Female Pelvic Medicine and Reconstructive Surgery最新文献

Objectives: In recent years, new intravaginal support devices for stress urinary incontinence have been introduced to the market. Although studies have demonstrated their safety and efficacy, few studies have examined adverse events attributed to their use. The objective of this study was to characterize reported adverse events for an over-the-counter intravaginal support device and determine whether further medical treatment was necessary to manage the adverse event.

Methods: We searched the Manufacturer and User Device Experience database from January 2015 to September 2020 for pertinent reported adverse events, which included the unique report key, event date, report date, event text descriptions, and resulting course of treatment. Per Manufacturer and User Device Experience database mandatory requirements, all reports were submitted by the manufacturer within 30 days of receiving the consumer's voluntary submission.

Results: A total of 257 reports were included for analysis. The most common reported adverse event was related to the string of the device, which broke with either removal or insertion of the device (230 of 257 [89.5%]). The majority of patients who required medical attention (133 of 257 [51.8%]) were evaluated and managed in the office setting (85 of 133 [63.9%]), whereas 37% (95 of 257) of patients were able to self-treat.

Conclusions: Most complications attributed to device use were self-managed or managed in the outpatient setting. No emergent hospitalizations or deaths were attributed to their use, supporting their generally low-risk profile and high tolerability. Limitations of this review include the inability to decipher a denominator for these reported adverse events and the potential bias attributed to voluntary consumer reporting.

Importance: Obesity may be a modifiable risk factor for pelvic floor disorders.

Objectives: The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth.

Study design: In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 - 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year).

Results: Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone.

Conclusions: Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.

Importance: Outreach based on user characteristics through social media advertising is significantly more effective than outreach based on user interests with search engine advertising for female stress urinary incontinence.

Objective: The aim of the study was to compare the effectiveness of 2 online outreach platforms to engage women at risk of stress urinary incontinence with a high-quality patient education website.

Study design: A geographic randomized trial was performed comparing online advertising on Facebook, a social media site, versus Google Ads, a search engine, to direct viewers to VoicesForPFD.org. Advertisements were developed using health communication theory and pretested before the randomized trial. Counties in the Pacific Northwest were grouped into approximately equal populations, called "supercounties," and randomized to advertisement platforms. Educational website views resulting from each campaign, called sessions, were measured using Google Analytics; the primary outcome was the number of sessions per supercounty. County characteristics were obtained from national survey data. Effectiveness of the advertising platforms was compared between randomization arms using Welch's unequal variances t test, and crude and adjusted linear regression models.

Results: Mean user sessions were significantly higher in areas randomized to Facebook advertising (470 sessions) compared with areas randomized to Google Ads advertising [44 sessions; mean, 426 session difference (95% confidence interval, 199-653 sessions); P = 0.001]. After accounting for adult female population and rurality, randomization to Facebook instead of Google Ads still resulted in 409 additional sessions (95% confidence interval, 317-501 sessions; P < 0.001).

Conclusions: Social media was 10 times more effective (470 versus 44 mean sessions per supercounty) than search engine outreach advertising and should be prioritized in outreach efforts. Future work is needed on engagement and behavior change with online outreach.

Objective: The objective of this study was to describe mean urethral pressure (MUP) during filling cystometry in continent and incontinent women.

Methods: Incontinent women were recruited from a urogynecology clinic if they answered "sometimes" or "always" to 1 of the items on the Medical, Epidemiologic, and Social Aspects of Aging questionnaire. Participants were categorized by Medical, Epidemiologic, and Social Aspects of Aging scores into stress urinary incontinence (SUI) or urgency urinary incontinence (UUI) groups. Continent women were recruited from the community. Multichannel urodynamics were performed using microtip catheters. Urethral pressure profiles were obtained with an empty bladder and at 100-mL increments during filling. Data were analyzed in SPSS. Continuous variables were compared with independent t test or analysis of variance, categorical variables with the χ2 test, and multivariable comparisons were made with linear regression.

Results: Eighty-six women (30 continent, 56 incontinent: 37 SUI, 19 UUI) with a mean ± SD age of 48 ± 15 years and a body mass index (BMI) of 31 ± 9 participated. Sixty-nine percent were White, 43% were postmenopausal, and 80% were parous. Continent women were younger (P < 0.001) and had a lower BMI (P = 0.004). Mean cystometric capacity was higher in women with SUI and continent women than in women with UUI (430 ± 142, 448 ± 101, and 332 ± 160, P = 0.04). Continent women had higher MUP at baseline when controlling for age, BMI, and parity (84 ± 35 cmH2O vs 62 ± 28 cmH2O; aR2 = 0.2, P = 0.02) compared with incontinent women. During filling, MUP in continent women was 20-30 cmH2O higher at all bladder volumes than incontinent women. Mean urethral pressure increased significantly between baseline and 300 mL in continent women (P < 0.005) and women with SUI (P = 0.04), but not in women with UUI (P = 0.48).

Conclusions: Continent women have greater baseline MUP and greater increases in MUP during bladder filling than incontinent women.