International Urogynecology Journal最新文献

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.

Introduction and hypothesis: Multiple procedures exist to treat stress urinary incontinence. A database records outcomes and complications and ascertains how surgical and patient characteristics affect outcomes.

Methods: A retrospective cohort study of 31,901 women undergoing continence surgery from the British Society of Urogynaecologists Surgical Database (2008-2019), including 24,923 retropubic mesh-tapes, 4740 bulking agents, 538 fascial slings and 1700 colposuspension. Multivariable logistic regression was used for primary analyses to compare outcomes between treatments and secondary analysis to assess how different characteristics affect outcomes within treatment groups.

Results: Similar outcomes for patient reported global impression of improvement were observed following retropubic mesh-tapes, fascial slings and colposuspension (91%, 89%, 87%, respectively) compared to bulking agents (56.6%). For retropubic mesh-tapes, reduced odds of positive global impression of improvement was seen with increased age, body mass index, detrusor overactivity and intraoperative bladder injury. Odds of bladder injury increased with non-consultant grade operator and decreased with increasing BMI. For colposuspension, increased age led to decreased odds of success and increased odds of return to hospital and readmission. Repeat procedures led to decreased odds of success for retropubic tapes, bulking agents and colposuspension.

Conclusions: This large national database demonstrated that increased age, higher BMI, preoperative detrusor overactivity and bladder injury are associated with treatment failure. This information should be used in bespoke counselling to encourage personalised medical decision-making. Missing data is a limitation and would be improved with a mandatory database.

Introduction and hypothesis: Tranexamic acid, an antifibrinolytic agent with a well-established safety profile, promotes hemostasis by inhibiting fibrin degradation. In recent years, intravenous tranexamic acid has gained wide acceptance as a prophylactic antihemorrhagic agent in surgical settings. However, data on its local administration remain limited. This study was designed to evaluate whether prophylactic local infiltration of tranexamic acid into cervical and vaginal tissues before surgery could reduce intraoperative blood loss.

Methods: A double-blind, randomized, placebo-controlled trial was conducted at a tertiary medical center between April 2022 and December 2024. Sixty women undergoing benign vaginal hysterectomy were randomized (1:1) to receive either 1 g TXA (in 10 ml saline) or placebo via local cervical/vaginal infiltration 5 min pre-incision. The primary outcome was delta hemoglobin (ΔHb; pre- to postoperative hemoglobin change). Outcomes were compared using appropriate tests (t test or Mann-Whitney U, as indicated) with α = 0.05. Ethical approval was obtained from our institutional review board.

Results: Sixty patients were enrolled. Baseline characteristics of the two groups were comparable. The mean hemoglobin reduction was 1.48 ± 0.73 g/dl in the tranexamic acid group versus 1.27 ± 1.02 g/dl in controls (p = 0.36). Estimated blood loss, transfusion rates, and operative parameters did not differ significantly. Mucosal dissection was significantly easier in the tranexamic acid group (86.7% vs 40.0%, p < 0.01). No thromboembolic events occurred.

Conclusion: Local prophylactic tranexamic acid did not reduce total blood loss. Vaginal hysterectomy remains a safe procedure with minimal bleeding.

Introduction and hypothesis: The levator hiatus is an important determinant of pelvic organ prolapse and prolapse recurrence after surgery. Manufacturers are now offering automatic determination of hiatal dimensions.

Methods: This was an observational study using data sets of 437 women attending a urogynaecological unit in 2024 and 2025. All had 4D pelvic floor ultrasound using a Voluson E 22 system with SonoPelvic™ software. Data sets obtained on Valsalva were used for automated measurements. Manual measurements were performed later on stored data sets blinded against all other data. For statistical analysis we employed ICC and Bland Altman plots. Patients in whom measurements differed by ≥20% were reviewed.

Results: The 437 women seen during the study period presented with stress urinary incontinence (n = 304), urgency urinary incontinence (n = 334) and symptoms of pelvic organ prolapse (n = 229). Automated measurements yielded a mean of 25.45 (4.08-64.76) cm², whereas manual hiatal area measurements provided a mean of 26.8 (6.97-65.7) cm² (Pearson's correlation 0.59, p < 0.0001). The difference between individual measurements was statistically nonsignificant on t test. A direct comparison was possible in 425, with 80/425 (19%) showing a discrepancy of ≥20%. These were reviewed separately by the authors and found to be due to loss of symphysis pubis (n = 20) or anorectal angle (n = 35) or both (n = 10) in higher stages of prolapse.

Conclusion: Automated analysis by the current version of SonoPelvic™ shows a strong correlation with manual measurements, except in women with highly abnormal pelvic organ support. The software is under continuous development for which several recommendations are made.

Introduction and hypothesis: The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a tool developed to assess patient knowledge regarding the etiology, diagnosis, and treatment of urinary incontinence (UI), and pelvic organ prolapse (POP) conditions. This study was aimed at translating the PIKQ into Persian and testing its validity and reliability.

Methods: The present descriptive cross-sectional study was conducted in the women's clinics of Mashhad University of Medical Sciences in 2024, and included 205 women. The English PIKQ was translated into Persian using a standardized translation/back-translation method. The psychometric properties of the final version were tested for content validity, construct validity, and reliability. Construct validity was examined by confirmatory factor analysis. Reliability was assessed by test-retest reliability and the Kuder-Richardson Coefficient (KR-20).

Results: The PIKQ demonstrated acceptable fit in a final model for both UI and POP. For PIKQ-UI, average variance extracted (AVE) was initially below 0.5, but after removing items 1, 5, 6, and 9, it improved to 0.5, confirming convergent validity. The final fit indices were acceptable (Chi-squared = 30.710, df = 20, goodness-of-fit index [GFI] = 0.970). For PIKQ-POP, items 11 and 4 were removed, resulting in an AVE of 0.5 and improved fit indices (Chi-squared = 34.645, df = 20, GFI = 0.976). However, to maintain the originality of the questionnaire, no changes were applied in the final version. Reliability was good, as indicated by the intraclass coefficients of 0.852 (0.627-0.942) for PIKQ-UI, and 0.646 (0.107-0.860) for PIKQ-POP. Also, KR-20 was 0.775 and 0.756 respectively.

Conclusions: The Iranian version of the PIKQ is a dependable and valid tool for evaluating knowledge related to UI and POP.