International Urogynecology Journal最新文献

Introduction and hypothesis: The new urethral ligament plication (ULP) operation for curing SUI is tape free. Instead of using a tape, the pubourethral ligament (PUL) is prevented from lengthening to cause urine loss on effort by a single collagen-creating polyester suture that confines all four branches of the PUL and adds new collagen to strengthen the ligaments. Its anatomical basis is identical to that for the midurethral sling (MUS).

Methods: The 108 patients were randomized by computer, 54 in each arm. Informed consent was obtained. The transobturator tape (TOT) technique was standard outside/in. The ULP technique is a bilateral operation. Two 4-cm full-thickness vaginal incisions were made in the paraurethral anterolateral vaginal sulci extending from the bladder neck to the lateral external urethral meatus on each side of the urethra. The incisions were opened up to reveal the PULs. A No. 2 collagen-creating polyester suture was inserted into the four PUL attachment points: midurethra; retropubic; external urethral ligament; pubococcygeus muscle.

Results: The ULP was found to be superior to conventional TOT in all measures. Cure rates were 90.7% vs 81.5% (p < 0.05), Urinary Distress Inventory-6 (UDI-6) scores were 0.61 vs 1.17 (p < 0.05), and operating time was 18 min vs 26 min (p > 0.06) respectively. Complications of the TOT were pain (7.4%), mesh erosion/extrusion (7.4%). The ULP had no significant complications. Results were independently confirmed by an external reviewer.

Conclusions: The ULP is low-cost ($2 for the polyester sutures), safe, direct-vision surgery (no blind insertion instruments to damage organs, vessels, or nerves) with a shallow learning curve. Minimal facilities are required, with a local anesthetic option.

Introduction and hypothesis: As aging societies become increasingly widespread worldwide, the prevalence of pelvic floor (PF) disorders is also increasing, particularly among older women. We hypothesized that PF fragility associated with aging could be detected by examining its configurations and the condition of the levator ani muscle. Therefore, in the present study, we aimed to establish a method for detecting age-related PF fragilities by analyzing PF configuration and levator ani muscle thickness using magnetic resonance imaging (MRI).

Methods: In total, 328 healthy female participants aged 20-91 years were enrolled in this study. T2-weighted coronal MR images of the pelvis were used to classify PF configuration into four types: wing, shallow-V, deep-V, and cup. The correlation between age and levator ani muscle thickness was analyzed for each classification.

Results: PF configuration was observed to transition from wing to shallow-V, deep-V, and finally to cup type with age. Additionally, a strong negative correlation was identified between age and levator ani muscle thickness (r = -0.75, P < 0.001). Levator ani muscle thickness decreased progressively in the following order: wing, shallow-V, deep-V, and cup.

Conclusions: This MRI-based visual classification method provides a simple and practical approach to evaluate age-related PF changes. Visually assessing PF configuration facilitates the detection of structural decline associated with aging.

Introduction and hypothesis: We evaluated the complications and medium- to long-term therapeutic outcomes of the modified Manchester procedure for pelvic organ prolapse.

Methods: The clinical data of 254 patients who underwent the modified Manchester procedure in our hospital from July 2015 to May 2023 were retrospectively analyzed. In addition, the perioperative situation and medium- to long-term follow-up results were analyzed.

Results: No injury to the adjacent organs (such as the bladder and ureter) or complications (including massive hemorrhage or hematoma) were reported in 254 patients during the operation. During the perioperative period, urinary retention, postoperative fever, and urinary tract infections were observed in 19 patients (7.5%), 13 patients (5.1%), and three patients (1.2%), respectively. Follow-up ranged from 1 to 8.8 years, with a median follow-up time of 4.18 (2.46, 6.15) years, and 173 patients (68%) completed telephonic or outpatient follow-up. Among them, 16 patients (9.25%) had subjective recurrence. Of these 16 patients, three (1.7%) had failed surgery, nine (5.2%) had de novo stress urinary incontinence, and two (1.2%) had dysuria. The most serious complications were grade III according to the Clavien-Dindo classification. After the operation, the subjective satisfaction rate of the PGI-I questionnaire was 94.8%.

Conclusions: The modified Manchester procedure for pelvic organ prolapse has a low incidence of severe complications, has satisfactory medium- to long-term therapeutic outcomes, and shows favorable safety and efficacy.

Pelvic organ prolapse (POP) is a morbid and costly condition that affects millions of women worldwide. Given the shortcommings of the current treatments, novel preventative and therapeutic approaches are needed. This manuscript is part of the International Urogynaecologogy Consultation (IUC) on pelvic organ prolapse (POP) chapter four on new and novel treatments for pelvic organ prolapse. The current expert narrative review (1) highlights the rationale for novel treatments for POP; (2) summarizes the exisitng mechanistic insights into physiologic alterations needed to inform the development of novel preventative and therapeutic strategies for POP; (3) reviews relevant modern tools that can help establish causal relationships between epidemiologic risk factors and POP pathogenesis; (4) describes prevention-focused interventions and advancements in treatment-focused interventions to date; and (4) emphasizes requirements for responsible translation of discoveries into novel treatments and safe incorporation of new treatments into clinical practice. Importantly, the review underscores the need for multidisciplinary adequately funded research and training programs as an absolute prerequisite for enabling a long overdue shift in clinical paradigm-instead of relying on delayed compensatory "one-size-fits-all" treatments that do not address the underlying pathophysiology, the focus should be on preventing or mitigating POP through personalized medicine approaches supported by team science.

Introduction and hypothesis: This study is aimed at evaluating the clinical efficacy of matrix radiofrequency combined with myofascial manipulation in the treatment of myofascial pelvic pain (MPP) and to assess its effects on pain relief and pelvic floor muscle function improvement.

Methods: A retrospective analysis was conducted on the clinical data of 87 MPP patients treated at our hospital between January 2021 and December 2024. According to their treatment modalities, patients were divided into the observation group (matrix radiofrequency combined with myofascial manipulation) and the control group (myofascial manipulation alone). Pain levels and pelvic floor muscle function were assessed using the Visual Analog Scale (VAS) and pelvic floor surface electromyography by Glazer evaluation before and after treatment in both groups.

Results: After the treatment course, the VAS scores significantly decreased in both groups. However, the post-treatment VAS score in the observation group (1.21 ± 0.95) was significantly lower than that in the control group (2.76 ± 0.80), with a statistically significant difference between the two groups (p < 0.001). The Glazer evaluation of pelvic floor muscles showed that the improvements in fast-twitch contraction, tonic contraction, and endurance contraction in the observation group were significantly greater than those in the control group (p < 0.001), and the reduction in resting electromyographic amplitude was also more pronounced. Moreover, the overall effective rate in the observation group was significantly higher than that in the control group (p < 0.05).

Conclusion: Matrix radiofrequency combined with myofascial manipulation is significantly more effective than myofascial manipulation alone in alleviating pain and improving pelvic floor muscle function in patients with MPP. This combination therapy provides a safe and effective treatment option, which can significantly improve the clinical efficacy of patients.

Introduction and hypothesis: Pelvic floor dysfunction (PFD) significantly impacts women's health, yet its assessment and management remain inconsistently covered in Obstetrics and Gynaecology training. This study evaluates the knowledge and training exposure of Obstetrics and Gynaecology trainees in Ireland regarding PFD, identifying gaps and potential areas for improvement.

Methods: A cross-sectional survey-based study included all non-consultant hospital doctors (NCHDs). An anonymous electronic survey was distributed assessing respondent demographics and their training exposure and knowledge of pelvic floor dysfunction through 25 structured questions. Sub-analyses were conducted to explore associations between participant characteristics and knowledge scores. Descriptive statistics, t-tests, Mann-Whitney U tests, and Spearman's correlation were used for data analysis.

Results: Of 113 respondents, 109 (96.5%) participated. The median knowledge score was 14/25 (IQR 0-16), with a mean of 9.32. Years since graduation positively correlated with knowledge scores (Spearman's ρ = 0.66, p = 0.05). Higher scores were associated with participation in higher specialty training (15 vs. 7, p < 0.01), exposure to urogynaecology clinics (15 vs. 12, p < 0.01), and operative urogynaecology (15 vs. 3, p < 0.01). Participants with a specific interest in urogynaecology or general/ambulatory gynaecology achieved higher scores (15 vs. 12, p = 0.04).

Conclusions: Wide variability in knowledge and training exposure in pelvic floor dysfunction was identified amongst trainees. Structured programmes emphasizing urogynaecology could enhance trainee competency, ensuring improved understanding and management of pelvic floor dysfunction.

Introduction and hypothesis: Urinary tract infections (UTIs) associated with nontyphoidal Salmonella (NTS; NTS-UTI) are uncommon. Although NTS infections typically result in gastroenteritis, cases of isolated UTIs have been documented. This report examines over 300 NTS-UTI cases described since 1980, highlighting trends in patient demographics, clinical presentation, and environmental exposure.

Methods: A search of the PubMed database was conducted for NTS-UTI reports published between 1980 and 2025. Urine isolate data reported by the Centers for Disease Control and Prevention (CDC) across the USA between 2020 and 2024 were analyzed to estimate the incidence of Salmonella Bareilly (S. Bareilly) UTI. Correlation between S. Bareilly incidence and both chicken and egg production was assessed to explore potential associations.

Results: A total of 321 patients with NTS-UTI were identified in our systematic review. The cohort had an average age of 54.5 ± 24.0 years and an approximate male-to-female ratio of 8:10. Contributing factors for NTS-UTI included comorbidities, such as diabetes and hypertension, and underlying urological conditions, including urolithiasis and recurrent UTI. Analysis of CDC surveillance data revealed a higher incidence of S. Bareilly UTI in the Four-State Area (Arkansas, Kansas, Missouri, Oklahoma) compared with the national average.

Conclusions: Our findings highlight the importance of considering nontyphoidal Salmonella (NTS) in the differential diagnosis of UTI. Environmental exposure, comorbid conditions, and genitourinary abnormalities appear to play a role in the pathogenesis of NTS-UTI. A better understanding of these contributing factors may help to identify at-risk populations in regions where enhanced surveillance may be warranted.