International Urogynecology Journal最新文献

Introduction: Stress urinary incontinence (SUI) imposes a high healthcare burden and significantly affects quality of life and daily functioning. While midurethral slings remain the standard surgical treatment, periurethral bulking with polyacrylamide hydrogel (PAHG) is increasingly utilized. Existing studies focus on PAHG success, and have been limited by small sample sizes and short follow-up. This study aimed to assess PAHG failure risk, time to failure, and the likelihood of repeat injections, while identifying associated risk factors.

Hypothesis: Periurethral injection with PAHG for SUI in a complex patient cohort, will have a significant failure rate within 24 months, with a mean time to failure under 2 years and a high rate of repeat SUI surgery.

Methods: We conducted a retrospective review of all SUI patients who underwent PAHG injection at a single center from January 1, 2014, to August 31, 2020. We defined subjective PAHG failure as patient-reported recurrent SUI symptoms.

Results: Among the 256 patients who underwent PAHG injection during the study period, 35.9% (N = 92) experienced PAHG failure within 2 years (mean time to failure 9.061 months (SD 11.60 months)). Repeat PAHG injection was performed in 12% (N = 30), while 15% (N = 38) underwent other incontinence surgery. Multivariable analysis did not show any factors associated with increased risk of PAHG failure.

Conclusions: Polyacrylamide hydrogel for SUI, in medically and surgically complex patients, has similar failure rates and mean time to failure, as in uncomplicated patients.

Introduction and hypothesis: The objective was to develop a retrieval-augmented ChatGPT model grounded in evidence-based patient education materials and compare its performance against the standard ChatGPT model in responding to common urogynecology patient questions in this pilot study.

Methods: We developed a retrieval-augmented ChatGPT-4.0 model that prioritized content from International Urogynecological Association patient information leaflets. Ten commonly asked patient questions were submitted to both the standard and retrieval-augmented models. Six board-certified urogynecologists evaluated responses using the validated Quality Analysis of Medical Artificial Intelligence (QAMAI) tool, which assesses accuracy, clarity, relevance, completeness, usefulness, and sources. Total and domain-specific QAMAI scores were compared using the Wilcoxon signed-rank test, and a sensitivity analysis was performed, excluding the unblinded Source domain.

Results: The retrieval-augmented model demonstrated significantly higher total QAMAI scores than the standard model (median 22 [interquartile range, IQR, 19-25] vs 16 [IQR 13-18], p < 0.01) and outperformed the standard model in all six domains. In the sensitivity analysis, the retrieval-augmented model maintained significantly higher performance (18 [IQR 16-20] vs 14.5 [IQR 11-17], p < 0.01). Clinician raters preferred the retrieval-augmented model in 81% of responses.

Conclusions: Grounding AI tools in vetted patient education materials significantly improved the quality of ChatGPT-generated responses in urogynecology. Retrieval-augmented models offer a promising approach to enhance patient education and promote patient-centered care.

Introduction and hypothesis: To evaluate in-hospital analgesic use patterns for pelvic organ prolapse (POP) repair and identify predictors of higher opioid prescribing using a large, national patient administrative database.

Methods: This retrospective cohort study used a large, national administrative database (2010-2022) to identify women undergoing vaginal non-apical (NAR), vaginal apical (VAR), laparoscopic apical (LAR), or robotic apical (RAR) repairs. Opioid doses were converted to morphine milligram equivalents (MME). The primary outcome was total opioid, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAID) use. Secondary outcomes included differences in analgesic doses by surgical approach, predictors of higher POD-0 opioid use, postoperative 30-day readmission/emergency room (ER) visit rate, and the relationship between opioid use and 30-day readmission/ER visits.

Results: Among 102,329 procedures, median POD-0 opioid dose was lowest in NAR (77.5 MME) (p < 0.001). NSAID and acetaminophen use was more common with minimally invasive approaches. Concurrent hysterectomy was the strongest predictor of higher POD-0 opioid use (exp(β) = 1.41, p < 0.001), along with adhesiolysis (exp(β) = 1.26, p < 0.001), bladder injury repair (exp(β) = 1.24, p < 0.001), anti-incontinence procedures (exp(β) = 1.05, p < 0.001), noncommercial insurance (exp(β) = 1.04, p = 0.002), and large hospital size (exp(β) = 1.09, p = 0.037). Older age (exp(β) = 0.87 per decade, p < 0.001), high Elixhauser comorbidity index (exp(β) = 0.9, p < 0.001), and NAR (exp(β) = 0.93, p < 0.001) were associated with lower opioid use. Receiving > 90 MME on POD-0 was linked to higher 30-day readmission/ER visit rates (8.3% vs 5.6%; p < 0.001, respectively).

Conclusions: Apical repair techniques did not show significant differences in predicting higher opioid use. Concurrent hysterectomy was the strongest predictor of higher opioid use. Higher opioid doses on POD-0 were associated with increased 30-day readmission/ER rates.

Introduction: Labiaplasty is the most frequently performed female genital cosmetic surgery worldwide, with indications extending beyond aesthetics to functional and psychosocial concerns. Labia minora elongation is frequently accompanied by clitoral prepuce prominence, yet this remains overlooked in surgical planning. This study describes a surgical technique integrating labia minora reduction with clitoral prepuce contouring and reports outcomes in a retrospective cohort.

Methods: Women who underwent labiaplasty between 2018 and 2023 were contacted, and 132 of 185 (71.3%) returned anonymous questionnaires addressing motivations, perioperative experience, satisfaction, self-esteem, body image, and sexual function. The procedure was performed predominantly in an outpatient setting under local anesthesia. Excision and hemostasis were performed using the Fraxx System with ultrafine cutting and bipolar tips.

Results: The "Y technique" was employed in 103 cases, particularly when clitoral prepuce prominence accompanied labia minora elongation. In the remaining 29, labiaplasty was performed without prepuce correction or with an alternative technique. Motivations included dissatisfaction with aesthetics, discomfort, and embarrassment; over one-third reported all three. The perioperative experience was favorable, with most patients reporting the procedure as less painful and more tolerable than expected. No major complications occurred; postoperative effects included minor wound dehiscence and occasional requests for aesthetic revision procedures. Patients reported significant reductions in dissatisfaction with genital appearance.

Conclusions: Outpatient labiaplasty under local anesthesia is safe, feasible, and well accepted, offering privacy and comfort. The "Y technique" adds value by being simple, reproducible, and delivering excellent functional, psychosocial, and aesthetic outcomes through simultaneous correction of labial and clitoral prepuce prominence.

Introduction and hypothesis: The vaginal and urinary microbiomes are closely linked, yet the role of this relationship in recurrent and chronic urinary tract infections (UTIs) remains uncertain. Research into genitourinary ecology and UTI has largely focused on acute infections and reproductive age groups, leaving a gap in understanding the role of the microbiome in recurrent and chronic cases. This review is aimed at presenting that disruptions within vaginal microbiota contribute to UTI chronicity in menopausal women, highlighting the potential for microbiome-targeted interventions in this high-risk group.

Methods: A comprehensive literature review was conducted, with search terms including cystitis, urogenital, antibiotic, infection, and bladder, vaginal microbiome, vaginal ecology, topical oestrogen, atrophy, genitourinary syndrome of menopause, vulvo-vaginal atrophy (VVA), bacterial vaginosis and lactobacillus. Relevant articles were screened, critiqued, and synthesised based on key themes.

Results: Lactobacillus spp. appears to be the key component of a healthy vaginal microbiome. Decreased vaginal Lactobacillus abundance, seen with vaginal dysbioses and the menopause, correlates with an increased presence of urinary pathogens, increasing susceptibility to UTI. This review demonstrates that interventions to optimise vaginal ecology could reduce UTI burden. These approaches offer non-antibiotic treatment strategies, lowering antimicrobial resistance risk. However, studies frequently exclude those with chronic and recurrent infections, underscoring the necessity for more research targeting this group.

Conclusions: This review highlights the link between disrupted vaginal ecology and recurrent and chronic UTI, and the need for expanded research into microbiome-targeted treatments. A paucity of studies researching recurrent and chronic UTI cohorts limits the evidence base for clinical generalisation, meaning that more focussed studies are needed to improve understanding and clinical management.

Introduction and hypothesis: Pelvic Floor Disorders (PFDs) are common and negatively affect women's quality of life. Despite availability of treatments, women often do not seek medical care. Patient knowledge is a known barrier to accessing care. It has been shown that knowledge of PFDs is lower in Canadian immigrant communities. We hypothesized that educating Cultural Health Brokers (CHBs) on PFD will significantly increase the CHBs' knowledge and empower them to effectively communicate this knowledge to their communities, improving awareness and access to care among immigrant women.

Methods: We developed a "train-the-trainer" model on PFD knowledge for CHBs. Two workshops were held for 36 CHBs. Written material was produced in ten languages. CHB perspectives on the training was assessed with the Kirkpatrick model and knowledge retention was assessed with Prolapse and Incontinence Knowledge Questionnaires (PIKQ) pre and post workshops and at 1-year follow-up.

Results: Participants found that workshop content, the facilitators' knowledge, and delivery were appropriate. Participating in the workshop increased knowledge in urinary incontinence PIKQ score (9.6 ± 1.9 vs. 11.2 ± 0.9; p = 0.0003); and prolapse (7.8 ± 2.4 vs. 9.8 ± 1.4; p < 0.0005). The 1-year follow-up survey revealed that over 80% of CHBs felt empowered to discuss PFD with clients, and 80% of CHBs believed that the training empowered clients to seek care.

Conclusions: The "train-the-trainer" model was well received by our community partners and improved PFD knowledge in CHBs. We expect this will result in increased knowledge of PFDs among immigrant women and better access to care for this population.

Introduction and hypothesis: The posterior urethrovesical angle (PUVA) is larger in women with general stress urinary incontinence (SUI) than those without. We aimed to determine whether baseline PUVA or changes in PUVA after a treadmill run differ between runners with and without running-induced SUI (RI-SUI). Among runners with RI-SUI, we also compared those who leaked urine during a treadmill protocol and those who did not.

Methods: We recruited female runners with and without RI-SUI. Ultrasound imaging was used to measure bladder volume (BV) in supine (transabdominal) and PUVA in standing (transperineal), before and after a standardized treadmill run. Separate general linear models (α = 0.05) included PUVA as the dependent variable, time (pre- vs post-run) and group (continent vs incontinent) as independent variables, and baseline BV and PUVA, age and parity as covariates, first comparing runners with and without RI-SUI then, among runners with RI-SUI, comparing those who leaked urine and those who did not.

Results: Of the 96 participating runners, data from 85 (28 with RI-SUI, 57 without) were analyzed after excluding images with poor PUVA visualization. PUVA increased after running (continent 120.4 ± 15.8º to 125.6 ± 15.7º; RI-SUI 123.8 ± 15.6º to 127.0 ± 17.1º) with no significant between-group differences or interactions (time × group F(1,1) = 1.32, p = 0.25, partial η² = 0.016). There was no difference in PUVA or change in PUVA between those with RI-SUI who did and did not leak urine during the run.

Conclusions: Although proximal urethral support is reduced in women after a treadmill run, the PUVA does not appear to be independently associated with RI-SUI.

Introduction and hypothesis: Constipation is one of the most frequent functional gastrointestinal dysfunctions, with a negative impact on women's quality of life. There are currently no epidemiological data on the magnitude of constipation among adult women in the Democratic Republic of Congo (DRC). To determine the prevalence of constipation among adult women in the DRC and to identify the risk factors associated with it.

Methods: This was a community-based cross-sectional study conducted from 2021-2023 among 516 adult women (≥18 years) in six provinces of the DRC. A multistage, geographically and ethnolinguistically stratified sampling approach was used. Pregnant or postpartum women ≤ 6 months, survivors of sexual violence and those with anorectal and rectovaginal fistulas were excluded. The diagnosis of constipation was made for a score of ≥ 11 on the KESS constipation questionnaire. Pelvic floor muscles were assessed according to the PERFECT scheme. Binary logistic regression was performed to identify risk factors.

Results: The prevalence of constipation was 16.1% (95% CI 13.1-19.6%), with a higher prevalence observed among women over the age of 50. Hard stool consistency and difficult, painful evacuating were the most common suggestive symptoms encountered in constipated women (p < 0.001). Constipation negatively affected sexual quality of life (p < 0.001). In the multivariable analysis, lower mental health scores of life quality (adjusted odds ratio [aOR] 0.98; 95% CI 0.97-0.99) and belonging to the Baluba ethnolinguistic group (aOR 0.31; 95% CI 0.13-0.68) were protective factors against.

Conclusion: Constipation is a non-negligible health concern among adult women in the DRC.