International Urogynecology Journal最新文献

Objective: Pelvic organ prolapse (POP) is a common health problem that significantly impairs quality of life, particularly in terms of sex. Our study aimed to assess the quality of sexual life of women after successful POP repair with laparoscopic sacrocolpopexy (LSC).

Methods: This prospective cohort study was aimed at assessing the influence of successful laparoscopic sacrocolpopexy on the quality of sexual life after the surgery. Pre- and postoperative examinations included the Pelvic Organ Prolapse Quantification (POPQ) scale and validated quality-of-life questionnaires. PFDI-20 and PFIQ were used to choose patients who were satisfied with the results of the surgery. The quality of sexual life of sexually active and nonactive patients was subsequently evaluated via the PISQ-IR questionnaire. Post-surgery evaluation was planned 8-12 months after the procedure.

Results: A total of 181 patients were included in the study. The mean age of the patients was 58.2±9.6 years. Patients in the sexually active group were significantly younger (55.5±9.5) than were those in the nonactive group (63.4±7.7). Follow-up visits took place 10±2.34 months after surgery. We achieved statistically significant improvements in the PFDI-20 questionnaire, particularly in the POPDI-6 section, the PFIQ-7 questionnaire, and the POPQ scale. Among sexually active women, improvements in sexual function were observed across most domains, including global quality (p = 0.003), arousal and orgasm (p < 0.001), condition impact (CI, feelings of sexual inferiority, embarrassment, or anger during sexual activity, p < 0.001), and condition-specific (CS, feelings of fear or shame during sexual activity, p < 0.001). A notable finding was the significant reduction in dyspareunia, which decreased from 12.7% to 3.3%. The study also revealed that sexual inactivity was correlated with negative self-perception, which improved significantly following surgery (CS, p = 0.04; CI, p < 0.001).

Conclusion: These findings suggest that laparoscopic sacrocolpopexy improves the quality of sexual life and leads to a reduction in dyspareunia and distress related to POP symptoms.

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: Coital incontinence is defined as urinary incontinence before, during, or after sexual intercourse. This study aimed to determine the frequency of coital incontinence and when it occurs in women with urinary incontinence.

Methods: A systematic review and meta-analysis was conducted. The publications meeting the inclusion criteria were searched between February and April 2024. A search of the PubMed, ScienceDirect, Web of Science, EBSCO CINAHL Plus, and Cochrane Library databases was performed. The methodological qualities of the studies were examined using a checklist developed by the Joanna Briggs Institute. All analyses were performed using comprehensive meta-analysis (CMA).

Results: The study included 23 articles with a total sample size of 21,650. According to the study results, the estimated prevalence of coital incontinence in women with urinary incontinence was 35.3% (95% CI 0.363 (0.272-0.443); z 0.91, p < 0.0001), coital incontinence was most frequently observed during penetration, and its estimated prevalence was 50.5% (95% CI 0.505 (0.336-0.673); tau 1.163, p < 0.0001).

Conclusion: Coital incontinence is common in women with urinary incontinence. It was also concluded that approximately half of the women with urinary incontinence leak urine during penetration.

Prospero registration no: CRD42024512307.

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.