Stephanie W. Zuo, Jaden R. Kohn, Chi Chiung Grace Chen, Laura Tellechea, Harley Roberts, Ilir Agalliu, Ava Leegant, Nitya Abraham, Melissa Laudano
This study aimed to measure frailty using the Edmonton frail scale (EFS) and examine whether frailty is associated with presenting complaints or worse pelvic floor symptom severity in older urogynecology outpatients. We conducted a cross-sectional study of new urogynecology patients aged 50 and older at 2 urban academic centers between November 2018 and January 2020. Pelvic floor symptom severity was assessed using surveys [overactive bladder validated 8-question screener (OAB-V8), pelvic floor distress inventory, and 6-item female sexual function index]. Multivariable linear and logistic regression analyses were performed to compare chief complaint and questionnaire scores by EFS score, frailty status, and EFS component. A total of 138 women were recruited, with a mean age of 65 years (standard deviation 9.3). 11.6% met the criteria for frailty. Frail women had 6.2 greater adjusted odds of endorsing urinary incontinence symptoms as their presenting complaint, and women with higher EFS scores had worse OAB-V8 scores (adjusted ß=0.04, p=0.03). Depression/sadness were associated with worse urinary and prolapse symptoms. Frailty is common in older urogynecology outpatients, especially those presenting with urinary incontinence. Individual components of the EFS associated with symptomatic pelvic floor dysfunction included depressed mood, lack of reliable help, and incontinence.
{"title":"Assessing frailty in urogynecology patients: a comparative analysis of the Edmonton frail scale and pelvic floor symptom severity","authors":"Stephanie W. Zuo, Jaden R. Kohn, Chi Chiung Grace Chen, Laura Tellechea, Harley Roberts, Ilir Agalliu, Ava Leegant, Nitya Abraham, Melissa Laudano","doi":"10.4081/uij.2023.309","DOIUrl":"https://doi.org/10.4081/uij.2023.309","url":null,"abstract":"This study aimed to measure frailty using the Edmonton frail scale (EFS) and examine whether frailty is associated with presenting complaints or worse pelvic floor symptom severity in older urogynecology outpatients. We conducted a cross-sectional study of new urogynecology patients aged 50 and older at 2 urban academic centers between November 2018 and January 2020. Pelvic floor symptom severity was assessed using surveys [overactive bladder validated 8-question screener (OAB-V8), pelvic floor distress inventory, and 6-item female sexual function index]. Multivariable linear and logistic regression analyses were performed to compare chief complaint and questionnaire scores by EFS score, frailty status, and EFS component. A total of 138 women were recruited, with a mean age of 65 years (standard deviation 9.3). 11.6% met the criteria for frailty. Frail women had 6.2 greater adjusted odds of endorsing urinary incontinence symptoms as their presenting complaint, and women with higher EFS scores had worse OAB-V8 scores (adjusted ß=0.04, p=0.03). Depression/sadness were associated with worse urinary and prolapse symptoms. Frailty is common in older urogynecology outpatients, especially those presenting with urinary incontinence. Individual components of the EFS associated with symptomatic pelvic floor dysfunction included depressed mood, lack of reliable help, and incontinence.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136068556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vesicovaginal fistula (VVF) management is primarily backed by evidence from retrospective studies and expert opinions and therefore lacks standardization. Newer generations of surgeons are more proactive toward changing clinical practices in domains lacking good-quality evidence. This survey-based cross-sectional study aims to elicit consensus on management practices regarding various domains of VVF management and look for any changes in clinical practice trends. A nationwide survey of urologists was conducted, and responses were grouped into 3 categories (overall response, response from young urologists, and response from experienced urologists) and compared. Based on the level of overall consensus, the responses were categorized as highly preferred, preferred, and somewhat preferred. Consensus was noted in conservative and endoscopic management of VVF, timing of VVF repair, definition of simple/complex VVF, approach for surgical repair for trigonal and supratrigonal VVF, use of interposition tissue for repair, and patient positioning in the postoperative period. A lack of consensus was noted in other domains. Changing trends in clinical practices were noted in attempts at conservative and endoscopic management, investigations considered mandatory for evaluation, surgical approach for complex VVF with bladder neck involvement and radiation-induced fistulas, the use of interposition grafts during surgical repair, the use of cystograms during follow-up, and the definition of a successful repair. There is uniformity in practices regarding many domains of VVF management. Those areas, where discordance in opinions is noted, require further research to bring standardization into practice. Regarding certain aspects of VVF management, there appears to be a change in trends among the younger generation of urologists.
{"title":"Prevalent practices and changing trends in the management of vesicovaginal fistula: a cross-sectional study from a nationwide questionnaire-based survey of urologists from a developing country","authors":"Anupam Choudhary, Anshuman Singh, Suyog Shetty, Surag K.R., Manjunath Irappa Wali, Arun Chawla, Padmaraj Hegde, Bommireddy V. Reddy, Goli Venkata Sai Abhishek","doi":"10.4081/uij.2023.313","DOIUrl":"https://doi.org/10.4081/uij.2023.313","url":null,"abstract":"Vesicovaginal fistula (VVF) management is primarily backed by evidence from retrospective studies and expert opinions and therefore lacks standardization. Newer generations of surgeons are more proactive toward changing clinical practices in domains lacking good-quality evidence. This survey-based cross-sectional study aims to elicit consensus on management practices regarding various domains of VVF management and look for any changes in clinical practice trends. A nationwide survey of urologists was conducted, and responses were grouped into 3 categories (overall response, response from young urologists, and response from experienced urologists) and compared. Based on the level of overall consensus, the responses were categorized as highly preferred, preferred, and somewhat preferred. Consensus was noted in conservative and endoscopic management of VVF, timing of VVF repair, definition of simple/complex VVF, approach for surgical repair for trigonal and supratrigonal VVF, use of interposition tissue for repair, and patient positioning in the postoperative period. A lack of consensus was noted in other domains. Changing trends in clinical practices were noted in attempts at conservative and endoscopic management, investigations considered mandatory for evaluation, surgical approach for complex VVF with bladder neck involvement and radiation-induced fistulas, the use of interposition grafts during surgical repair, the use of cystograms during follow-up, and the definition of a successful repair. There is uniformity in practices regarding many domains of VVF management. Those areas, where discordance in opinions is noted, require further research to bring standardization into practice. Regarding certain aspects of VVF management, there appears to be a change in trends among the younger generation of urologists.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134910251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Narayanamoorthy, K. Balhotra, M. Silver, Rodney McLaren Jr., E. Mckay
With the reduction in obstetric anal sphincter injuries (OASIS) cases, it is unknown if learning and exposure to their repair is compromised during obstetrics and gynecology (OBGYN) residency in the United States (US). The aim of this study was to evaluate the exposure and confidence level of the US OBGYN residents to OASIS repair. Residents’ education on OASIS repair was also assessed. This was a cross sectional online survey that collected residents’ demographics, characteristics of residency program, the number of deliveries and OASIS repairs performed, the site and technique of OASIS repair, post-repair care provided, residents’ confidence level in OASIS repair and their education on the repair. Descriptive analyses, Fisher’s Exact tests, Ordinal regression models and Spearman’s correlation were performed. Response from 160 residents (11% response rate) was obtained. Confidence was higher with increasing level of training (OR = 3.442, 95% CI, 2.473-4.791, p<0.004), a greater number of deliveries (OR=2.672, 95% CI, 1.511-4.723, p<0.001), third-degree repairs (OR=5.522, 95%CI, 3.67-8.308, p<0.001) and fourth-degree repairs (OR=4.364, 95% CI, 2.785-6.837, p<0.001) performed. Exposure to lecture or/and simulation improved confidence than no exposure to either (OR= 0.225, 95% CI, 0.092-0.545, p<0.001). Residents’ confidence level increased with a greater number of simulations attended (r=0.368, p< 0.001). Lectures and simulations enhance residents’ knowledge and skills in OASIS repair. Surgical skill curriculum is essential to maintain good quality training, prompt recognition, and meticulous perineal repair among OBGYN physicians despite the declining OASIS cases.
{"title":"Residents’ experience and training in obstetric anal sphincter injury repair in the United States","authors":"S. Narayanamoorthy, K. Balhotra, M. Silver, Rodney McLaren Jr., E. Mckay","doi":"10.4081/uij.2023.299","DOIUrl":"https://doi.org/10.4081/uij.2023.299","url":null,"abstract":"With the reduction in obstetric anal sphincter injuries (OASIS) cases, it is unknown if learning and exposure to their repair is compromised during obstetrics and gynecology (OBGYN) residency in the United States (US). The aim of this study was to evaluate the exposure and confidence level of the US OBGYN residents to OASIS repair. Residents’ education on OASIS repair was also assessed. This was a cross sectional online survey that collected residents’ demographics, characteristics of residency program, the number of deliveries and OASIS repairs performed, the site and technique of OASIS repair, post-repair care provided, residents’ confidence level in OASIS repair and their education on the repair. Descriptive analyses, Fisher’s Exact tests, Ordinal regression models and Spearman’s correlation were performed. Response from 160 residents (11% response rate) was obtained. Confidence was higher with increasing level of training (OR = 3.442, 95% CI, 2.473-4.791, p<0.004), a greater number of deliveries (OR=2.672, 95% CI, 1.511-4.723, p<0.001), third-degree repairs (OR=5.522, 95%CI, 3.67-8.308, p<0.001) and fourth-degree repairs (OR=4.364, 95% CI, 2.785-6.837, p<0.001) performed. Exposure to lecture or/and simulation improved confidence than no exposure to either (OR= 0.225, 95% CI, 0.092-0.545, p<0.001). Residents’ confidence level increased with a greater number of simulations attended (r=0.368, p< 0.001). Lectures and simulations enhance residents’ knowledge and skills in OASIS repair. Surgical skill curriculum is essential to maintain good quality training, prompt recognition, and meticulous perineal repair among OBGYN physicians despite the declining OASIS cases.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42735368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salma Samir Omar, Khaled F. Elmulla, Noran Abo Khadr, Ahmed Ashour Badawy, Eman Nabih Ramadan, Ahmed Hassouna, Lamia Heikal, Waleed Arafat
Vaginal atrophy is a commonly encountered problem among young cancer survivors. Patients suffer from vaginal dryness, irritation, and dyspareunia secondary to oestrogen deficiency. Oestrogenbased hormone replacement therapy is effective, but unfortunately health concerns or contraindications in cancer survivors frequently limit its use. A 35-year-old female patient with dyspareunia that markedly affected her sexual relationship was referred to the gynaecology clinic. Treatment using topical oestrogen cream and sexual counselling were not successful. We treated her using two submucosal injections of PRP-non-cross-linked hyaluronic acid injections into the vestibule and lower third of the anterior vaginal wall mucosa, spaced a month apart. The patient reported marked reduction of dyspareunia and demonstrated an improvement of FSFI total score 1 month after the second injection. Both the patient and her husband showed an improvement of the index of sexual satisfaction score one month after the second injection compared to their pretreatment scores. Examination of the vaginal mucosa showed improvement of thickness and integrity of the mucosa and increased lubrication. PRP-non-cross-linked hyaluronic acid submucosal injections can be effective for cancer therapy-related vaginal atrophy, coitus-related pain, and sexual satisfaction.
{"title":"Impact of vaginal submucosal platelet-rich plasma combined with non-cross-linked hyaluronic acid injections on dyspareunia and sexual satisfaction in a Hodgkin lymphoma cancer survivor: a case report","authors":"Salma Samir Omar, Khaled F. Elmulla, Noran Abo Khadr, Ahmed Ashour Badawy, Eman Nabih Ramadan, Ahmed Hassouna, Lamia Heikal, Waleed Arafat","doi":"10.4081/uij.2023.306","DOIUrl":"https://doi.org/10.4081/uij.2023.306","url":null,"abstract":"Vaginal atrophy is a commonly encountered problem among young cancer survivors. Patients suffer from vaginal dryness, irritation, and dyspareunia secondary to oestrogen deficiency. Oestrogenbased hormone replacement therapy is effective, but unfortunately health concerns or contraindications in cancer survivors frequently limit its use. A 35-year-old female patient with dyspareunia that markedly affected her sexual relationship was referred to the gynaecology clinic. Treatment using topical oestrogen cream and sexual counselling were not successful. We treated her using two submucosal injections of PRP-non-cross-linked hyaluronic acid injections into the vestibule and lower third of the anterior vaginal wall mucosa, spaced a month apart. The patient reported marked reduction of dyspareunia and demonstrated an improvement of FSFI total score 1 month after the second injection. Both the patient and her husband showed an improvement of the index of sexual satisfaction score one month after the second injection compared to their pretreatment scores. Examination of the vaginal mucosa showed improvement of thickness and integrity of the mucosa and increased lubrication. PRP-non-cross-linked hyaluronic acid submucosal injections can be effective for cancer therapy-related vaginal atrophy, coitus-related pain, and sexual satisfaction.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135692574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Khalid, A. Alhassan, J. O. Ejembi, A. Abdulwahab-Ahmed
Vesicouterine fistula as described by Youssef manifests with amenorrhea, and cyclic haematuria (menouria) without urinary incontinence commonly following caesarean section. Other aetiologies have been reported for this disease. The post-caesarean section gossypiboma, a dual aetiology causing this condition is rare and can make its presentation atypical, thus posing a diagnostic dilemma. The clinical evaluation alone in the atypical presentation of the vesicouterine fistula is insufficient except complemented by imaging investigations and endoscopic examination of the related organs. We report a case of vesicouterine fistula that was managed initially as chronic pelvic inflammatory disease despite urinary incontinence until further evaluation including a transvaginal ultrasound scan and urethrocystoscopy raised an index of suspicion of a vesical mass suggestive of gossypiboma. The mass was confirmed to be a foreign body, an abdominal gauze pack, or gossypiboma. Its removal and repair of the vesicouterine fistula were associated with a satisfactory outcome.
{"title":"Atypical presentation of vesicouterine fistula (Youssef’s syndrome) post-caesarean gossypiboma: a case report","authors":"A. Khalid, A. Alhassan, J. O. Ejembi, A. Abdulwahab-Ahmed","doi":"10.4081/uij.2023.305","DOIUrl":"https://doi.org/10.4081/uij.2023.305","url":null,"abstract":"Vesicouterine fistula as described by Youssef manifests with amenorrhea, and cyclic haematuria (menouria) without urinary incontinence commonly following caesarean section. Other aetiologies have been reported for this disease. The post-caesarean section gossypiboma, a dual aetiology causing this condition is rare and can make its presentation atypical, thus posing a diagnostic dilemma. The clinical evaluation alone in the atypical presentation of the vesicouterine fistula is insufficient except complemented by imaging investigations and endoscopic examination of the related organs. We report a case of vesicouterine fistula that was managed initially as chronic pelvic inflammatory disease despite urinary incontinence until further evaluation including a transvaginal ultrasound scan and urethrocystoscopy raised an index of suspicion of a vesical mass suggestive of gossypiboma. The mass was confirmed to be a foreign body, an abdominal gauze pack, or gossypiboma. Its removal and repair of the vesicouterine fistula were associated with a satisfactory outcome.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45707596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of our study was to determine the incidence of Urinary Tract Infections (UTI) following intradetrusor onabotulinumtoxinA injections within our trust. This was a retrospective study of all patients who underwent intradetrusor onabotulinumtoxinA injections at our trust from August 2005 to 2015. Information was taken from our botulinum database, clinic letters and microbiology results. The primary outcome criterion was a positive urine culture together with symptoms suggestive of infection within 6 months post-procedure. A total of 290 intradetrusor onabotulinumtoxinA procedures were performed on 86 patients. The rate of UTI within 6 months following a procedure was 33%. There was a high resistance rate to our standard antibiotic prophylaxis, which was changed together with the addition of pre-procedure urine cultures and an on the day urine dipstick test. A re-audit was performed between January and June 2016 of 41 procedures and showed a reduction in UTI incidence to 20%. The rate of UTI post procedure within our trust was 33%. Following the implementation of multiple management protocol changes, a re-audit showed a reduction of UTI incidence to 20%.
{"title":"Urinary tract infections in the intradetrusor onabotulinumtoxinA population","authors":"Esme White, A. Brewin, T. Nitkunan","doi":"10.4081/uij.2023.304","DOIUrl":"https://doi.org/10.4081/uij.2023.304","url":null,"abstract":"The aim of our study was to determine the incidence of Urinary Tract Infections (UTI) following intradetrusor onabotulinumtoxinA injections within our trust. This was a retrospective study of all patients who underwent intradetrusor onabotulinumtoxinA injections at our trust from August 2005 to 2015. Information was taken from our botulinum database, clinic letters and microbiology results. The primary outcome criterion was a positive urine culture together with symptoms suggestive of infection within 6 months post-procedure. A total of 290 intradetrusor onabotulinumtoxinA procedures were performed on 86 patients. The rate of UTI within 6 months following a procedure was 33%. There was a high resistance rate to our standard antibiotic prophylaxis, which was changed together with the addition of pre-procedure urine cultures and an on the day urine dipstick test. A re-audit was performed between January and June 2016 of 41 procedures and showed a reduction in UTI incidence to 20%. The rate of UTI post procedure within our trust was 33%. Following the implementation of multiple management protocol changes, a re-audit showed a reduction of UTI incidence to 20%.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42998388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ballooning of the levator hiatus is a unique phenomenon of hyperdistention seen during the Valsalva maneuver in Pelvic Organ Prolapse (POP) patients. Although it is related to the weakness of pelvic floor muscles, there is only limited evidence of its effect on Levator Ani Muscle (LAM) strength, especially in Indonesia. The aim of this study was to describe the prevalence of levator hiatal ballooning in POP patients and its effect on LAM strength. A cross-sectional study was done on POP patients at Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from July 2019 to June 2021. Subjects who could not perform the Valsalva maneuver or perineometer and those having a history of perineal rupture were excluded. Subjects were grouped into hiatal ballooning and non-ballooning group based on the maximum hiatal genital length measured using ultrasound examination. Clinical characteristics, hiatal ballooning status, and LAM strength were compared between groups. A total of 99 subjects (47 ballooning and 52 non-ballooning) were recruited during the study. The prevalence of hiatal ballooning in POP patients was 47.5%. There was significantly lower LAM strength in the ballooning group measured by perineometer (p = 0.018). There was a significant relationship between the perineometer result and Modified Oxford Grading Scale result in both groups (p < 0.001). Lower LAM strength was observed in POP patients with hiatal ballooning.
{"title":"Levator hiatal ballooning prevalence in pelvic organ prolapse patients and its relation to levator ani muscle strength","authors":"F. Moegni, Andrew Yurius Christian","doi":"10.4081/uij.2022.293","DOIUrl":"https://doi.org/10.4081/uij.2022.293","url":null,"abstract":"Ballooning of the levator hiatus is a unique phenomenon of hyperdistention seen during the Valsalva maneuver in Pelvic Organ Prolapse (POP) patients. Although it is related to the weakness of pelvic floor muscles, there is only limited evidence of its effect on Levator Ani Muscle (LAM) strength, especially in Indonesia. The aim of this study was to describe the prevalence of levator hiatal ballooning in POP patients and its effect on LAM strength. A cross-sectional study was done on POP patients at Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from July 2019 to June 2021. Subjects who could not perform the Valsalva maneuver or perineometer and those having a history of perineal rupture were excluded. Subjects were grouped into hiatal ballooning and non-ballooning group based on the maximum hiatal genital length measured using ultrasound examination. Clinical characteristics, hiatal ballooning status, and LAM strength were compared between groups. A total of 99 subjects (47 ballooning and 52 non-ballooning) were recruited during the study. The prevalence of hiatal ballooning in POP patients was 47.5%. There was significantly lower LAM strength in the ballooning group measured by perineometer (p = 0.018). There was a significant relationship between the perineometer result and Modified Oxford Grading Scale result in both groups (p < 0.001). Lower LAM strength was observed in POP patients with hiatal ballooning.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46360201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Bashir, Abdul Rouf Khawaja, Yaseer Dar, T. Dar, Javeed Magray
SUI affects quality of life. Ulmsten and Petros reported mid urethral sling operations using Tension-free Vaginal Tape (TVT) and Delorme used Transobturator Tape (TOT). Cystoscopy is often used in retropubic sling procedures to identify lower urinary tract injury. Cystoscopy protects patients and accurately identifies iatrogenic injuries. The goal is to evaluate the efficacy of a standard Trans-Obturator (TOT-O) mid urethral sling for female Stress Urinary Incontinence (SUI) without intraoperative cystoscopy. A total of 120 female SUI patients from 2014 to 2019 were studied. Stress-related incontinence and diaper use were preoperative variables. Under spinal anesthesia, the procedure improved stress incontinence, sexual dysfunction, complications, and overall satisfaction. All patients improved after the procedure, and 116 (96.6%) completely resolved. Post-operative complications included urinary retention in 3 patients (2.5%), increased daytime urinary frequency in 3 (2.5%), urge incontinence in 4 (3.33%), groin/thigh pain in 2 (1.66%), and local mesh excision for mesh erosion in 1 (0.83%). Open EPI software calculated insignificant p values for clinical profile and satisfaction with symptom resolution. Brief Index of SF for Women was used to assess sexual function. At 6-month followup, all patients were satisfied with sexual function. TOT-O technique for female stress urinary incontinence is easy to learn and reproducible for beginners.
SUI影响生活质量。Ulmsten和Petros报道了使用无张力阴道带(TVT)和Delorme使用transsoturator带(TOT)进行中尿道悬吊手术。膀胱镜检查常用于耻骨后吊带手术，以确定下尿路损伤。膀胱镜检查可保护患者并准确识别医源性损伤。目的是评估标准的经闭孔(TOT-O)中尿道吊带治疗女性压力性尿失禁(SUI)的疗效，无需术中膀胱镜检查。选取2014 - 2019年女性SUI患者120例。压力相关性尿失禁和尿布使用是术前变量。在脊髓麻醉下，手术改善了压力性尿失禁、性功能障碍、并发症和总体满意度。所有患者术后均有改善，其中116例(96.6%)完全缓解。术后并发症包括尿潴留3例(2.5%)，日间尿频增加3例(2.5%)，急迫性尿失禁4例(3.33%)，腹股沟/大腿疼痛2例(1.66%)，局部补片切除1例(0.83%)。开放式EPI软件计算的临床概况和症状解决满意度的p值不显著。使用女性SF指数(Brief Index of SF for Women)评估性功能。随访6个月，所有患者性功能均满意。TOT-O技术治疗女性压力性尿失禁容易学习，对初学者具有可重复性。
{"title":"Transobturator-tape outside in (TVT-O) as saviour for female stress urinary incontince without available cystoscope for gynecologist: A case series","authors":"F. Bashir, Abdul Rouf Khawaja, Yaseer Dar, T. Dar, Javeed Magray","doi":"10.4081/uij.2022.296","DOIUrl":"https://doi.org/10.4081/uij.2022.296","url":null,"abstract":"SUI affects quality of life. Ulmsten and Petros reported mid urethral sling operations using Tension-free Vaginal Tape (TVT) and Delorme used Transobturator Tape (TOT). Cystoscopy is often used in retropubic sling procedures to identify lower urinary tract injury. Cystoscopy protects patients and accurately identifies iatrogenic injuries. The goal is to evaluate the efficacy of a standard Trans-Obturator (TOT-O) mid urethral sling for female Stress Urinary Incontinence (SUI) without intraoperative cystoscopy. A total of 120 female SUI patients from 2014 to 2019 were studied. Stress-related incontinence and diaper use were preoperative variables. Under spinal anesthesia, the procedure improved stress incontinence, sexual dysfunction, complications, and overall satisfaction. All patients improved after the procedure, and 116 (96.6%) completely resolved. Post-operative complications included urinary retention in 3 patients (2.5%), increased daytime urinary frequency in 3 (2.5%), urge incontinence in 4 (3.33%), groin/thigh pain in 2 (1.66%), and local mesh excision for mesh erosion in 1 (0.83%). Open EPI software calculated insignificant p values for clinical profile and satisfaction with symptom resolution. Brief Index of SF for Women was used to assess sexual function. At 6-month followup, all patients were satisfied with sexual function. TOT-O technique for female stress urinary incontinence is easy to learn and reproducible for beginners.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41263986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. N. Hidayah, S. Hakim, F. Moegni, N. Ibrahim, B. Santoso, Suskhan Djusad, Tyas Priyatini, A. Meutia
Pelvic Floor Muscle Training (PFMT) is an effective, non-invasive, and cost-effective treatment for Stress Urinary Incontinence (SUI). However, its success rate varies. We evaluated the factors predicting success in PFMT, such as age, initial urinary leakage, initial pelvic floor muscle contraction strength, urethral hypermobility, and myostatin level. A nested case-control study was conducted at Dr. Cipto Mangunkusumo hospital between February and October 2021. We evaluated demographic characteristics, UDI-6 and IIQ-7 questionnaire scores, physical exam, pad weight test, urethral hypermobility ultrasound, perineometry, myostatin level, and we instructed the subjects in PFMT according to a guidebook. After 12 weeks of PFMT, we evaluated therapy success, defined as less than 3g on the pad weight test. The study involved 58 women: 5 subjects dropped out, 47 subjects reached treatment success, and 6 subjects did not reach treatment success. Following bivariate analysis, we found that initial pad weight was the only variable that was significantly associated with treatment success (p=0.001, 95% CI: 1.02 – 2.25). The PFMT success rate was 88.68%, and initial urine leakage lower than 6.5g predicts PMFT success with 80.9% sensitivity and 83.3% specificity (p=0.001, 95% CI1.02–2.25).
{"title":"Evaluation of the factors contributing to success of pelvic floor muscle training in stress urinary incontinence","authors":"G. N. Hidayah, S. Hakim, F. Moegni, N. Ibrahim, B. Santoso, Suskhan Djusad, Tyas Priyatini, A. Meutia","doi":"10.4081/uij.2022.290","DOIUrl":"https://doi.org/10.4081/uij.2022.290","url":null,"abstract":"Pelvic Floor Muscle Training (PFMT) is an effective, non-invasive, and cost-effective treatment for Stress Urinary Incontinence (SUI). However, its success rate varies. We evaluated the factors predicting success in PFMT, such as age, initial urinary leakage, initial pelvic floor muscle contraction strength, urethral hypermobility, and myostatin level. A nested case-control study was conducted at Dr. Cipto Mangunkusumo hospital between February and October 2021. We evaluated demographic characteristics, UDI-6 and IIQ-7 questionnaire scores, physical exam, pad weight test, urethral hypermobility ultrasound, perineometry, myostatin level, and we instructed the subjects in PFMT according to a guidebook. After 12 weeks of PFMT, we evaluated therapy success, defined as less than 3g on the pad weight test. The study involved 58 women: 5 subjects dropped out, 47 subjects reached treatment success, and 6 subjects did not reach treatment success. Following bivariate analysis, we found that initial pad weight was the only variable that was significantly associated with treatment success (p=0.001, 95% CI: 1.02 – 2.25). The PFMT success rate was 88.68%, and initial urine leakage lower than 6.5g predicts PMFT success with 80.9% sensitivity and 83.3% specificity (p=0.001, 95% CI1.02–2.25).","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47387259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the recent years, potential longterm complications of permanent implants for urinary incontinence has become a topic of debate. As a result there is an increasing interest in less invasive and bioresorbable procedures from both healthcare professional as well as patients that ideally can be performed in an out-patient setting. This brief report describes our initial results using a novel bioresorbable injectable product for the treatment of female mild to moderate stress urinary incontinence. The results show that the majority of patients respond well to treatment and remain continent for the initial 12 months following injection. Complication rate is low and consisted of mild and transient events. These initial results are promising and merit further investigation into using this procedure as first-choice after unsuccessful conservative treatments such as pelvic floor muscle therapy.
{"title":"A retrospective analysis of 47 procedures using a bioresorbable polycaprolactone based injectable for the treatment of mild to moderate stress urinary incontinence in adult females","authors":"Anđelo Mojsović, E. Koldewijn","doi":"10.4081/uij.2022.283","DOIUrl":"https://doi.org/10.4081/uij.2022.283","url":null,"abstract":"Over the recent years, potential longterm complications of permanent implants for urinary incontinence has become a topic of debate. As a result there is an increasing interest in less invasive and bioresorbable procedures from both healthcare professional as well as patients that ideally can be performed in an out-patient setting. This brief report describes our initial results using a novel bioresorbable injectable product for the treatment of female mild to moderate stress urinary incontinence. The results show that the majority of patients respond well to treatment and remain continent for the initial 12 months following injection. Complication rate is low and consisted of mild and transient events. These initial results are promising and merit further investigation into using this procedure as first-choice after unsuccessful conservative treatments such as pelvic floor muscle therapy.","PeriodicalId":35651,"journal":{"name":"Urogynaecologia International Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44037165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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