International Urogynecology Journal最新文献

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.

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.