International Urogynecology Journal最新文献

Introduction and hypothesis: The uterosacral ligaments (USLs) are bilateral deep pelvic support structures used in pelvic floor reconstructive surgery for treatment of apical pelvic organ prolapse (POP). We assessed the feasibility of a new surgical technique using the distal USLs.

Methods: Fresh frozen un-embalmed female cadavers were studied over a 2-year period (2021 to 2023) to evaluate USL characteristics. The surgical technique involved harvesting the distal USL and applying it to the anterior and posterior cervix. Selected specimens underwent suture pull-out strength testing of the harvested USL, performed using a handheld digital tensiometer device.

Results: Twenty-one specimens underwent laparotomy. Seven had inadequate pelvic access secondary to extensive adhesions or significant pathology. Eleven of the 14 final specimens had a uterus present. Five had evidence of pelvic surgery or disease. The average age was 85 years. USL tissue mass and quality varied; however, it was feasible to perform distal transection of at least one USL in all specimens. Mean harvested USL length was 5.1 cm. Mean distance between the harvested USL to the ipsilateral ureter was 3.5 cm. Applying the harvested USL to the anterior and posterior cervix was possible in all specimens intended for the novel procedure. Specimen supply precluded testing the novel procedure on a vaginal vault. Vaginal suture pull-out mean strength was 12.1 N. Mean abdominal suture pull-out strength was 9.9 N.

Conclusions: The USL is a strong and accessible pelvic support structure. This anatomy-based study demonstrates technical feasibility of our novel apical suspension procedure. Further study of the post-hysterectomy cohort is required.

Objective: To investigate the association between hormonal contraception (HC) and lower urinary tract symptoms (LUTS) and recurrent urinary tract infections (rUTIs) among premenopausal women in the Boston Area Community Health Survey.

Methods: At baseline in 2002-2005 and 5 years later, participants provided information on contraception use, 14 LUTS, and rUTIs. We used this information to investigate HC use (ever, past, current, and ever systemic) in relation to the prevalence and risk of urinary incontinence, other storage symptoms, voiding/emptying symptoms, lower urinary tract pain, and rUTIs. Associations were estimated using Poisson regression with robust variance estimation, adjusting for age, race/ethnicity, vaginal parity, body mass index, waist circumference, cigarette smoking, diabetes, and sexual activity (rUTI analyses only).

Results: In both prevalent (n = 881) and incident analyses (n = 608-867, depending on the LUTS), no associations were observed for HC use with urinary incontinence, other storage LUTS, voiding/emptying LUTS, or lower urinary tract pain. In contrast, positive associations were observed for rUTIs in prevalent analyses (ever [adjusted prevalence ratio (aPR) 6.4, 95% confidence interval (CI) 1.0-41.3] and current use [aPR 16.3, 95% CI 1.8-152.1] compared to never use), with similar suggestive positive associations in incident analyses (ever use [adjusted relative risk = 4.4, 95% CI 0.9-21.2] and current use [aPR 5.9, 95% CI 0.7-53.5]).

Conclusions: Our prospective findings do not support associations between HC use and risk of most LUTS or conditions, except for rUTIs. Future studies should explore this association further to determine whether it is explained by residual confounding by sexual activity or the possible influence of HC use on the hormonal genitourinary tract milieu.

Introduction and hypothesis: This study evaluates the prevalence of pelvic organ prolapse (POP) symptoms among women in Fushun and compares transperineal ultrasound (TPUS) and pelvic floor muscle (PFM) strength parameters across different symptom groups.

Methods: A cross-sectional study recruited 237 participants aged ≥ 18 years. Data collection included the self-reported simple pelvic floor impact questionnaire (SPFIQ), three-dimensional TPUS, and PFM strength measurements. Among them, 196 participants underwent physician interviews and were divided into two groups based on International Continence Society (ICS) diagnostic criteria to compare TPUS and PFM parameters.

Results: Higher body mass index (BMI) and alcohol consumption were associated with stress incontinence. Urinary retention correlated with self-reported conditions and higher dynamic vaginal pressure (DVP). A higher bladder neck position at rest (BNPR) reduced POP risk, while increased bladder neck mobility (BNM) elevated the risk of stress incontinence and POP. Levator hiatus area during Valsalva (LHA-Valsalva) was positively correlated with POP symptoms. Postmenopausal women showed more colorectal-anal symptoms, linked to type II pelvic floor muscle fatigue (PFMF-II). Clustering analysis identified two groups: one with mild symptoms and minimal quality-of-life impact, and another with significant urinary incontinence (UI) affecting daily activities, characterized by increased BNM and reduced PFM strength. In the physician-interviewed subset, bladder neck position during Valsalva (BNPV), BNM, and LHA-Valsalva showed varying predictive values for urinary incontinence.

Conclusions: POP symptoms are significantly associated with higher BMI, alcohol consumption, self-reported conditions, postmenopause, and specific PFM and TPUS parameters. TPUS measurements, including BNPV, BNM, and LHA-Valsalva, offer predictive insights for clinical assessment and management of POP.

Introduction and hypothesis: Pelvic organ prolapse (POP) is a multifactorial condition defined as an anatomical prolapse of vaginal walls with the sensation of a vaginal bulge or functional compromise. This study was aimed at estimating the prevalence of pelvic floor disorders in women aged 30-65 years and to evaluate the correlation between subjective symptoms, and objective clinical findings of POP.

Methods: This cross-sectional study was conducted at the Women's Clinic of Tartu University Hospital in 2022-2023 and included 604 women who visited the outpatient department for a cancer screening test. Participants were asked about vaginal bulging sensations and filled out the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) tools. POP-Q assessment instrument was applied to assess for anatomical prolapse by trained midwives.

Results: The prevalence of POP was 9.2% among women at the age of 30-65 years. Anatomical prolapse (POP-Q stage > 1) was observed in 62 women (10%). A total of 257 (42.6%) patients reported feeling a vaginal bulge, including 90 women without anatomical prolapse (POP-Q stage 0) and 111 with mild prolapse (POP-Q stage I). Women without anatomical POP but with a vaginal bulging sensation had higher PDFI-20 and PFIQ-7 scores than those with anatomical POP but no sensation of bulging (p < 0.05). BMI and obstetric factors (e.g., perineal lacerations) were significantly associated with both anatomical POP and the sensation of vaginal bulging (p < 0.05).

Conclusions: When managing POP, it is essential to provide comprehensive care that considers both the anatomical and self-reported symptoms of patients.

Introduction and hypothesis: The relationship between pudendal neuromodulation and patient factors is not well understood. This observational study was aimed at identifying and quantifying physiological, demographic, and stimulation factors that significantly affect external anal sphincter (EAS) recruitment and outcomes in participants receiving pudendal neuromodulation for treatment of lower urinary tract symptoms and pelvic pain.

Methods: Participants (N = 16) provided demographic and diagnostic information upon entry to this observational study. EAS activation at different stimulation amplitudes and pulse widths was recorded during lead implantation. Magnetic resonance imaging and computed tomography were used to determine the distance of the electrodes on the implanted lead from the nerve. Linear mixed modeling was used to quantify the impact of each variable on EAS recruitment.

Results: Participant sex, age, and body mass index did not significantly affect EAS recruitment. Participant diagnoses had significant relationships with EAS recruitment, likely because of unbalanced group sizes. A pulse width of 210 µs required less current than 60 µs (p = 0.005) and less charge than 450 µs (p = 0.02) to activate the EAS. Increased electrode-to-nerve distance decreased the magnitude of the EAS response (p = 0.0011), increased the EAS activation threshold (p < 0.001), and was related to reduced bladder symptom improvements.

Conclusions: Of the three tested pulse widths, 210 µs best balances current and charge for EAS recruitment. Minimizing the distance between the electrode and pudendal nerve should be a priority during lead implantation. External sphincter activation threshold and response magnitude could be useful clinical indicators of electrode-to-nerve distance.

Introduction and hypothesis: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

Methods: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

Results: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

Conclusions: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

Objective: Pelvic organ prolapse (POP) is a common health problem that significantly impairs quality of life, particularly in terms of sex. Our study aimed to assess the quality of sexual life of women after successful POP repair with laparoscopic sacrocolpopexy (LSC).

Methods: This prospective cohort study was aimed at assessing the influence of successful laparoscopic sacrocolpopexy on the quality of sexual life after the surgery. Pre- and postoperative examinations included the Pelvic Organ Prolapse Quantification (POPQ) scale and validated quality-of-life questionnaires. PFDI-20 and PFIQ were used to choose patients who were satisfied with the results of the surgery. The quality of sexual life of sexually active and nonactive patients was subsequently evaluated via the PISQ-IR questionnaire. Post-surgery evaluation was planned 8-12 months after the procedure.

Results: A total of 181 patients were included in the study. The mean age of the patients was 58.2±9.6 years. Patients in the sexually active group were significantly younger (55.5±9.5) than were those in the nonactive group (63.4±7.7). Follow-up visits took place 10±2.34 months after surgery. We achieved statistically significant improvements in the PFDI-20 questionnaire, particularly in the POPDI-6 section, the PFIQ-7 questionnaire, and the POPQ scale. Among sexually active women, improvements in sexual function were observed across most domains, including global quality (p = 0.003), arousal and orgasm (p < 0.001), condition impact (CI, feelings of sexual inferiority, embarrassment, or anger during sexual activity, p < 0.001), and condition-specific (CS, feelings of fear or shame during sexual activity, p < 0.001). A notable finding was the significant reduction in dyspareunia, which decreased from 12.7% to 3.3%. The study also revealed that sexual inactivity was correlated with negative self-perception, which improved significantly following surgery (CS, p = 0.04; CI, p < 0.001).

Conclusion: These findings suggest that laparoscopic sacrocolpopexy improves the quality of sexual life and leads to a reduction in dyspareunia and distress related to POP symptoms.