International Urogynecology Journal最新文献

Introduction and hypothesis: Direct comparison of lower urinary tract symptoms (LUTS) such as overactive bladder (OAB) and stress urinary incontinence (SUI) before and after laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) for pelvic organ prolapse (POP) is not reported enough. We investigated the prevalence of OAB and SUI before and after LSC and RSC, comparing the effects of these surgical methods on LUTS.

Methods: A retrospective analysis was performed for patients who underwent LSC or RSC for POP (294 LSC and 104 RSC cases) at a single general hospital in Japan from 2022 to 2023. Preoperative and 6-month postoperative OAB and SUI prevalences were determined based on the OAB symptom scores and International Consultation on Incontinence Questionnaire-Short Form. Changes in the prevalence of OAB and SUI before and after surgery were examined within and between the RSC and LSC groups.

Results: The prevalence of OAB in the RSC group decreased significantly from 43.9% (n = 43) preoperatively to 26.5% (n = 26) postoperatively, and in the LSC group from 43.6% (n = 119) to 24.9% (n = 68), with no significant difference in the proportion of de novo OAB between the groups. The prevalence of SUI in the RSC group increased significantly from 36.4% (n = 36) preoperatively to 58.6% (n = 58) postoperatively, and in the LSC group from 54.0% (n = 148) to 62.0% (n = 170) postoperatively, with no significant difference in the proportion of de novo SUI.

Conclusions: Both RSC and LSC for POP may improve symptoms in patients with pre-OAB and induce de novo SUI, with no significant difference between the groups.

Introduction and hypothesis: Low back pain may play a contributing role in the emergence or worsening of stress urinary incontinence (SUI) in women, by affecting neuromuscular control and pelvic stability. This study aimed to examine the relationship between SUI, musculoskeletal performance, and physical activity level (PAL) in women with nonspecific low back pain (NSLBP) by comparing them with a healthy control group.

Methods: One hundred fifty-two women were assigned to either the healthy control (no NSLBP) group (n = 76) or the NSLBP group (n = 76). Pain severity was evaluated using the Visual Analog Scale (VAS), the severity of SUI was detected using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF), musculoskeletal performance was measured using the trunk flexor endurance test (TFET), wall sit-hold test (WSHT), 3-minute burpee test (3-MBT), and sit and reach test (SRT), respectively. International Physical Activity Questionnaire-Long Form (IPAQ-LF) assessed the PAL. The Mann-Whitney U test was used to compare groups, and Spearman correlation analysis determined the intra-group correlation levels.

Results: The NSLBP group had significantly higher ICIQ-SF, lower TFET, 3-MBT, and SRT scores (p = 0.016). In the healthy control group, ICIQ-SF was not associated with any musculoskeletal performance test parameters and IPAQ-LF (p > 0.05). While a significant positive correlation was found between IPAQ-LF and VAS during activity (r = 0.266, p = 0.020), ICIQ-SF had a negative correlation with TFET (r = -0.308, p = 0.007), 3-MBT (r = -0.320, p = 0.005), and IPAQ-LF (r = -0.298, p = 0.009) in the NSLBP group.

Conclusions: As NSLBP gets worse, SUI complaints increase. Trunk flexor muscle endurance, agility, and physical activity levels decrease as the severity of SUI increases in women with NSLBP.

Introduction and hypothesis: To translate and perform cultural adaptation of the Pelvic Floor Dysfunction-SENTINEL (PFD-SENTINEL) screening tool into Turkish and to establish its reliability and validity for female athletes.

Methods: The study included 200 female athletes (mean age 22 ± 4 years). The translation of the PFD-SENTINEL, which comprised the symptoms related to PFD and item sections related to general risk factors and sports-related risk factors, was performed in accordance with international recommendations. The severity of PFD symptoms was assessed with the Pelvic Floor Distress Inventory-20 (PFDI-20). Psychometric analyses consisted of assessing the following: internal consistency reliability using the Kuder-Richardson-20 (KR-20) coefficient, construct validity using confirmatory factor analysis, and criterion validity.

Results: The reliability was acceptable for the PFD-SENTINEL items assessed using the KR-20, at 0.581, indicating moderate internal consistency. All fit indices except standardized root mean square residual indicated a perfect fit for the final models. Criterion validity was supported by positive correlations between the PFD-SENTINEL symptom score and the PFDI-20 score (r = 0.724, p < 0.001) and between the PFD-SENTINEL item score and the PFIQ-20 scores (r = 0.334; p < 0.001).

Conclusions: The Turkish version of the PFD-SENTINEL is a reliable and valid instrument to screen for PFD in female athletes.

Introduction: LeFort colpocleisis is a surgical alternative for women with pelvic organ prolapse (POP). Complications are rare and typically minor. The accumulation of purulence within the uterine cavity, or pyometra, after this procedure is exceptionally uncommon. To date, only a handful of cases have been reported. Hereby, we present a narrative review on the current knowledge regarding the diagnosis and treatment of this atypical complication.

Methods: A literature search was conducted using five different databases to identify previously published articles on this subject. Relevant keywords included colpocleisis, LeFort colpocleisis, pyometra, and reoperation. Studies describing complications after colpocleisis with concurrent hysterectomy or colpocleisis of vaginal vault were excluded.

Results: Six case reports were identified, all from English-language sources. Data form an additional case at our institution was included. Median age was 78 years, and most women had multiple comorbidities. All underwent LeFort colpocleisis, with varying additional procedures. Only one case had a successful conservative approach; hysterectomy via laparotomy was ultimately required in the remaining cases. No cases of underlying malignancy were reported.

Conclusions: Pyometra is a rare but important differential diagnosis in patients with a history of LeFort colpocleisis presenting with fever, vaginal discharge, and abdominopelvic pain. A high index of clinical suspicion is paramount, since prompt diagnosis and appropriate surgical management are a standard of care.

Introduction and hypothesis: Transcutaneous tibial nerve stimulation (TTNS) is used to treat overactive bladder (OAB) syndrome. We hypothesized that TTNS instruction delivered via telehealth (TH) would be as effective as face-to-face (FtF) instruction in improving OAB symptoms.

Methods: In this prospective cohort study, 99 women with OAB self-selected FtF (n = 79) or TH (n = 20) instruction for TTNS setup. Groups received standardized education on device placement and usage. Primary outcome was the between-group comparison of change in International Consultation on Incontinence Questionnaire (ICIQ-SF) scores at 3 and 12 months. Secondary outcomes included between-group comparisons of Patient Global Impression of Improvement (PGI-I) score at 3 months and treatment persistence at 12 months. Between-group differences were analyzed using Student's t tests.

Results: At 3 months, FtF and TH groups showed mean ICIQ-SF score reductions of 2.3 ± 1.8 and 1.9 ± 1.6 points respectively (between-group difference 0.4 points; 95% CI -1.79, 2.59; p = 0.60). PGI-I scores indicated improvement in 48.1% of FtF and 50.0% of TH participants. At 12 months, treatment persistence was 60.8% for FtF and 55.0% for TH groups. Among continued treatment responders, sustained improvement was observed, with mean ICIQ-SF reductions of 3.6 ± 2.4 points (FtF) and 4.0 ± 2.6 points (TH) from baseline (p = 0.48). Progression to third-line therapies was comparable between groups (FtF 24.0%, TH 25.0%).

Conclusions: Telehealth shows promise as an effective method for initiating TTNS treatment for OAB, providing comparable outcomes with FtF instruction. The approximate 50% response rate and sustained benefits among responders support TTNS as a viable treatment. Findings support broader implementation of TH TTNS instruction, potentially improving treatment access for suitable patients.

Introduction and hypothesis: The objective was to compare the outcomes of dorsal and ventral onlay urethroplasties using buccal mucosal grafts for the treatment of urethral strictures in women, focusing on patency, complications, de novo incontinence, and impact on sexual function.

Methods: A retrospective analysis was conducted on 65 patients who underwent dorsal (n = 38) and ventral (n = 27) onlay female urethroplasty using a buccal mucosal graft between July 2017 and January 2024 across three centers. Patency was determined by the successful passage of a 16-French cystoscope or by a maximum flow rate exceeding 15 ml/s.

Results: Median age, etiology, and stenosis characteristics of the two groups were comparable. At the final follow-up, the patency rates for dorsal and ventral onlay female urethroplasty were 92.1% and 92.6% respectively (p = 1.0). There was no significant difference in postoperative maximum flow rates, postvoid residual urine, Female Sexual Function Index scores, Patient Global Impressions of Change scores, and de novo incontinence rates between the groups. The median blood loss was significantly lower in the ventral onlay group than in the dorsal onlay group (10 vs 20 ml, p = 0.001).

Conclusions: Dorsal and ventral onlay urethroplasties with buccal mucosal graft are safe and effective techniques for managing female urethral stricture, with similar patency, complications, de novo incontinence rates, and improvements in sexual function. Ventral onlay female urethroplasty has been associated with reduced intraoperative bleeding. To the best of our knowledge, this study represents the largest individual comparative cohort in the literature that directly evaluates dorsal and ventral onlay female urethroplasty.

Introduction and hypothesis: Pregnant women's physical health and quality of life are affected by gestational stress urinary incontinence (GSUI), requiring therapeutic attention to this obstetric issue.

Methods: To review and analyze the factors influencing GSUI, a literature search was conducted in both Chinese and English databases, including Web of Science, PubMed, Embase, WanFang, and China National Knowledge Infrastructure. Cohort studies, cross-sectional studies, and other studies that fit the population and research focus were included; conference papers and review articles were not.

Results: Twenty studies were included. In the univariate analysis, factors influencing GSUI included: previous vaginal delivery, parity, miscarriage, previous infant > 4 kg, age, constipation during pregnancy, pelvic floor muscle training (PFMT), and multiple gravidity. In the multivariate analysis, factors influencing GSUI included previous vaginal delivery, parity, previous infant > 4 kg, age, constipation during pregnancy, PFMT, BMI during pregnancy, and gestational age.

Conclusions: Previous vaginal delivery, constipation, and previous infant > 4 kg are key risk factors for GSUI, with PFMT showing a protective effect. Clinicians should integrate preventive strategies into antenatal care to reduce the incidence of GSUI.

Introduction and hypothesis: Despite FDA bans due to safety concerns, transvaginal mesh (TVM) offers lower recurrence rates for pelvic organ prolapse (POP) compared to native tissue repair. Current Chinese guidelines recommend TVM for recurrent or severe POP (POP-Q stage III-IV) in patients over 60 years. However, evidence regarding its long-term outcomes in younger patients (median age ≤ 60 years) remains limited.

Methods: This retrospective study included women who underwent TVM from 2013 to 2023 at a tertiary medical center. Baseline characteristics and perioperative details were extracted from electronic medical records. Follow-up data were collected through telephone interviews and/or in-person examination and questionnaires. Primary outcome was subjective surgical success. Secondary outcomes were quality of life changes and surgery-related adverse events, including mesh exposure, sexual dysfunction, and urinary complications.

Results: Of 728 women who underwent TVM, 140 (median age 56) were analyzed. At the last follow-up with a median of 52 months (IQR 12, 74), all 140 patients (100%) completed telephone questionnaires, while 42 (30.0%) additionally underwent in-person examination. The subjective cure rate was 95.7% (95% CI, 92.3-99.1%). Quality of life significantly improved postoperatively (both PFIQ-7 and PFDI-20 scores, P < 0.001). Only 4.3% (95% CI, 0.9-7.7%) had mesh exposure. Sexual activity and function remained stable, with a low rate of dyspareunia (4.3%).

Conclusions: TVM demonstrate satisfactory clinical results and a low complication rate in women ≤ 60 with severe POP. It does not significantly impair sexual function in patients who remain sexually active postoperatively.

Introduction and hypothesis: Pelvic floor dysfunction (PFD), primarily manifesting as pelvic organ prolapse (POP) and urinary incontinence (UI), is a prevalent condition that severely impairs women's quality of life. While management strategies exist, outcomes are often suboptimal, highlighting the need for a deeper understanding of research trends and their clinical relevance.

Methods: This study employed a mixed-methods exploratory design. First, a comprehensive bibliometric analysis of 23,005 publications from the Web of Science Core Collection (2003-2023) was conducted to map the global PFD research landscape, identify key trends, and detect thematic shifts. Second, to contextualize these findings, a retrospective analysis of clinical outcomes from 350 women with moderate PFD who received standardized pelvic floor muscle training (PFMT) was performed. Pre- and post-treatment pelvic floor muscle function (via surface electromyography) and anatomical support (via perineal ultrasound) were compared.

Results: Bibliometric analysis revealed a significant acceleration in publications after 2011, led by the United States, China, and the United Kingdom. Keyword analysis identified a clear thematic shift from a focus on surgical management (pre-2018) towards prevention, rehabilitation, and quality of life (post-2018), with PFMT emerging as a prominent research hotspot. The retrospective clinical analysis demonstrated that after one to two courses of PFMT, patients showed statistically significant improvements in muscle strength, endurance, and resting tone (all p < 0.01). These functional gains were corroborated by ultrasound evidence of pelvic organ elevation and a reduced levator hiatus area.

Conclusions: By synergistically integrating macro-level bibliometric trends with micro-level clinical evidence, this study provides a holistic overview of the evolving PFD research landscape. The alignment of a growing academic focus on conservative management with real-world clinical outcomes from a PFMT cohort suggests a paradigm shift towards function-oriented, patient-centered care and highlights its role as a cornerstone of PFD management.

Introduction and hypothesis: Patients with stage 3 or 4 pelvic organ prolapse (POP) may concurrently have hydronephrosis. Consequences of hydronephrosis, such as acute kidney injury and chronic kidney disease, have significant costs to patients and healthcare facilities. In this study, we evaluate the cost-effectiveness of renal ultrasound to screen for hydronephrosis in patients with stage 3 or 4 POP.

Methods: We designed a decision tree model comparing screening renal ultrasound versus usual care for patients with stage 3 or 4 POP. In the screening strategy, patients undergo ultrasound and subsequently proceed with pessary or surgery should they screen positive for hydronephrosis or proceed with expectant management, pessary, or surgery should they screen negative. In the non-screening strategy, patients choose treatment as they normally would and those with underlying hydronephrosis either continue to have hydronephrosis or have resolution of hydronephrosis. We modeled a time horizon of 5 years, with a 3% discount rate annually for future costs and quality-adjusted life-years (QALY). This was an IRB-exempt study.

Results: At a willingness to pay threshold of $150,000/QALY, renal ultrasound was cost-effective when the majority of patients who screen positive for hydronephrosis choose pessary instead of surgery. Screening renal ultrasound is cost-effective if less than 36.3% of patients with hydronephrosis choose surgery. At 5 years, screening renal ultrasound was cost-effective regardless of the prolapse treatment chosen by patients with hydronephrosis.

Conclusion: Routine renal ultrasound screening of patients with stage 3 or 4 POP is a cost-effective strategy to identify hydronephrosis and guide treatment that mitigates risk of permanent renal damage.