Urogynecology (Hagerstown, Md.)最新文献

Importance: An improved understanding of associations of bladder-related knowledge and agentic beliefs with bladder health can be informative for developing strategies to prevent lower urinary tract symptoms (LUTS).

Objectives: The objectives of this study were to evaluate associations of bladder knowledge and agentic beliefs with bladder health status.

Study design: We assessed bladder-related knowledge and beliefs in RISE FOR HEALTH participants using the Bladder Health Knowledge, Attitudes and Beliefs instrument (BH-KAB, range 0-100) in a cross-sectional analysis. Bladder health was assessed using the Global scale of the Bladder Health Scales (BHS, 0-100), the Total Bladder Function Index (BFI, 0-100), and the Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10, 0-38). Associations of bladder-related knowledge and agentic beliefs with each bladder health outcome were assessed using linear regression.

Results: The mean age of participants was 49.2 years (range=18-101 years). The mean knowledge score was 67.5 and the mean agency score was 56.5. The associations of the knowledge score with Global BHS and BFI were weak (-0.9 and -1.1), while associations of the agency score with Global BHS and BFI were stronger, with a 2.4 and 1.4 higher score (better health), respectively, for every 10-point increase in agency. Increased agency was also associated with fewer LUTS; for every 10-point increase in agency score, there was a 0.5 decrease in the LURN SI-10 score.

Conclusions: Bladder-related knowledge was weakly associated and agentic beliefs were more strongly associated with bladder health and function. Longitudinal prevention intervention studies can help determine whether increases in agentic beliefs promote bladder health and prevent the development and worsening of LUTS.

Importance: The effect of a short interpregnancy interval (IPI) on pelvic floor disorders is unknown.

Objectives: We investigated the relationship between a short IPI and the development of stress incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence (AI) in the decade after the first delivery.

Study design: We performed a secondary analysis of the Mothers' Outcomes After Delivery study-a prospective cohort of women recruited 5-10 years following their first delivery and followed annually between 2008 and 2018. A short IPI was defined as ≤18 months, calculated as the number of months between deliveries minus the length of the second pregnancy. SUI, POP, and AI were identified by annual validated questionnaires, examination, or history of treatment. Data were analyzed in SAS. Variables significant on bivariate analysis were entered into multivariable logistic regression models predicting each outcome using the generalized estimating equations approach for repeated measures.

Results: Of 1,127 women, the majority (671, 59%) never had a short IPI, 395 (35%) had 1 short IPI, and 61 (6%) had 2 or more. Within 10-15 years, 219 women (19%) reported SUI, 156 (14%) reported POP, and 251 (22%) reported AI. We found that a short IPI was not associated with SUI ( P =0.69), POP ( P =0.71), or AI ( P =0.95). When restricting the cohort to women with only nonoperative vaginal deliveries (n=440), there remained no difference in the presence of SUI, POP, or AI ( P = 0.88, 0.84, 0.78, respectively).

Conclusions: A short IPI is not associated with pelvic floor disorders in the decade following the first delivery. This should be reassuring to women at risk of PFDs who elect to become pregnant within 18 months of childbirth.

Importance: Mixed evidence suggests that nocturia may be related to major adverse cardiovascular events (MACEs).

Objectives: Our objective was to estimate the association between nocturia, quantified on bladder diaries, and MACE.

Study design: From 2021 to 2024, the Symptoms of Lower Urinary Tract Dysfunction Research Network observational study (LURN II) enrolled participants with or without nocturia. Baseline characteristics, patient-reported outcomes, and bladder diary data were collected and joined with MACE outcomes from the electronic medical records at a single site. Participants with a diagnosis of a MACE outcome before LURN II enrollment were excluded. Estimates of the associations between the number of nocturia events, nocturia volumes, and the proportion of daily urine made at night, or nocturnal polyuria index (NPI), and ranked MACE outcomes were generated. Associations were estimated using Bayesian proportional odds ordinal models with skeptical priors. Model covariates included age and sex.

Results: Of the 146 participants, 10.3% developed a MACE. Median follow-up time (IQR) was 31.5 (18.7) months. The probability of an association between NPI and MACE outcomes was 98% (adjusted odds ratio [aOR], 1.01; credible interval, 1.00, 1.02). The probability of an association between the number of nocturia episodes and MACE was 84% (aOR, 1.09; credible interval, 0.93, 1.29). The probability of an association between NPI with male sex and MACEs was 0.98, and with female sex and MACEs was 0.00005 (aOR, 1.01; 95% credible interval, 1.00, 1.02).

Conclusion: NPI, especially in males, and the number of nocturia episodes have a high probability of being associated with MACE outcomes.

Importance: Pelvic organ prolapse is a major cause of morbidity in women, affecting quality of life. The ideal surgical technique for apical support with minimal complications remains debated.

Objectives: This study aimed to compare the anatomic and surgical success rates between 2 vaginal apical suspension techniques, sacrospinous ligament fixation (SSF) and high uterosacral ligament suspension (HUSLS), in preventing recurrence of pelvic organ prolapse (POP).

Study design: A randomized controlled trial was conducted in women undergoing vaginal hysterectomy for POP. Participants were randomly assigned to receive either HUSLS or unilateral SSF. The primary outcomes were anatomic success (Pelvic Organ Prolapse Quantification [POP-Q] stage 0/1) and surgical success (symptom relief without re-surgery) at 1, 6, and 12 months. Secondary outcomes included functional improvement assessed by Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) and Female Sexual Function Index (FSFI) scores.

Results: Of 228 enrolled patients, 204 completed follow-up (HUSLS, 103; SSF, 101). Baseline characteristics and mean POP-Q stage (3.1±0.6 vs 3.2±0.59, P=0.36) were comparable. Operative time was longer in the SSF group (198±18.8 vs 168±21.7 min, P=0.04), but other perioperative outcomes were similar. At 12 months, POP-Q stage 0 was achieved in 75.7% (HUSLS) and 79.2% (SSF), with overall surgical success rates of 84.4% and 85.1%, respectively. POPDI-6 scores improved significantly (72.2±12.8 to 17.3±9.7 in HUSLS; 72.7±14.4 to 19.1±9.2 in SSF, P<0.001). FSFI scores also improved markedly (17.4±4.8 to 25.5±4.6 in HUSLS; 17.5±2.9 to 25.2±3.4 in SSF).

Conclusion: Both HUSLS and SSF are safe and effective for apical prolapse repair, offering comparable anatomic and functional outcomes at 1-year follow-up.

Importance: Perineal instability is a stressful condition for women. The study evaluates the relationship of the puboanal and puboperineal fibromuscularis to the perineal body and the pelvic floor.

Objective: The objective of this study was to describe the ultrasound anatomy of the puboanalis (PA) and its relationship to the arcus tendineus rectovaginalis (ATRV) in patients with and without posterior vaginal wall prolapse.

Study design: This study included descriptive anatomy of 37 patients with rectocele (points Ap and Bp ≥0) and 22 nulliparous patients without, who completed a questionnaire, pelvic examination, and a 3-D endovaginal ultrasound (EVUS). Posterior compartment structures, PA, and ATRV were traced on EVUS desktop software. PA volume was segmented starting from the superficial transverse perinei and continued 5 mm stepwise to a length of 2.5 cm cephalad. Two independent observers confirmed visualization and volumes.

Results: PA has a butterfly-like structure, encircling the anal canal at one end, traversing anteriorly to insert in the retropubic fascia cephalad, becoming continuous with investing fascia of the pelvis and the lateral rectovaginal fascia attachments at ATRV. Nulliparous patient PA mean volume was 4.45 cm3 (SD: 0.96), total length of 2-2.5 cm. Ultrasound and cadaveric anatomy are highly correlated. Mean PA volume in the posterior vaginal wall prolapse group was 5.6 cm3 (22% volume increase compared with nulliparous group); 48% had ATRV defects on the right side, and 54% had PA injuries on the left side. Bilateral ATRV defects were present in 27%, and 75% on at least one side.;33% of nulliparous patients, and 95% of posterior vaginal wall prolapse patients had splinting or bulge symptoms.

Conclusions: PA stabilizes the anal outlet and merges with posterior vaginal support. The disruption of ATRV attachment was common in posterior vaginal wall prolapse.

Importance: Despite increasing focus on the benefits of expedited recovery after minimally invasive surgery (MIS), urogynecology lacks a validated, simple question to assess recovery.

Objectives: The objectives of this study were to explore how patients evaluate postoperative recovery following MIS for apical pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI), and to confirm understanding of a recovery patient-reported outcome (PRO).

Study design: This study enrolled women who underwent MIS for apical POP or an isolated procedure for SUI (midurethral sling placement or urethral bulking) in the past 4 weeks. English and Spanish cognitive interviews were conducted with the goal of identifying components of a participant's perception of recovery and their understanding of the PRO.

Results: Sixty-three women recovering from POP procedures (41/63) and SUI procedures (22/63) underwent a cognitive interview at a median time since the index surgery of 3 weeks (range: 0-8). Common factors influencing a participant's report of recovery included activity and/or pain level, ability to participate in regular activities, and resolution of symptoms. Most participants defined recovery as getting back to "normal," and viewed recovery as distinct from symptom resolution; however, some included symptom resolution in their definition. All participants understood the PRO, and the majority (48/63) felt either 75% or "completely" recovered at the time of their interview.

Conclusions: Women undergoing surgical procedures for POP or SUI define recovery as getting back to normal or regular activities. "To what extent do you feel physically recovered after surgery" is understood by both English and Spanish-speaking participants recovering from POP or SUI surgery.

Importance: Prior studies of patient decision aids in urogynecology have not shown benefit, but these tools may have been written at a reading level above that of the average patient.

Objectives: The primary aim was to determine if consent using an audiovisual decision aid (AVDA) written below eighth-grade reading level in English or Spanish affects patient preparedness for surgery. Secondary aims included correlating health literacy with preparedness and assessing patient satisfaction with the decision for surgery.

Study design: We conducted a randomized controlled trial on patients undergoing surgery for pelvic organ prolapse or urinary incontinence. We compared standard informed consent (control) with watching the AVDA. The primary outcome was the overall response on the "Preoperative Preparedness For Surgery" questionnaire. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. Postoperatively, satisfaction with the decision for surgery was assessed.

Results: One hundred fifty-one participants completed the study. In each group, 98.7% of participants strongly agreed or agreed that they felt prepared for surgery (AVDA 74/75, control 75/76, P = 0.364). Most participants had adequate health literacy (AVDA 82.1%, control 81.8%). Among those with low health literacy, there was no significant difference in preparedness for surgery between AVDA and control (P = 0.363). Most participants in both groups were satisfied with their decision for surgery (AVDA 98.6%, control 100%, P = 0.737).

Conclusions: Use of an audiovisual decision aid written below eighth-grade reading level did not significantly affect preparedness for surgery, even among participants with low health literacy. Preparedness for surgery was high in both groups.

Importance: Postoperative urinary retention (POUR) is a frequent and burdensome complication following urogynecologic surgery. Studies in other specialties suggest intraoperative glycopyrrolate may increase POUR risk; however, this association has not been explored in prolapse surgery, where baseline rates of POUR are higher and same-day surgery is now standard.

Objective: The objective of this study was to evaluate the association between intraoperative glycopyrrolate and POUR among patients undergoing laparoscopic prolapse repair with same-day discharge.

Study design: We conducted a retrospective cohort study of patients undergoing outpatient laparoscopic sacrocolpopexy, sacrocervicopexy, or sacrohysteropexy surgery from June 2017 through January 2024. All patients underwent a standardized postoperative voiding trial with 300 mL of saline instilled through a transurethral catheter, followed by a void within 15 minutes. The exposure was intraoperative glycopyrrolate; the primary outcome was POUR, defined as voiding <200 mL. Log-binomial regression was used to estimate relative risk (RR) and 95% CI, adjusting for age, body mass index, surgeon, concomitant sling, and perioperative scopolamine use.

Results: Among 321 patients, 77% received glycopyrrolate. After adjusting for confounders, patients who received glycopyrrolate had an increased risk of POUR (RR: 1.93, 95% CI; 1.16 to 3.22) compared with those who did not receive glycopyrrolate. This relationship may be dose-dependent: patients who received a low dose had an RR of 1.28 (95% CI; 0.70 to 2.33), while those receiving a high dose had an RR of 2.57 (95% CI; 1.51 to 4.38).

Conclusions: Intraoperative glycopyrrolate was associated with a significantly increased POUR risk, particularly at higher doses commonly used during neuromuscular blockade reversal. Surgeons should engage with anesthesiologists to discuss the potential effect of drugs on postoperative outcomes.

Importance: Women experiencing symptoms of urinary incontinence (UI) may be reluctant to discuss their symptoms with their primary care physicians (providers) due to embarrassment and stigma surrounding the condition.

Objectives: As part of a primary care quality improvement pilot intervention for UI, this study aimed to assess the success of an online screening tool in identifying bothersome urinary UI in a primary care setting. A secondary analysis sought to determine the percentage of women who discussed the condition with their providers.

Study design: Providers from a regional medical group in Southern California and their female patients 18 years of age and older were invited to participate between July 2019 and February 2020. Female patients were recruited via a screening survey. Providers were alerted by email and the patient's electronic health record when a patient screened positive.

Results: Twenty-four providers participated in the study. A total of 6,360 screening surveys were sent to female patients. Seven hundred nine (11.15%) responses were received. Three hundred two patients reported experiencing symptoms of UI, but only 166 patients chose to participate. Of the 166 participating patients, 35 (21.08%) spoke with their providers about their symptoms after they were screened.

Conclusions: Online screening for UI is feasible. The observation that only 21% of patients had conversations with their providers about their symptoms during the appointment, even after the provider was notified of the positive screen, suggests the need for better tools, such as alerts in the medical record, to enhance provider awareness of their patients' UI.