International Urogynecology Journal最新文献

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.

Introduction and hypothesis: Endometrial cancer therapy may affect lower urinary tract function and quality of life (QoL). We prospectively evaluated short-term urodynamic and QoL outcomes after surgical treatment with or without adjuvant radiotherapy.

Methods: Women with biopsy-confirmed endometrial cancer underwent standardized urodynamic testing before surgery and 6 months after treatment completion. Parameters included detrusor pressure, bladder capacity, compliance, and post-void residual (PVR) urine volume. QoL was assessed using EORTC QLQ-C30 and QLQ-EN24 questionnaires. Pre- and post-treatment data were compared using nonparametric tests (α = 0.05). Surgery was performed either robotically or via the open abdominal approach.

Results: Of the 101 participants, 55 received adjuvant radiotherapy and 46 were treated with surgery alone. No clinically significant  urodynamic deterioration was observed post-surgery. Median PVR urine volume decreased from 50 to 40 mL (p = 0.002) and detrusor pressure from 30 to 28 cmH₂O (p = 0.08) following surgery; other parameters remained stable. No acute radiation cystitis occurred. QoL scores were high at baseline and follow-up, with no domain showing a ≥ 10-point change. Sexual and urinary symptom scores remained unchanged.

Conclusions: Within 6 months after endometrial cancer treatment, urodynamic parameters and QoL remained stable. These results suggest short-term functional safety of contemporary surgical and radiotherapy protocols, warranting longer-term follow-up.

Introduction and hypothesis: The objective was to evaluate the learning curve of vaginoplasty procedures performed by two trainees with different levels of experience using the Learning Curve Cumulative Summation (LC-CUSUM) method.

Methods: This prospective study included 80 consecutive vaginoplasty cases performed by two trainees after structured theoretical and hands-on training. Trainee 1 was a senior resident in the third year of the Obstetrics and Gynecology specialty training program, with no prior experience in urogynecological surgery, whereas Trainee 2 was a certified specialist with a relevant surgical background. Both trainees were evaluated using LC-CUSUM parameters based on predefined acceptable (10%) and unacceptable (17.5%) failure rates. The number of procedures required to reach competency was recorded.

Results: Trainee 1 reached the predefined performance level after 27 procedures, whereas Trainee 2 achieved it after 14. No major complications occurred. The LC-CUSUM curves confirmed gradual and safe skill acquisition in both cases. Patient satisfaction scores were high in both groups, with no statistically significant differences in complication rates.

Conclusion: The LC-CUSUM method provides an objective and individualized tool to assess surgical competence in vaginoplasty. It enables dynamic monitoring of learning curves and may contribute to safer surgical training, especially in procedures where experience heavily influences outcomes.

Introduction and hypothesis: This study aimed to compare free and invasive uroflowmetry in women with different clinical diagnoses and to evaluate how the discrepancies between both measurements vary by clinical context.

Methods: We conducted a retrospective cross-sectional study of 407 women aged ≥18 years who underwent urodynamic studies (UDS) from 2015 to 2021 at an academic hospital in Chile. UDS included free uroflowmetry, cystometry, and pressure-flow studies, following International Continence Society standards. Prior to UDS, patients were classified into five clinical groups: voiding dysfunction (VD), mixed urinary incontinence (MUI), stress urinary incontinence (SUI), overactive bladder-urge incontinence (OAB), and prior anti-incontinence surgery. Maximum flow rates during free uroflowmetry (fQmax) and pressure-flow studies (iQmax) were recorded. ΔQmax (fQmax-iQmax) was analyzed among the different clinical groups and other urodynamic variables using nonparametric tests.

Results: Mean age was 53.9±12 years. Median fQmax was 30 ml/s, significantly higher than iQmax at 17 ml/s; p < 0.001, with a median ΔQmax of 12 ml/s. Correlation between fQmax and iQmax was poor (r = 0.271). ΔQmax varied among groups, being the lowest in VD (5 ml/s; p = 0.004) and the highest in SUI (17 ml/s; p = 0.002). Patients with diabetes also showed a lower ΔQmax (p = 0.001). Patients with urodynamic SUI showed a higher ΔQmax (p = 0.028), while altered cystometric bladder sensation correlated with a lower ΔQmax (p = 0.015).

Conclusions: Differences between free and invasive uroflowmetry vary significantly by diagnosis. SUI patients show the greatest discrepancy, whereas VD and altered sensation result in smaller differences. These findings highlight the need to interpret flow parameters in their clinical context.