, qualitative design was used in this study. Guided by the PHB, semi-structured face-to-face interviews were conducted with 21 middle-aged and older women diagnosed with UI. Data analysis was carried out using a combination of inductive and deductive methods.

Results: A total of 7 themes and 15 sub-themes were identified. The themes were: misconception and sub-optimal behaviors; diminished subject agency and insufficient outcome perception; the inadequacy of standardized UI management; lack of social support and information sources; life pressures and time management challenges; lifestyle patterns and transformations; and historical constraints of the era. Most participants demonstrated low adherence to sustained self-management practices and limited willingness to pursue medical treatment. The study identified factors for self-management including the micro level (cognitive and motivational factors), meso level (inadequate social support), and macro level (health care system and resource constraints).

Conclusion: Self-management behaviors of middle-aged and older women with UI are influenced by multiple factors. The findings suggest that multi-level, comprehensive interventions might be needed to support women in effectively managing UI, which should focus on improving patients' awareness, competencies, and behavioral change.

Introduction and hypothesis: Stress urinary incontinence (SUI) is highly prevalent among adult women and can significantly impact quality of life (QoL), including sexual function (SF). The midurethral sling (MUS) has become the gold-standard intervention for SUI owing to its high efficacy and minimal invasiveness. However, its impact on SF is less well understood. This review is aimed at examining the impact of MUS techniques on SF in women with SUI and outlines evidence-based interventions for managing MUS complications or failure.

Methods: The PubMed database was searched to identify original, peer-reviewed articles published from 2014 to 2025 that examined changes in SF and treatment options in patients undergoing MUS surgery for SUI.

Results: Ninety-eight studies were included in this review. Our analysis found that most studies reported an improvement or preservation of SF following MUS placement. However, surgical outcomes varied depending on the type of sling, follow-up duration, and individual patient characteristics. A subset of patients may also experience postoperative complications such as mesh exposure and recurrent incontinence, requiring further intervention. Treatment options after MUS failure range from conservative approaches, including pelvic floor muscle training and steroid injections, to more invasive surgical interventions such as sling mobilization or removal, urethral bulking injections, and repeat SUI surgeries.

Conclusion: Further long-term studies using validated SF instruments are needed to guide clinical decision-making and optimize outcomes for women undergoing MUS surgery.

Introduction and hypothesis: Perineal trauma is frequent after childbirth and may be influenced by maternal position. We aimed to synthesize pooled estimates comparing positions in the second stage of labour and their association with perineal tears and episiotomy, using a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Methods: Systematic review and NMA of RCTs identified in Cochrane Library Plus, EMBASE, Scopus, PubMed, and ClinicalTrials through June 2024, without language or date restrictions. Outcomes were 1st-degree tears (involving skin and mucosa), 2nd-degree tears (involving perineal muscles), and 3rd/4th-degree tears (involving the anal sphincter and rectal mucosa), as well as episiotomy. We estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for upright vs supine/lithotomy and performed a network of individual positions. This review article is based exclusively on previously published literature. Therefore, ethical approval was not required and was exempted by the Institutional Review Board.

Results: Nine RCTs (n = 7621) were included. In pooled analyses of upright vs supine/lithotomy, we found no significant differences for 1st-degree tears (OR 1.14, 95% CI 0.76-1.72), 2nd-degree tears (OR 0.98, 95% CI 0.70-1.38), 3rd/4th-degree tears (OR 0.92, 95% CI 0.06-13.93), or episiotomy (OR 0.54, 95% CI 0.22-1.34). In position-level network analyses, standing was ranked lowest-risk for 1st-degree tears (SUCRA 79.1%); squatting ranked lowest-risk for 2nd-degree (SUCRA 93.9%) and for 3rd/4th-degree tears (SUCRA 94.3%); and hands and knees ranked lowest-risk for episiotomy (SUCRA 100%). These position-level findings were based on a limited number of contributing trials and should be interpreted cautiously.

Conclusions: Overall, pooled RCT evidence shows no significant difference in perineal tears of any degree or episiotomy between upright and supine/lithotomy positions. Network estimates suggest potential differences between specific positions, but the evidence is limited and heterogeneous. Birthing position should primarily reflect women's preferences and comfort, while considering other key predictors of perineal trauma (e.g. parity, operative delivery, and episiotomy itself). In addition, the findings from this meta-analysis can be used to provide individualized counselling, taking into account each woman's specific risk factors. This approach may help inform and guide shared decision-making, supporting women in choosing the birthing position that best aligns with their circumstances, preferences, and clinical profile.

Introduction and hypothesis: The 8-item Overactive Bladder Questionnaire (OAB-V8) is a readily available instrument for assessing overactive bladder (OAB) symptoms in clinical and research settings. Despite its established validity in Turkish, its psychometric property remains unevaluated. This study aimed to determine the responsiveness, minimal detectable change (MDC), and minimal clinically important difference (MCID) of the Turkish version of the OAB-V8.

Methods: This retrospective study consisted of 160 women (age 47.49 ± 12.07 years) with OAB who completed a standardized, guideline-adherent 8-week pelvic floor muscle training. The OAB-V8 was administered pre- and post-training. The responsiveness of the OAB-V8 was assessed using the Wilcoxon signed-rank test, standardized response means (SRMs), and effect sizes (ESs). The MDC was calculated at the 95% confidence level. Receiver operating characteristic (ROC) analysis was used to determine the MCID, maximizing both sensitivity and specificity.

Results: The responsiveness of the Turkish version of the OAB-V8 was excellent (ES = 1.57, SRM = 1.56, p < 0.001). The MDC and MCID values were 12.97 and 12.50, respectively. The ROC analysis demonstrated excellent discriminative ability, with an area under the curve of 0.99 (sensitivity 98.0%, specificity 90.0%).

Conclusions: The main findings of this study confirm that the OAB-V8 demonstrated excellent responsiveness and discriminative ability, making it an effective tool for assessing symptoms in women with OAB. Clinicians can confidently use the Turkish version of the OAB-V8 scale to not only monitor treatment efficacy but also to determine whether the observed changes are both statistically significant and clinically relevant for the patient.

Background: Urinary incontinence (UI) in women is commonly managed through pelvic health rehabilitation. Home-based multimodal pelvic health programs (MMPHPs) are gaining attention as a conservative intervention combining multiple components. However, the evidence surrounding their use remains underexplored.

Objective: To map the current trial evidence (including randomized controlled trials and quasi-experimental studies) on home-based MMPHPs for managing UI in women, and to identify their core components, including pelvic floor muscle training (PFMT), bladder training (BT), breathing exercise, behavioral and lifestyle adjustment, and pelvic health education.

Methods: This scoping review followed the (JBI) methodology and PRISMA-ScR checklist. A comprehensive search was conducted across five databases (PubMed, Scopus, Web of Science, MEDLINE via Ovid, and Cochrane Library) and gray literature sources until 31 May 2025. Four independent reviewers screened studies using Rayyan software. Eligibility was limited to experimental studies evaluating home-based multimodal interventions that combined multiple pelvic health components.

Results: Forty studies met the inclusion criteria involving women with UI across diverse settings and countries. They evaluated home-based formats, including paper booklets, printed instructions, digital resources, and mobile applications, over 4 to 12 weeks. Most combined PFMT with additional components, including education, behavioral and lifestyle adjustments, and BT. Outcomes included UI severity, quality of life, and adherence. However, heterogeneity limits comparability.

Conclusion: Home-based MMPHPs show promise for managing UI among women. However, variation in program design, delivery methods, outcome measures, and inconsistencies highlight the need for standardized protocols in future trials.

Introduction and hypothesis: To investigate whether integrating constipation management into tele-supervised pelvic floor muscle training (PFMT) improves continence outcomes compared with PFMT alone, and to determine whether constipation, pelvic floor self-efficacy, body awareness, and adherence predict treatment response.

Methods: In this randomized controlled trial, 200 women aged 18-60 years with stress urinary incontinence (SUI) were randomized to group A (tele-supervised PFMT only) or group B (PFMT plus constipation management). All participants completed a 12-week live Zoom®-based PFMT program. In addition, group B received dietary fiber regulation, hydration guidance, bowel habit training, optimal defecation posture instruction, and osmotic laxatives when clinically indicated according to Rome IV and Wexner criteria. Outcomes-ICIQ-UI SF, 1-h pad test, Oxford pelvic floor strength, self-efficacy, body awareness, constipation severity (Wexner), bowel frequency, and quality of life (ICIQ-LUTSqol)-were assessed at baseline, week 12 and 3-month follow-up. Analyses were performed under an intention-to-treat framework with multiple imputation; longitudinal changes were examined using repeated-measures ANOVA (or Friedman tests for non-normal variables), and baseline-adjusted between-group comparisons were evaluated using ANCOVA.

Results: Both groups improved significantly in urinary symptoms, leakage, muscle strength, self-efficacy, and body awareness (p < 0.001). However, group B showed greater improvement in ICIQ-UI SF scores (-7.9 ± 2.6 vs -6.4 ± 2.8; p = 0.021), pad-test leakage (-6.6 g vs -5.4 g; p = 0.034) and quality of life (-12.0 vs -9.3; p = 0.026). Constipation severity decreased only in group B (p < 0.001).

Conclusions: Functional constipation reduces responsiveness to PFMT-based tele-rehabilitation in women with SUI. Integrating bowel management, self-efficacy strengthening, and body awareness into PFMT supports a multidisciplinary, gut-informed continence rehabilitation approach.

Introduction and hypothesis: This study was aimed at assessing core stabilization strength and pelvic floor function in patients with primary Sjögren's syndrome (pSS), as well as identifying factors associated with pelvic floor functionality and that serve as potential predictors.

Methods: This study was planned as a case-control study. Healthy controls consisted of companions of patients with pSS and friends of the authors. A visual analog scale (VAS; to assess vaginal dryness and general pain intensity), McGill Static endurance tests (trunk flexors/extensors endurance, lateral bridge tests), the Health Assessment Questionnaire (HAQ), the Pelvic Floor Distress Inventory-20 (PFDI-20), the Incontinence Impact Questionnaire-7 (IIQ-7), and the Sexual Quality of Life-Female, Biopsychosocial Questionnaire (BETY-BQ) were evaluated. The PFDI-20 consists of three questionnaires: the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Colorectal-Anal Distress Inventory-8 (CRADI-8), and the Urinary Distress Inventory-6 (UDI-6).

Results: A total of 29 individuals with pSS and 27 healthy controls were included. In a group comparison, there was a difference in HAQ (p < 0.001), PFDI-20 (p < 0.001), POPDI-6 (p < 0.001), CRADI-8 (p < 0.001), UDI-6 (p < 0.001), IIQ-7 (p < 0.001), and BETY-BQ (p < 0.001) in favor of the healthy group. In pSS, the PFDI-20 has a very strong correlation with the IIQ-7 (r 0.864, p < 0.001); a strong correlation with the HAQ (r 0.668, p < 0.001), the BETY-BQ (r 0.667, p < 0.001); a moderate correlation with trunk flexor endurance (r -0.579, p = 0.003), lateral bridge tests (right) (r -0.479, p = 0.018), VAS-general pain intensity (r 0.440, p = 0.017); a weak correlation with VAS-vaginal dryness (r 0.395, p = 0.034). In regression analysis, the IIQ-7 was the strongest predictor of pelvic floor functionality in pSS (ß = 0.563; p < 0.001).

Conclusions: No group differences were found in core endurance or sexual quality of life. Compared with controls, pSS patients had reduced general and pelvic floor function, greater urinary incontinence, and poorer biopsychosocial status, with urinary incontinence being the strongest predictor of pelvic floor dysfunction.

Trial registration: This study was registered with ClinicalTrials.gov under the number NCT06879444.