International Urogynecology Journal最新文献

Introduction: The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) is a validated tool for assessing sexual health in women with pelvic floor disorders, divided into sections for sexually active (SA) and not sexually active (NSA) women. Although widely used, it has not yet been implemented in Denmark. This study aims to translate and validate the Danish translation of PISQ-IR.

Methods: Following the IUGA PISQ-IR Translation Protocol, the Danish version was approved and distributed digitally to women with pelvic floor disorders recruited from four hospitals in Denmark. Participants completed PISQ-IR, PFDI-20, PFIQ-7, and ICIQ-UI questionnaires both at baseline and 10-days retest. Internal reliability, test-retest reliability, and criterion validity were tested, followed by confirmatory (CFA) and exploratory factor analysis (EFA).

Results: Of 305 invited women, 201 (66%) completed the PISQ-IR; 82 (NSA) and 119 (SA). In general, internal reliability was good (Cronbach's alpha > 0.8). Test-retest reliability was acceptable (ICC 0.59-0.89 NSA; 0.54-0.83 SA). Criterion validity was better in the SA group but below standard. CFA showed acceptable factor loadings but poor fit indices (RMSEA 0.177 NSA, 0.096 SA; TLI 0.660 NSA, 0.840 SA). EFA revealed a three-factor solution (NSA) and two-factor solution (SA), with high uniqueness in several items, correlating with the low fit in the CFA.

Conclusions: The Danish PISQ-IR showed good internal consistency and test-retest reliability, supporting its use in Denmark. However, low fit indices and factor loadings in several items suggest the need for further revision.

Introduction and hypothesis: Overactive bladder (OAB) has higher prevalence and increased morbidity in older people. Owing to side effects and inefficacy of OAB medications, patients frequently choose onabotulinumtoxin A intradetrusor injections (BTX-A). There is limited research investigating efficacy and adverse event (AE) rates of BTX-A in older female populations. Our objective was to evaluate rates of BTX-A discontinuation, treatment failure, UTI, and retention in women ≥ 80 compared to younger cohorts.

Methods: This retrospective cohort study included a convenience sample of women who underwent in-office BTX-A for OAB between 1/2014 and 12/2020. Data was analyzed with Kruskal-Wallis, ANOVA, chi-square, and Fisher's exact tests.

Results: Overall, 547 women were included with 215 (39%) < 65 years old, 249 (46%) 65-79, and 83 (15%) ≥ 80. When comparing age cohorts, rate of BTX-A discontinuation increased with age (54% at < 65, 58% 65-79, 72% ≥ 80, p = 0.01) with no significant difference in discontinuation due to ineffectiveness (19% < 65, 28% 65-79, 23% ≥ 80, p = 0.22). Those < 65 had the lowest rate of UTI (19%), but UTI rate was the same for women 65-79 (29%) and ≥ 80 (29%, p < 0.01). Rates of retention were highest in women 65-79 (8% < 65, 17% 65-79, 8% ≥ 80, p = 0.01).

Conclusions: Women ≥ 80 years old were most likely to discontinue BTX-A but discontinuing for ineffectiveness was the same regardless of age. Women > 65 are more likely to experience UTI after BTX-A; however, AEs do not significantly increase in women ≥ 80 years old, making BTX-A a good option in elderly patients.

Introduction and hypothesis: The Martius flap technique includes the cultivation of a well-vascularized labial fat pad from the labium majus for the interposition between a surgical site and the vaginal wall. Our objective was to determine the optimal location for incision and dissection of a Martius flap based on nerve and vascular density in cadaveric dissections.

Methods: The labium majus from ten lightly embalmed or fresh frozen cadavers were excised in their entirety. Each specimen was divided into a total of 18 sections per specimen, with nerve and vascular densities subsequently assessed.

Results: The highest nerve density was found within the anterior aspects of the right and left labia. An increased nerve density was observed in the right labium (9% increase vs left, 95% CI 5-12%, p < 0.001) and the medial column (5% increase vs lateral, 95% CI 1-10%, p = 0.019), but no difference was observed in the anterior versus the posterior position (p = 0.88). The highest vascular density was seen in the right lateral labium. There was significantly greater vascular density on the right vs left labium (8% increase, 95% CI 5-12%, p < 0.001), but no significant difference in medial vs lateral (p = 0.55) or in anterior versus posterior (p = 0.86).

Conclusions: These data may provide evidence that utilizing the right labia majus may yield a safer Martius flap. The highest vascularity was in the lateral aspects of the right labial fat pad, and the highest nerve density was in the anterior and medial aspects of the fat pad bilaterally.

Introduction and hypothesis: To explore whether concurrent midurethral sling surgery (MUS) is necessary for pelvic organ prolapse (POP) patients with simple anatomical stress urinary incontinence (SUI) undergoing laparoscopic lateral abdominal wall suspension (LLS).

Methods: A multicenter prospective cohort study enrolled 200 eligible patients (stage Ⅱ + apical/anterior POP with SUI) from 2022-2024, divided into LLS + MUS (n = 100) and LLS alone (n = 100), with 40 healthy controls. Outcomes included urodynamic tests, ISI, POP-Q, MRI, and PGI-I at baseline, 3 months, and 1 year.

Results: 170 patients (85%) completed 1-year follow-up. LLS + MUS group had higher SUI cure rate (85.3% vs 50.9%, P < 0.05) but more complications (urinary tract infection:17.6% vs 5.9%; urinary retention:8.8% vs 0%; dyspareunia:35.3% vs 15.7%; mesh exposure:14.7% vs 2%, all P < 0.05). LLS alone group showed higher satisfaction (86.3% vs 67.6%, P < 0.05). POP anatomical reduction rates were similar between groups (P > 0.05).

Conclusions: For apical/anterior POP with SUI, LLS alone is preferred, with delayed MUS if needed, reducing complications and improving satisfaction.

Introduction and hypothesis: Postoperative bleeding is a recognized, potentially life-threatening complication after pelvic surgery. This case describes the management of such an event using laparoscopic techniques following vaginal hysterectomy for pelvic organ prolapse (POP), highlighting the importance of early detection and intervention, even with altered postoperative anatomy.

Methods: A 63-year-old woman underwent a vaginal hysterectomy, apical support with McCall culdoplasty, bilateral salpingo-oophorectomy (BSO), anterior and posterior colporrhaphy (APC), and a trans-obturator tape (TOT) procedure for POP. Evaluation before surgery was performed using the Pelvic Organ Prolapse Quantification system: Ba +2 cm, C +4 cm, Bp +1 cm, TVL 11 cm. On postoperative day 1, she reported severe abdominal pain; blood work showed a drop in her hemoglobin levels, and imaging confirmed intra-abdominal bleeding. Despite receiving two units of packed red blood cells, her hemoglobin continued to decline, necessitating exploratory laparoscopy. In this case, the laparoscopic approach improved visualization while allowing for precise identification and management of the bleeding source. The observed vaginal cuff hematoma was drained, the retroperitoneum was accessed bilaterally using the white line of Toldt as an anatomical landmark to develop the avascular spaces; then, the ureters were identified, and hemostasis was achieved by coagulating the infundibulopelvic ligaments and clipping the uterine arteries.

Results: The patient received two additional units of blood during surgery and experienced no additional events in the postoperative recovery time. She remained hemodynamically stable with no further complications.

Conclusions: Laparoscopic intervention for postoperative hemorrhage after vaginal hysterectomy is a safe and effective approach. Early detection and prompt management of intra-abdominal bleeding can prevent additional morbidity. Identifying and securely closing the uterine arteries are crucial for controlling bleeding, especially when anatomical changes from previous surgery are present.