International Urogynecology Journal最新文献

Introduction and hypothesis: Pelvic organ prolapse (POP) negatively impacts the quality of life of many women. Effective treatment options include the use of a pessary and surgery. This study was aimed at exploring the facilitators and barriers influencing decision-making between pessary and surgical treatment from both the patients' and gynecologists' perspectives.

Methods: This qualitative study involved semi-structured interviews with 14 women from the own choice cohort in the PEOPLE study and 12 gynecologists from various hospitals throughout the Netherlands. Participants were purposively sampled to capture a range of experiences and professional backgrounds. The women varied in age and prolapse severity and had differing experiences with both pessary use and surgery, whereas gynecologists represented a mix of junior and senior specialists from academic and regional hospitals. Interviews were conducted until thematic saturation was reached. Data were analyzed using thematic analysis following Braun and Clarke.

Results: Three main themes emerged. Treatment goals were a reflection of fears and misconceptions, illustrating the reasons behind women's treatment choices; patient presentation delay as a result of ignorance and shame, addressing the societal taboos surrounding POP; and consultation at the gynecologist with communication gaps and decision-making challenges, highlighting the barriers faced during consultations with gynecologists.

Conclusions: Optimal decision-making can be limited because of a lack of knowledge among the general population, patients, and general practitioners. Ignorance and feelings of fear and shame on the subject in patients further hinder the decision-making process. Addressing these barriers could improve the shared decision-making process and enhance patient satisfaction with their chosen treatment.

Introduction and hypothesis: The objectives of this video are to provide an overview of autologous grafts, flaps, and biologic grafts for use in vaginal lengthening procedures and to discuss management of shortened vaginal length with differing approaches.

Methods: This video reviews iatrogenic and medical causes of shortened vaginal length and management through conservative and surgical approaches. We discuss vaginal dilation-only protocols. We also describe surgical management with buccal grafts, split-thickness grafts, pudendal thigh flaps, and biologic grafts. The first case presents a patient with graft-versus-host disease who was managed via lysis of vaginal adhesions. The second case presents an iatrogenic shortened vaginal length with use of a split-thickness graft via a vaginal surgical approach. The third case presents a patient with a complex genitourinary sinus with upper vaginal obliteration who was managed via a robotics-assisted approach with a biologic graft for vaginal lengthening.

Conclusions: Common causes of shortened vaginal length are iatrogenic and medical etiologies that urogynecologists will see. As vaginal and minimally invasive surgeons, urogynecologists may consider acquiring grafting techniques or collaborative patient care to offer vaginal lengthening procedures to their patients.

Introduction and hypothesis: A recent study found that young power and weightlifters reported a high prevalence of pelvic floor disorders (PFDs) with urinary incontinence (UI) 50%, anal incontinence 80% and pelvic organ prolapse 23%. Performing "the knack", a voluntary pre-contraction of the pelvic floor muscles (PFMs), before and during stressful events, can prevent UI during coughing and daily activities. However, the effect of this manoeuvre has not been investigated during strenuous exercises. This study was aimed at investigating the feasibility of using the femfit® to measure intra-abdominal pressure (IAP) and PFM pressure during strength exercises and at discovering if a voluntary pre-contraction of the PFMs can exceed increases in IAP during strength exercises.

Methods: This was a short-term, cross-sectional, experimental study. Eleven participants were tested in squat, deadlift, leg press and curl up, performed in a random order with and without voluntary pre-contraction of the PFMs. Assessment of the ability to contract the PFMs was conducted by suprapubic 2D ultrasound. IAP and PFM pressure were measured with the femfit®. Wilcoxon Signed Rank Test was used to estimate differences in change between IAP and PFM pressure with and without voluntary pre-contraction during the strength exercises.

Results: No participants reported displacement or discomfort from the femfit® device. Voluntary pre-contraction of the PFMs did not exceed the rise in IAP during squat, deadlift, leg press and curl up.

Conclusions: The PFM pressure was not significantly higher than the IAP during strength exercises. Further longitudinal studies are warranted to investigate if systematic PFM training can improve the strength of the voluntary pre-contraction.

Introduction and hypothesis: High impact physical activity (PA) in sportswomen is a risk factor for the development of stress-induced urinary incontinence and potentially for other dysfunctions of the pelvic floor. This study was aimed at assessing the occurrence of lower urinary tract symptoms (LUTS) in professional female judo practitioners.

Methods: This observational, cross-sectional study included a total of 88 women practising professional judo and 88 women practising other sports disciplines. Participants completed Core Lower Urinary Tract Symptom Score (CLSS) questionnaire to assess the condition of the lower urinary tract, along with sport-related data questionnaires and self-reported anthropometric measures.

Results: Among 19.31% of women practising judo no LUTS were recorded and the majority of the remaining judo athletes (67.6%) indicated the occurrence of one or two symptoms. Urgency was the most common symptom (40.9%). Six of the 10 analysed LUTS were statistically significantly less frequent in female judo athletes and the average number of LUTS was statistically significantly lower in this group (95% CI 1.67-2.48 vs 2.9-3.94; p < 0.001). Severity of three symptoms (nocturia, incomplete emptying of the bladder and urethral pain) was statistically significantly lower in women practising judo and their overall CLSS score was statistically significantly lower (95% CI 1.96-3.1 vs 3.9-5.68; p < 0.001). These athletes were also more satisfied with the level of acceptance of the CLSS condition (95% CI 0.67-1.18 vs 1.19-1.84; p < 0.01).

Conclusions: Compared to other disciplines, competitive judo is not a risk factor for increased LUTS; therefore, the level of health satisfaction with the condition of the lower urinary tract in women practising judo is high.

Background: Pelvic floor dysfunction (PFD) impacts 20% of adult women with prevalence increasing with age. Physiotherapy is considered first-line care and can greatly improve quality of life for those experiencing symptoms. However, few women over 60 seek professional help. Little is known regarding how this population receives care for their PFD, including if, and when, they are referred to physiotherapy. The aim of this study is to review the current literature on the journey of women over 60 years with PFD to accessing physiotherapy.

Methods: A search of electronic databases was completed to inform the scoping review. Articles were included if they were in English and analysed the journey to physiotherapy for women 60 years or over with PFD. Analysis of the studies were completed by reviewers and organised into key themes.

Results: Four articles met inclusion criteria and were included in the scoping review. Four themes were identified: the General Practitioner (GP) as gatekeepers to pelvic care, timely initiation of physiotherapy care, bias towards passive care for women over 60 with PFD and lack of awareness around the benefits of physiotherapy for PFD in women over 60.

Conclusions: Given the limited literature found on this topic it is difficult to draw conclusions about the current pathway to physiotherapy for women over 60 years with PFD. However, the available literature suggests this population is less likely to be referred to physiotherapy and more likely to be prescribed passive care, which differs from international guideline recommendations and younger age groups.

Introduction: Pelvic floor dysfunction (PFD) is a common condition that affects many women after childbirth. A considerable number of studies have been published on postpartum PFD; however, there is a lack of systematic quantification and comprehensive summary of these studies. This study employed bibliometric methods to systematically analyze the research status, hotspots, and emerging trends in postpartum PFD from 2005 to 2024.

Methods: Studies that were concerned with postpartum PFD were extracted from the Web of Science Core Collection (WoSCC), covering the period from January 1, 2005, to December 31, 2024. Authors, countries, institutions, references, and keywords in the field were visualized and analyzed using CiteSpace software.

Results: Over the past two decades, the number of publications has increased, with 1149 publications identified. International Urogynecology Journal was the most-cited journal. The research institution with the most publications was the University of Oslo. Kari Bø is the most prolific author in this field. Keyword analysis suggested that stress urinary incontinence, anal incontinence, chronic pain, mode of delivery, and transperineal ultrasound have become research hotspots in recent years.

Conclusions: This study provides a reference for current research hotspots and trends in the field of postpartum PFD through a bibliometric analysis. Future efforts should foster global collaboration, strengthen multidisciplinary studies, and advance the exploration of AI-based diagnostic and therapeutic technologies.

Introduction and hypothesis: The objective was to evaluate quality-of-life (QoL) improvements following Revi® implantable tibial neuromodulation (ITNM) in patients with urgency urinary incontinence (UUI).

Methods: This prospective, multicenter study evaluated the Revi® System, an ITNM device that allows for at-home therapy using an external, battery-operated unit. The primary efficacy and safety endpoints were assessed at 6 and 12 months; thereafter, participants either exited the study or consented to extend follow-up. This completers analysis evaluated QoL outcomes using the Overactive Bladder Questionnaire (OAB-q) and the total transformed Health-Related QoL (HRQL) score through 24 months.

Results: Subfascial implantation of the Revi System was performed in 151 participants. Primary efficacy and safety endpoints were met and no device- or procedure-related serious adverse events occurred. Consistent QoL benefits were seen throughout 24 months, with clinically significant (≥ 10-point change) and sustainable improvements in symptom severity in all domains of the OAB-q and HRQL scores. Additionally, 96.8% reported treatment benefit, 96.7% reported satisfaction, and 100% reported a willingness to continue therapy at 24 months. Notably, among participants who did not meet the primary efficacy endpoint at 24 months (n = 20; 20.6%), appreciable therapeutic benefit was still noted; 83.3% reported treatment benefit, 66.7% reported satisfaction, and 100% reported a willingness to continue this therapy.

Conclusions: Revi is an effective and safe intervention for UUI. Two-year results of the Revi System demonstrate clinically meaningful and sustainable improvements to bladder-related and overall health-related QoL, including those whose objective benefit did not meet the primary efficacy endpoint.

Introduction and hypothesis: Recent studies have reported higher frequencies of overactive bladder (OAB) symptoms in both male and female patients diagnosed with obstructive sleep apnea (OSA) in sleep medicine centers. However, there is a paucity of data on the prevalence of OSA in female urogynecological patients with a primary diagnosis of OAB. The aims of the present study were: (i) to evaluate the prevalence of OSA among urogynecological patients diagnosed with OAB compared with a control group (non-OAB gynecological patients), (ii) to assess the correlation between the severity of OSA and OAB symptoms.

Methods: All patients underwent the home sleep apnea test based on peripheral arterial tonometry (PAT). The analysis included the PAT Apnea Hypopnea Index (pAHI), PAT Respiratory Disturbance Index (pRDI), sleep time with desaturations < 90%, and blood oxygen saturation (%).

Results: The results of the present study can be summarized as follows: (i) both study groups carried a high risk of OSA (> 85%) as defined by the AHI cutoff score ≥ 5 but the OAB group showed a significantly higher risk of OSA as assessed by the Berlin Questionnaire, (ii) there was a higher prevalence of more severe forms of OSA (AHI scores ≥ 15) among OAB patients, (iii) there was no correlation between the severity of OSA and OAB symptoms in OAB patients.

Conclusions: OAB diagnosis in female urogynecological patients may be associated with an altered distribution of AHI scores and more severe OSA symptoms as compared to other gynecological patients.

Introduction and hypothesis: Sexual dysfunction is a common yet often underrecognized concern among women with urinary incontinence (UI), a distressing condition that adversely affects quality of life and sexual well-being. While global data link UI with sexual dysfunction, evidence among Thai women remains scarce. This study aimed to determine its prevalence and associated factors in this population.

Methods: A cross-sectional study was conducted at a tertiary care hospital between February 2024 and June 2025. Sexually active women aged ≥20 years with clinically diagnosed UI were enrolled. Participants completed self-administered questionnaires assessing demographics, UI characteristics (Urinary Distress Inventory-6 [UDI-6] and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF]), and sexual function (Thai version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-IUGA Revised [PISQ-IR]).

Results: Of 230 women recruited, 174 sexually active participants were analyzed (mean age 50.05 ± 8.31 years). Mixed UI was most common (78.16%), and moderate UI severity predominated (55.75%). The overall prevalence of sexual dysfunction was 37.93%. Women with sexual dysfunction were significantly older than those without (52.02 ± 7.07 vs. 48.9 ± 8.8 years; p = 0.016). Although UI type or severity was not independently associated with sexual dysfunction, mixed and severe UI were linked to lower scores in condition-specific, global quality, and condition-impact domains.

Conclusion: Approximately one-third of sexually active Thai women with urinary incontinence experience sexual dysfunction. Although incontinence type and severity were not associated with overall dysfunction, mixed and severe incontinence affected specific sexual function domains.