Pub Date : 2024-09-01Epub Date: 2024-07-23DOI: 10.1007/s00192-024-05876-3
Nevine Te West, Katie Harris, Michael Chapman, Kate Hilda Moore
Introduction and hypothesis: Most studies attempting to estimate the age-related prevalence of urinary incontinence (UI) have used questionnaires. In the present study we analysed a consecutive series of urodynamic test results to determine the distribution of the different types of UI in pre- and post-menopausal women. We hypothesised that the prevalence of urodynamic stress incontinence (USI) would be significantly greater in pre-menopausal than in post-menopausal women.
Methods: All women from a large tertiary urogynaecology department, who underwent urodynamic tests during the years 2000-2015 were included. Patient history and test results were collected. A sample size of 1,475 was calculated, based on the hypothesis that the prevalence of USI will be 20% larger in the pre- versus the post-menopausal group.
Results: A total of 2,994 women with UI on urodynamics were available. There was a significant difference between pre- and post-menopausal status for each of the three diagnoses: USI 483 (59.3%) versus 912 (41.8%), detrusor overactivity (DO) 125 (15.4%) versus 399 (18.3%) and USI with concomitant DO 206 (25.3%) versus 869 (39.9%). A bimodal pattern of age was seen in women with USI, with a peak in the 46-50 and 61-65 age group, before decreasing with age. DO generally increased with age. USI with concomitant DO increased steadily after the menopause, becoming the predominant type after the age of 66.
Conclusions: In this large cohort of women attending urodynamics, we have shown that USI is the predominant type of incontinence in pre-menopausal women; however, USI with concomitant DO increases after menopause, eventually predominating.
{"title":"Does Urodynamic Stress Incontinence Increase After the Menopause?: Results from 2,994 Urodynamic Studies in Australian Women.","authors":"Nevine Te West, Katie Harris, Michael Chapman, Kate Hilda Moore","doi":"10.1007/s00192-024-05876-3","DOIUrl":"10.1007/s00192-024-05876-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Most studies attempting to estimate the age-related prevalence of urinary incontinence (UI) have used questionnaires. In the present study we analysed a consecutive series of urodynamic test results to determine the distribution of the different types of UI in pre- and post-menopausal women. We hypothesised that the prevalence of urodynamic stress incontinence (USI) would be significantly greater in pre-menopausal than in post-menopausal women.</p><p><strong>Methods: </strong>All women from a large tertiary urogynaecology department, who underwent urodynamic tests during the years 2000-2015 were included. Patient history and test results were collected. A sample size of 1,475 was calculated, based on the hypothesis that the prevalence of USI will be 20% larger in the pre- versus the post-menopausal group.</p><p><strong>Results: </strong>A total of 2,994 women with UI on urodynamics were available. There was a significant difference between pre- and post-menopausal status for each of the three diagnoses: USI 483 (59.3%) versus 912 (41.8%), detrusor overactivity (DO) 125 (15.4%) versus 399 (18.3%) and USI with concomitant DO 206 (25.3%) versus 869 (39.9%). A bimodal pattern of age was seen in women with USI, with a peak in the 46-50 and 61-65 age group, before decreasing with age. DO generally increased with age. USI with concomitant DO increased steadily after the menopause, becoming the predominant type after the age of 66.</p><p><strong>Conclusions: </strong>In this large cohort of women attending urodynamics, we have shown that USI is the predominant type of incontinence in pre-menopausal women; however, USI with concomitant DO increases after menopause, eventually predominating.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-21DOI: 10.1007/s00192-024-05890-5
Thea Christoffersen, Jonatan Kornholt, Troels Riis, David P Sonne, Niels Klarskov
Introduction and hypothesis: Despite the high prevalence of fecal incontinence, existing treatment options may be inadequate. Drugs that enhance the tone of the anal sphincter complex could potentially be an effective pharmacological approach. This study investigated the effect of the tricyclic antidepressant imipramine on anal sphincter tone in healthy women, employing anal acoustic reflectometry as the evaluating method.
Methods: In a double-blind, randomized, placebo-controlled crossover study, 16 healthy female volunteers were randomized to one of two treatment sequences. The participants attended two study visits separated by at least 7 days' washout. At each visit, they received a single dose of 50 mg imipramine or matching placebo, in alternating order. We assessed the anal opening pressure under the resting state and during voluntary squeezing of the pelvic floor. Measurements were performed pre-dose and 1 h after drug administration, corresponding to the estimated time of peak plasma concentration of imipramine.
Results: All participants completed the study. In total, 44% of the participants reported at least one adverse effect, primarily anticholinergic. Compared with placebo, imipramine increased anal opening pressure by 15.2 cmH2O (95% confidence interval [CI] 2.0-28.2 cmH2O, p = 0.03) in the resting state and 15.1 (95% CI 4.2-26.0 cmH2O, p = 0.01) cmH2O during squeezing.
Conclusions: The findings indicate that imipramine increases anal sphincter tone in healthy women. However, further research is required to evaluate its clinical impact on individuals with fecal incontinence. This research also demonstrates the effectiveness of using anal acoustic reflectometry for assessing pharmacological effects on anal sphincter function.
{"title":"Effect of Single-Dose Imipramine on Anal Sphincter Tone in Healthy Women: A Randomized, Placebo-Controlled Study Using Anal Acoustic Reflectometry.","authors":"Thea Christoffersen, Jonatan Kornholt, Troels Riis, David P Sonne, Niels Klarskov","doi":"10.1007/s00192-024-05890-5","DOIUrl":"10.1007/s00192-024-05890-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Despite the high prevalence of fecal incontinence, existing treatment options may be inadequate. Drugs that enhance the tone of the anal sphincter complex could potentially be an effective pharmacological approach. This study investigated the effect of the tricyclic antidepressant imipramine on anal sphincter tone in healthy women, employing anal acoustic reflectometry as the evaluating method.</p><p><strong>Methods: </strong>In a double-blind, randomized, placebo-controlled crossover study, 16 healthy female volunteers were randomized to one of two treatment sequences. The participants attended two study visits separated by at least 7 days' washout. At each visit, they received a single dose of 50 mg imipramine or matching placebo, in alternating order. We assessed the anal opening pressure under the resting state and during voluntary squeezing of the pelvic floor. Measurements were performed pre-dose and 1 h after drug administration, corresponding to the estimated time of peak plasma concentration of imipramine.</p><p><strong>Results: </strong>All participants completed the study. In total, 44% of the participants reported at least one adverse effect, primarily anticholinergic. Compared with placebo, imipramine increased anal opening pressure by 15.2 cmH<sub>2</sub>O (95% confidence interval [CI] 2.0-28.2 cmH<sub>2</sub>O, p = 0.03) in the resting state and 15.1 (95% CI 4.2-26.0 cmH<sub>2</sub>O, p = 0.01) cmH<sub>2</sub>O during squeezing.</p><p><strong>Conclusions: </strong>The findings indicate that imipramine increases anal sphincter tone in healthy women. However, further research is required to evaluate its clinical impact on individuals with fecal incontinence. This research also demonstrates the effectiveness of using anal acoustic reflectometry for assessing pharmacological effects on anal sphincter function.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-26DOI: 10.1007/s00192-024-05898-x
Daisuke Obinata, Makoto Hara, Sho Hashimoto, Ken Nakahara, Tsuyoshi Yoshizawa, Junichi Mochida, Kenya Yamaguchi, Satoru Takahashi
Introduction and hypothesis: This study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.
Methods: We conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0-II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.
Results: The median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = -0.37, p = 0.014).
Conclusions: Advanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.
导言和假设:本研究评估了盆腔器官脱垂(POP)、虚弱和肌肉疏松症之间的关联,以探讨治疗 POP 如何延长老年妇女的健康预期寿命:我们对前瞻性收集的数据进行了一项回顾性研究,比较了轻度 POP(0-II 期)和晚期 POP(III 期和 IV 期)妇女的情况。这项研究的纳入标准是,在 2020 年 4 月至 2022 年 11 月期间,至少有一种盆底功能障碍症状并接受影像学检查的就诊女性。最初有 119 名患者符合这些纳入标准。如果患者曾接受过 POP 治疗、未对研究调查做出回应或失去随访机会,则将其排除在外。应用这些排除标准后,82 名患者被纳入最终分析,其中 65 人接受了手术(腹腔镜骶尾部结扎术、阴道结扎术、无张力阴道胶带和原生组织修复术)。评估包括 POP 定量、Kihon 检查表、盆腔器官脱垂生活质量(P-QOL)问卷、国际前列腺症状评分(IPSS)、膀胱过度活动症状评分(OABSS)和尿失禁症状问卷(ICIQ-SF)。骨盆肌肉通过核磁共振成像或 CT 进行测量。对43名患者的手术标本进行了雌激素受体α(ERα)、雌激素受体β和雄激素受体的免疫组化分析:结果:参与者的中位年龄为 75 岁。在 82 名患者中,48 人(58.5%)被归类为体弱或体弱前期,22 人(26.8%)表现出运动障碍。41 名患者属于晚期 POP(3 期和 4 期)。这些患者有更多的运动功能障碍(晚期,16 例;轻度,6 例;P = 0.01)。晚期 POP 患者的 P-QOL、ICIQ-SF(中位数:9.5 vs 4,p = 0.006)和 OABSS(7 vs 4,p = 0.008)评分较差,耻骨尾骨肌直径较小(2.5 vs 3 cm,p = 0.017)。术后,P-QOL 有了明显改善(除人际关系外的所有领域:P 结论:POP 晚期与 POP 患者的 P-QOL 差异相关:与轻度 POP 相比,晚期 POP 患者的 QOL 较差,泌尿系统症状加重,耻骨尾骨肌直径缩小,这与肌肉疏松症一致。
{"title":"Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study.","authors":"Daisuke Obinata, Makoto Hara, Sho Hashimoto, Ken Nakahara, Tsuyoshi Yoshizawa, Junichi Mochida, Kenya Yamaguchi, Satoru Takahashi","doi":"10.1007/s00192-024-05898-x","DOIUrl":"10.1007/s00192-024-05898-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.</p><p><strong>Methods: </strong>We conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0-II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.</p><p><strong>Results: </strong>The median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = -0.37, p = 0.014).</p><p><strong>Conclusions: </strong>Advanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-17DOI: 10.1007/s00192-024-05889-y
Luciana Pistelli Gomes Freitas, Helga Elisa Marquesini Gonzales Monaco, Aparecida Maria Pacetta, Sérgio Carlos Nahas, Edmund Chada Baracat, Jorge Milhem Haddad
Introduction and hypothesis: Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Brazilian Portuguese and to clinically validate it in a Brazilian Portuguese-speaking population.
Methods: Translation and validation of the PISQ-IR was performed according to the International Urogynecological Association-recommended process and guidelines. For external validity, PISQ-IR subscales were compared with the clinical measures, Pelvic Organ Prolapse Quantification system (POP-Q) stage, pelvic floor muscle tone, and Oxford Grading Scale (Pearson correlations). Descriptive statistics, internal consistency (Cronbach's alpha coefficient), and test-retest reliability (interclass correlation coefficient) were calculated for all PISQ-IR subscales.
Results: A total of 120 sexually active and 106 not sexually active women were enrolled in the study between March 2015 and July 2019. Internal consistency was acceptable, with Cronbach's alpha values 0.60-0.80, except for the sexual arousal and orgasm, sexual arousal and partner-related issues, sexual arousal and condition-specific issues, global rating of sexual quality and condition impact subscales. PISQ-IR demonstrated good reliability (α > 0.6, CIC = 0.996). The agreement for each individual questionnaire item also individually presented substantial agreement between the assessments (κ 0.61-0.8). There was a correlation between PISQ-IR and POP, mixed, stress and fecal incontinence diagnosis and a positive correlation with pelvic floor muscle function according to the Oxford Scale in sexually active women. For sexually inactive women there was a correlation between PISQ-IR and mixed urinary symptoms.
Conclusions: The Brazilian Portuguese version of PISQ-IR is a reliable and valid tool that can be easily used for the identification and assessment of sexual function in Brazilian Portuguese-speaking women with pelvic floor disorders.
{"title":"Brazilian Portuguese Translation and Validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA revised.","authors":"Luciana Pistelli Gomes Freitas, Helga Elisa Marquesini Gonzales Monaco, Aparecida Maria Pacetta, Sérgio Carlos Nahas, Edmund Chada Baracat, Jorge Milhem Haddad","doi":"10.1007/s00192-024-05889-y","DOIUrl":"10.1007/s00192-024-05889-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Brazilian Portuguese and to clinically validate it in a Brazilian Portuguese-speaking population.</p><p><strong>Methods: </strong>Translation and validation of the PISQ-IR was performed according to the International Urogynecological Association-recommended process and guidelines. For external validity, PISQ-IR subscales were compared with the clinical measures, Pelvic Organ Prolapse Quantification system (POP-Q) stage, pelvic floor muscle tone, and Oxford Grading Scale (Pearson correlations). Descriptive statistics, internal consistency (Cronbach's alpha coefficient), and test-retest reliability (interclass correlation coefficient) were calculated for all PISQ-IR subscales.</p><p><strong>Results: </strong>A total of 120 sexually active and 106 not sexually active women were enrolled in the study between March 2015 and July 2019. Internal consistency was acceptable, with Cronbach's alpha values 0.60-0.80, except for the sexual arousal and orgasm, sexual arousal and partner-related issues, sexual arousal and condition-specific issues, global rating of sexual quality and condition impact subscales. PISQ-IR demonstrated good reliability (α > 0.6, CIC = 0.996). The agreement for each individual questionnaire item also individually presented substantial agreement between the assessments (κ 0.61-0.8). There was a correlation between PISQ-IR and POP, mixed, stress and fecal incontinence diagnosis and a positive correlation with pelvic floor muscle function according to the Oxford Scale in sexually active women. For sexually inactive women there was a correlation between PISQ-IR and mixed urinary symptoms.</p><p><strong>Conclusions: </strong>The Brazilian Portuguese version of PISQ-IR is a reliable and valid tool that can be easily used for the identification and assessment of sexual function in Brazilian Portuguese-speaking women with pelvic floor disorders.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-31DOI: 10.1007/s00192-024-05907-z
Taylor Morganstein, Mihnea Gangal, Eric Belzile, Dorsa Sohaei, Jouhayna Bentaleb, Adi Reuveni-Salzman, Lisa Merovitz, Jens-Erik Walter, Maryse Larouche
Introduction and hypothesis: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. This study was aimed at comparing perioperative and short-term postoperative outcomes of vNOTES versus laparoscopic approaches to uterosacral ligament suspension (USLS) for apical pelvic organ prolapse.
Methods: A retrospective cohort study included all women who underwent vNOTES versus laparoscopic USLS at two university-affiliated centers between 2017 and 2023. The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest.
Results: This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar.
Conclusion: Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.
引言和假设:阴道自然腔道经内镜手术(vNOTES)是妇科手术中的一种新方法。本研究旨在比较vNOTES与腹腔镜子宫骶骨韧带悬吊术(USLS)治疗顶端盆腔器官脱垂的围手术期和术后短期疗效:一项回顾性队列研究纳入了2017年至2023年期间在两所大学附属中心接受vNOTES与腹腔镜USLS手术的所有女性。使用费雪精确检验或t检验对变量之间的关系进行了检验,包括比较组内子宫切除术和子宫整形术结果的子分析。逻辑回归评估了基线因素和手术因素对主要和主要次要结果的影响:这项研究包括47例vNOTES和54例腹腔镜USLS病例(分别包括11例和15例子宫切除术)。两组的基线人口统计学特征相似。手术结果无差异,也无输尿管损伤病例。vNOTES技术每侧使用的缝合线明显更多(2.0 [2.0-4.0] vs 1.0 [1.0-1.0],p = 0.001)。术后 6 周内的并发症无明显差异。两组患者的 POP 主观症状基线发生率相当(100% vs 96.2%,p = 1.00),但在 6 周后均有明显改善(4.3% vs 11.1%,p = 0.282)。6周时,使用vNOTES的患者获得解剖学成功的比例明显更高(93.5% vs 78.6%,p = 0.042)。子宫切除术亚组和子宫肌瘤切除术亚组的基线和6周POP症状相似:结论:vNOTES和腹腔镜USLS术后6周的主观成功率相当。VNOTES方法在6周时的解剖成功率更高,但在调整手术因素后,差异并不显著。
{"title":"vNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.","authors":"Taylor Morganstein, Mihnea Gangal, Eric Belzile, Dorsa Sohaei, Jouhayna Bentaleb, Adi Reuveni-Salzman, Lisa Merovitz, Jens-Erik Walter, Maryse Larouche","doi":"10.1007/s00192-024-05907-z","DOIUrl":"10.1007/s00192-024-05907-z","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. This study was aimed at comparing perioperative and short-term postoperative outcomes of vNOTES versus laparoscopic approaches to uterosacral ligament suspension (USLS) for apical pelvic organ prolapse.</p><p><strong>Methods: </strong>A retrospective cohort study included all women who underwent vNOTES versus laparoscopic USLS at two university-affiliated centers between 2017 and 2023. The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest.</p><p><strong>Results: </strong>This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar.</p><p><strong>Conclusion: </strong>Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-08-31DOI: 10.1007/s00192-024-05915-z
Jittima Manonai
{"title":"Levator Ani Muscle Avulsion after Vaginal Delivery Between Routine Versus Restrictive Episiotomy: A Pilot Study.","authors":"Jittima Manonai","doi":"10.1007/s00192-024-05915-z","DOIUrl":"10.1007/s00192-024-05915-z","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-03DOI: 10.1007/s00192-024-05844-x
Ahmed Soliman, Mariam Adel, Mohamed A Elnagar, Saif Elsonbaty, Ahmed El Hefnawy
Introduction and hypothesis: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized by chronic inflammation that affects the bladder. The study was aimed at evaluating the effectiveness of intravesical platelet-rich plasma (PRP) injections in patients with IC/BPS.
Methods: We conducted a comprehensive search strategy to involve studies that investigate the efficacy of intravesical PRP injections or instillations over different time intervals. Various outcome measures were assessed, including pain scores, functional outcomes, urodynamic parameters, and surface expressions on the urothelium.
Results: Our search strategy revealed 1,125 studies. After screening, ten articles met the inclusion criteria. Intravesical PRP significantly reduced the visual analog scale (VAS) compared with baseline scores. Several clinical trials reported significant improvements in the global response rate (GRA), O'Leary-Sant Symptom (OSS) questionnaire, Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI). Urodynamic parameters such as maximum flow rate (Qmax) and post-voiding residual (PVR) showed significant improvements in some studies.
Conclusion: The study concluded that intravesical PRP injections could be a promising effective treatment option for IC/BPS patients by their significant ability to reduce pain. However, improvement of urodynamic and functional outcomes is still not clear. Further large comparative trials are still warranted to assess the efficacy of PRP instillation.
{"title":"How Intravesical Platelet-Rich Plasma Can Help Patients with Interstitial Cystitis/Bladder Pain Syndrome: A Comprehensive Scoping Review.","authors":"Ahmed Soliman, Mariam Adel, Mohamed A Elnagar, Saif Elsonbaty, Ahmed El Hefnawy","doi":"10.1007/s00192-024-05844-x","DOIUrl":"10.1007/s00192-024-05844-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized by chronic inflammation that affects the bladder. The study was aimed at evaluating the effectiveness of intravesical platelet-rich plasma (PRP) injections in patients with IC/BPS.</p><p><strong>Methods: </strong>We conducted a comprehensive search strategy to involve studies that investigate the efficacy of intravesical PRP injections or instillations over different time intervals. Various outcome measures were assessed, including pain scores, functional outcomes, urodynamic parameters, and surface expressions on the urothelium.</p><p><strong>Results: </strong>Our search strategy revealed 1,125 studies. After screening, ten articles met the inclusion criteria. Intravesical PRP significantly reduced the visual analog scale (VAS) compared with baseline scores. Several clinical trials reported significant improvements in the global response rate (GRA), O'Leary-Sant Symptom (OSS) questionnaire, Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI). Urodynamic parameters such as maximum flow rate (Qmax) and post-voiding residual (PVR) showed significant improvements in some studies.</p><p><strong>Conclusion: </strong>The study concluded that intravesical PRP injections could be a promising effective treatment option for IC/BPS patients by their significant ability to reduce pain. However, improvement of urodynamic and functional outcomes is still not clear. Further large comparative trials are still warranted to assess the efficacy of PRP instillation.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-13DOI: 10.1007/s00192-024-05868-3
Bernard L Harlow, Gerald McGwin, Siobhan Sutcliffe, Colleen M Fitzgerald, Jerry L Lowder, Diane K Newman, Melanie Meister, Deepa R Camenga, Ann Stapleton, Vanika Chary, Emily S Lukacz
Introduction and hypothesis: Women with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking.
Methods: Women in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social-occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling.
Results: Of 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8-54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6-59.8), and no pain (59.3; 95% CI 53.3-65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4-67.9) compared with nongenital pain (72.1; 95% CI 67.7-76.5) and no pain (77.4; 95% CI 73.0-81.8).
Conclusions: Heightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function.
导言和假设:患有外阴阴道或生殖器疼痛的女性通常会出现间质性膀胱炎/膀胱疼痛综合征(IC/BPS)和尿路感染。然而,生殖器疼痛与膀胱健康之间的关系尚缺乏研究:预防下尿路症状联盟的 RISE FOR HEALTH 群体研究中的女性回答了有关膀胱健康的全球性问题,以及有关保持、功效、社交-职业、身体活动、亲密关系、旅行、情感、感知和自由等九个膀胱健康领域的问题。膀胱功能通过六项指数进行评估,包括尿频、感觉、持续性、舒适度、排空和菌群失调(如尿路感染)。使用经过验证的疼痛图表对参与者进行分组,包括除短暂事件(即轻微头痛、牙痛或扭伤)外无疼痛、仅与生殖器无关的疼痛以及任何生殖器疼痛。采用一般线性模型对调整后的平均得分和指数进行比较:在 1,973 名符合条件的妇女中,250 人(12.7%)报告了生殖器疼痛,609 人(30.9%)报告了非生殖器疼痛,1,114 人(56.5%)报告了无疼痛。与仅有非生殖器疼痛的女性(53.7;95% CI 47.6-59.8)和无疼痛的女性(59.3;95% CI 53.3-65.4)相比,有任何生殖器疼痛的女性在所有膀胱健康量表(BHS;BHS 总体调整后平均值为 47.5;95% CI 40.8-54.1)中的调整后平均得分较低(较差)。同样,与非生殖器疼痛(72.1;95% CI 67.7-76.5)和无疼痛(77.4;95% CI 73.0-81.8)相比,生殖器疼痛患者的膀胱功能指数调整后平均总分较低(63.1;95% CI 58.4-67.9):对生殖器疼痛与膀胱健康之间关系的进一步认识,应促使临床医生对患有生殖器疼痛的女性进行膀胱健康和功能评估。
{"title":"Genital Pain and the Spectrum of Bladder-Related Symptoms: Findings from the Prevention of Lower Urinary Tract Symptoms Research Consortium RISE FOR HEALTH Study, USA.","authors":"Bernard L Harlow, Gerald McGwin, Siobhan Sutcliffe, Colleen M Fitzgerald, Jerry L Lowder, Diane K Newman, Melanie Meister, Deepa R Camenga, Ann Stapleton, Vanika Chary, Emily S Lukacz","doi":"10.1007/s00192-024-05868-3","DOIUrl":"10.1007/s00192-024-05868-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Women with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking.</p><p><strong>Methods: </strong>Women in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social-occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling.</p><p><strong>Results: </strong>Of 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8-54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6-59.8), and no pain (59.3; 95% CI 53.3-65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4-67.9) compared with nongenital pain (72.1; 95% CI 67.7-76.5) and no pain (77.4; 95% CI 73.0-81.8).</p><p><strong>Conclusions: </strong>Heightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-02DOI: 10.1007/s00192-024-05912-2
Lisa Stevens, Mariana Masteling, Kruthi Srinivasa Raju, Sara Mastrovito, James A Ashton-Miller, John O L DeLancey
Introduction and hypothesis: Vaginal dimensions have clinical and surgical implications. We sought to quantify the differences between vaginal and labial dimensions in healthy ethnic Chinese and Western women with normal pelvic organ support.
Methods: This is a cross-sectional study of a convenience sample of ethnic Chinese nulliparas (n = 33) and Western nulliparas (n = 33) recruited for research purposes. For each subject, magnetic resonance imaging was used to quantify the vaginal and labial dimensions. Specifically, we identified the anterior and posterior vaginal wall, the outline of the cervix in the mid-sagittal and coronal planes, and the distance from the labia majora to the hymenal ring at the urethral meatus.
Results: There were significant differences in age and weight between groups. Substantial variation in vaginal and labial dimensions was found within each group. The vaginal and labial dimensions of ethnic Chinese women ranged from 9-21% smaller than those of Western women; In the ethnic Chinese group, increasing weight and BMI correlated with greater labial distance (r = 0.66 and r = 0.63 respectively); as did height and the distance from the vaginal opening to the cervical os (r = 0.5). In the Western group, only weight correlated with the labial distance (r = 0.51).
Conclusions: Significant group differences in vaginal and labial dimensions were found, with the dimensions of Chinese nulliparas being up to 21% smaller than those of Western nulliparas.
{"title":"Comparison of the Vaginal and Labial Dimensions of Ethnic Chinese and Western Nullipara.","authors":"Lisa Stevens, Mariana Masteling, Kruthi Srinivasa Raju, Sara Mastrovito, James A Ashton-Miller, John O L DeLancey","doi":"10.1007/s00192-024-05912-2","DOIUrl":"10.1007/s00192-024-05912-2","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal dimensions have clinical and surgical implications. We sought to quantify the differences between vaginal and labial dimensions in healthy ethnic Chinese and Western women with normal pelvic organ support.</p><p><strong>Methods: </strong>This is a cross-sectional study of a convenience sample of ethnic Chinese nulliparas (n = 33) and Western nulliparas (n = 33) recruited for research purposes. For each subject, magnetic resonance imaging was used to quantify the vaginal and labial dimensions. Specifically, we identified the anterior and posterior vaginal wall, the outline of the cervix in the mid-sagittal and coronal planes, and the distance from the labia majora to the hymenal ring at the urethral meatus.</p><p><strong>Results: </strong>There were significant differences in age and weight between groups. Substantial variation in vaginal and labial dimensions was found within each group. The vaginal and labial dimensions of ethnic Chinese women ranged from 9-21% smaller than those of Western women; In the ethnic Chinese group, increasing weight and BMI correlated with greater labial distance (r = 0.66 and r = 0.63 respectively); as did height and the distance from the vaginal opening to the cervical os (r = 0.5). In the Western group, only weight correlated with the labial distance (r = 0.51).</p><p><strong>Conclusions: </strong>Significant group differences in vaginal and labial dimensions were found, with the dimensions of Chinese nulliparas being up to 21% smaller than those of Western nulliparas.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-04DOI: 10.1007/s00192-024-05863-8
Reut Rotem, Orfhlaith E O'Sullivan
{"title":"Re: Excluding Male Trainees in Obstetrics and Gynecology: Why We Do It and Why It's Wrong.","authors":"Reut Rotem, Orfhlaith E O'Sullivan","doi":"10.1007/s00192-024-05863-8","DOIUrl":"10.1007/s00192-024-05863-8","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}