International Urogynecology Journal最新文献

Introduction and hypothesis: Electrical stimulation, which has become widely used in the treatment of overactive bladder (OAB) to reduce symptoms, is a treatment method included in guidelines. However, there are shortcomings in the standardization of its application. This study is aimed at investigating the response to different frequencies of posterior tibial nerve stimulation (PTNS) in this context.

Methods: Male and female patients aged 18-65 with refractory OAB were included in the study. Participants were divided into two groups. One group received PTNS treatment once a week for 12 weeks (group 1), whereas the other group received PTNS treatment twice a week (group 2). All patients completed a 3-day voiding diary before starting PTNS treatment, recording frequency, nocturia, urgency, urge incontinence, and voided volume values. The International Continence Interrogation Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire (OAB-V8), and Overactive Bladder Questionnaire Short Form (OAB-q SF) were completed. Patients filled out the same voiding diary and questionnaires at the 4th and 12th weeks.

Results: When the scores at the 4th and 12th weeks were compared with the baseline, there was a significant difference in both groups (repeated measures analysis of variance [ANOVA], p < 0.001). Similarly, the scores for OAB-q SF, ICIQ-SF, and OAB-V8 at the 4th and 12th weeks were significantly different in both groups compared with baseline (ANOVA, p < 0.001). When response rates were evaluated, the 12th-week results were similar in the two groups for all questionnaires (p > 0.05). However, there was a difference in the ICIQ-SF and OAB-V8 forms. At the 4th week, the results for these two questionnaires differed between the groups (p = 0.03, 0.002). When the treatment response was compared, the difference from baseline in the frequency and urgency parameters at the 4th week was greater in group 2, and this difference was statistically significant (p = 0.031, 0.015). However, this was not the case for the 12th week, where no significant difference was found between the groups (p = 0.12, 0.22).

Conclusions: This study was conducted to address the lack of standardization in PTNS, a treatment method strongly recommended in European urology guidelines for the treatment of OAB. Significant improvements in voiding diary parameters were observed in both treatment groups, but the group receiving two sessions per week showed faster improvement at the 4th week, although the results were similar by the 12th week. Early improvement may be associated with a faster neuromodulation response in patients with severe symptoms. These results highlight the importance of individualized treatment protocols and suggest that further prospective studies might be needed to assess the long-term effectiveness of PTNS.

Introduction and hypothesis: Obstetric anal sphincter injuries (OASIs) are associated with increased risk of postpartum complications, including short- and long-term dyspareunia and sexual dysfunction. The primary aim of this analysis is to evaluate whether engagement in a telehealth urogynecology consultation was associated with decreased sexual health concerns after OASIs.

Methods: This is an analysis of sexual health data, secondary outcomes from a prospective study comparing standard postpartum care versus standard postpartum care plus a telehealth urogynecology consultation. The analyzed outcomes were Female Genital Self-Image Scale (FGSI) and Female Sexual Function Index (FSFI-6) scores at 16 weeks postpartum. Chi-squared and t tests were used to compare groups.

Results: A total of 119 participants with OASIs completed the study (control group n = 62, intervention group n = 57). The intervention group had significantly improved FGSI scores (18.9 vs 20.4, p = 0.02). There was no significant difference on the FSFI-6 (12.0 vs 12.1, p = 0.90), with 77% of the control group and 81% of the intervention group (p = 0.66) classified as having female sexual dysfunction by the FSFI-6. In the telehealth consult group, only 28% of participants (n = 16) had resumed sexual activity, with 88% of those participants endorsing dyspareunia. Interventions reviewed during the telehealth consult included vaginal estrogen, use of lubricants, and pelvic floor physiotherapy.

Conclusions: A postpartum telehealth urogynecology consultation was associated with improved genital self-image but did not reduce sexual dysfunction as measured on the FSFI. These results highlight the significant impact that OASIs can have on sexual function, and the importance of postpartum evaluation and care to support patients after severe obstetric perineal trauma.

Introduction and hypothesis: The retroperitoneal tunneling technique during sacrocolpopexy (SCP) has been suggested as being associated with a shorter ope rative time, adhesion formation, and nerve injuries, but rigorous data on this technique are limited.

Methods: A randomized, single-center trial of tunneling versus dissection technique for robotics-assisted (RA) SCP was conducted. Eligible participants had stage 2-4 POP and desired SCP. The primary outcome was operative time between two techniques. Secondary outcomes included POP-Q measurement, Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), Decision Regret Scale (DRS), Patient Global Impression of Improvement (PGI-I), and Satisfaction with Decision Scale (SDS). Participants were followed up at 6 and 12 weeks postoperatively.

Results: Among 39 participants, 20 (51.3%) were in the dissection group and 19 (48.7%) were in the tunneling group. The dissection group had a longer technique operative time (13.11 ± 2.96 min vs 9.06 ± 3 min; p < 0.0005). At 12 weeks' follow-up, there was no significant difference in POP-Q measurements between groups (all p > 0.05). Quality-of-life measures including PFDI-20, PFIQ-7, SDS, DRS, and PGI-I are similar between groups (all p > 0.05). However, the dissection group had fewer prolapse symptoms than the tunneling group based on the subscale Pelvic Organ Prolapse Distress Inventory-6 (16.23 ± 12.41 vs 33.56 ± 15.82, p = 0.0379).

Conclusions: During RA SCP, operative time is longer when using retroperitoneal dissection than when using the tunneling technique. However, both techniques offer comparable anatomical and quality-of-life outcomes in the short-term postoperative follow-up.

Introduction and hypothesis: To translate and perform cultural adaptation of the Pelvic Floor Dysfunction-SENTINEL (PFD-SENTINEL) screening tool into Turkish and to establish its reliability and validity for female athletes.

Methods: The study included 200 female athletes (mean age 22 ± 4 years). The translation of the PFD-SENTINEL, which comprised the symptoms related to PFD and item sections related to general risk factors and sports-related risk factors, was performed in accordance with international recommendations. The severity of PFD symptoms was assessed with the Pelvic Floor Distress Inventory-20 (PFDI-20). Psychometric analyses consisted of assessing the following: internal consistency reliability using the Kuder-Richardson-20 (KR-20) coefficient, construct validity using confirmatory factor analysis, and criterion validity.

Results: The reliability was acceptable for the PFD-SENTINEL items assessed using the KR-20, at 0.581, indicating moderate internal consistency. All fit indices except standardized root mean square residual indicated a perfect fit for the final models. Criterion validity was supported by positive correlations between the PFD-SENTINEL symptom score and the PFDI-20 score (r = 0.724, p < 0.001) and between the PFD-SENTINEL item score and the PFIQ-20 scores (r = 0.334; p < 0.001).

Conclusions: The Turkish version of the PFD-SENTINEL is a reliable and valid instrument to screen for PFD in female athletes.

Introduction and hypothesis: Direct comparison of lower urinary tract symptoms (LUTS) such as overactive bladder (OAB) and stress urinary incontinence (SUI) before and after laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) for pelvic organ prolapse (POP) is not reported enough. We investigated the prevalence of OAB and SUI before and after LSC and RSC, comparing the effects of these surgical methods on LUTS.

Methods: A retrospective analysis was performed for patients who underwent LSC or RSC for POP (294 LSC and 104 RSC cases) at a single general hospital in Japan from 2022 to 2023. Preoperative and 6-month postoperative OAB and SUI prevalences were determined based on the OAB symptom scores and International Consultation on Incontinence Questionnaire-Short Form. Changes in the prevalence of OAB and SUI before and after surgery were examined within and between the RSC and LSC groups.

Results: The prevalence of OAB in the RSC group decreased significantly from 43.9% (n = 43) preoperatively to 26.5% (n = 26) postoperatively, and in the LSC group from 43.6% (n = 119) to 24.9% (n = 68), with no significant difference in the proportion of de novo OAB between the groups. The prevalence of SUI in the RSC group increased significantly from 36.4% (n = 36) preoperatively to 58.6% (n = 58) postoperatively, and in the LSC group from 54.0% (n = 148) to 62.0% (n = 170) postoperatively, with no significant difference in the proportion of de novo SUI.

Conclusions: Both RSC and LSC for POP may improve symptoms in patients with pre-OAB and induce de novo SUI, with no significant difference between the groups.

Introduction and hypothesis: Low back pain may play a contributing role in the emergence or worsening of stress urinary incontinence (SUI) in women, by affecting neuromuscular control and pelvic stability. This study aimed to examine the relationship between SUI, musculoskeletal performance, and physical activity level (PAL) in women with nonspecific low back pain (NSLBP) by comparing them with a healthy control group.

Methods: One hundred fifty-two women were assigned to either the healthy control (no NSLBP) group (n = 76) or the NSLBP group (n = 76). Pain severity was evaluated using the Visual Analog Scale (VAS), the severity of SUI was detected using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF), musculoskeletal performance was measured using the trunk flexor endurance test (TFET), wall sit-hold test (WSHT), 3-minute burpee test (3-MBT), and sit and reach test (SRT), respectively. International Physical Activity Questionnaire-Long Form (IPAQ-LF) assessed the PAL. The Mann-Whitney U test was used to compare groups, and Spearman correlation analysis determined the intra-group correlation levels.

Results: The NSLBP group had significantly higher ICIQ-SF, lower TFET, 3-MBT, and SRT scores (p = 0.016). In the healthy control group, ICIQ-SF was not associated with any musculoskeletal performance test parameters and IPAQ-LF (p > 0.05). While a significant positive correlation was found between IPAQ-LF and VAS during activity (r = 0.266, p = 0.020), ICIQ-SF had a negative correlation with TFET (r = -0.308, p = 0.007), 3-MBT (r = -0.320, p = 0.005), and IPAQ-LF (r = -0.298, p = 0.009) in the NSLBP group.

Conclusions: As NSLBP gets worse, SUI complaints increase. Trunk flexor muscle endurance, agility, and physical activity levels decrease as the severity of SUI increases in women with NSLBP.

Introduction: LeFort colpocleisis is a surgical alternative for women with pelvic organ prolapse (POP). Complications are rare and typically minor. The accumulation of purulence within the uterine cavity, or pyometra, after this procedure is exceptionally uncommon. To date, only a handful of cases have been reported. Hereby, we present a narrative review on the current knowledge regarding the diagnosis and treatment of this atypical complication.

Methods: A literature search was conducted using five different databases to identify previously published articles on this subject. Relevant keywords included colpocleisis, LeFort colpocleisis, pyometra, and reoperation. Studies describing complications after colpocleisis with concurrent hysterectomy or colpocleisis of vaginal vault were excluded.

Results: Six case reports were identified, all from English-language sources. Data form an additional case at our institution was included. Median age was 78 years, and most women had multiple comorbidities. All underwent LeFort colpocleisis, with varying additional procedures. Only one case had a successful conservative approach; hysterectomy via laparotomy was ultimately required in the remaining cases. No cases of underlying malignancy were reported.

Conclusions: Pyometra is a rare but important differential diagnosis in patients with a history of LeFort colpocleisis presenting with fever, vaginal discharge, and abdominopelvic pain. A high index of clinical suspicion is paramount, since prompt diagnosis and appropriate surgical management are a standard of care.

Introduction and hypothesis: Transcutaneous tibial nerve stimulation (TTNS) is used to treat overactive bladder (OAB) syndrome. We hypothesized that TTNS instruction delivered via telehealth (TH) would be as effective as face-to-face (FtF) instruction in improving OAB symptoms.

Methods: In this prospective cohort study, 99 women with OAB self-selected FtF (n = 79) or TH (n = 20) instruction for TTNS setup. Groups received standardized education on device placement and usage. Primary outcome was the between-group comparison of change in International Consultation on Incontinence Questionnaire (ICIQ-SF) scores at 3 and 12 months. Secondary outcomes included between-group comparisons of Patient Global Impression of Improvement (PGI-I) score at 3 months and treatment persistence at 12 months. Between-group differences were analyzed using Student's t tests.

Results: At 3 months, FtF and TH groups showed mean ICIQ-SF score reductions of 2.3 ± 1.8 and 1.9 ± 1.6 points respectively (between-group difference 0.4 points; 95% CI -1.79, 2.59; p = 0.60). PGI-I scores indicated improvement in 48.1% of FtF and 50.0% of TH participants. At 12 months, treatment persistence was 60.8% for FtF and 55.0% for TH groups. Among continued treatment responders, sustained improvement was observed, with mean ICIQ-SF reductions of 3.6 ± 2.4 points (FtF) and 4.0 ± 2.6 points (TH) from baseline (p = 0.48). Progression to third-line therapies was comparable between groups (FtF 24.0%, TH 25.0%).

Conclusions: Telehealth shows promise as an effective method for initiating TTNS treatment for OAB, providing comparable outcomes with FtF instruction. The approximate 50% response rate and sustained benefits among responders support TTNS as a viable treatment. Findings support broader implementation of TH TTNS instruction, potentially improving treatment access for suitable patients.