International Urogynecology Journal最新文献

Introduction and hypothesis: This study is aimed at analyzing global public interest in treatment modalities for stress urinary incontinence (SUI) from 2004 to 2025 using Google Trends, a digital tool that captures real-time search behavior.

Methods: Google Trends data were collected for eight urinary incontinence treatment modalities, including both conservative and surgical options, over a 21-year period. The search terms analyzed were: "pelvic floor exercise" (PFE), "artificial urinary sphincter" (AUS), "transobturator tape", "Burch colposuspension," "midurethral sling" (MUS), "Bulkamid", "tension-free vaginal tape", and "pubovaginal sling" (PVS). Linear regression was used to evaluate the direction and magnitude of trend changes, and Pearson correlation analysis assessed inter-relationships among modalities. Data were retrieved on 2 April 2025, and analyzed using IBM SPSS Statistics.

Results: Pelvic floor exercise demonstrated the strongest and most consistent upward trend among all modalities (R² = 0.664, adjusted R² = 0.663, p < 0.001). MUS also showed a pronounced and statistically significant increase in relative search volume (RSV) over time (R² = 0.535, adjusted R² = 0.533, p < 0.001). Bulkamid demonstrated a strong positive temporal trend (R² = 0.585, adjusted R² = 0.583, p < 0.001). AUS exhibited a statistically significant upward trend over the study period (R² = 0.284, adjusted R² = 0.281, p < 0.001). Burch colposuspension showed a significant but more modest increase in RSV (R² = 0.293, adjusted R² = 0.290, p < 0.001). Sling-based surgical techniques demonstrated statistically significant declines in public interest over time.

Conclusions: Public interest is shifting toward conservative management, especially PFE, whereas interest in certain surgical techniques is declining. These findings highlight evolving treatment preferences and the need for region-specific health strategies. Despite its limitations, Google Trends can help to monitor awareness and inform future public health efforts.

Introduction and hypothesis: Urinary incontinence (UI) significantly impairs women's quality of life and often leads to the adoption of self-management coping strategies. This study aimed to develop and validate the UI Self-Management Coping Strategies Instrument (UI-SMCSI) to assess coping strategies in women with UI.

Method: A sample of 1538 Portuguese women aged 40-65 years with self-reported UI participated in the study. A quantitative design was employed to evaluate the instrument's factor structure, multigroup invariance, internal consistency, and validity evidence based on its internal structure and relations to other variables.

Results: Confirmatory factor analysis supported a bidimensional first-order structure comprising defensive and hiding strategies, with excellent model fit indices (CFI = .989; TLI = .987; RMSEA = .072). Internal consistency was strong (α_defensive = .94; α_hiding = .80). Measurement invariance was confirmed across UI subtypes (stress, urge, and mixed). Convergent validity was supported by a moderately strong correlation (r = .615, p < .001) with the severity measures dimension of the King's Health Questionnaire.

Discussion: The UI-SMCSI is a reliable and valid instrument for assessing UI self-management coping strategies among Portuguese women with UI. It offers a practical tool for healthcare professionals to identify behavioral patterns that may hinder effective UI management. Future research should explore the scale's sensitivity to intervention and its applicability to other demographic and cultural populations.

Background: Perineal trauma during childbirth is a common complication with significant short- and long-term maternal consequences. Perineal protection devices (PPDs) have been developed as a potential preventive strategy, yet their clinical effectiveness remains under evaluation.

Aim: To assess the effectiveness of perineal protection devices in reducing the incidence and severity of birth-related perineal trauma.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Eligible studies were identified from PubMed, Scopus, Web of Science, and Embase. Primary outcomes included rates of intact perineum, perineal tears (grade ≥ 2), labial tears, episiotomy, and Apgar scores. Secondary outcomes included adverse effects and feasibility. The Cochrane Risk of Bias tool 2 and GRADE assessment were used to evaluate study quality.

Results: Five RCTs involving 2331 participants were included. PPD use was associated with a significantly increased rate of intact perineum (RR 1.41; 95% CI 1.18-1.69; p < 0.001). No significant differences were found for grade 1 (RR 1.05; p = 0.48), grade 2 (RR 0.92; p = 0.32), or grade 3-4 perineal tears (RR 0.76; p = 0.26). Labial tears showed no significant reduction overall (RR 0.90; p = 0.64), but sensitivity analysis revealed a benefit after excluding one study (RR 0.72; p = 0.02). No significant differences were found in episiotomy rates (RR 0.96; p = 0.62) or Apgar scores < 7 at 5 min (RR 0.99; p = 0.93).

Conclusion: PPDs appear safe and effective in increasing intact perineum rates without adverse neonatal outcomes. Further large-scale, standardized trials are needed to confirm their role in obstetric practice.

Introduction and hypothesis: Obstetric anal sphincter injury (OASI) is a severe complication of vaginal delivery leading to short- and long-term consequences affecting women's physical and psychological health. This study is aimed at evaluating the incidence and risk factors of OASI at a tertiary care centre over the past decade.

Methods: This retrospective cohort study included all singleton primiparous and multiparous women who delivered vaginally between 2014 and 2023. Women giving birth at < 24 weeks and whose child weighed < 500 g at birth, or with incomplete records, were excluded. Key maternal and obstetric factors were extracted and analysed using univariate and multivariate logistic regression.

Results: Among 9956 women, the overall incidence of OASI was 9.4% (third-degree 8.7% and fourth-degree 0.7%). The incidence of OASI declined from 9.8% to 6.1% in the past decade, coinciding with a reduction in episiotomy rates. Multivariate analysis identified forceps extraction (aOR 6.15, 95% CI 3.66-10.33), prolonged second stage of labour (aOR 2.47, 95% CI 2.00-3.05), labour augmentation (aOR 1.62, 95% CI 1.38-1.89), deliveries performed by a faculty member (aOR 1.25, 95% CI 1.03-1.51) and every 100-g increase in neonatal birthweight (aOR 1.09, 95% CI 1.08-1.11) as significant risk factors. Delivery without an episiotomy was a protective factor (aOR 0.41, 95% CI 0.30-0.56).

Conclusions: The high incidence of OASI at our institution highlights the impact of obstetric practices. The findings reinforce the need for restrictive episiotomy policies and targeted strategies to mitigate modifiable risk factors associated with OASI.

Introduction and hypothesis: Obstetric tears are a common complication of vaginal delivery, with second-degree tears and episiotomies being the most prevalent types. Despite their prevalence, the incidence of healing complications are not clearly defined. This review aims to consolidate the current knowledge.

Methods: This systematic review examines the risk of wound dehiscence and infection following second-degree tears and episiotomies. Literature searches were conducted across three databases: PubMed, Embase, and Cochrane. Two authors independently and blindly selected studies deemed relevant based on their title and abstract. Full-text screening was then performed, and included studies were assessed for risk of bias.

Results: The review included 15 papers and found that the risk of infection ranged from 0 to 30%, and wound dehiscence from 0 to 22%. However, the review revealed substantial variation in definitions, evaluation methods, assessment timing, and preventive treatments. Studies incorporating clinical evaluations 1-3 weeks postpartum reported a higher prevalence of complications (infection 5.3%, dehiscence 9.3%) compared to those without such assessments (infection 1.8%, dehiscence 3.6%).

Conclusions: Second-degree tears and episiotomies are common, with up to 30% experiencing healing complications. This review found higher rates in studies with clinical follow-up 1-3 weeks postpartum, though precise estimates are limited by varying follow-up times and outcome definitions. This underscores the need for further research and increased clinical focus on these complications.

Introduction and hypothesis: Stress urinary incontinence (SUI) may be related to dysfunction of the core stabilizing system. We hypothesized that women with more severe SUI would demonstrate reduced abdominal-muscle thickness and decreased lumbopelvic control. This study investigated differences in abdominal-muscle thickness and lumbopelvic control among women with different SUI severities compared with continent women.

Methods: This cross-sectional study included 54 women: 21 women with mild SUI, 12 women with moderate SUI, and 21 healthy controls. Abdominal-muscle thickness was measured using ultrasonography. Lumbopelvic control was assessed using one- and double-leg-lowering tests. One-way analysis of variance and post hoc tests were used for data analysis.

Results: Women with both mild and moderate SUI demonstrated significantly reduced thickness of the transversus abdominis (p < 0.01), internal oblique (p < 0.01), and external oblique muscles (p < 0.01). The SUI groups also exhibited lower angles in the one-leg-lowering test (control = 67.04 ± 20.78°; mild SUI = 46.25 ± 31.43°; moderate SUI = 34.31 ± 32.10°; p < 0.01) and the double-leg-lowering test (control = 45.19 ± 24.56°; mild SUI = 28.96 ± 23.90°; moderate SUI = 24.38 ± 26.17°; p = 0.04).

Conclusions: Women with SUI demonstrated significantly reduced abdominal-muscle thickness and lower performance on lumbopelvic control tests than continent women, with more pronounced deficits in moderate SUI. These findings highlight alterations in the core stabilizing system associated with SUI severity. Comprehensive rehabilitation approaches addressing both pelvic-floor and core-muscle function may be beneficial.

Introduction and hypothesis: Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth. The burden is expected to be high in Nigeria due to high fertility and aversion to caesarean section (C/S); however, the incidence, effects on urinary incontinence (UI)/anal incontinence (AI), and quality of life (QoL) are largely unknown. This study determined the incidence of and risk factors for OASIS, as well as the effects of OASIS on UI/AI after childbirth, and QoL.

Methods: A prospective cohort study of post-partum women in Nigeria over a 16-month period, from January 2022 to April 2023. The study consisted of three groups-the OASIS group (group A) and two comparison groups (groups B and C). Group A had OASIS, group B had episiotomy/2nd degree spontaneous perineal tear (SPT), while group C had intact perineum/1st degree SPT. The women were followed-up for 3 months to determine incidence of and risk factors for OASIS, as well as the effects of OASIS on UI/AI, and QoL using validated questionnaires.

Results: There were 3027 vaginal births with 60 OASIS (1.98%). Incidence of UI/AI was higher with group A than B (p = 0.026 and 0.005, respectively) and C (p = 0.011 and 0.003, respectively). There were no differences between groups B and C (p > 0.05). Risk factors for OASIS were age ≥ 35 years, low social class, nulliparity, previous C/S, prolonged labor, and macrosomia. QoL mean scores were lower in group A than group B (p = 0.027) and group C (p = 0.009).

Conclusions: Approximately two in every 100 Nigerian women experience OASIS following vaginal birth in a hospital setting, which is associated with increased risks of UI, AI, and reduced QoL, underscoring the need for preventive strategies and appropriate postpartum care.