International Urogynecology Journal最新文献

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.

Introduction and hypothesis: This scoping review is aimed at identifying three-dimensional ultrasound parameters associated with successful outcomes after bulking agent injection for stress urinary incontinence.

Methods: A comprehensive search in Medline, Scopus, and Embase databases was conducted using combinations of the following keywords: 3D; Ultrasonography; Bulking agent. Inclusion criteria included cohort studies, observational studies, and reviews published in English from 2001 to August 2025.

Results: Out of 157 articles in the initial database, 5 studies with 202 patients were eligible for inclusion in our literature review. Circumferential distribution (or horseshoe-shaped distribution) with proximal (or proximal and at the middle level) urethral location of bulking agent seems to be associated with better clinical outcomes.

Conclusions: Although further studies are needed, 3D ultrasound could be a useful tool in the management strategy for stress urinary incontinence using bulking agents.

Introduction and hypothesis: Neovagina creation is an essential area of research in gynecological and reconstructive surgery, addressing congenital conditions like Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and transgender health needs. This study aims to provide a comprehensive bibliometric analysis of global research trends, influential contributors, and thematic developments in this evolving field.

Methods: Data were retrieved from the Web of Science Core Collection, encompassing 357 publications from 56 countries. Bibliometric tools, including VOSviewer, were used to analyze publication trends, author and institutional contributions, and keyword co-occurrences. The study also visualized global collaborations and thematic patterns.

Results: The United States and Italy emerged as the leading contributors, reflecting their advanced research infrastructure and resources. Frequently occurring keywords, including "neovagina," "vaginal agenesis," and "Mayer-Rokitansky-Küster-Hauser syndrome," highlighted the focus on congenital conditions and surgical reconstruction. Time-series analysis revealed increasing attention to uterus transplantation and transgender health since 2018. However, the study identified limited contributions from low-resource regions and insufficient international collaboration.

Conclusions: This analysis highlights the evolving landscape of neovagina creation research, driven by multidisciplinary approaches and thematic diversity. While significant progress has been made, global disparities and research gaps remain. Addressing these issues through international collaborations and equitable research initiatives is critical to advancing clinical practices and improving outcomes for all patients requiring neovagina creation.

Introduction and hypothesis: This project aimed to evaluate the impact of a nurse-physiotherapist triage clinic (NPTC) on service delivery within a urogynaecology department. The NPTC model was designed to be the first point of contact for urogynaecology referrals to supplement a consultant-led model and was run by specialist nurses and pelvic floor physiotherapists. The project period spanned one year before and one year after the NPTC's introduction.

Methods: This was a service evaluation project registered with the local clinical governance team (reference number GYNAE374). A retrospective review of 200 case notes compared patients referred before the NPTC's establishment, pre-NPTC or group 1 (100 new patients), with those referred afterwards, post-NPTC or group 2 (100 new patients), with ensured comparability of primary reasons for referral between both groups. The patient selection for group 1 was conducted using statistical software R version 4.4.2 (R Foundation for Statistical Computing, Vienna, Austria).

Results: The process measure for the project was to determine whether implementation of the NPTC reduced time intervals between general practitioner (GP) referral to first appointment and from the first visit to treatment completion. In both analyses, the NPTC showed significant reduction in the time intervals. The time interval between GP referral and first appointment was significantly reduced in group 2, with a p value of < 0.001. Similarly, the time interval from the first visit to treatment completion was shorter for group 2, with a p value of < 0.001, demonstrating the NPTC's efficiency in accelerating the care process and reducing treatment timelines. The balance measure was to investigate patient satisfaction, using feedback forms, which was overwhelmingly positive; 95% of respondents rated the clinic's service as 'excellent', and 5% rated it as 'good'.

Conclusions: The NPTC model provides an effective, resource-efficient solution to urogynaecological service delivery, demonstrating its potential as a benchmark for modern urogynaecological practice. This was a successful quality improvement journey that can lead the way for adaptation of the same approach by different units.

Introduction and hypothesis: Injuries to the anal sphincter (AS) and levator ani muscles (LAM) are linked to pelvic floor disorders and can be assessed through medical imaging. Artificial intelligence (AI), particularly machine learning and deep learning, is increasingly used in pelvic floor imaging to support clinicians in their diagnostic assessment. However, the quality of AI research in this domain has not been systematically evaluated. Reviewing current AI research and its applications is essential to understand its benefits, as well as its limitations and knowledge gaps.

Methods: We conducted a systematic search of PubMed, Scopus, Web of Science, Embase, and IEEExplore to identify papers on AI development and/or validation for any AS or LAM-related health conditions. Reporting quality was evaluated using the AI version of the Transparent Reporting of a Multi-variable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD-AI) checklist.

Results: We identified 40 studies: 24 using ultrasound and 16 magnetic resonance imaging. Most studies (n = 27) focused on pelvic floor disorders, followed by oncology (n = 8). AI tools often surpassed traditional methods in time efficiency and clinical acceptability. Segmentation was the most common task (n = 25), with UNet-based models dominating (n = 22). Quality assessment showed moderate adherence to reporting standards, with 31 studies meeting 50-75% of TRIPOD-AI items.

Conclusion: AI shows potential in assisting pelvic floor imaging, especially for segmentation tasks. However, most models are not yet ready for widespread clinical adoption. Future studies should focus on improving dataset diversity, external validation, and reporting transparency to enable safe and effective clinical translation.

Registration: PROSPERO (CRD42023464383).

Introduction and hypothesis: This study aimed to investigate the relationship between preoperative pelvic floor muscle (PFM) strength and the efficacy of tension-free vaginal tape-obturator (TVT-O) surgery in women with stress urinary incontinence (SUI).

Methods: Two hundred women diagnosed with SUI who underwent TVT-O surgery were included. PFM strength was assessed preoperatively using a validated digital palpation method. The evaluation of the effectiveness of surgical treatments for SUI was based on standardized criteria for urine leakage during stress conditions, changes in the 1-h pad test urine volume compared to preoperative levels, and the postoperative IIQ-7 scores. Patients were classified into "improved" and "unimproved" groups. Univariate and multivariate logistic regression models were used to analyze the association between PFM strength and postoperative improvement.

Results: A total of 170 patients were categorized as the improved group, while 30 patients were classified in the unimproved group. The improved group demonstrated a mean PFM strength of 3.5 ± 1.4 cmH2O vs. 2.8 ± 1.2 cmH2O (p < 0.01). In both univariate and multivariate logistic regression analyses, PFM strength was significantly associated with postoperative improvement, with odds ratios of 2.8 (95% CI 1.4 to 5.5, p = 0.004) and 2.5 (95% CI 1.2 to 5.0, p = 0.01), respectively. Subgroup analyses revealed that the association was particularly strong in postmenopausal women, multiparous patients, and those with comorbidities.

Conclusion: Preoperative PFM strength is significantly associated with the efficacy of TVT-O surgery for SUI. This study highlights the importance of PFM strength in predicting surgical outcomes and suggests that preoperative assessment of PFM strength may help in optimizing patient selection for SUI patients undergoing TVT-O.

Introduction and hypothesis: The aim of this study was to compare the quality-adjusted life-years (QALYs) attained 1 year after robotics-assisted sacral hystero-colpopexy (RASC) versus Uphold™ vaginal mesh surgery for pelvic organ prolapse repair.

Methods: This was a secondary analysis of a previously published cohort study. A total of 65 patients who underwent RASC and 71 who underwent the Uphold™ procedure completed the 15-dimensional (15D) and the EuroQol five-dimensional three-level (EQ-5D-3L) instruments measuring health-related quality of life (HR-QoL). All patients had symptomatic and anatomical apical prolapse (POP-Q C ≥ stage II) with or without other vaginal wall defects. Changes in HR-QoL instruments were calculated and compared with minimal important change (MIC) thresholds and QALYs gained were estimated for each intervention.

Results: The 15D and EQ-5D-3L mean index scores were improved from preoperatively to 1 year after RASC ([0.88 ± 0.10 to 0.90 ± 0.01] and [0.85 ± 0.1 to 0.90 ± 0.1]) and after Uphold™= ([0.87 ± 0.1 to 0.89 ± 0.1] and [0.86 ± 0.1 to 0.93 ± 0.1], p 0.024 to p < 0.001) with no significant difference between cohorts. Prolapse-related 15D profile index measures, including discomfort, sexual activity, and distress were significantly improved after RASC (p = 0.039 to < 0.001), whereas excretion, discomfort, and sexual activity were significantly improved after the Uphold™ (p = 0.009 to < 0.001). The improvement in 15D scores from baseline to 1-year follow-up of + 0.026 for RASC and + 0.025 for Uphold™ exceeded the MIC, indicating meaningful improvements in patient quality of life. The overall 1-year QALY gain was estimated to be 0.90 ± 0.1 in the RASC and 0.88 ± 0.1 in the Uphold™ cohorts (p < 0.001), with no significant difference between the two interventions (p = 0.514).

Conclusions: The RASC and Uphold™ are both meaningful surgical treatments for prolapse, with significant improvement in the HR-QoL and the 1-year QALY gain and with no significant difference between the two surgeries.