International urogynecology journal and pelvic floor dysfunction最新文献

Introduction and hypothesis: This study describes pelvic organ support after childbirth.

Methods: This ancillary analysis of the Childbirth and Pelvic Symptoms Imaging Study compares pelvic organ prolapse quantification 6-12 months after childbirth among three cohorts of primiparous women: vaginal delivery with sphincter tear (n = 106), vaginal delivery without sphincter tear (n = 108), and cesarean without labor (n = 39).

Results: Of participants, 31.2% had stage II support. Prolapse to or beyond the hymen was present in 14% after vaginal delivery with sphincter tear (95% confidence interval 8%, 22%), 15% (9%, 24%) after vaginal delivery without sphincter tear, and 5% (1%, 17%) after cesarean without labor (p = 0.23). A study of 132 women per group would be required for 80% power to test differences between 5% and 15%.

Conclusions: While these data provide insufficient power to dismiss a difference in pelvic organ support between modes of delivery, they add to our understanding of support following childbirth.

Introduction and hypothesis: Aim of this study was to investigate the pattern of the foreign body reaction of macroporous polypropylene mesh (MPPM) used in females for the treatment of stress urinary incontinence and to compare this pattern between eroded and noneroded tapes.

Methods: Ten explanted suburethral slings, five eroded and five noneroded, were examined immunohistochemically under light microscopy; the tissue reaction was compared between eroded and noneroded materials.

Results: Eroded material showed a significantly higher accumulation of macrophages around the filaments of the mesh.

Conclusions: This is the first study comparing reaction around eroded and noneroded MPPMs and indicates a more intense tissue reaction around eroded mesh, when compared to noneroded material. More studies are needed to prove whether the detected foreign body reaction was the actual trigger for the erosion.

Introduction and hypothesis: The objective of this study is to describe pelvic floor muscle function (PFMF) in relation to age and parity in a general female population and to test whether strength/endurance measurements represent all functions of the pelvic floor musculature.

Methods: A cross-sectional study was performed on 95% of the women aged 45-85 years from a small Dutch town. Validated questionnaires were used to obtain general information, and vaginal examination to test PFMF was performed on 649 women. Chi-square tests were used to analyse the relation between PFMF versus age and parity. Analysis of variance was used to compare muscle strength and endurance to the other PFMF items.

Results: Response rate to the questionnaire was 62.7% (1,869/2,979). PFM strength and endurance are not positively associated with the effective involuntary muscle contractions during coughing.

Conclusions: Voluntary muscle contractions decreased with age, but there was no relation with parity. Muscle strength and endurance measurements alone are not sensitive enough to determine PFMF.

Introduction and hypothesis: Pelvic organ prolapse and hernia are common disorders which share several pathopysiological and epidemiological features. We therefore aimed to assess whether women with advanced pelvic organ prolapse have a higher prevalence of hernia.

Methods: We reviewed charts of women undergoing surgery for advanced pelvic organ prolapse and compared them to age-matched controls with mild or no prolapse.

Results: We identified 60 patients who underwent surgery for advanced pelvic organ prolapse and 60 controls. The total prevalence of hernias was significantly higher among patients with pelvic organ prolapse (31.6% vs. 5%, p = 0.0002), attributed to hiatal (16.6% vs. 1.6%, p = 0.004) and inguinal (15% vs. 3.3%, p = 0.04) hernias.

Conclusions: Patients with advanced pelvic organ prolapse have a higher prevalence of hiatal and inguinal hernias. This finding may be explained by similar pathophysiological mechanisms shared by both disorders.

Introduction and hypothesis: A case of inadvertent self-introduction into the urethra of a folded contraceptive vaginal ring (NuvaRing) in a 22-year-old woman is reported.

Methods: The patient presented with lower urinary tract symptoms, including dysuria, urgency, and terminal hematuria, that appeared a few minutes after insertion of the device.

Results: The diagnosis was made by abdominal echography. The abdominal pelvic computed tomography scan confirmed the intravesical presence of the unfolded ring.

Conclusions: Vaginal contraceptive rings should be added to the list of potential intravesical foreign bodies causing lower urinary tract symptoms.

Background: India lacks prevalence and incidence data on obstetric fistula, a near miss maternal mortality.

Methodology: Retrospective data were collected on obstetric fistula cases from hospital records of 24 tertiary care facilities during the period 2000-2006.

Results: Overall, 717 women underwent genital fistula repair, but medical records could be retrieved for only 401 (56%) cases. States of Bihar, Uttar Pradesh, and West Bengal had more than 100 cases each, while Karnataka had none. Obstructed labor caused nearly 97% of genital fistulae while pelvic surgery and accidental trauma contributed to 1.5% cases each. Commonest type of fistula was genitourinary (86.6%), others included rectovaginal (12.1%) and both genitourinary and rectovaginal fistulae (1.2%). Fistula repair was attempted in 322 (83%) cases of whom 289 (89.71%) were successfully repaired.

Conclusions: There is a need for ongoing systematic data collection mechanism like a fistula registry that would provide facility-based prevalence and incidence, time trends, and changes in etiology of fistula. This information could be used for implementation of prevention and treatment strategies.

Introduction and hypothesis: The National Institute for Health and Clinical Excellence (NICE) recommends antenatal pelvic floor exercises during first pregnancy to reduce postpartum stress incontinence. The aim of this audit was to assess patient awareness and compliance with this guideline.

Methods: An anonymous self-constructed questionnaire was given to patients after their first delivery.

Results: A total of 223 questionnaires were returned over a 6-month period. Although 95% of patients were aware of the importance of pelvic floor exercises, only a limited proportion of them had the right information and a minority practised them. Printed material seemed to be very influential in getting the message across. The importance of giving information early in pregnancy and national awareness was shown in the suggestions for improvement.

Conclusions: Patient awareness and actual practise of antenatal pelvic floor exercises did not meet NICE guidelines, calling for strategies to improve awareness and adherence.

Longitudinal vaginal septum is a rare mullerian anomaly and its association with pelvic organ prolapse (POP) is unusual. A case of longitudinal vaginal septum with stage IV POP in a 35-year-old multiparous woman is being reported. Examination revealed an incomplete longitudinal vaginal septum (9 x 6 x 2 cm) with stage IV POP. Vaginal hysterectomy with repair and reconstruction was done along with excision of the longitudinal vaginal septum which was technically challenging due to proximity to rectum. This is the only case report of stage IV pelvic organ prolapse associated with a thick longitudinal vaginal septum in a multiparous woman without any obstetric complications. Surgery required increased caution per operatively while dissecting the septum from the vaginal wall and the adjacent organs.