Urogynecology (Hagerstown, Md.)最新文献

Importance: There is a need to understand phenotype-specific therapies for interstitial cystitis/bladder pain syndrome (IC/BPS) at the clinical trial level to move beyond trial-and-error treatment approaches.

Objective: The objective of this study was to characterize IC/BPS clinical trials that incorporate patient phenotype into the eligibility criteria in accordance with the American Urological Association (AUA) guidelines.

Study design: Registered IC/BPS clinical trials were identified from ClinicalTrials.gov. Trials were included if they enrolled patients with IC/BPS and addressed pain-related outcomes. Trials were assessed for phenotype recognition and categorized by intervention type, funding source, and registration date relative to the AUA's 2015 IC/BPS guidelines for initial phenotype recognition.

Results: Out of 170 trials, 37 (21.8%) included phenotype stratification. The majority focused on bladder-centric presentations. Men were underrepresented in IC/BPS clinical trials. Phenotypic stratification was more frequently reported in industry-funded trials compared with those without industry support (40.5% vs 16.5%, P =0.0031). Trials registered after the 2015 AUA guideline update showed greater phenotype inclusion, though this was not statistically significant (26.6% vs 15.8%). Therapeutic trials comprised the majority of trials. Stratification appeared more often in physical therapy and psychosocial trials at 40% and in drug studies at 34.3%. Intravesical instillation and injection trials showed lower rates at 19.6% and 13.0%, respectively.

Conclusions: Failure to incorporate IC/BPS phenotypes into trial design limits the ability to evaluate treatments within the context of real-world symptom variability. Bridging this methodological gap is essential to ensure that clinical research supports the development of more targeted and effective therapies.

Importance: Comprehensive understanding of anatomic landmarks is essential for safe and successful apical suspension during vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) procedures. However, detailed descriptions of these landmarks remain scarce in the current literature.

Objective: We aimed to delineate the anatomic relationships of key landmarks relevant to apical suspension procedures performed through vNOTES.

Study design: Ten embalmed female cadavers were dissected. A 9.5 cm Alexis retractor from the commercially manufactured vNOTES port was used. Distances were measured from the inner ring of the retractor to the following anatomic structures: the ischial spine (sagittal and transverse planes), S1 root, urethra, trigone, pubic crest, and iliac vessels.

Results: The mean distance from the retractor's inner ring to the ischial spine was 1.0 cm (range: 0.9-1.3, SD: 0.1) sagittally and 3.6 cm (range: 3.0-4.9, SD: 0.6) transversely. The S1 foramen was located 6.4 cm (range: 5.0-8.0, SD: 1.0) from the ring's midpoint. Sagittal measurements revealed a mean distance of 2.6 cm (range: 1.7-3.5, SD: 1.0) from the proximal urethra and 1.9 cm (range: 1.4-3.5, SD: 0.7) from the trigone. The external iliac vessels were 3.2 cm (range: 2.1-4.1, SD: 0.7) from the ring's edge, while the pubic crest was 2.7 cm (range: 1.6-3.3, SD: 0.5) away.

Conclusions: The spatial relationships described in this study provide crucial reference points for surgeons performing apical suspension during vNOTES. Knowledge of these relationships can enhance safety and provide a roadmap for future innovation and the advancement of complex gynecologic interventions.

Importance: Despite the popularity of urethral bulking with polyacrylamide hydrogel (PAHG) for stress urinary incontinence (SUI)/intrinsic sphincter deficiency (ISD), no studies have assessed optimal anesthetic protocols.

Objectives: To compare pain scores between 2 anesthetic protocols in women undergoing in-office PAHG injection: (1) combined anesthetic [external lidocaine-plus-prilocaine (EMLA) cream, intraurethral lidocaine gel, and lidocaine periurethral block] or (2) topical-only (external EMLA cream and intraurethral lidocaine gel).

Study design: This single-blinded trial randomized women to 1 of 2 anesthetic protocols. The primary outcome was pain reported via a 10-point visual analog scale (VAS). Secondary outcomes included International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) and Patient Global Impression of Improvement (PGI-I) scores. A safety endpoint of 3 subjects in the topical-only arm requiring unplanned periurethral block to complete the PAHG procedure, and an a priori sample size of 52 subjects was set.

Results: Recruitment stopped at 23 subjects (N=11 combined anesthetic vs. N=12 topical-only) upon meeting the safety endpoint. Mean procedural VAS pain scores were lower with concomitant periurethral block (4.5±2.7 combined anesthetic vs. 7.4±2.3 topical-only; P<0.01). For 3 subjects in the topical-only arm requiring additional anesthesia, VAS pain scores were reduced following periurethral block (10.0±0.0 preblock to 4.0±2.6 postblock; P=0.04). There was no difference between arms in procedure duration, reinjection, or questionnaire scores. Subjects in the combined anesthetic arm were less likely to require post-procedure straight catheterization (0% vs. 33% topical-only; P=0.04).

Conclusions: Use of a periurethral block with topical anesthetics reduced pain scores and improved postprocedure voiding. These findings support using a combined anesthetic protocol for women undergoing in-office PAHG injection.

Importance: This research describes which articles published in Urogynecology are garnering the most attention online. Understanding which articles are having the largest impact in the online community has become increasingly important due to the exponential increase in the use of social media on the internet.

Objective: The Altmetric Attention Score (AAS) is a quantitative and qualitative measure of the articles' online attention in social media and news outlets, blogs, and reference managers. The aim of this study was to provide an analysis of those accessing and sharing the 100 most popular articles published in Urogynecology .

Study design: This was a retrospective descriptive analysis. Using Dimensions, a "linked research knowledge system," data about each article's demographics on Twitter and other media sources was extracted from each of the articles within Urogynecology with the highest AAS. No articles were excluded. The articles were categorized by topic and metrics of online sharing were compared among categories.

Results: Fifteen categories were created. Sexual health and education articles had the highest average Altmetric scores per article and reached the highest impressions per article and had the highest average follower count per Twitter user. On average, social justice in medicine had the highest number of tweets per article. Tweets were most often composed by members of the public (58%) compared with health care practitioners (14%), researchers (13%), and science communicators (12%).

Conclusions: Sexual health and education articles had the highest average AAS and impressions on Twitter. We observed a difference in which articles are being shared most among the general public and health care professionals. The general public comprised a majority of those sharing articles online regardless of category. Additionally, there may be a disparity in research, its funding, and online scientific communications within the field of urogynecology.

Importance: To evaluate and consider how prescribing practices have changed in relation to high-risk overactive bladder (OAB) medications.

Objective: The objective of this study was to evaluate trends in the prevalence of OAB and pharmacologic treatment over time in the United States.

Study design: Data from the National Health and Nutrition Examination Survey (NHANES, 2001-2018, n = 30,478) and the National Ambulatory Medical Care Survey (NAMCS, 2003-2019, n = 251,330) were used to identify women with symptomatic incontinence and overactive bladder (OAB) (NHANES) as well as determine the frequency of prescription use for OAB medications (NHANES and NAMCS) using sampling-based weights. Joinpoint regression was used to determine adjusted annual percent change (APC, adjusting for race, age, body mass index, and insurance status). Trends were assessed overall and by race, age, body mass index, and insurance status.

Results: The prevalence of OAB was 31.2% in the final survey year of NHANES (2017-2018). Women aged >65 years had the highest prevalence of OAB at 54% compared with other age groups. There was an overall increase in OAB (APC 1.24 [0.64, 1.84], P  = 0.002) over time. Overall, only 3.5% of patients with symptoms of OAB reported pharmacologic treatment in NHANES. The NAMCS demonstrated a significant decrease in anticholinergic prescriptions from 2003 until 2019 (APC -6.44 [-9.77, -2.98], P  = 0.001). However, in NHANES, there was no significant change in anticholinergic use (APC 0.62 [-20.2, 26.8], P  = 0.944). There was a stable prevalence of β 3 -adrenergic agonist prescriptions since they were introduced to market (APC 0.65 [-2.24, 3.62], P  = 0.616).

Conclusion: This study demonstrates an increasing prevalence of OAB and highlights the likely undertreatment of symptomatic patients. The high and increasing prevalence coupled with the relative undertreatment of OAB underscores the importance of screening for this condition.

Importance: Obliterative vaginal surgery is often reserved for older patients with prolapse, but the effect of age as an independent risk factor for perioperative complications in this cohort is poorly understood.

Objective: The aim of this study was to assess the association between age and perioperative complications in women undergoing obliterative vaginal surgery.

Study design: This was a retrospective cohort study that included 371 patients undergoing colpocleisis between 2010 and 2013 at a single academic medical center. Seventy demographic and clinical variables, including complications within 12 weeks of surgery, were analyzed. The χ 2 and Fisher exact tests were used for categorical variables. Student t and Mann-Whitney U tests were used for continuous variables. Univariate logistic regression was performed to identify predictors of perioperative complications, and candidate variables with P  < 0.2 were used in multivariate logistic regression.

Results: The mean patient age was 75.4 ± 6.4 years (range, 59-94 years). One hundred ten (29.7%) patients experienced at least 1 complication, the most common of which was urinary tract infection (n = 47, 12.7%). In the final multivariable model, only age (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.08) remained a significant predictor of perioperative complications. A cut point of age ≥70.5 years maximized sensitivity and specificity for predicting complications.

Conclusions: Among women undergoing obliterative vaginal surgery, age is a predictor of perioperative complications. Each increasing year of age increases the complication likelihood by 1.05-fold, such that an 85-year-old woman is 1.05^20 or 2.65 times more likely than a 65-year-old woman to have a complication. A cut point of ≥70.5 years best predicted complications. Despite this association, severe perioperative complications following obliterative surgery are rare.

Abstract: This Clinical Consensus Statement on the management of asymptomatic bacteriuria (ASB) in adult females reflects statements drafted by content experts within the American Urogynecologic Society Bacteriuria Writing Group. The writing group created 32 clinically relevant topic questions, which were collapsed into 30 questions due to thematic overlap. The group used a modified Delphi process to evaluate the statements for consensus. Eight out of 30 questions did not reach consensus after the first Delphi round. Based on group discussion, several questions were restructured or omitted and 25 were retained. Consensus was reached on all 25 statements after 2 further rounds of discussion. Evidence summaries were developed from a structured literature search and are presented with each topic question and statement. Overall, ASB is common and increases with age in the female population. Treatment of ASB is thought to confer more harm than benefit in most women. For women with chronic lower urinary tract symptoms and bacteriuria, an acute change in symptoms should be evaluated with urinalysis and urine culture to guide decision making for antimicrobial therapy.