Current Opinion in Obstetrics & Gynecology最新文献

Purpose of review: There is limited data on contraceptive options in the setting of gynecologic and breast dysplasia. Despite this, many patients who report a history of these precancers retain their reproductive organs and seek contraception to avoid pregnancy. These patients require evidence-based counseling to guide their contraceptive choices, particularly in the setting of hormonally driven pathology.

Recent findings: In this review article, we outline known data on contraceptive options for patients with borderline ovarian tumors, endometrial hyperplasia, cervical/vulvar dysplasia, and atypical lobular and ductal hyperplasia. We also identify gaps in knowledge and opportunities for further research.

Summary: Patients with gynecologic and breast dysplasia benefit from comprehensive contraception counseling. More research is needed on contraceptive options for patients with dysplasia.

Purpose of review: To synthesize the current literature regarding the evaluation and management of genitourinary fistula in women.

Recent findings: Genitourinary fistula are aberrant communications between the urinary tract and genital tract that present with urinary leakage per the vagina. Initial management often involves conservative measures, such as urethral catheter or ureteral stent placement, progressing to surgical repair when needed. Key surgical principles include a tension-free, watertight closure with well-vascularized tissue including tissue interposition as appropriate, and postoperative urinary drainage. When surgical management of vesicovaginal fistula is necessary, a transvaginal repair is the most common. Other minimally invasive approaches are increasing and result in similarly high success rates with lower patient morbidity compared to open abdominal surgeries. The initial management of ureterovaginal fistula commonly includes ureteral stent placement. When not feasible or in persistent fistula, laparoscopic and robotic surgical repair with ureteral reconstruction offers high success rates with lower morbidity than an open approach.

Summary: Successful management of genitourinary fistula ranges from conservative urinary tract drainage to surgical interventions based on etiology, location, and complexity. Approaches to repair are shifting toward less invasive procedures. With optimal technique and surgical planning, high success rates can be achieved, particularly in primary repairs.

Purpose of review: Social networks, now including social media platforms, are increasingly important sources of health information for many patients, particularly patients of reproductive age. Observing and understanding conversations about contraception happening on social media can help clinicians address patient concerns and misinformation.

Recent findings: Studies evaluating social media posts on contraception have found the most popular methods discussed across platforms are intrauterine devices and oral contraceptive pills. Side effects are the most frequently discussed topic on all social media formats, with negative effects discussed much more frequently than benefits. People viewing social media are often more drawn to posts around the logistics of contraception. Most videos are created by nonhealthcare professionals and are more likely to contain misinformation than videos created by healthcare professionals.

Summary: Social media is an important tool that patients are using to access information about contraception. Physicians and clinicians should understand the themes patients are discussing so that they can address them in counseling. Physicians, clinicians, and healthcare organizations should consider contributing high-quality information to social media to improve accuracy and counter misinformation.

Purpose of review: Multicompartment pelvic organ prolapse, including concurrent rectal and vaginal prolapse, is increasingly recognized in aging populations. This review summarizes recent advances in diagnostic imaging, multidisciplinary evaluation, and surgical techniques for combined repair.

Recent findings: Multicompartment prolapse is increasingly prevalent and often underrecognized without coordinated evaluation. Dynamic defecography, particularly upright or MRI-based, improves detection of multicompartment descent. Minimally invasive combined sacrocolpopexy (SCP) and ventral mesh rectopexy (VMR) is increasingly used with favorable outcomes. Surgical series report low complication rates and suggest a potential reduction in prolapse recurrence with combined repair. Robotic platforms, including newer systems, enhance precision, and visualization. Emerging techniques include laparoscopic resection rectopexy with SCP and selective use of biologic mesh. Multidisciplinary care improves coordination and recurrence prevention.

Summary: Contemporary management of multicompartment prolapse requires a collaborative, patient-centered approach. Advances in imaging and minimally invasive surgery, particularly robotic SCP and VMR, have improved outcomes. Future research should focus on standardizing techniques, optimizing mesh configurations, and long-term functional results.

Purpose of review: This review article examines recent research on the advantages and limitations of functional exercise, such as yoga and Pilates, in relation to pelvic floor health and urge urinary incontinence (UUI) and overactive bladder (OAB). There is ample evidence of functional exercises and mindfulness improving stress urinary incontinence, but limited data thus far for OAB or UUI.

Recent findings: There continues to be a paucity of rigorous data on the use of functional exercise in the management of OAB, with most recent literature limited to small prospective pilot studies. The few recent randomized controlled trials support the safety of these exercise regimens; however, results were not consistently superior to generalized muscle strengthening. Recent data does continue to support the physiologic benefit of mindfulness and yogic breathing to the autonomic nervous system and its potential impact on reducing bothersome lower urinary tract symptoms. Promising work has been published on the feasibility of app- or video-based programs, offering a more accessible option to motivated individuals.

Summary: While data remains uncertain as to the impact of yoga or Pilates on OAB symptom improvement, these low-impact exercises can have a role as complementary treatment strategies that are more accessible and provide a holistic approach to care.

Purpose of review: The etiology of urogynecologic conditions is multifactorial and complex. However, the inability of the host pelvic tissues to repair and regain their original function in response to various insults, including maternal birth injury or age-related changes in the endogenous regenerative potential, underlies the pathophysiology of the morbid pelvic floor disorders (PFDs). Regenerative medicine approaches are poised to not only treat but potentially prevent the development of these deleterious conditions, the prevalence of which continues to increase. We aim to highlight the existent work at the crossroads of urogynecology and regenerative medicine and to underscore areas in need for continued and novel investigations.

Recent findings: Regenerative medicine techniques, including stem cell therapies, extracellular vesicles, secretomes, platelet-rich plasma, laser-based interventions, and bioinductive acellular scaffolds, are being studied in the context of urogynecology, with many showing promise in revolutionizing prevention and treatment of PFDs by enhancing constructive tissue repair.

Summary: Regenerative medicine techniques hold the key to changing the clinical paradigm in Urogynecology from reactive to preventive.

Purpose of review: Chatbots based on large language models have been rapidly incorporated into many aspects of medicine in a short time despite an incomplete understanding of their capabilities. This review focuses on ways these chatbots have been utilized in urogynecology.

Recent findings: Publications regarding chatbots in urogynecology have centered on patient education, scientific literature review, clinical decision-making, documentation, and research. Several authors have evaluated the ability of chatbots to generate accurate and complete information about prolapse and urinary incontinence. While chatbots can generate accurate information about pelvic floor disorders most of the time, the studies we review indicate that incomplete, misleading, or incorrect information is generated up to 33% of the time. Newer chatbots that are trained for medical applications may help to limit some of these problems. Using chatbots to assist with scientific literature review and research is currently hampered by unpredictable 'hallucinations', where the chatbot may generate information or references that sound plausible but are factually incorrect.

Summary: While chatbots are being rapidly integrated into many aspects of medicine, the research evaluating these tools in urogynecology is limited. Publicly available chatbots should only be used for patient education, clinical decision-making, and research with caution.

Purpose of review: The vaginal microbiome plays an important role in protecting the vagina and bladder from infection. There is significant interest in understanding whether probiotics can normalize the vaginal microbiome and lead to decreased incidence of vulvovaginal-associated infections. Probiotics are an appealing treatment option as they are well tolerated, have a low risk profile, and potentially can reduce antibiotic usage.

Recent findings: Recent research suggests that probiotics may play a role in preventing recurrent bacterial vaginosis (BV) when administered with or after antibiotic treatment. Probiotics do not seem to be helpful for preventing recurrent vulvovaginal candidiasis. Probiotics prevent vaginal colonization with uropathogens from the gastrointestinal tract, and decrease recurrent urinary tract infections (UTIs) 76% when administered as part of a nonantibiotic recurrent UTI treatment bundle, which includes D-mannose, cranberry supplementation, and probiotics. Probiotics are a hopeful treatment for human papillomavirus (HPV), and evidence suggests that probiotic administration increases clearance of HPV and results in the resolution of abnormal papanicolaou test results.

Summary: Evidence shows that probiotics are useful treatments for BV, recurrent UTIs, and HPV. More research is necessary to recommend specific bacterial strains or products for each indication.

Purpose of review: Abnormal uterine bleeding (AUB) is a common complaint in adolescents and is mostly treated with hormonal medication. This review provides an update on adolescent AUB evaluation and treatment.

Recent findings: Anovulatory cycles and coagulopathies remain the most common reasons for AUB. Structural causes of AUB are still overall rare in adolescents, but recent advances in imaging techniques show they are more prevalent than previously thought. Since hormonal medication is the main treatment for AUB, acknowledging updates about their safety in certain populations is necessary. Investigations on nonhormonal medications for AUB and conservative surgical approaches are promising.

Summary: Recent updates to the safety of hormonal interventions impact management of AUB in adolescents. More research is needed to identify novel methods for managing AUB, as this can have negative impacts on both physical and mental health.