International Urogynecology Journal最新文献

Introduction and hypothesis: This retrospective cohort study was aimed at comparing two native tissue suspension techniques for correcting apical pelvic organ prolapse (POP): sacrospinous ligament suspension (SSLS) and arcus tendineus fascia pelvis suspension (ATFPS).

Methods: Medical charts of 145 patients who underwent one of the two techniques for symptomatic uterine prolapse at two academic centers from 2017 to 2022 were reviewed. The success rate of each surgery, along with the risks of complications, pain, and urinary and bowel symptoms were evaluated.

Results: Mean postoperative follow-up time was 42.4 ± 9.1 weeks. No significant differences in baseline characteristics were noted. Anatomical objective recurrence (POP-Q ≥ stage 2 POP in any compartment) was more prevalent following SSLS (SSLS 49.0%, AFTPS 23.4%; p = 0.005), with nearly all recurrences being anterior. There were no differences in resolution of apical prolapse. Subjective recurrence, defined as prolapse symptoms of vaginal bulge and pressure, also occurred at a higher rate post-SSLS (SSLS 22.4%, AFTPS 8.2%; p = 0.019). Postoperative buttock pain at 6 weeks was more common post-SSLS (SSLS 18.2%, AFTPS 1.6%; p = 0.006). Overall, reoperation for POP recurrence and/or incontinence occurred in 8.2% of SSLS and 3.1% of ATFPS (p = 0.222).

Conclusions: In the short term, ATFPS exhibited lower subjective and objective POP recurrence rates and less early postoperative pain compared with standard SSLS at the time of hysterectomy for POP.

Introduction and hypothesis: Vaginal estrogen therapy is widely accepted as a safe and effective treatment for symptoms of genitourinary syndrome of menopause (GSM), yet it is likely underutilized owing to various factors relating to patient perceptions, barriers to access, and health care system outreach. The aim of our study is to explore patient beliefs and opinions regarding its use.

Methods: A qualitative study was conducted with patients prescribed vaginal estrogen at an ambulatory urogynecology office between October 2022 and August 2023. Participants completed a symptom inventory followed by a 1:1 in-depth interview based on a structured guide designed to elicit candid insights and detailed responses into perceptions and experiences with vaginal estrogen. Data were analyzed using grounded theory methods in a three-phase coding process to identify key themes.

Results: Twenty-two participants were interviewed. Six major themes emerged: knowledge base, barriers to health care access, motivation for symptom relief, concerns regarding side effects, physician-patient relationship, and barriers to compliance. Although participants understood the connection between GSM and aging, they often felt unclear about which symptoms vaginal estrogen targeted, how to apply it, and how it differed from systemic hormone replacement therapy. Barriers such as cost, lack of insurance coverage, and concerns about cancer were frequently reported. Physician education helped to alleviate fears, improving patient confidence in using vaginal estrogen.

Conclusions: This study identified key beliefs and barriers affecting the use of vaginal estrogen for GSM. These findings highlight the need for improved patient education, better physician counseling, and enhanced communication to support adherence to this beneficial therapy.

Introduction and hypothesis: We have examined prospectively a large cohort of primipara with VA deliveries and previously reported that approximately one in five had an anal sphincter injury of which one quarter were clinically unrecognized. In this paper, we examine the development and potential predictors of postpartum anal incontinence (AI) in the cohort. We hypothesized that both clinically recognized and unrecognized anal sphincter injuries would be associated with AI development.

Methods: The participants were interviewed 9-12 months postpartum using the St. Marks incontinence score (SMIS). The primary outcome was the prevalence of de novo AI development defined as SMIS > 0. Logistic regression analysis was used to calculate the odds ratios for selected variables.

Results: Of 334 eligible women, 271 (81%) were initially included in the study and 248 of them (92%) completed the interview. The prevalence of de novo AI was 21.8% (95% CI 16.4-28.4). Both clinically recognized and unrecognized anal sphincter injuries increased the odds significantly about threefold. Only 35.2% of the symptomatic women had a sphincter injury, and we identified no predictors in the rest.

Conclusions: Approximately one in five primipara undergoing a VA delivery developed AI. About one third of them were associated with either a clinically recognized or unrecognized anal sphincter injury. Thus, the combination of the two provides the most clinically relevant distinction between anal sphincter injury dependent and independent predictors of AI development. In the symptomatic women with no sphincter injuries, we found no predictive variables.

Introduction and hypothesis: This study evaluated the reoperation rate and risk factors among women who underwent midurethral sling (MUS) insertion for stress urinary incontinence (SUI). Reoperation was defined as an additional incontinence procedure due to insufficient benefit from the initial MUS, excluding surgeries for mesh-related complications or device removal.

Methods: We analyzed 221,082 women aged ≥ 20 years who received MUS between 2009 and 2015 in South Korea. Data from the National Health Insurance Service were used to determine reoperation rates, and Cox regression identified independent risk factors.

Results: Reoperation rates were 0.8% at 1 year, 2.7% at 5 years, and 4.8% at 12 years. Younger age (< 60 years) was associated with a higher likelihood of reoperation (hazard ratio [HR] 1.957, p < 0.001). Overactive bladder (HR 2.308, p < 0.001), neurogenic bladder (HR 2.308, p < 0.001), and diabetes were also significant risk factors. However, diagnoses were based on claims data, potentially leading to misclassification. Variability in surgical expertise and evolving medical practices may further limit generalizability.

Conclusions: Among 221,082 women undergoing MUS, the long-term reoperation rate was 4.8%. Younger age, overactive bladder, neurogenic bladder, and diabetes were key risk factors. Preoperative assessment of these factors is essential for optimizing patient selection.

Introduction and hypothesis: Sacrospinous ligament fixation (SSF) is a widely accepted native tissue technique for apical pelvic organ prolapse (POP), especially following the decline in mesh-based procedures. However, the optimal suture technique remains under debate.

Objectives: To compare the clinical outcomes of double versus loop suture techniques in SSF, with a focus on operative efficiency, complications, recurrence, and reoperation rates over a 24-month follow-up.

Patients and methods: This retrospective cohort study included 195 patients with stage 3 or 4 POP who underwent SSF with nonabsorbable polypropylene suture between January 2020 and January 2023 in a tertiary-care academic hospital specializing in urogynecologic surgery. Group 1 (n = 115) underwent classical double suture SSF, while group 2 (n = 80) received the loop suture technique. Demographic characteristics, operative times, perioperative complications, recurrence, and reoperation rates were recorded and compared between the groups.

Main outcome measures: Primary outcomes were total operative time. Secondary outcomes included postoperative complications such as gluteal pain, recurrence rate, and reoperation rate.

Results: Both groups were similar in age, BMI, and baseline POP stage. The loop suture group had significantly shorter total operative time (154.04 ± 41.83 vs. 112.85 ± 37.34 min, p < 0.001) and SSF-specific surgical time (59.09 ± 22.97 vs. 37.34 ± 10.91 min, p < 0.001). Although recurrence rates were similar (24.3% in the double suture group vs. 18.7% in the loop suture group, p = 0.452), reoperation was significantly less frequent in the loop group (5% vs. 14.7%, p = 0.035). Gluteal pain occurred more often in the double suture group, although these differences were not statistically significant.

Conclusion: The loop suture technique appears to be a safe and efficient alternative to the classical double suture method for SSF, offering reduced operative time and lower reoperation rates without compromising effectiveness.

Introduction and hypothesis: Pelvic organ prolapse (POP) is a complication of childbirth that may impair the overall health of women. We hypothesized that women with symptomatic pelvic organ prolapse (sPOP) would rate their health lower than women without sPOP 1 year after childbirth.

Methods: The Swedish National Pregnancy Register, and the Pregnancy Survey were merged and searched for women with data on self-rated health and POP 1 year after childbirth. The women (n = 43,082), who answered these validated questions in the Pregnancy Survey between December 2022 and October 2024 comprised our study population, of which 40,392 were included in the final analysis. Analysis was performed using descriptive statistics and a binary logistic regression model to estimate the associations between self-rated health and sPOP 1 year after childbirth.

Results: In total, 5704 (13.2%) participants reported sPOP; 1617 (28.3%) women with sPOP and 6669 (17.8%) women without sPOP rated their health as poor. sPOP was associated with poor self-rated health 1 year after childbirth (OR 1.557, 95% CI 1.453-1.669). Additionally, the following covariates: low education, urinary incontinence, fecal incontinence, and poor self-rated health before pregnancy were also associated with poor self-rated health 1 year after childbirth.

Conclusions: Women with sPOP had higher odds of reporting poor self-rated health 1 year after childbirth compared to women without sPOP. In Sweden, sPOP represents a public health concern affecting women in their prime years and may lead to poorer health outcomes throughout the rest of their lives.

Introduction and hypothesis: Pregnancy and childbirth are established causes of pelvic floor dysfunction (PFD), but screening for antenatal and postnatal PFD is not routine in the United Kingdom. This study aimed to identify antenatal and postnatal women with PFD using a validated electronic patient reported outcome measure (PROM) and provide targeted intervention based on symptom scores.

Methods: During the evaluation period, 15,093 patients across three NHS hospitals were invited to complete ePAQ-Pelvic Floor. Invites were sent electronically after ultrasound confirmed viable pregnancy and 16 weeks postnatal. Respondents with scores 50-79 in any domain were triaged to review by a therapy assistant practitioner; scores > 80 to a specialist physiotherapist or urogynaecologist. Responses were divided into antenatal and postnatal cohorts. Mann-Whitney tests were used to assess differences in mean domain scores, with odds ratios calculated for symptom presence (domain score > 0).

Results: A total of 3366 PROMs were completed (response rate 22.3%); 1804 antenatal and 806 postnatal respondents gave consent to data analysis. Mean ages, BMI and parity were 30.3, 27.1 and 0.7 (antenatal) and 31.2, 27.8 and 1.7 (postnatal). Six hundred one patients were triaged to physiotherapy assistants and 150 to specialist review based on symptom scores. Mean domain scores for stress urinary incontinence, bowel continence, pelvic organ prolapse, dyspareunia, body image and general sex life were all significantly worse in postnatal women (p < 0.0001).

Conclusions: Antenatal and postnatal patients are at risk of PFD and using electronic PROMs may aid identification of affected women. Further research is needed into optimal instruments, acceptability and improving response rates.

Introduction and hypothesis: Perineal wound breakdown is a rare but important complication following childbirth-related perineal trauma. Though many providers manage wound breakdown via expectant management, the optimal strategy remains debated. In this review, we systematically compile a comprehensive overview of existing data on management of perineal wound dehiscence with emphasis on timing, surgical technique and personnel, outcomes, and considerations to obstetric anal sphincter injuries (OASIS).

Methods: Our literature search utilized PubMed, SCOPUS, and EMBase databases.

Results: Thirteen relevant articles were included in our review. The majority of studies reported resuturing within 2 weeks of diagnosis (11/13), utilizing intraoperative antibiotics (10/13) and polyglactin suture (13/13). Repairs were largely completed in the operating room by an Ob/Gyn; Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialists were specified in two studies. Complete healing occurred in 57.1-92.9% of patients, typically by 3 months postoperatively, but also reported up to 1 year after repair. Dyspareunia was the most common complication (5.6-27.8%). Minor complications included superficial separation (14.3%) and surgical site infection (9.5%). Four studies focused on OASIS, and repair in these settings often required an URPS consultation and was associated with fecal urgency, flatal and/or fecal incontinence (13.6-37.0%).

Conclusions: Evidence supports early resuturing within 2 weeks of perineal wound breakdown, demonstrating good short-term outcomes. Optimal management includes intraoperative cephalosporin administration, polyglactin sutures, and URPS consultation, especially if breakdown of OASIS is suspected. Future studies should examine long-term outcomes, such as rates of persistent anal incontinence, and overall patient satisfaction regarding the timing and techniques of perineal laceration repair revision.