International Urogynecology Journal最新文献

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.

Introduction and hypothesis: Stress urinary incontinence (SUI) is a highly prevalent condition in women. We hypothesized that the Tampsec™ vaginal tampon will be efficacious and well tolerated in its treatment.

Methods: This was a multicenter open-label parallel-group randomized control trial. All participants were recommended to make lifestyle modifications and perform pelvic floor muscle training for SUI treatment. Additionally, women in the tampon group were instructed to use a Tampsec™ throughout the day. The primary outcome measure was a ≥50% reduction in pad weight by the end of treatment. Secondary outcome measures were women's perception of improvement evaluated using the Patient Global Impression of Improvement (PGI-I) questionnaire, decrease in the mean number of SUI episodes/day, and improvement in the impact of urinary incontinence (UI) on everyday life. Tampon tolerance and usability were also evaluated.

Results: Forty-six women with a positive urinary stress test were randomized 1:1 to tampon or control treatments. Regarding the primary outcome, a ≥50% reduction was achieved in 69.9% of patients in the tampon group and 26.1% in controls (RR 2.7; 95%CI 1.3-5.4). On the basis of PGI-I responses, the treatment was successful in 60.9% of women in the tampon group and 17.4% of controls (p = 0.003). The tampon group also reported greater decreases in SUI episodes/day (mean 2.0±2.2 vs 0.5±1.1; p = 0.007) and more improvement in the impact of UI on everyday life. Tolerance and usability were good in most women.

Conclusion: The Tampsec™ tampon is efficacious and well tolerated in women with SUI. This treatment decreases the number of SUI episodes/day and improves UI-related quality of life.

Introduction and hypothesis: Health-seeking behavior is habitual among people in a society, resulting from the interaction and balance between health needs, health resources, and socioeconomic factors. This study seeks to investigate the influence of health fatalism and health-seeking behaviors on the frequency of non-medication coping strategy use among women with urinary incontinence in Türkiye.

Methods: This cross-sectional study was conducted between 8 August 2024, and 22 September 2024. A total of 354 women voluntarily participated in the study, which was disseminated via social media platforms and online forums. Data collection involved the use of a Personal Information Form, the Health Fatalism Scale (HFS), the Health-Seeking Behaviour Scale (HSBS), and the Non-Medication Coping Strategies for Urinary Incontinence Frequency of Use Scale (NMCS-UIFUS).

Results: The mean total HFS score was 50.39 ± 29.70, the mean total HSBS score was 38.76 ± 20.48, and the mean NMCS-UIFUS score was 35.69 ± 17.31. A statistically significant, strong negative correlation was found between health fatalism and health-seeking behavior, whereas a significant, strong positive correlation was observed between health fatalism and the frequency of non-medication coping strategy use for urinary incontinence (p < 0.001). Regression analysis revealed that health fatalism explained 37% of the variance in the frequency of non-medication coping strategy use for urinary incontinence, whereas health-seeking behavior accounted for 30% of the variance (p < 0.001).

Conclusions: Our study demonstrated that women with urinary incontinence exhibit moderate levels of health fatalism, health-seeking behaviors, and the frequency of non-medication coping strategy use; further, as health fatalism increases, health-seeking behavior decreases, whereas the frequency of non-medication coping strategy use rises.

Introduction and hypothesis: This study aims to develop a postpartum stress urinary incontinence (PPSUI) risk prediction model based on an updated definition of PPSUI, using machine learning algorithms. The goal is to identify the best model for early clinical screening to improve screening accuracy and optimize clinical management strategies.

Methods: This prospective study collected data from 1208 postpartum women, with the dataset randomly divided into training and testing sets (8:2). Five machine learning algorithms-logistic regression, decision trees, random forests, support vector machines (SVM), and eXtreme gradient boosting (XGBoost)-were used to construct the PPSUI risk prediction model. Model performance was evaluated using multiple metrics, and the best-performing model was selected and validated for generalizability with the testing set.

Results: The final model retained ten features: birth weight, weight gain during pregnancy, BMI before delivery, pre-pregnancy BMI, age of delivery, gestation, parity, pre-delivery uterine height, age of first delivery, and labor analgesia. Among the five algorithms, the random forest model performed best, with a test AUC of 0.995 (95% CI 0.990-0.999, P < 0.05), accuracy of 0.956, precision of 0.957, recall of 0.944, specificity of 0.966, and F1 score of 0.951. The model's high generalizability was confirmed with the testing set and further validated through bootstrapping and tenfold cross-validation.

Conclusion: The random forest model shows strong clinical potential for PPSUI risk prediction and early screening. Future studies should expand the sample size and include multi-center data to further enhance the model's clinical applicability.

Introduction and hypothesis: Chronic Pelvic Pain Syndrome causes psychological distress, worsened by kinesiophobia and pain catastrophizing. This study assesses whether combining capacitive-resistive monopolar radiofrequency with myofascial techniques is more effective than myofascial techniques alone for improving psychological outcomes such as kinesiophobia and catastrophizing.

Methods: This double-blind, randomized controlled trial enrolled 81 chronic pelvic pain syndrome patients (67.9% female, mean age 43.6 years) from March 2019 to April 2021. Participants were assigned to either an activated (intervention) or deactivated (control) capacitive-resistive monopolar radiofrequency group, with both groups receiving physiotherapy and pain education over 10 weeks. Outcomes on kinesiophobia and catastrophizing were assessed at weeks 5 and 10, using the Spanish versions of the Tampa Scale (TSK-11) and Pain Catastrophizing Scale (PCS).

Results: At treatment's end, the intervention group showed greater improvement in kinesiophobia (3 points) compared to controls, though nonsignificant (p = .099). The intervention also significantly reduced catastrophizing scores by 8 points versus control (p = .042). No major adverse effects occurred, and adherence was high (86.4%), with no differences between groups.

Conclusion: This study shows that combining capacitive-resistive monopolar radiofrequency with myofascial techniques can improve kinesiophobia and catastrophizing in chronic pelvic pain syndrome patients, such as fear movement and catastrophic thinking related to pain. This marks a potential breakthrough in chronic pain management. Future research should focus on larger, multicenter RCTs with extended follow-up periods to better assess long-term effects.

Registration: Clinical trial registration (NCT03797911).

Introduction and hypothesis: This manuscript is part of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP), Chapter 3, Committee 1 focusing on pessary management of POP.

Methods: A narrative review was conducted by an international, multi-disciplinary group of clinicians working in the field of pelvic health following a search of the literature using the MeSH terms "pelvic organ prolapse" OR "urogenital prolapse" OR "vaginal prolapse" OR "uterovaginal prolapse" AND "pessary" OR "support device" OR "intravaginal device." Relevant studies, as determined after review using the Covidence manuscript review platform, were included.

Results: A total of 540 articles were reviewed, of which 313 were included for this narrative review. The reported pessary fitting success rate ranges from 41% to 96.6%, and the continuation of successful use rate varied from 21% to 97.7%. The most likely predictors of unsuccessful fitting trials were previous POP surgery, previous hysterectomy, short vaginal length, wide genital hiatus, and posterior compartment involvement. Following successful pessary placement in individuals with POP, vaginal bulge and pressure resolved in over 90%. A significant improvement in obstructive voiding was reported in 40-97% of participants, urinary urgency in 38%, urgency urinary incontinence in 29-77%, and stress urinary incontinence in 9-45%. Older age and women who can self-manage the pessary care or had family support were factors associated with pessary continuation. Common reasons reported for discontinuation included expulsion, vaginal pain/discomfort, unwillingness to continue, erosions, desire for surgery, bleeding, symptoms not improved with pessary, and incontinence. More serious complications (fistula, bowel obstruction, pessary impaction, and vaginal cancer) are rare, and occur usually in older women in whom pessary maintenance has been neglected. There is no high-quality evidence to guide pessary choice. The current literature lacks studies specifically focused on determining the role of preventative measures, i.e., estrogen, pessary type/material as regards to pessary-associated complications (PACs). The review identified a lack of information about the relevant and required training and education (for healthcare professionals and patients) for pessary provision, use, and management.

Conclusions: There is a considerable body of published work on the use of pessaries for POP, including effectiveness, factors associated with success and failure, and complications. However, there is a dearth of published literature regarding how pessary types are selected by providers, how providers are trained, what defines competency in pessary provision, and what constitutes appropriate patient education related to pessary use and management.

Introduction and hypothesis: Perineorrhaphy with levator myorrhaphy is considered a standard part of colpocleisis. Typically, this is done through a separate incision after colpocleisis is completed. We present a video to demonstrate a modified approach to LeFort colpocleisis incorporating perineorrhaphy into the procedure.

Methods: A rectangular piece of anterior vaginal mucosa is dissected off the underlying fibromuscular tissue starting from 2-3 cm distal to the cervix and ending proximal to the urethrovesical junction. Similarly, a symmetrical posterior vaginal mucosa is dissected starting from the introitus and ending 2-3 cm distal to the cervix. The lateral edges of the rectangles between the anterior and posterior vaginal walls are sutured to create channels. The raw surfaces, including the fibromuscular tissue on the anterior and posterior vagina, are sutured to each other in three rows. Vaginal epithelium is closed continuously starting from the anterior wall and ending with posterior epithelium at the introitus.

Results: Dissection of the anterior and posterior vaginal epithelium mimics standard colporrhaphy. The number of incisions and suturing is decreased by incorporating perineorrhaphy into colpocleisis. Sagittal closure with this technique restores the Aa point to a more anatomical position.

Conclusion: These modifications may decrease operative time and de novo stress incontinence and allow less experienced surgeons to consider colpocleisis. Our surgical approach, which incorporates perineorrhaphy into colpocleisis, enables easier adaptation to the procedure and may decrease de novo stress incontinence.

Introduction and hypothesis: Pudendal nerve release can be managed by the laparoscopic approach for pudendal nerve entrapment.

Methods: This is a case report of a stepwise demonstration of the technique with narrated video footage. A 71-year-old woman, gravid 7, parity 3, abortion 4, live births 3 vaginal delivery, complained of pain while sitting. She had been having vaginal and vulvar pain on the left side for 3 years. At vaginal examination, she had pain over the sacrospinous ligament with palpation. Tinel's sign (+) on the left side. Left side pudendal nerve block relieves pain for 1 h. Using a laparoscopic approach for a left pudendal nerve release at the level of sacrospinous ligament, the dissection started at the level of medial to the infundibulopelvic ligament, after visualization of obliterated umbilical artery and obturator nerve and vessels, dissection continued deeper to the pelvic floor visualizing the obturator internus muscle, then pudendal nerve and vessels are identified and the coccygeus muscle and sacrospinous ligament are observed. The sacrospinous ligament is cut all the way to the entrance of Alcock's canal.

Results: The operation was finished without any complication and the patient was discharged after the operation day. Pain decreased on her postoperative examination. Follow-up visits will be continued at 3 and 6 months.

Conclusions: Laparoscopic pudendal nerve release is reproducible, effective, safe, and has a steep learning curve method for the management of pudendal nerve entrapment.

Introduction and hypothesis: The relationship between autophagy and pelvic organ prolapse (POP) remains unknown. The aim of this novel experimental study, utilizing tissue samples derived from women undergoing gynecological surgery, is to investigate the role of autophagy in mitigating collagen degradation in human vaginal fibroblasts induced by oxidative stress, with particular emphasis on its implications in the pathogenesis of POP. Exploring the role of autophagy in protecting against collagen degradation and cellular senescence in human vaginal fibroblasts under oxidative stress may offer new insights into therapeutic strategies for conditions such as POP.

Methods: This study consists of laboratory-based experimental research that utilizes tissue samples collected from female patients undergoing gynecological surgery to analyze the role of autophagy in collagen degradation induced by oxidative stress. By treating with different concentrations of hydrogen peroxide (H₂O₂) and using rapamycin (RAPA) and 3-methyladenine (3-MA) as autophagy activators and inhibitors respectively, the effects on human vaginal fibroblasts (HVFs) were evaluated. Cell viability was determined using the Cell Counting Kit-8 test. Cellular senescence was determined with senescence-associated-β-galactosidase labeling and western blotting to identify the expression of p21 and p53. Reactive oxygen species (ROS) were determined with 2,7-dichlorofluorescin diacetate. Additionally, western blotting was used to establish collagen I, collagen III, microtubule-associated protein 1A/1B-light chain 3 (LC3), Beclin-1, and p62 and reverse transcription-quantitative polymerase chain reaction was used to determine the mRNA levels of COL3A1, COL1A1, TIMP1, MMP9, LC3, and Beclin-1 to investigate collagen metabolism and autophagic activity.

Results: The results showed that high-dose H₂O₂ significantly increased ROS levels, cell senescence, and collagen degradation in HVFs. The combined use of RAPA significantly reduced ROS levels, collagen degradation, and cell senescence, but this protective effect disappeared when 3-MA was added. Nevertheless, co-treatment of HVFs with RAPA, H₂O₂, and 3-MA abolished the positive impact of RAPA via boosting autophagy resistance.

Conclusions: Autophagy inhibits collagen degeneration and cellular senescence caused by oxidative stress.