International Urogynecology Journal最新文献

Introduction and hypothesis: Evidence on health system challenges mostly relate to high-income countries. Lack of context-specific knowledge, educational opportunities, and access to resources among pelvic health care providers could be barriers to effective implementation of pelvic health services in South Africa. The aim of this study was to determine the patient and therapist profile, and the educational and resource needs of pelvic health physiotherapists in South Africa.

Methods: Ninety-five pelvic health physiotherapists, recruited over 6 months, participated in a cross-sectional study during 2022-2023. Participants completed a REDCap survey covering the stipulated domains. Frequencies, percentages, and Chi-squared tests were used for data analysis.

Results: The majority were employed in the private sector (n = 72; 75.8%) and had undergraduate training in pelvic health (n = 86; 89.5%); mostly in pre- and postnatal care (n = 69; 72.6%). Urinary incontinence was the most frequently seen condition (n = 81; 85.3%). Conditions were seen very seldom (n = 46; 48.4%) and most participants treated < 5 patients per month (n = 75; 78.9%), did not have patient educational material available (n = 58; 61.1%), preferred hard-copy formats (63.8%, n = 60), whereas 94.7% (n = 90) felt that there is a lack of patient resources. Participants (n = 66; 69.5%) indicated a need for educational opportunities for clinicians.

Conclusions: This study highlights the contextualising of educational and resource needs in mid- to low-income countries, such as South Africa, which might be contrary to common beliefs and practices.

Introduction and hypothesis: Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth.

Methods: We systematically searched the PubMed, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and ICTRP databases from inception. We selected studies reporting on the anatomy of the LAM and ano-rectal function within 24 months after childbirth, the former determined by imaging and the latter measured through validated questionnaires or ano-rectal manometry. Meta-analyses were used to pool data from studies reporting on the association between LAM avulsion and ano-rectal function, with subgroup analysis according to the presence or absence of anal sphincter trauma. Summary odds ratio (OR) and mean difference (MD) are reported with 95% confidence intervals.

Results: From the 7,621 studies identified, 11 were included, reporting on 2,146 women. Ten studies used transperineal ultrasound (TPUS) and one study used magnetic resonance imaging (MRI) for LAM assessment. Ano-rectal function was assessed through validated questionnaires in all but one study, in which ano-rectal manometry was used. There was no evidence for an association between LAM avulsion and symptoms of incontinence (OR 1.75 [0.74, 4.12]; MD 0.13 [-0.58, 0.85]), including in the subgroup of patients with concomitant anal sphincter injury (OR 1.83 [0.71, 4.71]).

Conclusions: We did not identify an association between LAM avulsion and ano-rectal dysfunction following vaginal childbirth.

Introduction and hypothesis: When adopting new methods, surgeons may experience a period of complexity and longer operation times because of their inexperience. This period is known as the "learning curve." This study was aimed at systematically reviewing the current literature on functional urology learning curves.

Methods: A comprehensive search was conducted across multiple databases from inception to July 2023 with no language restrictions. All original studies on urogynecological and functional urological procedures, including cross-sectional, cohort, and clinical trials, were eligible for inclusion. Relevant data were extracted, and methodological quality was appraised using standardized Joanna Briggs Institute critical appraisal tools. To quantitatively investigate learning curves, a mixed-effects generalized linear regression analysis was conducted on studies employing cumulative summation methods.

Results: From the 7,104 records, 68 studies met the inclusion criteria. The majority of studies were observational and the most common outcome measures were surgical duration, blood loss, and hospital stay. The learning curves varied by procedure type-for incontinence surgeries, 15-80 cases were required; for pelvic organ prolapse surgeries, 18-47 cases; for laparoscopic procedures, 10-105 cases; and for robotic procedures, 5-84 cases. The analysis showed that the number of cases required to surpass the learning curve decreased over time, likely reflecting technological advancements and increased surgical experience.

Conclusion: The learning curve for surgical procedures varies significantly. It varies between 5 cases for robotic supratrigonal cystectomy to 75 cases for robot-assisted ventral mesh rectopexy or robotic sacrocolpopexy surgery in 84 cases. These variable learning curves highlight the need for structured training programs and ongoing assessment.

Introduction and hypothesis: The objective was to elucidate the clinical utility of two reference lines, the pubosacrococcygeal joint line (PCL_jnt) and pubococcygeal joint line (PCL_cc), in the quantitative diagnosis of pelvic organ prolapse (POP) and pelvic floor laxity.

Methods: A retrospective analysis of magnetic resonance defecography (MRD) in patients with stage II or above POP was conducted. POP and pelvic floor relaxation were quantitatively assessed using both PCL_jnt and PCL_cc as reference lines. Further research, point-to-point correlation analysis was performed between the pelvic organ prolapse quantification (POP-Q) system and MRD to investigate the discrepancies between the two reference lines.

Results: There was no significant statistical difference in the degree of cystocele and H line between the PCL_jnt and PCL_cc groups (p > 0.05). Nevertheless, significant differences in the degree of uterine prolapse and M-line between the two groups were observed (p = 0.00). Both the PCL_jnt and PCL_cc reference lines demonstrated better correlation with POP-Q, and the PCL_cc exhibited slightly higher correlation coefficients than the PCL_jnt.

Conclusions: The results revealed significant moderate correlations between both reference lines and key POP-Q landmarks. Both PCL_jnt and PCL_cc can be utilized for interpreting MRD images and diagnosing POP for anterior wall and uterine prolapse.

Background: Stress urinary incontinence (SUI) is a prevalent condition among women, significantly impairing their quality of life. Emerging evidence suggests that metabolic dysfunction may play a role in the development of SUI, although the underlying mechanisms remain unclear. This study aims to examine the association between the cardiometabolic index (CMI), a novel marker of metabolic health, and the risk of SUI in women.

Methods: Cross-sectional data from the 2001-2020 NHANES were analyzed. Weighted multivariable logistic regression models assessed the relationship between CMI and SUI risk, while restricted cubic spline (RCS) models examined potential nonlinear associations. Subgroup analyses and interaction tests were performed to explore how specific characteristics influenced the CMI-SUI relationship. Mediation analysis was performed to evaluate whether the triglyceride glucose (TyG) index mediated the CMI-SUI association. Sensitivity analyses using propensity score matching (PSM) ensured the robustness of the findings.

Results: Higher CMI was significantly associated with increased SUI risk in women (P < 0.001). RCS analysis revealed a nonlinear relationship, with a threshold at 1.64. Below this point, reducing CMI was significantly associated with a lower risk of SUI (overall P < 0.001, linear P < 0.001). Subgroup and interaction analyses showed stronger associations among women under 65 years, those with higher education, those without a history of hypertension or diabetes, and women taking oral contraceptives (P for interaction < 0.05). Mediation analysis showed that the TyG index completely mediated the relationship between CMI and SUI, accounting for 97.67% of the total effect. Sensitivity analyses using PSM confirmed the robustness of these results.

Conclusion: This study highlights that a higher CMI is associated with an increased risk of SUI in women, and this relationship may be largely mediated by the TyG index.

Introduction and hypothesis: Patients with differences in sex development or intersex traits (DSD/I) struggle to find clinically competent care in adulthood. We sought to describe the surgical exposure of Urogynecology and Reconstructive Pelvic Surgery (URPS) fellows who had previously trained in ObGyn (URPS-Gyn) to patients with DSD/I and their interest in performing 18 relevant procedures. We hypothesized that most graduating fellows would not have had exposure to many of the surgeries.

Methods: We administered a cross-sectional online questionnaire of graduating URPS-Gyn fellows from April to June 2021. Questions assessed procedural knowledge, training, and clinical interest.

Results: Of 56 eligible URPS-Gyn fellows graduating in 2021, a total of 14 completed the survey. Twelve (86%) had heard about most procedures (14 out of 18 surgeries listed); however, there was heterogeneity in exposure to specific surgeries and self-reported preparedness to perform them. Respondents were more interested in performing procedures that they were prepared to perform. Only 6 out of 11 who responded to questions about beliefs in training felt that it was important for residents to receive training regarding surgeries for patients with intersex traits, and only 8 felt it important for fellows to receive this surgical training. Three anticipated seeing patients with intersex traits.

Conclusions: Graduating URPS-Gyn fellows expressed interest in performing surgeries to meet the needs of patients with DSD/I. However, respondents had heterogeneous exposure and self-assessments of their proficiency. URPS-Gyn providers may be key collaborators in providing care for the growing number of adults with DSD/I seeking care.

Introduction and hypothesis: The relationship between cesarean section scars and active pelvic floor muscle tone lacks sufficient evidence. This study is aimed at investigating the relationship between the severity of cesarean section scars and active pelvic floor muscle tone in postpartum women.

Methods: We conducted a prospective cross-sectional study of 604 women at 6-8 weeks postpartum. Active pelvic floor muscle tone was assessed using the Glazer protocol, and scar severity was categorized as no scar, normal scar, and hypertrophic scar. We collected data on demographic and clinical variables, including age, body mass index (BMI), and comorbidities. Linear regression analysis was employed to assess the association between scar severity and active pelvic floor muscle tone, adjusting for potential confounders.

Results: Compared with the no scar group, the normal scar group exhibited higher levels of active pelvic floor muscle tone (β = 1.68 and 1.47), and the hypertrophic scar group had the highest levels of active pelvic floor muscle tone (β = 5.09 and 5.03). Active pelvic floor muscle tone was significantly higher in women with scars than in those without scars. The association remained significant after adjusting for age, BMI, and comorbidities. Moreover, women with hypertrophic scars exhibited higher active pelvic floor muscle tone than those with normal scars.

Conclusions: Cesarean section scar severity is positively associated with increased active pelvic floor muscle tone in postpartum women. This finding highlights the importance of scar management and targeted pelvic floor rehabilitation to optimize postpartum recovery.

Introduction and hypothesis: The aim of the study was to compare clinical outcomes when using robotic-assisted sacral hysterocolpopexy (RASC) and vaginal surgery using the Uphold™ Vaginal Support System mesh for pelvic organ prolapse repair.

Methods: This was a nonrandomized, prospective, multicenter study in which 72 women underwent RASC, and 73 Uphold™ surgery, for apical prolapse (POP-Q C ≥ stage II). Anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system. Subjective outcomes were evaluated using the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Floor Impact Questionnaire - short form (PFIQ-7), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), as well as pain estimation using the visual analog scale (0-10).

Results: One year after surgery, an optimal apical segment outcome (POP-Q C stage 0-1) was achieved in 96.4% and 93.3% for the RASC and Uphold™ respectively, p = 0.49. However, reoperation for prolapse recurrence was significantly more common after RASC (11 out of 72 [15.3%] vs Uphold™ (2 out of 71 [2.8%], p = 0.005), and an optimal outcome of the anterior vaginal wall was higher after Uphold™ (p < 0.001). Postoperative PFDI-20, PFIQ-7, and pain significantly improved for both RASC and Uphold™ (p = 0.004 to < 0.001), but a more pronounced improvement in the total PFDI-20 and POPDI-6 sub-scores was observed after Uphold™ than after RASC (-73 ± 55.6 vs -49.2 ± 43.7, p = 0.005 and -39.6 ± 23.6 vs -27 ± 23.9, p < 0.001 respectively).

Conclusions: Reoperation for prolapse recurrence within 1 year was more common after RASC than after Uphold™. However, the rate of complications was low overall and there were few and largely insignificant differences in outcomes when comparing RASC and Uphold™.