International Urogynecology Journal最新文献

Introduction and hypothesis: Magnetic stimulation is a noninvasive, painless neuromodulatory therapy that has emerged as a promising conservative treatment for urinary incontinence. This study aimed to evaluate its clinical effectiveness and safety in women with urgency urinary incontinence (UUI).

Methods: In this single-centre, prospective randomised controlled trial, 70 women with UUI were randomised in a 2:1 ratio to active MS or sham treatment. Participants received 12 sessions of magnetic stimulation over 6 weeks. The active group received individually adjusted stimulation intensity, while the sham group received minimal stimulation to preserve blinding. The primary outcome was change in symptom severity measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Secondary outcomes included bladder diary parameters (urinary frequency, urgency urinary incontinence episodes, nocturia), symptom-specific quality of life (UDI-6, IIQ-7), and patient-reported improvement (PGI-I). Outcomes were assessed at baseline and 6 months post-treatment.

Results: At 6 months, 40 participants in the active group and 16 in the sham group completed follow-up. The active group demonstrated significantly greater improvement in ICIQ-UI SF scores (mean change -4.05 ± 3.23) compared to sham (-1.19 ± 1.72; p < 0.001). Significant improvements were also observed in urgency incontinence episodes, nocturia, and quality of life measures in the active group. No serious adverse events were reported, confirming the favourable safety profile of MS.

Conclusions: This study provides new controlled evidence supporting MS as an effective, noninvasive, and well-tolerated treatment for women with UUI. These findings contribute important data on mid-term efficacy but highlight the need for further high-quality RCTs with standardised protocols and longer-term follow-up.

Introduction and hypothesis: Vaginal childbirth may cause levator ani muscle (LAM) avulsion and hiatal widening. 3D/4D transperineal ultrasound (TPUS) is widely used to assess the hiatal area and insertion of the LAM. We aimed to assess the quality of TPUS images for assessing the above when acquisitions were done immediately after vaginal childbirth.

Methods: Secondary analysis of images obtained after vaginal birth by experienced sonographers, in 100 randomly selected patients from two prospective cohort studies, was carried out. In those, TPUS volumes were acquired immediately after vaginal delivery at rest, during contraction of the pelvic floor muscles, and during Valsalva. Two investigators independently rated the image quality for visibility of midsagittal landmarks (symphysis, urethra, levator ani; yes/no), quality of visualization using a three-point Likert scale of the LAM in the axial plane and on tomographic ultrasound images (TUI), and visualization of the pubic symphysis and insertion points of the LAM. Sixty random volumes with adequate/ideal image quality were selected for intra- and inter-rater agreement of hiatal dimension measurements.

Results: In the midsagittal plane, all landmarks were visible in over 83% of TPUS volumes. "Ideal" or "adequate" visualization of the LAM in the axial plane was achieved in 50% and 40% respectively. Ideal visualization was highest during contraction of the pelvic floor muscles (63%). In TUI, the symphysis was visualized "ideally" or "adequately" in 71% or 22%, right LAM insertion in 73% or 19%, and left LAM insertion in 72% and 20% respectively. Hiatal dimension measurements showed excellent intra- and inter-rater agreement.

Conclusions: The quality of TPUS images obtained immediately after birth was adequate to ideal in over 90% of acquisitions.

Introduction and hypothesis: Vacuum-assisted vaginal deliveries (VAVD) represent a growing proportion of operative vaginal deliveries. Mediolateral episiotomy in patients undergoing VAVD has been shown to reduce obstetrical anal sphincter injuries (OASIS) in some settings; however, results of Canadian studies have been conflicted, and the practice has not been widely adopted by Canadian providers. The objective of this study was to estimate the association between episiotomy and OASIS among patients undergoing VAVD in a Canadian cohort.

Methods: A population-based, retrospective cohort of patients who underwent VAVD at term of non-anomalous, singleton, vertex fetuses between 2005 and 2023 were identified using the  Nova Scotia Atlee Perinatal Database. Augmented inverse probability weighting analyses were used to estimate risk ratios (RR) with 95% confidence intervals (CI) adjusting for confounding variables, overall and stratified by length of the second stage of labour and parity.

Results: Of 8407 VAVD, OASIS occurred in 970 (10.3%). Episiotomy was performed in 3780 (45.0%) VAVD. Overall, episiotomy was not found to be associated with OASIS risk (RR 0.94, 95% CI 0.83-1.07). Among individuals with a total second stage ≥ 60 min (RR 0.86, 95% CI 0.75-0.99) and an active phase ≥ 60 min (RR 0.60, 95% CI 0.34-1.06), episiotomy was associated with decreased OASIS risk. When stratified by parity, episiotomy was associated with reduced OASIS risk in nulliparous (RR 0.86, 95% CI 0.75-0.99) and increased risk in parous individuals (RR 1.37, 95% CI 0.99-1.90).

Conclusions: Among patients undergoing VAVD, episiotomy was protective against OASIS in certain populations, including nulliparous individuals and those with longer second stage of labour.

Introduction and hypothesis: This study aimed to characterize levator ani muscle (LAM) injury using conventional magnetic resonance imaging (MRI) following the first vaginal delivery and evaluate the feasibility of intravoxel incoherent motion (IVIM) imaging for its assessment.

Methods: This prospective study included 81 primiparous women post-vaginal delivery (primiparous group) and 54 nulliparous women (nulliparous group). All participants underwent pelvic floor MRI on the day of enrollment; primiparous women were scanned at 6 weeks postpartum (window 0-3 days). The imaging protocol included T2-weighted and IVIM sequences, followed by postprocessing. Morphological changes in LAM were described using a conventional MRI-based scoring system. IVIM parameters-including the pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) of left and right puborectalis and iliococcygeal muscles-were measured.

Results: Morphological injuries to the puborectalis and iliococcygeus were identified in 28 (34.57%) and nine (11.11%) primiparous women, respectively, whereas no LAM injuries were detected in the nulliparous group. Primiparous women exhibited higher puborectalis D values and lower puborectalis f values compared with nulliparous women (both P < 0.05), whereas puborectalis D* and all iliococcygeus IVIM parameters showed no significant differences. After adjusting for age, height, weight, and body mass index, partial correlation analyses revealed a weak-to-moderate positive correlation between puborectalis D values and conventional MRI-based LAM injury scores, and a weak negative correlation was observed between puborectalis f values and these scores.

Conclusions: LAM injury at 6 weeks postpartum was associated with vaginal delivery based on conventional MRI findings. IVIM imaging may reflect pathophysiological changes in water diffusion and microcirculatory perfusion associated with LAM injury after vaginal delivery, although further validation is required.

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.