International Urogynecology Journal最新文献

Introduction and hypothesis: The objective was to detect subtypes of urinary incontinence (UI) and their effects on quality of life (QoL) and sexual function among women seeking weight loss.

Methods: A cross-sectional study focusing on women seeking weight loss with UI symptoms was carried out. Participants were stratified into three groups: stress UI, urgency UI, and mixed UI groups. The effects of the three groups on QoL and sexual function were compared.

Results: A total of 564 individuals (46.8%) were reported to present with UI symptoms. Among these, 216 (38.3%), 71 (12.6%), and 277 (49.1%) had stress UI, urgency UI, and mixed UI respectively. The severity of UI was greater in the urgency UI and mixed UI groups than in the stress UI group, with varying ratios observed among patients with different severities of UI: stress UI was highest in mild cases, and the mixed UI was highest in moderate or severe cases. Mixed UI had the most detrimental effect on QoL and sexual function. However, after controlling for the severity of UI, mixed UI still had a greater detrimental effect on UI-specific QoL, and no differences were identified among the three groups regarding general QoL or sexual function.

Conclusion: This study revealed variations in the constituent ratios of UI subtypes related to the severity of UI and the effects of various UI subtypes on QoL and sexual function among women seeking weight loss. Notably, the mixed UI demonstrated the most severe symptoms and the most detrimental impact, particularly as assessed by UI-specific QoL questionnaires.

Introduction and hypothesis: Vaginal pessaries are the mainstay of the non-surgical management of pelvic organ prolapse (POP). A flexible silicone irregular hexagonal (SIH) pessary was developed based on the results of a prior vaginal case study. We hypothesised that the SIH pessary would have a higher rate of retention and self-management than the polyvinyl chloride (PVC) pessary.

Methods: This was a prospective non-blinded, randomised controlled trial with institutional review board approval. Eligible participants were randomised and fitted with the assigned pessary. They were reviewed 1 week, 6 months and 1 year after the initial pessary fitting. Participants who returned for follow-up completed the study questionnaires. The primary outcome was success, defined as continued use of the allocated pessary at 6 months. Secondary outcomes included the ability to perform pessary self-care, treatment satisfaction and pessary-related complications. Statistical tests were performed with alpha or statistical significance defined as a p value of ≤ 0.05, two-tailed.

Results: A total of 104 participants were randomised, with 52 subjects in each arm. Primary outcome data were analysed using per protocol analysis. Continuing pessary usage at 6 months was 68.1% for the PVC pessary group and 65.1% for the SIH group, with no statistically significant differences between the two groups (p = 0.765). Subjects with SIH were more likely to perform pessary self-care. There were no significant differences in subjects' satisfaction, quality-of-life scores or treatment complications between groups.

Conclusions: The pessary continuation rate between the SIH and the PVC pessary groups was similar at 6 months. Participants with an SIH pessary were more likely to self-manage.

Introduction and hypothesis: Despite the reputation of sacrocolpopexy as a highly durable reconstructive surgery for pelvic organ prolapse, mesh-related complications remain a significant deterrent for patients. This review discusses the incidence, presentation, diagnosis, management and prevention of sacrocolpopexy mesh complications.

Methods: We reviewed the literature on sacrocolpopexy focusing on long-term mesh complications and their management. As the literature is not specifically robust, we also give our recommendations based on experience from a large-volume center. Intraoperative videos and images are provided to illustrate findings and management techniques.

Results: Sacrocolpopexy mesh complications include vaginal mesh exposure; bladder or bowel erosions; inflammatory and infectious conditions including spondylodiscitis; and mesh-related pain. Presentation ranges from overt symptoms such as mesh palpated in the vagina to insidious-like spondylodiscitis manifesting as back pain and malaise. Diagnosis relies on methodical history taking, review of operative reports, and a physical examination, with office-based endoscopy studies and imaging as indicated. Various management options have been described in the literature. We recommend an expectant approach for asymptomatic patients; For symptomatic vaginal exposure, we encourage removal of entire mesh arm(s) via an abdominal approach; however, many prefer to utilize a transvaginal or partial excisional approach first. Spondylodiscitis is managed with long-term antibiotics and often requires mesh removal. Prevention strategies include using a lightweight polypropylene mesh attached to well- vascularized vaginal walls, avoiding direct placement on any sutured vaginotomy or cystotomy. Delayed absorbable monofilament suture is non-inferior to permanent suture.

Conclusions: Sacrocolpopexy mesh complications can be challenging to diagnose and manage. Symptomatic cases often require a proactive approach; listening to patients when they describe persistent symptoms with postoperative onset; a low threshold for further evaluation; and upfront discussion of management options.

Introduction and hypothesis: Previous work has suggested that refractory detrusor overactivity (DO) was commonly associated with urinary tract infection (UTI), which can lead to inflammatory changes in the bladder. This study aimed to investigate the concentrations of urinary cytokines in a large sample of women with refractory detrusor overactivity (DO) and age matched controls.

Methods: The urinary concentration of 27 cytokines in 140 women (95 with refractory DO and 45 age matched controls (women without urge incontinence)) was determined using the Human Cytokine 27-plex Assay. Cytokine concentrations were correlated with a "UTI score", the presence or absence of bacteriuria or pyuria on the day of sample collection and a previous history of UTI.

Results: Pro-inflammatory cytokines were increased in refractory DO women compared to the controls. In women with refractory DO, the UTI score significantly correlated with urinary cytokine concentrations in 15 of the 22 cytokines detected. A previous history of UTI did not affect urinary cytokine concentrations in refractory DO women with no current UTI. Increasing pyuria was associated with increasing concentrations of urinary cytokines.

Conclusion: Careful comparison of cytokine concentrations in women with refractory DO versus age matched controls has shown that changes in pro-inflammatory cytokines are related to the UTI disease burden, suggesting that an underlying inflammatory response, together with UTI, may be an aetiological contributor to the development of refractory DO.

Introduction and hypotheses: Few studies have investigated the relationship between work productivity (WP) and overactive bladder syndrome (OABS). The majority of those that do use generic productivity questionnaires or only include WP as a secondary outcome. We evaluated the impact of OABS on specific domains of WP, with the hypothesis that OABS has an impact on the domains of efficiency, concentration, vigor, and irritability, lost working hours, interruptions, and impairment to the work schedule.

Methods: An observational, cross-sectional study with 576 female employees (without SBH 447, dry OABS 63, wet OABS 66) was carried out. The 8-item Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and a WP questionnaire developed by the authors were used. Non-parametric tests were adopted to associate OABS with productivity. The correlation between the instruments was performed using the Spearman test, adopting a value of p = 0.05.

Results: There was a significant impact of urinary symptoms on WP (p = 0.03) in the domains of productivity/efficiency (p = 0.03), restlessness (p < 0.05), and interruptions to go to the bathroom (p = 0.03), which was higher among employees with wet OABS. Urgency and urge urinary incontinence (UUI) were the symptoms with the greatest productive impact (p = 0.01, p < 0.001). A significant correlation was found between WP scores and OAB-V8 and ICIQ-AOB scores in both groups (p < 0.05).

Conclusion: OABS impacted WP, in the domains of efficiency, restlessness, and interruptions to go to the bathroom, with urgency and UUI being the symptoms with the greatest impact on productivity.

Introduction: Obstetric anal sphincter injuries (OASI) are associated with significant risk of complications, including pain, infection, and long-term pelvic floor dysfunction. The primary aim of this study was to evaluate the utility and acceptability of a postpartum telehealth consultation focused on pelvic floor health for patients after OASI.

Methods: This prospective study used a pre-post design comparing standard postpartum care versus standard postpartum care plus a telehealth urogynecology consultation focused on pelvic floor recovery. The primary outcome was symptom burden as measured by the Pelvic Floor Distress Inventory (PFDI-20) score 16-weeks postpartum. Patient experience was evaluated using the QQ10 and the Patient Enablement Instrument. T-tests and chi-squared tests were used to compare groups.

Results: A total of 119 participants completed study activities (control group n = 62, intervention group n = 57). There was no significant difference between the two groups in PFDI-20 scores (55.6 versus 46.6, p = 0.23). The individual items most likely to be endorsed among all participants were related to flatal incontinence (52.1%) and fecal urgency (49.6%). For the subset analysis of 35 patients with severe OASI (3C or fourth-degree tears), those who had a telehealth consultation had lower PFDI-20 scores (56.6 versus 34.7; p = 0.04). QQ10 estimated a value score of 79/100 and a burden score of 18/100 for the telehealth consultation.

Conclusions: A postpartum telehealth consultation focused on pelvic floor health may benefit patients with severe OASI who reported reduced symptom burden. Participants rated a telehealth consultation as high value and low burden for this condition.

Introduction and hypothesis: Overactive bladder (OAB) affects 11-17% of the female population. First-line treatment with lifestyle modifications and second-line therapy with medications are often limited by inadequate efficacy or pharmacological side effects. This study was aimed at assessing the effect of 100 U onabotulinumtoxin A treatment on idiopathic OAB (iOAB) as a second-line treatment.

Methods: This prospective follow-up study involved 94 women who received onabotulinumtoxin A treatment at a dose of 100 U as a second-line treatment for iOAB at the Department of Obstetrics and Gynecology, Oulu University Hospital, Finland, between May 2018 and December 2023. The impact of the treatment on iOAB symptoms was evaluated 3 months after administration using self-reported symptoms and the following internationally validated questionnaires: Visual Analogue Scale (VAS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6). Postoperative complications were assessed.

Results: The follow-up data were obtained from 74 (78%) patients, of whom 66 (95.7%) reported a good outcome and 3 (4.3%) reported a poor outcome. Incontinence episodes, the number of incontinence pads needed, and daily micturitions were significantly reduced. For all questionnaires, the total scores decreased significantly after the treatment (VAS 8.27 ± 1.78 vs 3.50 ± 3.08, p < 0.001; IIQ-7 72.14 ± 20.55 vs 28.73 ± 29.40, p < 0.001; UDI-6 55.01 ± 18.86 vs 29.66 ± 22.03, p < 0.001). Postoperative urinary tract infection occurred in 9 patients (9.6%), whereas urinary retention occurred in 6 patients (6.4%).

Conclusions: Onabotulinumtoxin A (100 U) demonstrates good effectiveness in the second-line treatment of female iOAB.

Introduction and hypothesis: Obtaining informed consent to surgery is essential for ethical, legal, and quality-care reasons. This study evaluates patients' understanding, experience, and satisfaction with the informed consent process prior to pelvic reconstructive surgery.

Methods: A prospective study was conducted from April 2021 to April 2022, registered as a service evaluation project. It included all consenting women undergoing pelvic reconstructive surgery. A standardised questionnaire with closed and open-ended questions assessed patients' experiences and decision-making evaluated using the Decisional Conflict Scale (DCS). Satisfaction was evaluated through a five-point Likert scale and a ten-point visual analogue scale (VAS) for response reliability.

Results: The study included 87 patients with a mean age of 61.4 years (SD 11.4). A significant 96.6% read the consent form thoroughly, 98% affirmed detailed explanations by staff, and 88.5% found the explanation clear. Although 83.9% considered the surgery details sufficient, 16.1% found the information overly detailed or too brief. Most patients (91.9%) felt that they had ample time to think before signing, and 75.9% deemed both oral and written information helpful. Only 13.8% preferred medical staff to decide for them, whereas 55.2% valued being included in decision making. Key factors influencing satisfaction were detailed procedure information (72.4%) and reading the consent form (51.7%). The mean DCS score was 7, indicating a high level of satisfaction. Overall, 85% were very satisfied or satisfied with the consent process, with 89.7% scoring 8-10 on the VAS scale.

Conclusions: A thorough consent process is associated with high patient satisfaction and facilitates shared decision making.

Introduction and hypothesis: Telehealth is becoming more common, but there is a paucity of literature investigating the role of telehealth in perioperative gynecologic care. The authors hypothesized that patients evaluated via telehealth 4 weeks after minimally invasive hysterectomy would not have lower satisfaction than patients evaluated in clinic.

Methods: This was a randomized controlled noninferiority trial of patients who underwent minimally invasive hysterectomy at a single academic medical center. Participants were randomized to postoperative clinic visit or telehealth visit 4 weeks after hysterectomy. After the 4-week postoperative visit, patients were sent a satisfaction questionnaire. The primary outcome was overall patient satisfaction on a 100 mm visual analog scale. Secondary outcomes were 90-day postoperative complications and unplanned events.

Results: One hundred one patients who underwent minimally invasive hysterectomy were identified for inclusion. Complete data were collected for 47 in the clinic group and 45 in the telehealth group. Overall postoperative visit satisfaction did not differ between groups (94.3 clinic vs. 92.0 telehealth, p = 0.47). The clinic group was significantly more likely to contact the clinic two or more times (p = 0.02); both groups were similarly likely to contact the clinic at least once (57.4% vs. 51.1%). Postoperative complications did not differ between groups, nor did unplanned clinic visits or emergency department (ED) visits.

Conclusions: Postoperative visit satisfaction of patients evaluated via telehealth was noninferior to the satisfaction of patients seen in the clinic 4 weeks after minimally invasive hysterectomy. Unplanned clinic visits and ED visits did not differ between groups, nor did 90-day postoperative complications.