To assess the outcomes of mid-urethral sling (MUS) procedures for urodynamic stress incontinence (USI) following extensive pelvic reconstructive surgery (PRS) and identify risk factors for persistent USI (P-USI).
Methods
This retrospective study analyzed 84 women who underwent a staged approach to MUS for USI after PRS for advanced pelvic organ prolapse (Pelvic Organ Prolapse Quantification III and IV). The primary outcome was objective cure rate, defined by negative urine leakage on urodynamic study and a 1-h pad test weight of < 2 g. Subjective cure rate was through a negative response to question 3 of UDI-6.
Results
The overall objective cure rate was 81.0%. The highest cure rate was observed in de novo USI (MUS-D; 89.7%) compared with women with persistent USD (MUS-P). Patients with overt SUI exhibited lower cure rates than those with occult SUI. Predictive factors for persistent USI were lower pre-operative maximum urethral closure pressure (MUCP; p = 0.031) and higher BMI in the MUS-P group than in the MUS-D group (p = 0.008). Subjective improvement was noted, especially in the MUS-D group, with a subjective cure rate of 78.6%. Those with MUS-D reported a higher impact on patient well-being post-surgery. No complications were observed after MUS surgery at follow-up.
Conclusions
Overt USI, low MUCP and high BMI are independent predictors of persistent USI after a staged MUS approach after pelvic reconstructive surgery.
{"title":"Outcomes of Mid-Urethral Sling for Urodynamic Stress Incontinence Following Extensive Pelvic Reconstructive Surgery","authors":"Tsia-Shu Lo, Aisha Alzabedi, Lan-Sin Jhang, Wu-Chiao Hsieh, Maherah Kamarudin, Louiza Erika Rellora","doi":"10.1007/s00192-024-05918-w","DOIUrl":"https://doi.org/10.1007/s00192-024-05918-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>To assess the outcomes of mid-urethral sling (MUS) procedures for urodynamic stress incontinence (USI) following extensive pelvic reconstructive surgery (PRS) and identify risk factors for persistent USI (P-USI).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study analyzed 84 women who underwent a staged approach to MUS for USI after PRS for advanced pelvic organ prolapse (Pelvic Organ Prolapse Quantification III and IV). The primary outcome was objective cure rate, defined by negative urine leakage on urodynamic study and a 1-h pad test weight of < 2 g. Subjective cure rate was through a negative response to question 3 of UDI-6.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The overall objective cure rate was 81.0%. The highest cure rate was observed in de novo USI (MUS-D; 89.7%) compared with women with persistent USD (MUS-P). Patients with overt SUI exhibited lower cure rates than those with occult SUI. Predictive factors for persistent USI were lower pre-operative maximum urethral closure pressure (MUCP; <i>p</i> = 0.031) and higher BMI in the MUS-P group than in the MUS-D group (<i>p</i> = 0.008). Subjective improvement was noted, especially in the MUS-D group, with a subjective cure rate of 78.6%. Those with MUS-D reported a higher impact on patient well-being post-surgery. No complications were observed after MUS surgery at follow-up.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Overt USI, low MUCP and high BMI are independent predictors of persistent USI after a staged MUS approach after pelvic reconstructive surgery.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"65 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248565","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 : 2024-09-16DOI: 10.1007/s00192-024-05897-y
Danielle D. Antosh
Introduction and Hypothesis
Lumbosacral discitis and osteomyelitis constitute a rare but devastating complication after mesh sacrocolpopexy for pelvic organ prolapse.
Methods
We present a case series of 3 patients at a single institution and a literature review of 30 patients suffering from this complication along with presenting symptoms, evaluation with laboratory and imaging findings, and management.
Results
Lumbosacral discitis can present after sacrocolpopexy of any route (abdominal, laparoscopic, and robotic) and with various suture types and tacking devices. Patients presented with lower back pain at varying time frames and with elevated inflammatory markers, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
Conclusion
The majority of cases required both excision of pelvic mesh via laparotomy or laparoscopy in combination with an extended course of intravenous (IV) antibiotics.
{"title":"Lumbosacral Discitis and Osteomyelitis after Sacrocolpopexy: A Case Series and Review of Management","authors":"Danielle D. Antosh","doi":"10.1007/s00192-024-05897-y","DOIUrl":"https://doi.org/10.1007/s00192-024-05897-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Lumbosacral discitis and osteomyelitis constitute a rare but devastating complication after mesh sacrocolpopexy for pelvic organ prolapse.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p> We present a case series of 3 patients at a single institution and a literature review of 30 patients suffering from this complication along with presenting symptoms, evaluation with laboratory and imaging findings, and management.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Lumbosacral discitis can present after sacrocolpopexy of any route (abdominal, laparoscopic, and robotic) and with various suture types and tacking devices. Patients presented with lower back pain at varying time frames and with elevated inflammatory markers, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). </p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The majority of cases required both excision of pelvic mesh via laparotomy or laparoscopy in combination with an extended course of intravenous (IV) antibiotics.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"186 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248568","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 : 2024-09-16DOI: 10.1007/s00192-024-05920-2
Ditte Gommesen, Sarah Hjorth, Ellen A. Nohr, Niels Qvist, Vibeke Rasch
Introduction and Hypothesis
Postpartum urinary incontinence (UI) is common and a concern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women.
Methods
A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI.
Results
A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92–4.50; episiotomy: RR 2.22, 95% CI 0.99–4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18–6.28). The same was found for SUI, but with wider confidence intervals.
Conclusions
A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.
引言和假设产后尿失禁（UI）很常见，也是许多妇女关心的问题，因为产后尿失禁会导致生活质量和自尊心下降。会阴撕裂可能是产后尿失禁的一个危险因素，但很少有研究调查会阴撕裂程度与产后尿失禁风险之间的关系。该研究旨在探讨会阴撕裂程度和选定的产科风险因素与初产妇产后 12 个月出现任何尿意症状和压力超声（SUI）之间的关系。基线数据在产后 2 周的临床检查中获得。通过国际尿失禁咨询问卷-尿失禁简表问卷（网络版）对产后 12 个月的尿失禁症状进行评估。结果 在2015年7月至2018年1月期间，共纳入了603名初产妇（203名无/腹膜/一度撕裂，200名二度撕裂，200名三度/四度撕裂）。与没有/腹膜或一度撕裂的妇女相比，会阴肌肉撕裂的妇女更常报告任何UI（自发性二度撕裂：RR 2.04，95% CI 0.92-4.50；外阴切开术：RR 2.22，95% CI 0.99-4.96；三度或四度撕裂：RR：2.73，95% CI：1.18-6.28）。结论 与无会阴撕裂、阴唇撕裂或一级撕裂的女性相比，会阴撕裂涉及任何会阴肌肉的女性发生任何 UI 和 SUI 的几率更高。
{"title":"Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study","authors":"Ditte Gommesen, Sarah Hjorth, Ellen A. Nohr, Niels Qvist, Vibeke Rasch","doi":"10.1007/s00192-024-05920-2","DOIUrl":"https://doi.org/10.1007/s00192-024-05920-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Postpartum urinary incontinence (UI) is common and a concern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92–4.50; episiotomy: RR 2.22, 95% CI 0.99–4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18–6.28). The same was found for SUI, but with wider confidence intervals.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"46 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248526","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 : 2024-09-14DOI: 10.1007/s00192-024-05921-1
Sirine Abidi, Amine Ghram, Said Ahmaidi, Helmi Ben Saad, Mehdi Chlif
Introduction and Hypothesis
Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI.
Methods
Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT.
Results
The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001).
Conclusion
Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.
引言和假设盆底肌肉（PFM）参与呼吸机制。此外，压力性尿失禁（SUI）也会影响身体功能。本随机对照试验旨在研究吸气肌训练（IMT）对突尼斯 SUI 女性患者的 SUI 严重程度、盆底肌功能和身体功能的影响。对以下参数进行了评估：呼吸肌力量（RMS；最大吸气和呼气压力）、尿失禁严重程度（泌尿生殖系统压力量表-6；尿失禁影响问卷-7；尿垫测试）、PFM 功能（改良牛津量表、肌电图和耐力）和身体功能（定时向上&；Go 测试；6 分钟步行测试；增量穿梭步行测试）。结果IMT项目显著降低了SUI的严重程度（p <0.01），改善了PFM功能（p <0.001），增强了身体功能（p <0.01），提高了RMS（p <0.001）。
{"title":"Effects of Inspiratory Muscle Training on Stress Urinary Incontinence in North African Women: A Randomized Controlled Trial","authors":"Sirine Abidi, Amine Ghram, Said Ahmaidi, Helmi Ben Saad, Mehdi Chlif","doi":"10.1007/s00192-024-05921-1","DOIUrl":"https://doi.org/10.1007/s00192-024-05921-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The IMT program significantly reduced the severity of SUI (<i>p</i> < 0.01), improved PFM function (<i>p</i> < 0.001), enhanced physical function (<i>p</i> < 0.01), and increased RMS (<i>p</i> < 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"194 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248621","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 : 2024-09-14DOI: 10.1007/s00192-024-05911-3
Ruby Kuang, Christina Moldovan, Sydney Drury, Hillary Wagner, Forrest Jellison, Andrea Staack
Introduction and Hypothesis
Urodynamics (UDS) assesses voiding dysfunction using intravesical, vaginal, or rectal catheters, which can be distressing. This study was aimed at utilizing mindfulness to reduce anxiety and pain in patients undergoing UDS.
Methods
A single-institution randomized controlled trial was conducted on 60 patients who underwent UDS. Patients were assigned to a mindfulness group (n = 30) or a control group (n = 30). Before UDS testing, all patients completed validated questionnaires assessing lower urinary tract symptoms (Urogenital Distress Inventory 6, UDI-6), anxiety (State-Trait Anxiety Inventory 6, STAI-6), and pain (Visual Analog Scale, VAS). The mindfulness group listened to a mindfulness audio prompt before UDS. All patients received standardized UDS education before UDS testing in a calm environment. After UDS testing, all patients completed validated UDS-perception questionnaires, STAI-6, Likert scale, and VAS surveys. Statistical analysis was performed using paired t tests, independent t tests, Wilcoxon, and Chi-squared tests.
Results
Both groups had similar demographics, history of prior UDS, anxiety, and baseline UDI-6 and STAI-6. Post-UDS, anxiety scores decreased in both groups, with the mindfulness group reporting significant improvement in “calmness” (mean 1.7, SD = 0.84) compared with the control group (mean 2.3, SD = 1.0, p < 0.05). The mindfulness group reported increased relaxation whereas the control group reported decreased relaxation post-UDS. Patients in both groups without a history of UDS had a significant improvement in total anxiety compared with those with a history of UDS.
Conclusion
Mindfulness meditation may improve calmness and relaxation for patients undergoing UDS.
{"title":"Effects of Mindfulness Meditation on Patient Experience During Urodynamics: A Prospective Study","authors":"Ruby Kuang, Christina Moldovan, Sydney Drury, Hillary Wagner, Forrest Jellison, Andrea Staack","doi":"10.1007/s00192-024-05911-3","DOIUrl":"https://doi.org/10.1007/s00192-024-05911-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Urodynamics (UDS) assesses voiding dysfunction using intravesical, vaginal, or rectal catheters, which can be distressing. This study was aimed at utilizing mindfulness to reduce anxiety and pain in patients undergoing UDS.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A single-institution randomized controlled trial was conducted on 60 patients who underwent UDS. Patients were assigned to a mindfulness group (<i>n</i> = 30) or a control group (<i>n</i> = 30). Before UDS testing, all patients completed validated questionnaires assessing lower urinary tract symptoms (Urogenital Distress Inventory 6, UDI-6), anxiety (State-Trait Anxiety Inventory 6, STAI-6), and pain (Visual Analog Scale, VAS). The mindfulness group listened to a mindfulness audio prompt before UDS. All patients received standardized UDS education before UDS testing in a calm environment. After UDS testing, all patients completed validated UDS-perception questionnaires, STAI-6, Likert scale, and VAS surveys. Statistical analysis was performed using paired <i>t</i> tests, independent <i>t</i> tests, Wilcoxon, and Chi-squared tests.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Both groups had similar demographics, history of prior UDS, anxiety, and baseline UDI-6 and STAI-6. Post-UDS, anxiety scores decreased in both groups, with the mindfulness group reporting significant improvement in “calmness” (mean 1.7, SD = 0.84) compared with the control group (mean 2.3, SD = 1.0, <i>p</i> < 0.05). The mindfulness group reported increased relaxation whereas the control group reported decreased relaxation post-UDS. Patients in both groups without a history of UDS had a significant improvement in total anxiety compared with those with a history of UDS.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Mindfulness meditation may improve calmness and relaxation for patients undergoing UDS.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"194 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248569","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 : 2024-09-14DOI: 10.1007/s00192-024-05939-5
Rogério de Fraga,Maria Augusta Tezelli Bortolini
{"title":"Overactive Bladder Syndrome: The Urgency of Integrating Emerging Methodologies to Improve Therapeutic Outcomes.","authors":"Rogério de Fraga,Maria Augusta Tezelli Bortolini","doi":"10.1007/s00192-024-05939-5","DOIUrl":"https://doi.org/10.1007/s00192-024-05939-5","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248570","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 : 2024-09-10DOI: 10.1007/s00192-024-05917-x
Soundarya N. Sriram, Gowri Dorairajan, Ajay Rane
Introduction and Hypothesis
Guidelines recommend episiotomy for instrumental vaginal delivery with an optimal incision angle of 60° to protect the anal sphincter. The “Episiometer” is a new device promising a 60° incision angle. We compared the incidence of obstetric anal sphincter injury (OASI) and post-repair suture angle of episiotomies made with conventional “eyeballing” versus Episiometer guided during instrumental delivery.
Methods
We conducted this randomized controlled trial in a tertiary care teaching institute in southern India after ethical committee approval, trial registration, and informed consent. We randomized (block) 328 pregnant women aged 18 years and above with term, singleton fetuses delivered by instruments into Episiometer-guided (164) or conventional episiotomy (164) groups (allocation concealed). We compared the OASI (identified clinically) and the suture angle measured from the midline (assessor blinded) in the two groups. We followed up on the subjects at 6 and 12 weeks to assess perineal pain and fecal/flatus incontinence.
Results
The incidence of OASI of 0.61% in the Episiometer group was significantly lower compared with 4.88% in the eyeballing group (Chi-squared = 5.6; p = 0.02; adjusted risk ratio = 5.9; CI 0.7–46.1; p = 0.09). A significantly higher proportion of subjects (59.1%) in the Episometer group had a post-suture angle between 36 and 40° compared with 36.6% in the eyeballing group (Chi-squared = 21.8, p < 0.001). We found no significant difference in the perineal pain or Wexner score during follow-up.
Conclusion
The Episiometer-guided episiotomy during instrumental delivery resulted in a significantly higher suture angle and lower obstetric anal sphincter injuries than with conventional eyeballing.
{"title":"Obstetric Anal Sphincter Injury After Episiometer-Guided Versus Conventional Episiotomy in Instrumental Deliveries: A Randomized Controlled Trial","authors":"Soundarya N. Sriram, Gowri Dorairajan, Ajay Rane","doi":"10.1007/s00192-024-05917-x","DOIUrl":"https://doi.org/10.1007/s00192-024-05917-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Guidelines recommend episiotomy for instrumental vaginal delivery with an optimal incision angle of 60° to protect the anal sphincter. The “Episiometer” is a new device promising a 60° incision angle. We compared the incidence of obstetric anal sphincter injury (OASI) and post-repair suture angle of episiotomies made with conventional “eyeballing” versus Episiometer guided during instrumental delivery.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted this randomized controlled trial in a tertiary care teaching institute in southern India after ethical committee approval, trial registration, and informed consent. We randomized (block) 328 pregnant women aged 18 years and above with term, singleton fetuses delivered by instruments into Episiometer-guided (164) or conventional episiotomy (164) groups (allocation concealed). We compared the OASI (identified clinically) and the suture angle measured from the midline (assessor blinded) in the two groups. We followed up on the subjects at 6 and 12 weeks to assess perineal pain and fecal/flatus incontinence.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The incidence of OASI of 0.61% in the Episiometer group was significantly lower compared with 4.88% in the eyeballing group (Chi-squared = 5.6; <i>p</i> = 0.02; adjusted risk ratio = 5.9; CI 0.7–46.1; <i>p</i> = 0.09). A significantly higher proportion of subjects (59.1%) in the Episometer group had a post-suture angle between 36 and 40° compared with 36.6% in the eyeballing group (Chi-squared = 21.8, <i>p</i> < 0.001). We found no significant difference in the perineal pain or Wexner score during follow-up.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The Episiometer-guided episiotomy during instrumental delivery resulted in a significantly higher suture angle and lower obstetric anal sphincter injuries than with conventional eyeballing.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"15 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208221","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 : 2024-09-10DOI: 10.1007/s00192-024-05919-9
Ipek Betul Ozcivit Erkan, Eda Gorgun
Introduction and Hypothesis
The proximity of the pudendal nerve to the sacrospinous ligaments (SSLs) can lead to serious complications during sacrospinous ligament fixation (SSLF). This case series is aimed at providing an overview of the anatomy of the pudendal nerve, including insights from cadaver dissections and discussions on rare variations observed during these dissections.
Methods
Dissections were conducted on five female cadavers using a posterior gluteal approach on both sides. The course, morphometric features and variations in the branches of the pudendal nerve were assessed at the level of the SSL and within the pudendal canal.
Results
The number of pudendal trunks cranial to the SSL ranged from one to three, with double trunks being the most common (70%). In 2 out of 10 (20%) sides inferior rectal nerves (IRNs) pierced through the SSL. In Case 1, IRNs pierced the SSL bilaterally before entering the pudendal canal and exiting at distances of 23.81 mm and 41.18 mm from the ischial spine on the right and left sides respectively. In Case 2, nerves with a width of 2.12 mm and 2.49 mm pierced the SSL and joined the IRN, piercing the SSL at 13.38 mm and 12.55 medial to the ischial spine and 16.80 mm and 19.32 mm lateral to the sacrum, on the left and right sides respectively. In 60% of cases, the IRN entered the pudendal canal, exiting at a median distance of 21.25 mm from the ischial spine.
Conclusions
We identified significant variations in the number of trunks and branching patterns of the pudendal nerve around the SSL and the course of the IRN caudal to the SSL. We documented IRNs or nerves joining the IRNs piercing the SSL. Identifying these variations is crucial for surgeons to minimize the risk of pudendal nerve injury during SSLF.
{"title":"Cadaveric Insights into Pudendal Nerve Variations for Sacrospinous Ligament Fixation: A Case Series","authors":"Ipek Betul Ozcivit Erkan, Eda Gorgun","doi":"10.1007/s00192-024-05919-9","DOIUrl":"https://doi.org/10.1007/s00192-024-05919-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>The proximity of the pudendal nerve to the sacrospinous ligaments (SSLs) can lead to serious complications during sacrospinous ligament fixation (SSLF). This case series is aimed at providing an overview of the anatomy of the pudendal nerve, including insights from cadaver dissections and discussions on rare variations observed during these dissections.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Dissections were conducted on five female cadavers using a posterior gluteal approach on both sides. The course, morphometric features and variations in the branches of the pudendal nerve were assessed at the level of the SSL and within the pudendal canal.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The number of pudendal trunks cranial to the SSL ranged from one to three, with double trunks being the most common (70%). In 2 out of 10 (20%) sides inferior rectal nerves (IRNs) pierced through the SSL. In Case 1, IRNs pierced the SSL bilaterally before entering the pudendal canal and exiting at distances of 23.81 mm and 41.18 mm from the ischial spine on the right and left sides respectively. In Case 2, nerves with a width of 2.12 mm and 2.49 mm pierced the SSL and joined the IRN, piercing the SSL at 13.38 mm and 12.55 medial to the ischial spine and 16.80 mm and 19.32 mm lateral to the sacrum, on the left and right sides respectively. In 60% of cases, the IRN entered the pudendal canal, exiting at a median distance of 21.25 mm from the ischial spine.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>We identified significant variations in the number of trunks and branching patterns of the pudendal nerve around the SSL and the course of the IRN caudal to the SSL. We documented IRNs or nerves joining the IRNs piercing the SSL. Identifying these variations is crucial for surgeons to minimize the risk of pudendal nerve injury during SSLF.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"7 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208222","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 : 2024-09-10DOI: 10.1007/s00192-024-05910-4
Grace Pouch, Alemu Arja, Olivia Brookins, Courtney Jacks, Mulugeta Gebregziabher, Steven Swift, Nate Ross
Introduction and Hypothesis
Pelvic organ prolapse (POP) has a profound influence on a woman's quality of life (QoL). Assessment of QoL using patient-reported outcome (PRO) measures in pelvic organ prolapse surgery is common practice in developed countries, but despite the burden of POP in developing countries, such as Ethiopia, the use of PROs to record preoperative and postoperative QoL scores is limited. This study is aimed at assessing the QoL among Ethiopian women with POP before and after surgery using the validated Pelvic Organ Quality of Life (P-QoL) questionnaire. Additionally, we will compare postoperative QoL measurements of reconstructive procedures with those of obliterative procedures.
Methods
This is a prospective observational study conducted at a single hospital in Ethiopia on women who were scheduled for surgery for symptomatic POP. Patients' QoL was assessed preoperatively using the P-QoL questionnaire and at each subsequent follow-up visit for 1 year (3, 6, 9, and 12 months). Patients undergoing an obliterative procedure were evaluated and compared with those having reconstructive procedures.
Results
The mean score for general health perceptions, prolapse impact, role limitations, physical limitations, social limitations, and emotions was 0 at 12 months postoperatively. Despite significant improvements from baseline, personal relationships, sleep or energy disturbance, and symptom severity measures continued to negatively impact QoL at 12 months postoperatively.
Conclusions
Quality of life among Ethiopian women with POP is poor across all domains. Native tissue repair employing either reconstructive or obliterative methods significantly improves QoL across all domains up to 12 months postoperatively. The use of validated tools to assess PROs is essential to provide evidence-based care that improves QoL in ways that are meaningful to patients.
引言和假设盆腔器官脱垂（POP）对妇女的生活质量（QoL）有着深远的影响。在盆腔器官脱垂手术中使用患者报告结果（PRO）来评估 QoL 是发达国家的普遍做法，但在埃塞俄比亚等发展中国家，尽管盆腔器官脱垂的负担很重，但使用患者报告结果来记录术前和术后 QoL 评分的情况却很有限。本研究旨在使用经过验证的盆腔器官生活质量（P-QoL）问卷，评估埃塞俄比亚 POP 女性患者手术前后的 QoL。此外，我们还将比较重建性手术和阻塞性手术的术后 QoL 测量结果。方法这是一项前瞻性观察研究，在埃塞俄比亚的一家医院进行，对象是计划接受手术治疗症状性 POP 的妇女。患者的 QoL 在术前使用 P-QoL 问卷进行评估，并在随后 1 年（3、6、9 和 12 个月）的每次随访中进行评估。结果术后12个月时，患者在一般健康感知、脱垂影响、角色限制、身体限制、社交限制和情绪方面的平均得分均为0。尽管与基线相比有了明显改善，但术后 12 个月时，人际关系、睡眠或能量障碍以及症状严重程度仍对 QoL 有负面影响。采用重建或阻塞性方法进行原生组织修复，可明显改善术后 12 个月内各方面的生活质量。使用经过验证的工具来评估PROs对于提供循证护理、以对患者有意义的方式改善QoL至关重要。
{"title":"Pelvic Organ Prolapse Surgery: Postoperative Quality of Life in Ethiopian Women","authors":"Grace Pouch, Alemu Arja, Olivia Brookins, Courtney Jacks, Mulugeta Gebregziabher, Steven Swift, Nate Ross","doi":"10.1007/s00192-024-05910-4","DOIUrl":"https://doi.org/10.1007/s00192-024-05910-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction and Hypothesis</h3><p>Pelvic organ prolapse (POP) has a profound influence on a woman's quality of life (QoL). Assessment of QoL using patient-reported outcome (PRO) measures in pelvic organ prolapse surgery is common practice in developed countries, but despite the burden of POP in developing countries, such as Ethiopia, the use of PROs to record preoperative and postoperative QoL scores is limited. This study is aimed at assessing the QoL among Ethiopian women with POP before and after surgery using the validated Pelvic Organ Quality of Life (P-QoL) questionnaire. Additionally, we will compare postoperative QoL measurements of reconstructive procedures with those of obliterative procedures.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This is a prospective observational study conducted at a single hospital in Ethiopia on women who were scheduled for surgery for symptomatic POP. Patients' QoL was assessed preoperatively using the P-QoL questionnaire and at each subsequent follow-up visit for 1 year (3, 6, 9, and 12 months). Patients undergoing an obliterative procedure were evaluated and compared with those having reconstructive procedures.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The mean score for general health perceptions, prolapse impact, role limitations, physical limitations, social limitations, and emotions was 0 at 12 months postoperatively. Despite significant improvements from baseline, personal relationships, sleep or energy disturbance, and symptom severity measures continued to negatively impact QoL at 12 months postoperatively.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Quality of life among Ethiopian women with POP is poor across all domains. Native tissue repair employing either reconstructive or obliterative methods significantly improves QoL across all domains up to 12 months postoperatively. The use of validated tools to assess PROs is essential to provide evidence-based care that improves QoL in ways that are meaningful to patients.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":"58 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142208220","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 : 2024-09-01Epub Date: 2024-08-27DOI: 10.1007/s00192-024-05904-2
Zdenek Rusavy
{"title":"Commentary on \"Effect of An Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial\".","authors":"Zdenek Rusavy","doi":"10.1007/s00192-024-05904-2","DOIUrl":"10.1007/s00192-024-05904-2","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1935-1936"},"PeriodicalIF":1.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080234","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号