International Urogynecology Journal最新文献

Introduction and hypothesis: High-impact physical activity is a known risk factor for the development of pelvic floor disorders (PFDs) in women, affecting the pelvic floor muscles (PFMs). However, there is insufficient information to determine whether alterations in PFMs, or even in the lumbar muscles, can be detected before the onset of symptoms. The aim of the study was to identify whether high-impact physical activity influences the muscle mechanical properties (MMPs) of the lumbopelvic region in continent nulliparous women.

Methods: An observational cross-sectional study with a nonprobabilistic sampling of consecutive cases was designed. Fifty women who had practiced high-impact physical activity at least three times per week for more than 2 years were included in the high-impact group, and 50 women who did not practice high-impact activity were included in the control group. Data collection for both groups included sociodemographic data and MMPs (frequency, characterizing muscle tone; stiffness; logarithmic decrement, characterizing the inverse of the elasticity; relaxation time of stress; creep, characterizing fluidity) of PFMs and lumbar muscles, externally assessed using a hand-held tonometer device. Between-group comparison of the MMPs were calculated, together with intragroup correlations between the outcomes.

Results: The MMPs of PFMs showed statistically significant lower tone (0.76 Hz, 95% CI 0.04, 1.48) and stiffness (23.76 N/m, 95% CI 1.10, 46.42) and were more viscoelastic (relaxation: -1.04 ms, 95% CI -1.98, -0.11; creep: -0.04 De, 95% CI -0.07, -0.02) in women who practiced high-impact physical activity. No lumbar MMPs showed statistically significant between-group differences.

Conclusions: High-impact physical activity alters the MMPs of PFMs in nulliparous women, although not lumbar spinal MMPs, even before the appearance of signs.

Introduction and hypothesis: Accurate and complete reporting of the Pelvic Organ Prolapse Quantification (POP-Q) system is essential for reporting research outcomes in POP. We aimed to assess the accuracy and completeness of POP-Q reporting in studies published from selected journals in 2023 and evaluate the validity of available POP-Q calculators.

Methods: A systematic search of Medline and Embase was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify eligible studies from selected journals in 2023 that utilised the POP-Q system. An assessment of available POP-Q calculators was also performed.

Results: Of the 134 studies identified, 18 (13.4%) met the inclusion criteria. Twelve studies reported complete quantitative POP-Q data of which 9 (75%) contained identifiable POP-Q reporting errors. These included 5 studies reporting mean Aa > Ba, 2 reporting mean Ap > Bp, 6 reporting C > Bp, 5 reporting mean C > Ba, 1 reporting mean Aa > + 3, and 1 reporting mean D > C. The remaining 6 of the 18 studies reported incomplete POP-Q measurements, which restricted our ability to identify further reporting errors, except for 2 studies reporting C > Ba and C > Bp respectively. The evaluated POP-Q calculator permitted the input of inaccurate POP-Q data.

Conclusions: Erroneous and/or incomplete quantitative POP-Q data were identified in 15 of the 18 studies reviewed (83.3%). Our findings highlight the need for improved POP-Q data reporting. Journal editors and reviewers should ensure that publications provide complete and accurate quantitative POP-Q data. POP-Q calculators should be based on algorithms that ensure complete and accurate data inputs and outputs.

Introduction and hypothesis: Accurate identification of female populations at high risk for urinary incontinence (UI) and early intervention are potentially effective initiatives to reduce the prevalence of UI. We aimed to apply machine-learning techniques to establish, internally validate, and provide interpretable risk assessment tools.

Methods: Data from a cross-sectional epidemiological survey of female urinary incontinence conducted in 2022 were used. Sociodemographic and obstetrics-related characteristics, comorbidities, and urinary incontinence questionnaire results were used to develop multiple prediction models. Seventy percent of the individuals in the study cohort were employed in model training, and the remainder were used for internal validation. Model performance was characterized by area under the receiver-operating characteristic curve (AUC) and calibration curves, as well as Brier scores. The best-performing model was finally selected to develop an online prediction tool.

Results: The results showed that bothersome stress urinary incontinence (BSUI) occurred in 9.6% (849 out of 8,830) of parous women. The XGBoost model achieved the best prediction performance (training set: AUC 0.796, 95% confidence interval [CI]: 0.778-0.815, validation set: AUC 0.720, 95% CI: 0.686-0.754). Additionally, the XGBoost model achieved the lowest (best) Brier score among the models, with sensitivity of 0.657, specificity of 0.690, accuracy of 0.688, positive predictive value of 0.231, and negative predictive value of 0.948. Based on this model, the top five risk factors for the development of BSUI among parous women were ranked as follows: body mass index, age, vaginal delivery, constipation, and maximum fetal birth weight. An online calculator was provided for clinical use.

Conclusion: The application of machine-learning algorithms provides an acceptable, though not perfect, prediction of BSUI risk among parous women, requiring further validation and improvement in future research.

Introduction and hypothesis: The high recurrence rate (up to 40%) of native tissue surgery for pelvic organ prolapse (POP) is concerning and a better understanding of the effect of surgery is essential in optimizing treatment. As physical examination (Pelvic Organ Prolapse-Quantification, POP-Q) underestimates the degree of prolapse, upright assessment may provide new insights. Therefore, we compared supine POP-Q with upright magnetic resonance imaging (MRI) examination of the anatomical effect of native tissue POP surgery on the pelvic anatomy.

Methods: This prospective study included 59 women with stage ≥ 2 anterior compartment prolapse undergoing solely anterior colporrhaphy (AC) or in combination with posterior colporrhaphy (PC), sacrospinous hysteropexy (SSH) or Manchester Fothergill (MF). Preoperatively and 6 weeks postoperatively, anatomical measurements were obtained: POP-Q and upright MRI. The Patient Global Impression of Improvement (PGI-I) questionnaire was completed 6 weeks postoperatively.

Results: Significant lift of the lowest point of the bladder was observed on both POP-Q (37 ± 18 mm) and upright MRI (26 ± 22 mm), which was 10 ± 17 mm (p < 0.001) larger on POP-Q than on upright MRI. Symptomatic improvement (PGI-I) was reported by 93.2% of the patients, which showed a weak correlation with the bladder lift on upright MRI (Spearman's ρ -0.301, p = 0.021), but no correlation with the bladder lift on POP-Q (Spearman's ρ -0.078, p = 0.565).

Conclusions: The POP-Q examination overestimates the anatomical result of native tissue POP repair on the anterior vaginal wall by 1 cm compared with upright MRI examination upon 6 weeks' follow-up. Upright MRI examination is suggested to relate better to symptomatic outcome than does POP-Q examination.

Introduction and hypothesis: Uterine leiomyomata are widely believed to contribute to lower urinary tract symptoms in women, but it is unclear whether leiomyoma size, position, and location have important implications for these symptoms. We assessed whether greater leiomyoma volume, anterior position, and subserosal location were associated with urinary incontinence and frequent urination in a racially diverse, nationwide sample of premenopausal women in the USA.

Methods: A cross-sectional analysis of 477 premenopausal women from 12 USA sites undergoing evaluation for laparoscopic radiofrequency ablation or myomectomy for leiomyomata was carried out. Multivariable logistic regression models examined associations between leiomyoma volume, position, and location documented in clinical imaging reports and participant-reported urinary incontinence and distressing urination frequency, adjusting for age, race, parity, and body mass index.

Results: Among the 477 participants, 27.9% reported at least weekly incontinence, 72.8% distressing daytime urination frequency, and 63.4% frequent night-time urination. Greater total leiomyoma volume was associated with at least weekly incontinence of any type (OR 1.05, 95% CI 1.02-1.07, per 20-ml increase) and at least weekly stress-predominant incontinence (OR 1.04, 95% CI 1.01-1.07, per 20-ml increase), but not distressing daytime or night-time urination frequency. Although subserosal leiomyoma position was associated with a 2.01-fold (95% CI 1.14-3.56) greater odds of frequent night-time urination, no significant associations between leiomyomata location or position and incontinence were detected.

Conclusion: In this multicenter sample of women seeking treatment for symptomatic leiomyomata, greater leiomyomata volume was associated with weekly any-type and stress-type incontinence, but leiomyoma position and location were not independently associated with urinary incontinence.

Female bladder pain syndrome (FBPS), previously known as interstitial cystitis/bladder pain syndrome, is a life-altering and morbid condition that occurs primarily in female patients and can be variable in presentation. Given the absence of pathognomonic symptoms and sensitive diagnostic tests, significant symptomatic overlap with numerous other pelvic conditions (such as pelvic floor tension myalgia or endometriosis) occurring in women makes diagnosis of FBPS challenging. The frequent co-occurrence of FBPS with other pain conditions and functional somatic syndromes further complicates diagnosis and management. The challenges have limited the progress made in understanding the pathophysiology of the condition and improving approaches to treatment and prevention. Improvement in standardization of the terminology used to describe this unique condition is needed to improve the accuracy of diagnosis and the clinical care for affected patients. Given the variability in presentation and the differing definitions for the condition world-wide, the American Urogynecologic Society and the International Urogynecologic Association convened a joint writing group to standardize terminology around common signs and symptoms of the condition and to clarify the diagnosis as it pertains to female patients with the condition. After careful consideration of a broad range of available data and clinical experiences, consensus opinion recommended adopting the term "FBPS" instead of the misleading "interstitial cystitis" to describe a chronic, intermittent condition of at least 3 months' duration affecting women involving symptoms of pain or discomfort localized to the bladder, often with bladder filling, which are not attributed to other pathology. This term will allow clinicians, researchers, and learners alike to standardize their understanding of FBPS.

Introduction and hypothesis: Pelvic organ prolapse (POP) impacts women's health and quality of life. Post-surgery complications can be severe. This study uses rat models to replicate sacrocolpopexy and test materials for pelvic support, verifying the 4-week postoperative mortality rate, the mechanical properties of the mesh tissue, and the collagen content.

Methods: Twenty-one 12-week-old female Wistar rats were used. Eighteen rats were subjected to POP induction by cervical suction and constant traction. One week after prolapse modeling, 18 prolapsed rats underwent unilateral presacral suspension (UPS) surgery with polycaprolactone (PCL) scaffolds, decellularized porcine small intestinal submucosa (SIS) scaffolds, or polypropylene (PP) meshes (n = 6 each). UPS rats were compared with normal rats (n = 3). After 4 weeks, conditions and mortality were recorded. The rats were then euthanized for biomechanical testing and collagen analysis. Ultimate load (N) was defined as the highest load before the failure of the target sample.

Results: The UPS procedure requires 42.9 ± 4.5 min with no complications or deaths over 4 weeks. SIS was the stiffest mesh (14.53 ± 0.86 N), followed by PP (8.43 ± 0.40 N), and PCL was the least stiff (0.66 ± 0.05 N). After 4 weeks, the ultimate load of the PCL complex increased to 1.71 ± 0.41 N (p = 0.0120), but showed no significant difference from parametrial fascia (1.25 ± 0.85 N) and uterosacral ligament (0.66 ± 0.41 N). The ultimate load of the SIS complex decreased to 5.99 ± 0.37 N, still higher than native tissue. The PP complex's ultimate load (10.02 ± 1.80 N) showed no significant difference from PP alone. The collagen ratio of the PCL complex (48.11 ± 9.88%) was closest to that of the uterosacral ligament (36.66 ± 11.64%), whereas SIS and PP complexes had significantly higher collagen ratios than USL.

Conclusions: Unilateral presacral suspension mimics classical surgery for human POP in rats. First, this procedure can investigate the mechanical properties of pelvic floor tissues at the cellular level after correcting POP. Second, it can be used to validate new materials for the surgical treatment of POP, including but not limited to foreign body reactions with surrounding tissues, absorption time, etc. Third, it can be used to study the biological mechanisms of mesh exposure.

Introduction and hypothesis: The objective of our study was to evaluate the need for antibiotic prophylaxis for urinary tract infection (UTI) prevention before Onabotulinum toxin A injection for overactive bladder (OAB). We hypothesize that the lack of antibiotic prophylaxis might not be inferior to administering prophylaxis.

Methods: This was a multi-centered, nonblinded, randomized controlled trial conducted between August 2022 and September 2024. Participants were randomized to either receive oral antibiotics or no treatment. Our primary outcome was to measure the rate of UTI at 2 weeks. Our secondary outcomes included post-void residuals, assessment for antibiotic compliance, and UTI rates at 6 weeks. Given a 20% UTI rate and a delta of 20%, 64 participants per study arm were necessary to achieve 80% power with an alpha value of 0.05.

Results: Rates of UTI at 2 weeks post-procedure were 9.2% in the antibiotics group and 10.9% in the control group (p = 0.75). UTI rates 6 weeks post-procedure were 4.7% in the antibiotics group and 11.1% in the control group (p = 0.21). When analyzing variables such as age, race, body mass index, menopause status, vaginal estrogen use, or the rates of positive pre-procedure urine cultures, no factors proved to be predictors of developing a UTI at 2 weeks post-procedure. The urinary retention rate in our study was 0.8%.

Conclusions: Rates of UTI were not significantly different between patients who obtained antibiotics prophylaxis and those who did not at 2 and 6 weeks following injection. Foregoing antibiotics prophylaxis in order to safeguard from the dangers of antimicrobial resistance may be considered in the treatment of OAB with Onabotulinum toxin A.

Introduction and hypothesis: Although some evidence suggests that Chinese and white women might have different pelvic floor anatomy such as levator complex and connective tissue support for pelvic organs, it is unknown if these differences affect the mechanisms of pelvic organ prolapse. We sought to determine whether differences exist in MRI-based structural failure patterns between Chinese and American white women with prolapse.

Methods: This is a case-control study in different racial cohorts recruited in China and the USA. The Chinese cohort included 19 women with anterior-predominant prolapse and 24 controls with normal pelvic support. The American white cohort included 30 women with anterior-predominant prolapse and 30 controls. Both cohorts underwent the same clinical evaluation and MRI protocol. Three structural support systems were quantified on stress 3D MRI at maximal Valsalva: vaginal factors (length, width); connective tissue attachment (cervix, lateral paravaginal height); and hiatus factors (urogenital hiatus size, major levator ani injury). Abnormal structural support was defined as any measurement outside the normal range defined as the 5th to 95th percentile in controls from the respective cohort. The percentages of the women with abnormal support in the two cohorts were compared.

Results: Among those with prolapse, Chinese women were more likely than white women to have abnormally long vaginal length and width (90% vs 40%, p < 0.001; 53% vs 23%, p = 0.031 respectively). The occurrence of abnormal apical location, paravaginal location, and genital hiatus size ranged from 89 to 100% in Chinese women and from 63 to 80% in white women.

Conclusions: Prolapse in American white women most commonly involves structural failure of connective tissue attachments and hiatus factors and less frequently involves vaginal wall factors, whereas prolapse in Chinese women frequently involves all support structures.