International Urogynecology Journal最新文献

Introduction and hypothesis: Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV).

Methods: A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV.

Results: A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5 years (range 0-9) in the pre-discharge TOV group versus 1.0 year (range 0-6) in the post-discharge TOV group (p > 0.05).

Conclusions: In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

Introduction and hypothesis: There is a rising trend among women towards nonpharmacological approaches owing to their minimally invasive nature and limited adverse effects. Virtual reality (VR) has recently gained popularity as a new technology for reducing pain and anxiety in medical settings. Our research sought to investigate the impact of VR on pain and anxiety levels while undergoing episiotomy repair.

Methods: A comprehensive search was carried out across PubMed, Scopus, Cochrane Library, and ISI Web of Science to find relevant randomized clinical trials (RCTs) up to January 2024. These trials investigated the use of VR as a treatment during episiotomy repair compared with a control group that did not receive VR intervention. Meta-analysis was performed using Review Manager software to analyze the data collected. Our primary outcomes were pain scores reported during and after episiotomy repair measured by a visual analog scale. Secondary outcomes analyzed included anxiety scores during and after the procedure, as well as the duration of episiotomy repair.

Results: Seven RCTs, involving 578 patients, met the inclusion criteria. VR resulted in a significant reduction in pain scores both during and after episiotomy repair (p < 0.001). Additionally, anxiety levels during and after the procedure were significantly reduced in the VR group compared with the control group. Moreover, the duration of episiotomy repair was significantly shorter in the VR group.

Conclusion: Using VR has proven to be an effective technique in reducing pain and anxiety during and after episiotomy repair, as well as potentially speeding up the procedure.

Introduction and hypothesis: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS.

Methods: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront.

Results: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction.

Conclusions: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

Introduction and hypothesis: Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn.

Methods: The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand.

Results: This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications.

Conclusions: The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.

Introduction and hypothesis: Multicompartment prolapse is a complex pelvic floor condition that can involve coordination of both urogynecologists and colorectal surgeons.

Methods: Concomitant sacrocolpopexy and ventral rectopexy is a safe and effective approach to treating this condition.

Results: The combined procedure has high rates of patient satisfaction and symptom improvement, including defecatory dysfunction, sexual health, and overall increased quality of life.

Conclusion: Concomitant sacrocolpopexy with ventral rectopexy is safe and improves overall outcomes.

Introduction and hypothesis: Coital incontinence (CI) is common, with a significant impact on quality of life and sexual function. This multicentre study was aimed at measuring the association between overactive bladder (OAB), stress urinary incontinence (SUI) and different aspects of CI including orgasm and penetration incontinence.

Methods: Following ethical approval, data from the electronic Personal Assessment Questionnaire-Pelvic Floor patient-reported outcome measure was collated for Urogynaecology outpatients from seven participating UK Hospitals between April 2018 and January 2022. Data were anonymised and analysed centrally using Excel.

Results: A total of 12,877 responses were obtained, of which 4,843 were valid for inclusion. 79.3% of women presented with urinary incontinence of whom 41.6% also reported CI. 96.8% of women with CI reported mixed OAB and SUI, with 2.1% and 1.1% reporting pure OAB and SUI respectively. There was a small subset (2.4%) with no overt urinary incontinence who occasionally experienced CI. Spearman's rank-order correlation demonstrated a statistically significant association between CI symptom score with both SUI (R = 0.57, p < 0.001) and OAB (R = 0.40, p < 0.001); orgasm incontinence with SUI (R = 0.49, p < 0.001) and OAB (R = 0.36, P < 0.001); penetration incontinence with SUI (R = 0.48, p < 0.001) and OAB (R = 0.35, p < 0.001).

Conclusions: Coital incontinence is experienced by 42% of women with urinary incontinence. There is a statistically significant association between both SUI and OAB with orgasm incontinence and penetration incontinence, suggesting (a) common underlying mechanism(s). Limitations of this study include the large amount of missing data and the NHS outpatient setting that limit the conclusions that can be drawn from the data.

Introduction and hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach.

Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion. Patients who were parous, had no history of pelvic or abdominal surgery, and had a uterine weight ≤ 280 g on pathology were considered likely candidates for vaginal hysterectomy based on an algorithm developed to guide the surgical approach. Average annual changes in the proportion of likely vaginal hysterectomy candidates and route of hysterectomy were assessed using logistic regression.

Results: Of the 77,829 patients meeting the inclusion criteria, 13,738 (17.6%) were likely vaginal hysterectomy candidates. Among likely vaginal hysterectomy candidates, the rate of vaginal hysterectomy was 34.5%, whereas among unlikely vaginal hysterectomy candidates, it was 14.1%. The overall vaginal hysterectomy rate decreased -1.2%/year (p < 0.01). This decreasing trend was nearly twice as rapid among likely vaginal hysterectomy candidates (-1.9%/year, p < .01) compared with unlikely vaginal hysterectomy candidates (-1.1%/year, P < 0.01); the difference in trends was statistically significant (p < 0.01).

Conclusions: The rate of vaginal hysterectomy performed for eligible indications decreased between 2017 and 2020 in a national surgical registry. This negative trend was more pronounced among patients who were likely candidates for vaginal hysterectomy based on favorable parity, surgical history, and uterine weight.