International Urogynecology Journal最新文献

Introduction and hypothesis: The objective was to evaluate the long-term subjective efficacy of the tension-free vaginal tape-obturator (TVT-O) technique in the treatment of female stress urinary incontinence (SUI).

Methods: A retrospective analysis was performed on 84 patients who underwent TVT-O surgery for SUI in a tertiary center between January 2007 and December 2013. All patients filled in the Urinary Incontinence Quality of Life Questionnaire (I-QOL), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). Subjective efficacy, including surgical efficacy, clinical severity of SUI, improvement in quality of life (QoL), and sexual activity with regard to TVT-O were compared before and after surgery (≥ 10 years).

Results: The average postoperative follow-up time was 12.6 ± 1.9 years, range, 10-16 years. The overall subjective effectiveness of the surgery was 94.0% (79 out of 84). The subjective clinical severity significantly improved more than 10 years after surgery compared with the preoperative value (p = 0.000). The median I-QOL score was 88.1 (84.1-92.0) preoperatively and 98.3 (94.3-99.7) postoperatively, and the long-term QoL of postoperative patients was significantly improved (p < 0.05). The median ICIQ-SF score was 10.5 (8-15) preoperatively, and 3 (0-5) postoperatively, and the ICIQ-SF score before and after surgery showed significant improvement in urinary incontinence symptoms (p < 0.05). No difference was observed in the PISQ-12 scores before and after surgery in the sexually active population.

Conclusions: The TVT-O technique still has good subjective efficacy in SUI more than 10 years after surgery and significantly improves the QoL of patients.

Introduction and hypothesis: High-impact physical activity is a known risk factor for the development of pelvic floor disorders (PFDs) in women, affecting the pelvic floor muscles (PFMs). However, there is insufficient information to determine whether alterations in PFMs, or even in the lumbar muscles, can be detected before the onset of symptoms. The aim of the study was to identify whether high-impact physical activity influences the muscle mechanical properties (MMPs) of the lumbopelvic region in continent nulliparous women.

Methods: An observational cross-sectional study with a nonprobabilistic sampling of consecutive cases was designed. Fifty women who had practiced high-impact physical activity at least three times per week for more than 2 years were included in the high-impact group, and 50 women who did not practice high-impact activity were included in the control group. Data collection for both groups included sociodemographic data and MMPs (frequency, characterizing muscle tone; stiffness; logarithmic decrement, characterizing the inverse of the elasticity; relaxation time of stress; creep, characterizing fluidity) of PFMs and lumbar muscles, externally assessed using a hand-held tonometer device. Between-group comparison of the MMPs were calculated, together with intragroup correlations between the outcomes.

Results: The MMPs of PFMs showed statistically significant lower tone (0.76 Hz, 95% CI 0.04, 1.48) and stiffness (23.76 N/m, 95% CI 1.10, 46.42) and were more viscoelastic (relaxation: -1.04 ms, 95% CI -1.98, -0.11; creep: -0.04 De, 95% CI -0.07, -0.02) in women who practiced high-impact physical activity. No lumbar MMPs showed statistically significant between-group differences.

Conclusions: High-impact physical activity alters the MMPs of PFMs in nulliparous women, although not lumbar spinal MMPs, even before the appearance of signs.

Introduction and hypothesis: The objective was to determine the incidence of obstetric anal sphincter injuries (OASIs) and assess the predictive power of clinical risk factors for OASIs, both individually and collectively, using a US population-based birth registry.

Methods: We conducted a cross-sectional study using birth data from the National Vital Statistics System from 2016 to 2021. All vaginal births were included, excluding those with unspecified delivery route or perineal laceration status. Logistic regression models assessed the relationship between potential clinical predictors, determined a priori based on existing literature and inclusion in the registry data, and OASIs. The pseudo-R² (pR²), which indicates the proportion of variability in OASIs explained by the model out of 100%, was used to compare the predictive strength of different clinical factors.

Results: A total of 15,413,957 vaginal births were analyzed. The overall incidence of OASIs was 1.1%. The factors that exhibited the highest predictive capability for OASIs were vaginal parity (pR² 5.8%) and operative birth (pR² 4.8%), followed by infant weight (pR² 1.5%); all other factors had a pR² of 0.5% or lower. The final multivariable logistic regression model had a pR² of 11.8%.

Conclusion: Vaginal parity and operative birth are among the most predictive clinical risk factors for OASIs, each accounting for approximately 5% of the variation in OASI outcomes. However, a significant portion of OASI occurrences remains unexplained by clinical risk factors alone. Future research focusing on the mechanisms of OASIs will be crucial for identifying high-risk patients and developing targeted interventions to reduce the risk of OASIs.

Introduction and hypothesis: The ongoing pelvic mesh controversy, coupled with a regulatory pause in using pelvic mesh in some countries, has created a need for mesh-free alternatives for sacrocolpopexy (SCP). This article provides an overview of mesh-free alternatives for SCP.

Methods: MEDLINE and PubMed searches were conducted to identify studies reporting on autologous and non-autologous biologic grafts for SCP. Identified studies were reviewed by two of the authors (CY and MR).

Results: Emerging evidence on autologous fascia lata (AFL) and rectus sheath (ARS) for SCP is promising, with low donor site morbidity. Non-autologous biologic grafts for SCP are mostly reported to be inferior to mesh.

Conclusions: Emerging evidence suggests that AFL and ARS might be safe and effective alternative options to mesh SCP. The main advantages of AFL for SCP over ARS are laparoscopy or robot-assisted laparoscopy approaches, and that a larger graft can be safely harvested. The benefits of utilising allografts and xenografts are limited by their reduced durability compared with mesh and patient acceptability.

Introduction and hypothesis: Identifying patient-reported outcome measures allows management of urogenital prolapse to be tailored to reflect symptom bother and expectations of treatment. We devised a new single-item questionnaire, the Patient Perception of Prolapse Condition (PPPC), based on the Patient Perception of Bladder Condition (PPBC). The aim was to evaluate the criterion validity, test/re-test reliability and responsiveness of the PPPC.

Methods: Women attending a tertiary urogynaecology clinic were recruited. At visit 1, patients completed the Prolapse Quality of Life (P-QOL) and PPPC questionnaires, and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. This allowed assessment of criterion validity using Spearman's rank correlation (rho) of the PPPC against validated subjective and objective outcomes. At visit 2, within the next 6 weeks, PPPC was repeated to assess test/re-test reliability using Cronbach's alpha (α). In those undergoing pelvic floor surgery, responsiveness of the PPPC was assessed at visit 3 by correlating PPPC and P-QOL scores 6 weeks post-operatively.

Results: A total of 178 patients attended visit 1, 60 attended visit 2 and 58 attended visit 3. At visit 1, there were moderate correlations between the PPPC and both objective (POP-Q: rho = 0.385, p < 0.01, CI 0.192-0.549) and subjective (P-QOL: rho = 0.635, p < 0.01, CI 0.493-0.744) measures confirming criterion validity. Test/re-test reliability was high (α = 0.89). Correlation with post-operative PPPC and P-QOL confirmed moderate responsiveness (rho = 0.54, p < 0.01).

Conclusion: The PPPC, a novel single-item patient-reported measure of prolapse condition, demonstrated good criterion validity, test/re-test reliability and responsiveness. These findings support the use of the PPPC as a global assessment of prolapse condition.

Introduction and hypothesis: Laparoscopic sacrocolpopexy(LSC) is widely performed and has been reported to safe and effective. However, statistical data on this technique are unavailable. Therefore, we designed the Japanese-style LSC, a further evolution of the French-style LSC, and initiated this multicenter study to prospectively evaluate its efficacy and safety. If the Japanese-style LSC is successful, we may be able to propose a more reliable and standardized procedure.

Methods: This is a prospective study of Japanese-style LSC. The Japanese-style LSC is characterized by the dissection of the vaginal walls as distally as possible and fixation of the mesh with multiple sutures; fixation of the mesh on the promontory without traction; and closure of the peritoneum with high-level peritoneal sutures. We examined the primary (anatomical recurrence, adverse events, and quality of life) and secondary endpoints (voiding symptoms and sexual function) at 3 years postoperatively.

Results: In anatomical recurrence, 24 patients (9.2%) were ≥ stage2 in the Pelvic Organ Prolapse Quantification system at 3 years postoperatively, of which 4 (1.5%) and 20 (7.7%) were stages III and II respectively. No mesh-related complications were observed, and each questionnaire showed predominant improvement, except for sexual and evacuation functions.

Conclusions: The Japanese-style LSC demonstrated superior anatomical and functional results and we propose it to be an effective procedure.

Introduction and hypothesis: The aim was to investigate the feasibility of using an intravaginal intra-abdominal pressure (IAP) sensor worn by female runners during running to evaluate pelvic floor loading, and the association between IAP and running-induced stress urinary incontinence (RI-SUI).

Methods: Twenty-eight female runners participated in this cross-sectional study (15 with RI-SUI and 13 continent). Participants completed a 37-min treadmill running protocol instrumented with an intravaginal sensor measuring IAP, and a skin-mounted accelerometer measuring pelvic accelerations. Linear regression analyses evaluated the relationship between IAP and pelvic acceleration. One-way ANOVAs assessed the impact of running speed on IAP. Sensor dislodgement was recorded, and effect sizes (Cohen's d) were calculated for the comparison of IAP and accelerometry outcomes between runners with and without RI-SUI.

Results: Intra-abdominal pressure showed high variance and the sensor was expelled in almost 15% of participants. Positive associations were found between pelvic acceleration and both absolute peak and normalized IAP but explained only between 12% and 18.6% of the variance in the models. Pelvic acceleration during running was not associated with cumulative IAP. Peak IAP significantly increased with running speed. Although IAP tended to be higher in runners with RI-SUI than in continent runners (Cohen's d between 0.14 and 0.74), pelvic accelerations tended to be lower (Cohen's d between 0.02 and 0.55).

Conclusions: There is high variance in IAP recorded during running using an intravaginal sensor. Faster speeds increase pelvic floor loading. Runners with RI-SUI may experience higher IAP than continent runners, warranting investigation. Recruitment should include a 15% data loss rate owing to sensor expulsion.

Introduction and hypothesis: Minimally invasive abdominal sacrocolpopexy (SC) is the gold standard for managing symptomatic pelvic organ prolapse (POP). Robot-assisted laparoscopy (RSC) offers a promising surgical option compared to conventional laparoscopy (LSC). This study compares the clinical and operative outcomes of these techniques to determine if RSC is superior to LSC.

Methods: We conducted a retrospective, single-center study in the Gynecology Department at the Citadelle Hospital in Liège, Belgium. Data from all patients who underwent SC between January 2019 and December 2023 were collected. We evaluated demographic and clinical data, perioperative complications, operative time (OT), length of stay, risk of recurrence and follow-up duration. Statistical analysis was performed to compare outcomes between the groups.

Results: Data from 208 patients (97 LSC and 111 RSC) were analyzed. No significant differences were found between the groups. A higher body mass index trend was observed in the RSC group (mean BMI: 26.63, range: 20-43) compared to the LSC group (mean BMI: 25.45, range: 15-34; p = 0.0625). The median OT was similar (LSC: 111 min vs RSC 119 min; p = 0.104), with a notable reduction in OT compared to the literature. Additionally, more RSC procedures could be performed per day (3 RSC vs. a maximum of 2 for LSC).

Conclusion: Robot-assisted laparoscopy was not demonstrated to be superior to LSC. However, both procedures had comparable OT, significantly shorter than previously reported. RSC's operational efficiency might allow for a higher number of daily procedures, translating into practical benefits in clinical settings.