International Urogynecology Journal最新文献

Introduction and hypothesis: Pelvic dysfunction, including urinary incontinence, significantly impacts the quality of life of affected women, diminishing their freedom and dignity. In many African countries, challenges such as limited funding, competing health priorities and cultural stigma on pelvic health further restrict access to care. This information gap may hinder the effective design and implementation of interventions aimed at improving urogynaecological healthcare delivery. The objective of this study was to estimate the urogynaecological workload, the availability of tools to investigate and treat urinary incontinence in women, and to understand the challenges faced by providers of urogynaecological healthcare in 10 African countries.

Methods: A cross-sectional online survey of urogynaecological service providers.

Results: Forty-seven responses were analysed, revealing that 40% of gynaecological consultations addressed urogynaecological concerns, with 60% related to prolapse, 40% to bladder issues, 7.5% to bowel problems and 5% to sexual dysfunction. Among bladder issues, 35% involved obstetric fistulas, 22.5% stress urinary incontinence, 12.5% mixed urinary incontinence and 10% overactive bladder. Identified resource gaps included insufficient numbers and training of providers, limited access to diagnostic tools such as urodynamics equipment, and inadequate availability of neuromodulation and advanced surgical options. Key challenges in healthcare delivery were lack of patient awareness and inadequate funding, especially in public-sector facilities.

Conclusion: Gaps exist in the access and delivery of urogynaecological healthcare to patients with pelvic floor dysfunction in sub-Saharan Africa. Specific areas of focus should include patient education and capacity building, including human resources, access to affordable screening and diagnostic tools and technologies, and investment in affordable management options.

Introduction and hypothesis: Studies concerning the similarities and differences in relevant factors for PPUI in puerpera with delivery modes are scarce. This study aimed to investigate relevant factors for PPUI among primiparas grouped by different delivery modes using transperineal ultrasonography.

Methods: This is a retrospective cohort study. Seven hundred thirty-eight primiparas were included and their clinical and ultrasonographic data were collected. First, they were divided into the UI group (n = 233) and non-UI group (n = 505). Then all participants were redivided into the vaginal delivery without episiotomy group (n = 271), the vaginal delivery with episiotomy group (n = 158), and the cesarean section group (n = 309). Independent relevant factors of PPUI were analyzed with the delivery mode as one of the variables and as a grouping factor, respectively.

Results: BMI, delivery modes, vertical distances between the location of bladder neck and the reference line of the inferior symphyseal margin at rest (BSDr), and [bladder neck descent (BND)]/BSDr were independently associated with PPUI in the overall study population. Among the participants grouped by delivery modes, the maternal BMI, BSDr, and retrovesical angle during Valsalva maneuver (RVAv) were independently associated with PPUI in the vaginal delivery without episiotomy group. BND/BSDr was the independent relevant factor of PPUI in the cesarean section group. In the vaginal delivery with episiotomy group, no factors were independently associated with PPUI.

Conclusions: The independent relevant factors for PPUI in primiparas varied with delivery modes. Sonographic measurements were independently associated with PPUI related to different delivery modes, acting as differential markers to identify PPUI.

Introduction and hypothesis: High uterosacral ligament suspension (HUSLS) can be used to treat apical pelvic organ prolapse (POP). This can be performed both vaginally and laparoscopically. Data comparing the two suspension procedures remain limited. The aim of this study is to compare the effectiveness and safety of vaginal HUSLS and laparoscopic HUSLS at the time of hysterectomy.

Methods: This is a retrospective cohort study of women who underwent hysterectomy between 2019 and 2021 at a tertiary urogynaecology unit. Either vaginal or laparoscopic hysterectomy was performed, followed by vaginal or laparoscopic HUSLS respectively. Women were followed up at 6 weeks, and at 6 and 12 months postoperatively. The primary outcome was symptomatic recurrence of vaginal bulge symptoms. Secondary outcomes were anatomical recurrence, re-treatment and safety.

Results: A total of 111 women met the inclusion criteria. Twelve were excluded, leaving 99 for analysis. HUSLS was performed vaginally in 47 and laparoscopically in 52 women. There was no significant difference in demographics between the groups. At 12 months, 92% in the vaginal group and 48% of the laparoscopic group reported no symptoms of prolapse, 67% vs 36% had no anatomical recurrence and 0% vs 34% had re-treatment respectively. Logistic regression (adjusting for age, BMI, menopausal status, preoperative stage apical prolapse, procedure type) demonstrated that the laparoscopic route was the only variable associated with recurrent prolapse at or beyond the hymen and symptomatic prolapse at 12 months.

Conclusions: Symptomatic and anatomical recurrent POP was associated with this technique of laparoscopic HUSLS. Further research should consider prospective evaluation of these or modified techniques.

Introduction and hypothesis: The participation of women in sports such as powerlifting and weightlifting has grown over the years, and there is no consensus on the role of exercises in pelvic floor disorders (PFDs). We aimed to identify and summarize the current evidence on the impact of powerlifting and weightlifting on PFDs.

Methods: A systematic literature search was conducted on databases with no language restriction, from inception to 20 January 2024. We included observational studies or randomized controlled trials investigating female athletes in powerlifting or weightlifting providing information regarding the impact of these sports on pelvic floor structures. Studies on CrossFit trainers, nonfemale athletes, age <18, and congress abstracts were excluded. Two researchers independently performed the data extraction and quality assessment. The risk of bias was assessed using the Risk Of Bias In Non-randomized Studies-of Interventions. The main outcomes were the prevalence of PFDs in women practicing powerlifting or weightlifting, the factors associated with PFDs, and exercise related to urinary loss.

Results: Of the 221 articles found, 5 studies with 1,809 participants were included in the qualitative synthesis. The prevalence of urinary incontinence (UI) in powerlifters ranged from 41.0% to 48.8% and in weightlifters from 36.6% to 54.1%. The main associated factors were age, parity, and body mass index. Deadlift was the exercise most commonly associated with UI (42.5%), followed by squats (36.3%). High loads and repetitions, along with competitions, were associated with UI.

Conclusion: This systematic review reveals a clear connection between PFD, particularly UI, and the engagement of women in powerlifting and weightlifting.

Introduction and hypothesis: Stress urinary incontinence (SUI) is a common condition among women of childbearing age, often requiring surgical intervention. The midurethral sling (MUS), including first-generation tension-free vaginal tapes (TVT) and second-generation transobturator tapes (TOT, TVT-O), has long been the standard treatment. However, both approaches have associated risks, prompting the development of single-incision slings (SIS) as a third option. SIS have proven their efficacy in SUI treatment, but the impact of these slings on female sexual function specifically remains underexplored.

Methods: A literature search was conducted using PubMed using the keywords "stress urinary incontinence," "midurethral slings," "single-incision slings," "female sexual function," and "dyspareunia."

Results: The reviewed studies demonstrated that SIS generally maintain or improve sexual function postoperatively, but with varying impact on specific aspects of sexual function. While coital urinary incontinence often improved or resolved, new or worsened dyspareunia was reported in a significant number of patients.

Conclusion: SIS placement for SUI generally preserves or enhances sexual function, though individual aspects, such as dyspareunia, may worsen for some patients. Given that an important goal of SUI treatment is to improve quality of life, it is crucial to identify preoperative factors that will identify patients at risk of developing dyspareunia after surgery or are more likely to experience an improvement in sexual function. Further research is needed to better understand these predictors and optimize surgical outcomes for women undergoing SUI treatment with SIS.

Background: Midstream urine (MSU) samples are commonly collected at the time of patient evaluation despite known high rates of contamination.

Objective: The primary objective of this study was to evaluate the rate of mixed flora results in urine specimens obtained by MSU compared to straight catheterization urine (SCU).

Study design: This was a quality improvement project evaluating urine culture results of women who provided either an MSU or SCU sample for analysis. Adult women seen within urogynecology clinics at a tertiary care center between April and August 2023 who had urine cultures performed for any indication were included. Mixed flora was defined as the presence of ≥ 2 non-uropathogens or 1 uropathogen in low quantity (at least 10 times fewer) compared to the concentration of nonsignificant organisms.

Results: Three hundred forty women provided a urine specimen during the study period. SCU collection was performed for 171 (50.3%) women while 169 (49.7%) provided an MSU sample. Overall, 18.8% of urine cultures were reported as mixed flora (33.1% in MSU and 4.7% in SCU, p < 0.001). Mixed flora was more common with MSU specimens (87.5%, p < 0.001) and associated with a higher BMI compared to positive or negative cultures (mixed flora 29.8 kg/m² ± 16.3, positive or negative cultures 27.8 kg/m² ± 7.0, p = 0.04). MSU samples had increased odds of urine contamination compared to SCU collection (7.40 aOR, 95% CI 3.01-18.24).

Conclusion: The prevalence of mixed flora was reduced significantly when SCU samples were obtained. Clinicians should consider performing SCU collection when a urine specimen is required for patient evaluation.

Introduction and hypothesis: Systemic autoimmune rheumatic diseases (SARDs) cause musculoskeletal disorders and are associated with various issues that affect the quality of life. Since the musculoskeletal system is affected, the pelvic floor muscles can also be impacted, leading to possible pelvic floor dysfunctions (PFDs). Thus, the purpose of this study was to investigate the presence of PFDs, such as urinary incontinence (UI), anal incontinence (AI), genital-pelvic pain/penetration disorder (GPPPD), and pelvic organ prolapse (POP) symptoms in women with SARDs compared to a control group composed of women without SARDs; and investigate the association between SARDs and PFDs.

Methods: An online cross-sectional survey was carried out. Using a web-based questionnaire, data on demographic and anthropometric features, PFD (UI, nocturia, AI, GPPPD, and POP), and obstetric history were gathered. For quantitative variables, the Mann-Whitney U test was used, and for categorical variables, the chi-squared test was used for comparison between groups. The association between SARDs and PFD was investigated using logistic regression analysis.

Results: The questionnaire was completed by 326 women (224 with SARDs and 102 healthy controls). Women with SARDs reported significantly more symptoms of PFD, UI, nocturia, AI (flatus and fecal incontinence), POP, and GPPPD than healthy controls. SARDs were associated with PFD, flatus incontinence, fecal incontinence, dyspareunia, and vaginismus.

Conclusions: PFD was much more common in women with SARDs than in healthy women. Women with SARDs were 1.8 to 5.2 times more likely than the control group to report PFD symptoms than women without SARDs.

Introduction and hypothesis: This study was aimed at assessing the prevalence and factors contributing to pelvic floor disorder (PFD) symptoms.

Methods: A community-based cross-sectional study was employed among 737 women in the central Gondar Zone of Northwest Ethiopia from September to December 2022. Participants were selected using a multi-stage cluster sampling. The Amharic version of the Pelvic Floor Disorder Inventory 20 (PFDI-20) tool was employed to evaluate the occurrence of PFDs. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of PFDs.

Results: The prevalence of at least one form of PFD was 26.9% (95% CI 23.3 to 30.0%). Pelvic organ prolapse symptoms, urinary incontinence, and fecal incontinence were reported at rates of 19.9%, 19.7%, and 12.8% respectively. Factors associated with PFDs included increasing age (AOR = 3.61, 95% CI 1.01 to 6.91), residing in a rural area (AOR = 2.12, 95% CI 1.63 to 3.66), a history of difficult labor (AOR = 1.83, 95% CI 1.26 to 2.66), multiple vaginal deliveries (AOR = 2.41, 95% CI 2.18 to 3.92), home delivery (AOR = 1.29, 95% CI 1.86 to 2.93), and being postmenopausal (AOR = 1.62, 95% CI 1.55 to 2.89).

Conclusions: Currently, more than 25% of women are experiencing distressing symptoms associated with PFDs. Contributing factors include older age, rural residence, having multiple vaginal deliveries, and postmenopausal status. Therefore, it is essential to focus on the early identification of PFD symptoms, raise awareness within the community and among women regarding the connections between advanced age, menopause, and multiparity, and advocate for family planning initiatives.