International Urogynecology Journal最新文献

Introduction and hypothesis: Women with pelvic organ prolapse (POP) have reduced vaginal sensation. Vaginal birth has been associated with both sensory nerve injury and prolapse. It is unclear whether the impaired vaginal sensation seen in POP is caused during childbirth or by the prolapsing tissues themselves.

Methods: The objective was to perform to our knowledge the first study to compare vaginal sensation between women with postnatal POP and women without postnatal POP. A prospective cohort study (Canadian task force classification II-2) of 124 primiparous women who underwent Pelvic Organ Prolapse Quantification examination and neurophysiology at 3 and 6 months postnatally was carried out. Women underwent vibration quantitative sensory testing for Aβ nerve function and stretch quantitative sensory testing for Aα nerve function. POP was defined a priori as the distal-most portion of the vaginal wall at or below the hymen.

Results: There was no difference in age or BMI between women with POP and women without POP. Vaginal vibration and stretch sensation were reduced in women with POP compared with controls at 3 months postnatally (p = 0.021 and 0.007 respectively). At 6 months postnatally vibration sensation remained impaired in the POP group, whereas stretch sensation had recovered compared with the control group (p < 0.001 and 0.498 respectively).

Conclusions: Vaginal sensation was reduced in women with postnatal POP suggesting that childbirth might contribute to the impaired vaginal sensation seen in women with POP in later life. Further work is required to determine if the impairment persists and is the reason for impaired sensory function seen in women with POP in later life.

Introduction and hypothesis: Midurethral sling (MUS) success may depend on sling positioning along the urethra, which may be affected by concurrent apical prolapse repair. Our prospective cohort study evaluated differences in MUS positioning using translabial ultrasound in women who had MUS only versus those with concurrent apical prolapse repair.

Methods: Women undergoing MUS with or without concurrent prolapse repair were enrolled. MUS was placed after the apical suspension. Ultrasound images were obtained at the beginning of the case, after suspension (if applicable), and following sling placement. Two experts reviewed the images and measured the urethral length, sling positioning along the urethra, and the angle between the urethra and the pubic symphysis. Measurements were averaged for statistical analysis.

Results: Fifty-one women participated: 27 in the MUS alone group and 24 in the concurrent group. There were no differences in urethral length (27.4 vs 27.2 mm, p = 0.728), MUS position (0.24 vs 0.26 mm; p = 0.71), or angle (24° vs 23°, p = 0.574). Both groups demonstrated a significant improvement in Urinary Distress Inventory6 scores.

Conclusions: There have been conflicting reports of MUS success when placed on its own versus at the time of prolapse repair. One hypothesis has been that positioning of the MUS may be affected by the prolapse repair. Our study did not observe any difference in the MUS positioning along the urethra, nor sling angle when placed with or without a concurrent prolapse repair.

Introduction and hypothesis: Our aim was to compare residents' skill for anal sphincter injury repair in a silicone-latex simulation anal sphincter injury model after video demonstration, simulation-based training, and a combination of both.

Methods: We randomized obstetrics and gynecology residents to video demonstration by an expert (group 1), simulation-based training (group 2) and a combination training model (group 3) using a validated silicone-latex simulation anal sphincter injury model. We tested the anal sphincter injury repair skills of the residents using the global rating scale (GRS) and the objective structured assessment of technical skills (OSATS) scoring system. We assessed the validity of the GRS and OSATS scoring system in Bahasa using this anal sphincter injury model.

Results: Thirty-three residents were randomized into the three groups. Group 3 had the largest different in GRS scores (9.82 95% CI (8.45-11.19)). Group 2 (9.45 95% CI (7.85-11.05)) followed and the lowest different GRS score was in group 1 (7.18 95% CI (5.95-8.41)). There was a significant difference amongst the three group (p = 0.018). The highest OSATS score difference was in group 3 (8.91 95% CI (7.49-10.33)), followed by group 2 (6.82 95% CI (5.55-8.09)), and the lowest score difference was in group 1 (5.45 95% CI (3.39-7.52)). There was a significant difference amongst the three groups (p = 0.007).

Conclusions: Combination training is the most superior training for improving anal sphincter injury repair in a simulation model.

Introduction and hypothesis: This study was aimed at adapting, validating, and assessing the reliability of the Turkish version of the "Barriers to Incontinence Care-Seeking Questionnaire" (BICS-Q).

Methods: One hundred and forty-eight Turkish women with mild to moderate urinary incontinence (UI) was assessed. The adaptation process was conducted in alignment with the COSMIN guidelines: forward-backward translation, expert review, cultural adaptation, and a pilot study. For construct validity, items from the study by El-Azab and Shaaban, which measure barriers to seeking care for incontinence, were adapted to this self-reported questionnaire (BICS-Q), and their associations with the total score as well as the subscale scores of the questionnaire were evaluated. Cronbach's alpha was used for internal consistency, and the intraclass correlation (ICC) coefficient was estimated for test-retest reliability.

Results: The psychometric analyses indicated that the Turkish BICS-Q has high internal consistency (Cronbach's alpha = 0.846) and test-retest reliability (ICC = 0.854). Item analysis revealed that each item was significantly correlated with the total score, thereby confirming construct validity. It was also found that embarrassment, financial concerns, and low expectations from medical consultation were ranked as the most important barriers to treatment.

Conclusions: This study demonstrated the applicability of the Turkish BICS-Q for both research and clinical purposes, emphasizing its role in identifying health care inequalities and guiding policy improvements for women with UI. The present validation study provides evidence that the Turkish BICS-Q is an appropriate tool for assessing barriers to incontinence care seeking that can be used to further research and interventions toward overcoming the barriers in Turkey.

Background and purpose: Pelvic floor rehabilitation is a specialized therapeutic approach focused on assessing and treating pelvic floor muscle dysfunction to enhance bladder, bowel, and sexual function, as well as pelvic organ support, through targeted exercises and behavioral interventions. While applicable to all populations across the lifespan, it holds particular importance for women due to the high prevalence of pelvic floor disorders. As research in this field has grown rapidly, a comprehensive overview is needed to map its development and guide future directions. This bibliometric analysis aims to analyze publication trends, assess current knowledge, and investigate thematic structure in pelvic floor rehabilitation research.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection (coverage from 1900 to present). Articles and reviews published in English from database inception to December 2024 were included. VOSviewer and CiteSpace were employed to perform co-authorship, co-occurrence, co-citation, bibliographic coupling, and burst detection analyses.

Results: A total of 5020 publications (3768 articles and 1252 reviews) were included. The number of publications increased from 61 in 2000 to 468 in 2024, representing a 7.7-fold growth over this period. The top contributing countries were the United States, Brazil, England, China, and Australia. Eight thematic clusters were identified: urinary incontinence, pelvic pain, bowel dysfunction, conservative management, pelvic floor muscle, pregnancy-related care, exercise interventions, and psychometric evaluation. Co-authorship networks highlighted international collaboration, with prominent institutions in Canada, Australia, and Europe. Co-citation and burst analyses revealed seminal works and emerging topics, with recent trends focusing on women's health, sexual function, pelvic pain, and quality of life.

Conclusions: This bibliometric analysis highlights the rapid growth and evolving focus of pelvic floor rehabilitation research over the past 75 years. The findings identify key contributors, international collaborations, and emerging priorities, offering strategic insights for advancing clinical practice and research.

Introduction and hypothesis: Aging may place patients at greater risk for adverse perioperative outcomes. We hypothesized that women undergoing minimally invasive (MIS) sacrocolpopexy aged ≥ 70 years are more likely to experience adverse events (AE) within 8 weeks of surgery.

Methods: We performed a secondary analysis of a retrospective study on perioperative adverse events in women ≥ 61 years old undergoing prolapse surgery at a single academic center from January 2016 to May 2023. Only women undergoing MIS sacrocolpopexy were included. The primary outcome was a composite 8-week AE outcome. Secondary outcomes included prolapse recurrence and mesh complication. Variables were compared between the groups using t-test (or Mann-Whitney U) and chi-square (or Fisher's exact) analyses. Multivariable logistic regression was performed, controlling for variables with p < 0.05 on univariate analysis.

Results: Of the 709 women who underwent MIS sacrocolpopexy, 29.9% (n = 212) were aged ≥ 70 years. Age ≥ 70 was not significantly associated with 8-week perioperative AEs, nor was it associated with prolapse recurrence or mesh complication. The composite AE outcome was not associated with age ≥ 70 on multivariable analysis, controlling for CCI score, robotic approach, and concomitant hysterectomy (adjusted odds ratio (aOR) 0.64, 95% confidence interval (CI) [0.38-1.10]). Women aged ≥ 70 years had a 73% lesser adjusted odds of surgical site infections on multivariable analysis (95% CI [0.08-0.93]).

Conclusions: Age ≥ 70 years is not associated with perioperative AEs, prolapse recurrence, or mesh complication. These findings highlight the safety profile of this surgical approach in older women, an important consideration for urogynecologic surgeons caring for an aging population.

Introduction and hypothesis: There is limited literature regarding concomitant initiation of pelvic floor physical therapy (PFPT) and medications for overactive bladder treatment. PFPT improves patient symptoms, although adherence tends to be low. This retrospective cohort study assessed PFPT adherence of female patients with overactive bladder at a tertiary care center who were referred to PFPT. We hypothesized that concomitant PFPT and medication would correlate with decreased PFPT adherence among patients with overactive bladder.

Methods: Adherence to PFPT (defined as ≥ 50% attendance of the recommended sessions) was compared in patients with (PT + Med group) and in those without (PT group) concomitant medication prescription.

Results: We evaluated 346 patients, with 196 in the PT group and 150 in the PT + Med group. The PT + Med group had a higher body mass index (30.0 kg/m² vs 27.5 kg/m², p < 0.001), a higher rate of diabetes (20.7% vs 11.7%, p = 0.02), and higher urogenital distress inventory scores at baseline (p < 0.001). The PT group completed more PT sessions (p < 0.001) and was more likely to be adherent (30.6% vs 15.3%, p < 0.001). The PT + Med group was more likely to progress to minimally invasive therapy (10.0% vs 4.1%, p = 0.03). On multivariable logistic regression model, PFPT adherence remained significantly lower for the PT + Med group when controlling for comorbidities (adjusted OR 0.38, p = 0.001).

Conclusions: The addition of medication at the time of PFPT referral was associated with decreased PFPT adherence in overactive bladder patients.