Introduction and hypothesis: Trauma complications have been one of the most serious public health concerns worldwide. In most reports, urogenital injuries (UGIs) are seen in approximately 10% of adult traumatic patients and less than 3% of children with multiple/severe trauma to the abdomen or pelvis. Traffic accidents are the most common cause of UGIs. The purpose of this study is to systematically determine the prevalence and types of UGIs after car accidents.
Methods: The search strategy was aimed at finding relevant studies in October 2023. No restrictions on language or date were applied. The following criteria were considered eligibility criteria: reporting at least one epidemiological aspect of UGIs in people with road traffic injury (RTI) and a separate epidemiological analysis of RTIs in UGI (we also included those articles that pointed out all RTIs but separately mentioned UGIs). Two experts assessed the reporting quality of articles using standardized critical appraisal instruments from the Joanna Briggs Institute. Statistical analysis for this study was conducted using the CMA statistical software version 3.2.0.
Results: A total of 1,466,024 cases following RTIs through 107 studies were included in our review. Of these, 29 studies were related to children (20,036), and the others reported RTIs in adults (1,445,988). The total prevalence was 4.7%, and car accidents were responsible in 36 studies, followed by motorcycle accidents in 25, bicycles in 17 studies, and automobile-pedestrian collisions in 23 related studies. In subgroup analysis based on the damaged organ, the rate of bladder injury was 3.5%. This rate was 5.3% for kidneys.
Conclusion: This systematic review and meta-analysis found that the prevalence of UGI following RTIs was 4.7%, with car accidents being the most common cause. UGIs were more prevalent in adults than in children, and bladder and kidney injuries were the most commonly reported types. The prevalence of UGI varied by country and study design.
导言和假设:创伤并发症一直是全球最严重的公共卫生问题之一。在大多数报告中,泌尿生殖系统损伤(UGIs)见于约 10%的成年外伤患者和不到 3%的腹部或骨盆多发/严重外伤儿童。交通事故是导致 UGI 的最常见原因。本研究的目的是系统地确定车祸后 UGI 的发生率和类型:搜索策略旨在查找 2023 年 10 月的相关研究。对语言和日期没有限制。以下标准被视为合格标准:至少报道了道路交通伤害(RTI)患者 UGI 的一个流行病学方面,以及对 UGI 中 RTI 的单独流行病学分析(我们还纳入了那些指出所有 RTI 但单独提及 UGI 的文章)。两位专家使用乔安娜-布里格斯研究所(Joanna Briggs Institute)提供的标准化批判性评估工具对文章的报告质量进行了评估。本研究使用 CMA 统计软件 3.2.0 版进行统计分析:我们的研究共纳入了 107 项研究中的 1,466,024 例 RTI 病例。其中,29 项研究涉及儿童(20,036 例),其他研究报告了成人的 RTI(1,445,988 例)。总发病率为 4.7%,36 项研究中的肇事者为汽车事故,25 项研究中的肇事者为摩托车事故,17 项研究中的肇事者为自行车,23 项相关研究中的肇事者为汽车与行人碰撞。根据受损器官进行分组分析,膀胱损伤率为 3.5%。结论:本系统综述和荟萃分析发现,RTI 后的 UGI 发生率为 4.7%,车祸是最常见的原因。成人尿路感染的发病率高于儿童,膀胱和肾脏损伤是最常见的报告类型。尿路感染的发生率因国家和研究设计而异。
{"title":"Prevalence of Urogenital Injury following Road Accident: A Systematic Review.","authors":"Reza Aletaha, Amin Abbasi, Hamidreza Ashayeri, Raana Zakeri, Homayoun Sadeghi-Bazargani, Kavous Shahsavrinia, Ehsan Sepehran, Amirmohammad Navali, Hanieh Salehi-Pourmehr, Sakineh Hajebrahimi","doi":"10.1007/s00192-024-05870-9","DOIUrl":"https://doi.org/10.1007/s00192-024-05870-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Trauma complications have been one of the most serious public health concerns worldwide. In most reports, urogenital injuries (UGIs) are seen in approximately 10% of adult traumatic patients and less than 3% of children with multiple/severe trauma to the abdomen or pelvis. Traffic accidents are the most common cause of UGIs. The purpose of this study is to systematically determine the prevalence and types of UGIs after car accidents.</p><p><strong>Methods: </strong>The search strategy was aimed at finding relevant studies in October 2023. No restrictions on language or date were applied. The following criteria were considered eligibility criteria: reporting at least one epidemiological aspect of UGIs in people with road traffic injury (RTI) and a separate epidemiological analysis of RTIs in UGI (we also included those articles that pointed out all RTIs but separately mentioned UGIs). Two experts assessed the reporting quality of articles using standardized critical appraisal instruments from the Joanna Briggs Institute. Statistical analysis for this study was conducted using the CMA statistical software version 3.2.0.</p><p><strong>Results: </strong>A total of 1,466,024 cases following RTIs through 107 studies were included in our review. Of these, 29 studies were related to children (20,036), and the others reported RTIs in adults (1,445,988). The total prevalence was 4.7%, and car accidents were responsible in 36 studies, followed by motorcycle accidents in 25, bicycles in 17 studies, and automobile-pedestrian collisions in 23 related studies. In subgroup analysis based on the damaged organ, the rate of bladder injury was 3.5%. This rate was 5.3% for kidneys.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis found that the prevalence of UGI following RTIs was 4.7%, with car accidents being the most common cause. UGIs were more prevalent in adults than in children, and bladder and kidney injuries were the most commonly reported types. The prevalence of UGI varied by country and study design.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1007/s00192-024-05886-1
Giuseppe Ettore, Gabriella Torrisi, Raffaela Luisa Grimaldi, Carla Ettore
Introduction and hypothesis: The aim of this study was to evaluate anatomical and functional outcomes of a modified McCall culdoplasty compared with the traditional technique for pelvic organ prolapse.
Methods: This prospective clinical observational study was conducted in a secondary referral urogynecological center between October 2021 and October 2022. A modified McCall culdoplasty was performed in 85 patients (group A). It was characterized by dissection of uterosacral ligaments up to the ischial spines, their shortening and attachment to the vaginal apex and both the rectovaginal and the vesicovaginal fascia. Outcomes were compared with those of a group of 86 patients (group B) who underwent the traditional culdoplasty between September 2020 and September 2021. Primary outcome was prolapse recurrence. Secondary endpoints included subjective outcomes, vaginal length, quality of life, and urinary and anal incontinence. Statistical analysis was conducted using Fisher's exact, Mann-Whitney U, and Student's t tests.
Results: At 12 months, prolapse recurrence occurred in 2.5% (CI 0.7-8.8%) of patients in group A and in 6.7% (CI 2.9-14.7%) in group B. Postoperative vaginal length was 8.3 ± 0.78 cm in group A and 6.4 ± 1.1 cm in group B (p < 0.001). The Patient Global Impression of Improvement questionnaire revealed that 76 patients (96.2%) in group A versus 64 (85%) in group B were very satisfied (p < 0.03). Both groups showed an improvement in urinary symptoms and quality of life.
Conclusions: The modified McCall culdoplasty showed successful anatomical and functional outcomes, with a tendency towards lower recurrence rates than the traditional McCall procedure. Further long-term studies are needed to confirm our data.
{"title":"A Modified McCall Culdoplasty in Pelvic Organ Prolapse Surgery: Anatomical and Functional Outcomes.","authors":"Giuseppe Ettore, Gabriella Torrisi, Raffaela Luisa Grimaldi, Carla Ettore","doi":"10.1007/s00192-024-05886-1","DOIUrl":"https://doi.org/10.1007/s00192-024-05886-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The aim of this study was to evaluate anatomical and functional outcomes of a modified McCall culdoplasty compared with the traditional technique for pelvic organ prolapse.</p><p><strong>Methods: </strong>This prospective clinical observational study was conducted in a secondary referral urogynecological center between October 2021 and October 2022. A modified McCall culdoplasty was performed in 85 patients (group A). It was characterized by dissection of uterosacral ligaments up to the ischial spines, their shortening and attachment to the vaginal apex and both the rectovaginal and the vesicovaginal fascia. Outcomes were compared with those of a group of 86 patients (group B) who underwent the traditional culdoplasty between September 2020 and September 2021. Primary outcome was prolapse recurrence. Secondary endpoints included subjective outcomes, vaginal length, quality of life, and urinary and anal incontinence. Statistical analysis was conducted using Fisher's exact, Mann-Whitney U, and Student's t tests.</p><p><strong>Results: </strong>At 12 months, prolapse recurrence occurred in 2.5% (CI 0.7-8.8%) of patients in group A and in 6.7% (CI 2.9-14.7%) in group B. Postoperative vaginal length was 8.3 ± 0.78 cm in group A and 6.4 ± 1.1 cm in group B (p < 0.001). The Patient Global Impression of Improvement questionnaire revealed that 76 patients (96.2%) in group A versus 64 (85%) in group B were very satisfied (p < 0.03). Both groups showed an improvement in urinary symptoms and quality of life.</p><p><strong>Conclusions: </strong>The modified McCall culdoplasty showed successful anatomical and functional outcomes, with a tendency towards lower recurrence rates than the traditional McCall procedure. Further long-term studies are needed to confirm our data.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1007/s00192-024-05834-z
Sarah Ashmore, Elizabeth J Geller, C Emi Bretschneider
Introduction and hypothesis: Sacrocolpopexy (SCP) is the gold standard surgical management of apical pelvic organ prolapse (POP), and increasingly, minimally invasive SCP is being adopted as a primary treatment for advanced uterovaginal prolapse. Patients undergoing surgery for POP consider postoperative improvement in sexual function to be a highly important outcome, and sexual dysfunction and dyspareunia severe adverse events. Therefore, it is crucial to understand the impact of minimally invasive SCP on postoperative sexual function. We aimed to analyze the current literature available to discuss the impact of minimally invasive SCP on postoperative sexual function.
Methods: We performed a narrative review of minimally invasive SCP and its impact on sexual function. PubMed and EMBASE were searched from inception through 28 January 2024 for studies that reported sexual function following surgery for POP. Baseline and postoperative sexual activity, dyspareunia, and validated questionnaire scores for sexual function were documented.
Results: Minimally invasive SCP is associated with improved postoperative sexual function, increased rates of postoperative sexual activity, and low rates of dyspareunia. Dyspareunia was not associated with mesh related complications. Patients with baseline dyspareunia or pain were more likely to experience persistent dyspareunia after surgery.
Conclusion: The rates of POP are increasing in our aging population, and sexual function is very important to patients undergoing surgery for POP. Clinicians should consider all factors related to sexual function when planning surgery for POP and address dyspareunia prior to surgery. Sexual function appears to improve overall after minimally invasive SCP and de novo dyspareunia rates are low.
导言和假设:骶尾部阴道环切术(SCP)是治疗顶端盆腔器官脱垂(POP)的金标准手术方法,越来越多的人将微创骶尾部阴道环切术作为晚期子宫脱垂的主要治疗方法。接受 POP 手术的患者认为术后性功能的改善是非常重要的结果,而性功能障碍和排便困难则是严重的不良事件。因此,了解微创 SCP 对术后性功能的影响至关重要。我们旨在分析现有文献,讨论微创 SCP 对术后性功能的影响:我们对微创 SCP 及其对性功能的影响进行了叙述性综述。我们检索了从开始到 2024 年 1 月 28 日期间在 PubMed 和 EMBASE 上发表的有关 POP 术后性功能报告的研究。研究记录了基线和术后性活动、性生活障碍以及性功能有效问卷评分:结果:微创 SCP 与术后性功能的改善、术后性活动率的提高和性生活障碍率的降低有关。性生活障碍与网片相关并发症无关。基线存在排便障碍或疼痛的患者术后更有可能出现持续性排便障碍:结论:在我们的老龄人口中,POP 的发病率正在上升,而性功能对于接受 POP 手术的患者来说非常重要。临床医生在计划 POP 手术时应考虑与性功能相关的所有因素,并在手术前解决性生活障碍问题。微创 SCP 术后性功能似乎总体上有所改善,新出现的性功能障碍发生率很低。
{"title":"Minimally Invasive Sacrocolpopexy: Impact on Sexual Function.","authors":"Sarah Ashmore, Elizabeth J Geller, C Emi Bretschneider","doi":"10.1007/s00192-024-05834-z","DOIUrl":"https://doi.org/10.1007/s00192-024-05834-z","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Sacrocolpopexy (SCP) is the gold standard surgical management of apical pelvic organ prolapse (POP), and increasingly, minimally invasive SCP is being adopted as a primary treatment for advanced uterovaginal prolapse. Patients undergoing surgery for POP consider postoperative improvement in sexual function to be a highly important outcome, and sexual dysfunction and dyspareunia severe adverse events. Therefore, it is crucial to understand the impact of minimally invasive SCP on postoperative sexual function. We aimed to analyze the current literature available to discuss the impact of minimally invasive SCP on postoperative sexual function.</p><p><strong>Methods: </strong>We performed a narrative review of minimally invasive SCP and its impact on sexual function. PubMed and EMBASE were searched from inception through 28 January 2024 for studies that reported sexual function following surgery for POP. Baseline and postoperative sexual activity, dyspareunia, and validated questionnaire scores for sexual function were documented.</p><p><strong>Results: </strong>Minimally invasive SCP is associated with improved postoperative sexual function, increased rates of postoperative sexual activity, and low rates of dyspareunia. Dyspareunia was not associated with mesh related complications. Patients with baseline dyspareunia or pain were more likely to experience persistent dyspareunia after surgery.</p><p><strong>Conclusion: </strong>The rates of POP are increasing in our aging population, and sexual function is very important to patients undergoing surgery for POP. Clinicians should consider all factors related to sexual function when planning surgery for POP and address dyspareunia prior to surgery. Sexual function appears to improve overall after minimally invasive SCP and de novo dyspareunia rates are low.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1007/s00192-024-05882-5
Zoltan Nemeth, Peter Vida, Predrag Markovic, Peter Gubas, Kalman Kovacs, Balint Farkas
Introduction and hypothesis: Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing.
Methods: We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I).
Results: Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive.
Conclusions: The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.
{"title":"Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis.","authors":"Zoltan Nemeth, Peter Vida, Predrag Markovic, Peter Gubas, Kalman Kovacs, Balint Farkas","doi":"10.1007/s00192-024-05882-5","DOIUrl":"https://doi.org/10.1007/s00192-024-05882-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I).</p><p><strong>Results: </strong>Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as \"better\" or \"much better\" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as \"better\" or \"much better\" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive.</p><p><strong>Conclusions: </strong>The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-03DOI: 10.1007/s00192-024-05881-6
Helai Hesham, Francisco Orejuela, Kara M. Rood, Mark Turrentine, Brian Casey, Meena Khandelwal, Rori Dajao, Sarah Azad, Todd Rosen, Matthew K. Hoffman, Eileen Y. Wang, Laura Hart, Jean-Ju Sheen, Tamara Grisales, Kelly S. Gibson, Vanessa Torbenson, Shauna F. Williams, Edward Evantash, Hans P. Dietz, Ronald J. Wapner
Introduction and Hypothesis
The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery.
Methods
A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months.
Results
A total of 214 women were randomized to Device (n = 113) or Control (n = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (p = 0.040; two-tailed Fisher’s test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related.
Conclusions
The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse.
{"title":"Effect of an Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial","authors":"Helai Hesham, Francisco Orejuela, Kara M. Rood, Mark Turrentine, Brian Casey, Meena Khandelwal, Rori Dajao, Sarah Azad, Todd Rosen, Matthew K. Hoffman, Eileen Y. Wang, Laura Hart, Jean-Ju Sheen, Tamara Grisales, Kelly S. Gibson, Vanessa Torbenson, Shauna F. Williams, Edward Evantash, Hans P. Dietz, Ronald J. Wapner","doi":"10.1007/s00192-024-05881-6","DOIUrl":"https://doi.org/10.1007/s00192-024-05881-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 214 women were randomized to Device (<i>n</i> = 113) or Control (<i>n</i> = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (<i>p</i> = 0.040; two-tailed Fisher’s test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141880856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-13DOI: 10.1007/s00192-024-05871-8
Gabriela F Sarriera Valentin, Francis A Jefferson, Katherine T Anderson, Brian J Linder
Introduction and hypothesis: We describe the surgical management of intravesical mesh perforation following transvaginal mesh surgery for pelvic organ prolapse.
Methods: A 73-year-old woman presented with intravesical mesh perforation 17 years following transvaginal mesh-based prolapse repair at an outside hospital. The patient presented with intermittent hematuria and recurrent urinary tract infections. Cystoscopy demonstrated an approximately 3-cm area of intravesical mesh with associated stone spanning from the bladder neck through the left trigone and ureteral orifice. A robotic-assisted transvesical mesh excision and left ureteroneocystostomy was carried out. Robotic-assisted repair was performed transvesically via transverse bladder dome cystotomy. Dissection was carried out circumferentially around the mesh in the vesicovaginal plane, including a 1-cm margin of healthy tissue. The eroded mesh was excised, and the vaginal wall and bladder were closed with running absorbable sutures. Given the location of the mesh excision and repair, a left ureteral reimplantation was performed. The transverse cystotomy was closed and retrograde bladder filling with methylene blue-stained saline confirmed watertight repairs, with no vaginal extravasation.
Results: The patient was discharged the following morning and had an uneventful recovery, including transurethral indwelling catheter removal at 2 weeks after CT cystogram and subsequent ureteral stent removal at 6 weeks postoperatively. At 2-month follow-up she had no new urinary symptoms or obstruction of the ureteral reimplantation on renal ultrasound.
Conclusions: A robotic-assisted approach is a feasible option for managing transvaginal prolapse mesh perforation into the bladder. Pelvic surgeons must be well equipped to handle transvaginal mesh complications in a patient-specific manner.
{"title":"Robotic Excision of Intravesical Mesh Following Transvaginal Mesh-Based Prolapse Repair.","authors":"Gabriela F Sarriera Valentin, Francis A Jefferson, Katherine T Anderson, Brian J Linder","doi":"10.1007/s00192-024-05871-8","DOIUrl":"10.1007/s00192-024-05871-8","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>We describe the surgical management of intravesical mesh perforation following transvaginal mesh surgery for pelvic organ prolapse.</p><p><strong>Methods: </strong>A 73-year-old woman presented with intravesical mesh perforation 17 years following transvaginal mesh-based prolapse repair at an outside hospital. The patient presented with intermittent hematuria and recurrent urinary tract infections. Cystoscopy demonstrated an approximately 3-cm area of intravesical mesh with associated stone spanning from the bladder neck through the left trigone and ureteral orifice. A robotic-assisted transvesical mesh excision and left ureteroneocystostomy was carried out. Robotic-assisted repair was performed transvesically via transverse bladder dome cystotomy. Dissection was carried out circumferentially around the mesh in the vesicovaginal plane, including a 1-cm margin of healthy tissue. The eroded mesh was excised, and the vaginal wall and bladder were closed with running absorbable sutures. Given the location of the mesh excision and repair, a left ureteral reimplantation was performed. The transverse cystotomy was closed and retrograde bladder filling with methylene blue-stained saline confirmed watertight repairs, with no vaginal extravasation.</p><p><strong>Results: </strong>The patient was discharged the following morning and had an uneventful recovery, including transurethral indwelling catheter removal at 2 weeks after CT cystogram and subsequent ureteral stent removal at 6 weeks postoperatively. At 2-month follow-up she had no new urinary symptoms or obstruction of the ureteral reimplantation on renal ultrasound.</p><p><strong>Conclusions: </strong>A robotic-assisted approach is a feasible option for managing transvaginal prolapse mesh perforation into the bladder. Pelvic surgeons must be well equipped to handle transvaginal mesh complications in a patient-specific manner.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-12DOI: 10.1007/s00192-024-05866-5
JaNiese Elizabeth Jensen, Michael Derrick Ngobi, Flavia Matovu Kiweewa, Julia Diane Fleecs, Ramya Vemulapalli, Haley Alaine Steffen, Linder Hagstrom Wendt, Jay Brooks Jackson, Kimberly Ann Kenne
Introduction and hypothesis: Pelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study's purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women.
Methods: The translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4-8 months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach's α co-efficient for internal consistency and Spearman's correlation coefficients and Wilcoxon rank sum tests for construct validity.
Results: Of the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD.
Conclusions: The UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population.
{"title":"Reliability and Validation of the PFIQ-7 and PFDI-20 in the Luganda Language.","authors":"JaNiese Elizabeth Jensen, Michael Derrick Ngobi, Flavia Matovu Kiweewa, Julia Diane Fleecs, Ramya Vemulapalli, Haley Alaine Steffen, Linder Hagstrom Wendt, Jay Brooks Jackson, Kimberly Ann Kenne","doi":"10.1007/s00192-024-05866-5","DOIUrl":"10.1007/s00192-024-05866-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study's purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women.</p><p><strong>Methods: </strong>The translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4-8 months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach's α co-efficient for internal consistency and Spearman's correlation coefficients and Wilcoxon rank sum tests for construct validity.</p><p><strong>Results: </strong>Of the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD.</p><p><strong>Conclusions: </strong>The UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-01DOI: 10.1007/s00192-024-05850-z
Chenxin Zhang, Xiaowei Li, Xiuli Sun, Jiajia Luo, Jianliu Wang
Introduction and hypothesis: The effects of hysterectomy on pelvic floor function remain uncertain, with the levator ani muscle (LAM) playing a critical role in pelvic support. The levator ani subtended volume (LASV) is an objective measure of the LAM's anatomical volume, derived from magnetic resonance imaging (MRI). This study was aimed at assessing the consistency between MRI and computed tomography (CT) in quantifying LASV, and to investigate the effect of hysterectomy on the LAM.
Methods: This retrospective study analyzed a cohort of 55 hysterectomy patients, utilizing pre-operative pelvic MRI and post-operative CT scans to measure the LASV. To evaluate the consistency between MRI and CT, the study employed the intraclass correlation coefficient and Bland-Altman agreement analysis in a subset of 32 patients with both pre-operative scans. A paired-samplet test was used to analyze LASV changes pre- and post-hysterectomy, and linear regression analysis was performed to account for potential risk factors that may influence post-operative LASV.
Results: High consistency between MRI and CT in measuring LASV was found, with an ICC of 0.911. We observed a significant increase in LASV following hysterectomy, with mean volume pre- and post-operatively of 16.66 cm3 and 18.87 cm3 respectively. Age and body mass index were significant predictors of post-hysterectomy LASV, whereas parity and the type of hysterectomy had no significant impact.
Conclusions: Hysterectomy significantly affects the LAM, resulting in an increase in post-operative LASV. Moreover, this study verifies that MRI and CT can be used interchangeably for LASV measurements in clinical practice.
{"title":"Pre- vs Post-Operative Levator Ani Subtended Volume in Patients Undergoing Hysterectomy: A Comparative Imaging Study.","authors":"Chenxin Zhang, Xiaowei Li, Xiuli Sun, Jiajia Luo, Jianliu Wang","doi":"10.1007/s00192-024-05850-z","DOIUrl":"10.1007/s00192-024-05850-z","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The effects of hysterectomy on pelvic floor function remain uncertain, with the levator ani muscle (LAM) playing a critical role in pelvic support. The levator ani subtended volume (LASV) is an objective measure of the LAM's anatomical volume, derived from magnetic resonance imaging (MRI). This study was aimed at assessing the consistency between MRI and computed tomography (CT) in quantifying LASV, and to investigate the effect of hysterectomy on the LAM.</p><p><strong>Methods: </strong>This retrospective study analyzed a cohort of 55 hysterectomy patients, utilizing pre-operative pelvic MRI and post-operative CT scans to measure the LASV. To evaluate the consistency between MRI and CT, the study employed the intraclass correlation coefficient and Bland-Altman agreement analysis in a subset of 32 patients with both pre-operative scans. A paired-samplet test was used to analyze LASV changes pre- and post-hysterectomy, and linear regression analysis was performed to account for potential risk factors that may influence post-operative LASV.</p><p><strong>Results: </strong>High consistency between MRI and CT in measuring LASV was found, with an ICC of 0.911. We observed a significant increase in LASV following hysterectomy, with mean volume pre- and post-operatively of 16.66 cm<sup>3</sup> and 18.87 cm<sup>3</sup> respectively. Age and body mass index were significant predictors of post-hysterectomy LASV, whereas parity and the type of hysterectomy had no significant impact.</p><p><strong>Conclusions: </strong>Hysterectomy significantly affects the LAM, resulting in an increase in post-operative LASV. Moreover, this study verifies that MRI and CT can be used interchangeably for LASV measurements in clinical practice.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-08-26DOI: 10.1007/s00192-024-05903-3
Ian Vasicka
{"title":"A Commentary on \"Incidence and Risk Factors for Post-Operative Urinary Retention Following Surgery for Perineal Tears among Ugandan Women: A Prospective Cohort Study\".","authors":"Ian Vasicka","doi":"10.1007/s00192-024-05903-3","DOIUrl":"10.1007/s00192-024-05903-3","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-09DOI: 10.1007/s00192-024-05857-6
Thays Marina Roncato Barcelos, Luiz Gustavo de Oliveira Brito, Cristine Homsi Jorge, Silvio Antonio Franceschini, Julia Kefalas Troncon, Rui Alberto Ferriani, Lucia Alves da Silva Lara
Purpose: The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors.
Methods: Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life.
Results: Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life.
Conclusions: The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.
{"title":"Evaluation of Sexual Function of Transgender Individuals.","authors":"Thays Marina Roncato Barcelos, Luiz Gustavo de Oliveira Brito, Cristine Homsi Jorge, Silvio Antonio Franceschini, Julia Kefalas Troncon, Rui Alberto Ferriani, Lucia Alves da Silva Lara","doi":"10.1007/s00192-024-05857-6","DOIUrl":"10.1007/s00192-024-05857-6","url":null,"abstract":"<p><strong>Purpose: </strong>The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors.</p><p><strong>Methods: </strong>Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life.</p><p><strong>Results: </strong>Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life.</p><p><strong>Conclusions: </strong>The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}