International Urogynecology Journal最新文献

Background and purpose: Pelvic floor rehabilitation is a specialized therapeutic approach focused on assessing and treating pelvic floor muscle dysfunction to enhance bladder, bowel, and sexual function, as well as pelvic organ support, through targeted exercises and behavioral interventions. While applicable to all populations across the lifespan, it holds particular importance for women due to the high prevalence of pelvic floor disorders. As research in this field has grown rapidly, a comprehensive overview is needed to map its development and guide future directions. This bibliometric analysis aims to analyze publication trends, assess current knowledge, and investigate thematic structure in pelvic floor rehabilitation research.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection (coverage from 1900 to present). Articles and reviews published in English from database inception to December 2024 were included. VOSviewer and CiteSpace were employed to perform co-authorship, co-occurrence, co-citation, bibliographic coupling, and burst detection analyses.

Results: A total of 5020 publications (3768 articles and 1252 reviews) were included. The number of publications increased from 61 in 2000 to 468 in 2024, representing a 7.7-fold growth over this period. The top contributing countries were the United States, Brazil, England, China, and Australia. Eight thematic clusters were identified: urinary incontinence, pelvic pain, bowel dysfunction, conservative management, pelvic floor muscle, pregnancy-related care, exercise interventions, and psychometric evaluation. Co-authorship networks highlighted international collaboration, with prominent institutions in Canada, Australia, and Europe. Co-citation and burst analyses revealed seminal works and emerging topics, with recent trends focusing on women's health, sexual function, pelvic pain, and quality of life.

Conclusions: This bibliometric analysis highlights the rapid growth and evolving focus of pelvic floor rehabilitation research over the past 75 years. The findings identify key contributors, international collaborations, and emerging priorities, offering strategic insights for advancing clinical practice and research.

Introduction and hypothesis: Aging may place patients at greater risk for adverse perioperative outcomes. We hypothesized that women undergoing minimally invasive (MIS) sacrocolpopexy aged ≥ 70 years are more likely to experience adverse events (AE) within 8 weeks of surgery.

Methods: We performed a secondary analysis of a retrospective study on perioperative adverse events in women ≥ 61 years old undergoing prolapse surgery at a single academic center from January 2016 to May 2023. Only women undergoing MIS sacrocolpopexy were included. The primary outcome was a composite 8-week AE outcome. Secondary outcomes included prolapse recurrence and mesh complication. Variables were compared between the groups using t-test (or Mann-Whitney U) and chi-square (or Fisher's exact) analyses. Multivariable logistic regression was performed, controlling for variables with p < 0.05 on univariate analysis.

Results: Of the 709 women who underwent MIS sacrocolpopexy, 29.9% (n = 212) were aged ≥ 70 years. Age ≥ 70 was not significantly associated with 8-week perioperative AEs, nor was it associated with prolapse recurrence or mesh complication. The composite AE outcome was not associated with age ≥ 70 on multivariable analysis, controlling for CCI score, robotic approach, and concomitant hysterectomy (adjusted odds ratio (aOR) 0.64, 95% confidence interval (CI) [0.38-1.10]). Women aged ≥ 70 years had a 73% lesser adjusted odds of surgical site infections on multivariable analysis (95% CI [0.08-0.93]).

Conclusions: Age ≥ 70 years is not associated with perioperative AEs, prolapse recurrence, or mesh complication. These findings highlight the safety profile of this surgical approach in older women, an important consideration for urogynecologic surgeons caring for an aging population.

Introduction and hypothesis: There is limited literature regarding concomitant initiation of pelvic floor physical therapy (PFPT) and medications for overactive bladder treatment. PFPT improves patient symptoms, although adherence tends to be low. This retrospective cohort study assessed PFPT adherence of female patients with overactive bladder at a tertiary care center who were referred to PFPT. We hypothesized that concomitant PFPT and medication would correlate with decreased PFPT adherence among patients with overactive bladder.

Methods: Adherence to PFPT (defined as ≥ 50% attendance of the recommended sessions) was compared in patients with (PT + Med group) and in those without (PT group) concomitant medication prescription.

Results: We evaluated 346 patients, with 196 in the PT group and 150 in the PT + Med group. The PT + Med group had a higher body mass index (30.0 kg/m² vs 27.5 kg/m², p < 0.001), a higher rate of diabetes (20.7% vs 11.7%, p = 0.02), and higher urogenital distress inventory scores at baseline (p < 0.001). The PT group completed more PT sessions (p < 0.001) and was more likely to be adherent (30.6% vs 15.3%, p < 0.001). The PT + Med group was more likely to progress to minimally invasive therapy (10.0% vs 4.1%, p = 0.03). On multivariable logistic regression model, PFPT adherence remained significantly lower for the PT + Med group when controlling for comorbidities (adjusted OR 0.38, p = 0.001).

Conclusions: The addition of medication at the time of PFPT referral was associated with decreased PFPT adherence in overactive bladder patients.

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.