International Urogynecology Journal最新文献

Introduction and hypothesis: Chronic pelvic pain (CPP) affects approximately 26% of the world's female population and has various proposed etiologies. This manuscript aims to review concepts related to pelvic organ prolapse (POP) and CPP, encompassing its etiology, risk factors, clinical findings, and pain management.

Methods: A narrative review was performed using MeSH terms and text words on PubMed, and the Cochrane Database of Systematic Reviews through May 2024. A total of 33 references were used to address the questions posed in this review.

Results: Specific risk factors for CPP associated with POP include pain antedating POP onset, POP surgery duration, and extent of soft tissue trauma. Studies indicate that uterosacral ligament repair performed during surgical interventions for POP correction has alleviated CPP symptoms whether performed vaginally or laparoscopically. Women with preexisting CPP or central sensitization syndrome (CSS) undergoing pelvic reconstructive surgery for POP may experience less favorable postoperative outcomes compared to those without preexisting pain conditions. These outcomes include lower patient satisfaction, less resolution of discomfort, and poorer improvement in urinary symptoms.

Conclusions: On the basis of current evidence, surgeries for POP correction, especially those involving the uterosacral ligament, have shown a positive impact on reducing pelvic pain. However, untreated CPP is associated with lower satisfaction and less improvement in outcomes after POP surgery regarding pelvic symptoms and quality of life. Screening for and treating CPP conditions prior to POP surgery should be prioritized. Pain management of CPP should be addressed preoperatively, perioperatively, and postoperatively.

Introduction and hypothesis: We aimed to develop and validate a clinically applicable risk assessment model for identifying women at a high risk of pelvic organ prolapse (POP) based on a retrospective practice.

Methods: This study enrolled patients with and without POP between January 2019 and December 2021. Clinical data were collected and machine learning models were applied, such as multilayer perceptron, logistic regression, random forest (RF), light gradient boosting machine and extreme gradient boosting. Two datasets were constructed, one comprising all variables and the other excluding physical examination variables. Two versions of the machine learning model were developed. One was for professional doctors, and the other was for community-health providers. The area under the curve (AUC) and its confidence interval (CI), accuracy, F1 score, sensitivity, and specificity were calculated to evaluate the model's performance. The Shapley Additive Explanations method was used to visualize and interpret the model output.

Results: A total of 16,416 women were recruited, with 8,314 and 8,102 in the POP and non-POP groups respectively. Eighty-seven variables were recorded. Among all candidate models, the RF model with 13 variables showed the best performance, with an AUC of 0.806 (95% CI 0.793-0.817), accuracy of 0.723, F1 of 0.731, sensitivity of 0.742, and specificity of 0.703. Excluding the physical examination variables, the RF model with 11 variables showed an AUC, accuracy, F1 score, sensitivity, and specificity of 0.716, 0.652, 0.688, 0.757, and 0.545 respectively.

Conclusions: We constructed a clinically applicable risk warning system that will help clinicians to identify women at a high risk of POP.

Introduction and hypothesis: The incidence of obstetric anal sphincter injuries (OASI) has increased in recent years, which may be due to improved recognition and documentation. There is limited evidence regarding the effects of thorough documentation of obstetric anal sphincter injury repairs on postpartum clinical outcomes. Our objectives were to (1) compare the incidence of perineal wound complications between documentation groups, (2) compare other adverse events, and (3) to describe factors associated with adequate documentation. We hypothesized that better documentation would be associated with improved clinical outcomes.

Methods: This was a retrospective cohort study of 599 patients with OASI at a tertiary care referral center between January 2015 and December 2020. A priori definitions of documentation adequacy were utilized to stratify delivery notes. On the basis of these criteria, there were preferred, adequate, and inadequate documentation groups. Maternal characteristics, outcomes, and peripartum factors were compared between the groups.

Results: There were no significant differences in clinical outcomes between the groups. A higher degree of perineal laceration (p < 0.001), greater blood loss (p = 0.002), and the need for repairs in the operating room (p = 0.019) were significant factors associated with adequate documentation. Clinicians who were comprehensive in their documentation were more likely to refer patients to Urogynecology (p < 0.001) and to add OASI to the electronic medical record problem list (p = 0.005).

Conclusions: While certain factors are associated with adequate documentation, this did not improve clinical outcomes for OASI and further research is warranted to explore the importance of medical documentation surrounding OASI.

Introduction and hypothesis: The objective was to determine if mid-urethral sling (MUS) tensioning with a Mayo Scissor as a sub-urethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in differences in patient-reported outcomes and rates of repeat surgery over a 5-year follow-up.

Methods: Follow-up 5 years after a randomized clinical trial, utilizing primary data collection linked to administrative health data, was carried out to create a longitudinal cohort. The primary outcome was participant-reported bothersome SUI symptoms, as defined by the Urogenital Distress Inventory (UDI-6) questionnaire. Secondary outcomes included participant-reported bothersome overactive bladder (OAB) scores, median scores of three validated urinary symptom questionnaires, and rates of subsequent surgery determined through patient report and administrative data.

Results: Two hundred and sixty (81.8%) of the original study participants provided participant-reported data at 5 years. Administrative data linkage was completed for all of the original participants (n = 318). Demographic characteristics remained similar in the two groups at the 5-year follow-up mark. No differences existed in the primary outcome of reported bothersome SUI symptoms (30.8% Scissors vs 26.8% Babcock, p = 0.559), proportion of participants with bothersome OAB, the median scores of three validated bladder questionnaires, or in rates and cumulative incidence of recurrent MUS surgery or surgical revision of mesh-related complications.

Conclusion: Both the Scissor and Babcock tensioning techniques provided comparable outcomes at 5 years post-MUS surgery. The information from this study allows surgeons to better decide which technique to adopt in their practice, providing confidence in longer-term cure and safety.

Introduction and hypothesis: The relationship between depression and overactive bladder (OAB) is unknown. This study aimed to explore the association between depression and OAB in the U.S.

Population:

Methods: A cross-sectional study was performed utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Depression status and severity among participants were assessed via the Patient Health Questionnaire-9 (PHQ-9). The OAB symptoms of the participants were assessed via the OAB symptom score (OABSS) scale. Multivariate logistic regression was conducted to evaluate the association between depression and OAB.

Results: A total of 19,359 participants were enrolled in the study, with 91.01% (N = 17618) exhibiting minimal or mild depression, 7.92% (N = 1533) presenting with moderate or moderately severe depression, and 1.07% (N = 208) identified as severe depression. The overall prevalence of OAB was 21.62%. We found that depression was positively associated with OAB before and after adjustments for all covariates. After adjusting for covariates, individuals with moderate or moderately severe depression presented an elevated risk of OAB (OR = 2.52, 95% CI 2.11-3.01, p < 0.01), while those with severe depression presented a greater risk (OR = 3.74 95% CI 2.37-5.90, p < 0.01) than did participants with minimal or mild depression. Age may modify the correlation between depression and OAB.

Conclusions: Our study highlighted a positive association between depression and OAB in the U.S. population, and the association between depression and OAB was modified by age. However, more studies are needed in the future to verify the associations between depression and OAB and their underlying mechanisms.

Introduction and hypothesis: The objective of our study is to investigate the presence of lower urinary tract symptoms (LUTS) and its correlation with the risk of falling in older women with cognitive frailty.

Methods: The descriptive study was conducted on 102 female older adults, 60 women were classed as cognitively frail and 42 as healthy. Women were classified as having mild cognitive impairment based on the Clinical Dementia Rating Scale and as frail based on the Clinical Frailty Scale. The Bristol Female Lower Urinary Tract Symptoms questionnaire and Timed Up and Go test were applied to determine LUTS and fall risk respectively.

Results: Cognitively frail women scored considerably higher for LUTS including quality of life, filling, incontinence, and voiding, than the healthy group (p < 0.001). Timed Up and Go test seconds were significantly longer in cognitively frail women (p < 0.001).

Conclusions: These data suggest the notion that cognitive frailty might increase the risk of LUTS and falls. Older women at high fall risk are more likely to have LUTS. Thus, health practitioners must recognize that embarrassment may prevent individuals from seeking urinary care. Even in the absence of patient complaints, older women with cognitive frailty should have a comprehensive fall history and LUTS testing. Implementing LUTS and fall-risk measures may avoid future falls and serious complications such as fractures.

Introduction and hypothesis: The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery.

Methods: This study utilized a previously validated model for predicting post-POP surgery SSI within 90 days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database. Discriminatory performance was assessed via the c-statistic and calibration was assessed using calibration curves. Methods of recalibration in the large and logistic recalibration were used to update the models.

Results: The PHD contained 420,277 POP procedures meeting the inclusion criteria and 1.6% resulted in SSI. The NSQIP dataset contained 62,553 POP surgeries and 1.4% resulted in SSI. Discrimination of the original model was comparable with that seen in the initial validation (c-statistic = 0.57 in PHD, 0.59 in NSQIP vs 0.60 in the original Medicare data). Recalibration greatly improved model calibration when evaluated in NSQIP data.

Conclusion: A previously developed model for predicting SSI after POP surgery demonstrated stable discriminatory ability when externally validated on the PHD and NSQIP databases. Model recalibration was necessary to improve prediction. Prospective studies are needed to validate the clinical utility of such a model.

Introduction and hypothesis: Challenges to providing care to Spanish-speaking Latinas with pelvic floor disorders (PFDs) are well studied. Limited data exist on patient and provider perspectives on the unique challenges in providing language-discordant care. Our study was aimed at highlighting these challenges and providing evidence-based recommendations on how to optimize the care of these women.

Methods: Both Spanish-speaking patients with PFDs and non-Spanish speaking providers at the University of South Florida were recruited for this study. Interviews were conducted by a single bilingual interviewer. Topics included providers' experiences, specifically barriers, when caring for Spanish-speaking Latinas, and patients' experiences, focusing on differences between Spanish and non-Spanish speaking providers, while receiving care for PFDs. All interviews were analyzed using grounded theory qualitative methods.

Results: Thirteen interviews were conducted, 7 Spanish-speaking Latinas with PFDs and 6 non-Spanish-speaking urogynecology providers. Qualitative analysis yielded three major themes noted by both patients and providers: cultural stigma, barriers influencing care, and behavioral adaptations to language discordance. Concepts identified from these themes included: generational shame and embarrassment, aversion to treatment, interpreter use barriers, lack of resources, accommodation between patient and provider, and time constraints. Culturally competent recommendations were made based on study findings and review of the literature to improve care of Spanish-speaking Latinas.

Conclusions: This study highlights common themes experienced by both patients and their non-Spanish-speaking providers caring for Spanish-speaking Latinas. The study provides recommendations and implementable strategies that can improve care and help providers to build a stronger therapeutic relationship with Spanish-speaking Latinas.

Introduction and hypothesis: Constipation is defined as infrequent stools/difficultly passing stools, or the sensation of incomplete emptying. The prevalence of constipation is estimated at 14% worldwide. Caffeine is believed to increase gastric motility in the colon, causing a laxative effect. The results of the studies in the literature are conflicting. The aim of this review is to assess the effectiveness of caffeine in reducing constipation in adults.

Methods: We searched the Cochrane Library, AMED, MEDLINE, EMBASE, Web of Science and CINAHL. Search terms included "constipation", "faecal impaction" and "caffeine" in different forms. The screening of the titles was carried out by two independent reviewers for trials that assessed the effect of caffeine on constipation. We assessed the quality of the studies included and the data collated. ROBINS-I and risk-of-bias tools were employed to assess for risk of bias in the studies included.

Results: Eight studies were included in the final review. The studies assessed caffeine in the forms of coffee, tea, energy drinks, cocoa and kombucha with different doses. Three studies were at a low risk of bias, 3 were at a moderate risk of bias and the randomised controlled trial (RCT) had some concerns regarding blinding. Four studies concluded that caffeine may be effective in reducing constipation and 4 studies showed no improvement or an increase in constipation. Meta-analysis was not done as the studies were too dissimilar in interventions and outcome assessments.

Conclusion: The results of the studies are conflicting. Further rigorously designed and conducted RCTs need to be carried out to substantiate the effectiveness of caffeine on reducing constipation in adults.

Introduction and hypothesis: Pelvic floor dysfunction usually results in pelvic organ prolapse (POP) and/or urinary incontinence. In women, several factors, including pregnancy and vaginal delivery, can affect pelvic muscle conditions. The aim of the study was to perform a genetic analysis in young women with a family history of pelvic floor dysfunction to find potentially harmful variants or variants that increase the risk of developing pelvic floor disorders.

Methods: We employed whole exome sequencing to test ten young women with pelvic floor muscle dysfunction (along with their parents) and a family history. The average age of symptoms was 29.1 (± 3.98) years old, soon after their first delivery.

Results: In five out of ten patients, trio-based WES analysis revealed potentially pathogenic, causative nonsense variants in ion channel genes, including ATP1A4, CLCN1, GRIN2C, and ORAI1, as well as missense variants in PIEZO1 and RYR1. Additionally, some of these patients had variants in genes related to muscle function (MUSK) and connective tissue disorder (FKBP14, p.Glu122ArgfsTer7). The variants found in this study, such as CLCN1 (p.Arg894Ter) and MUSK (p.Val790Met), have already been associated with neuromuscular channelopathy and severe muscle weakness.

Conclusions: The identified candidate genes encode mainly proteins involved in electrical action potential and mechanical muscle contraction. The results suggest that the identified genetic variants may result in skeletal muscle ion channelopathies that affect muscle function, gradually leading to muscle hypotonia and weakness.