Can pelvic floor muscle function before surgery determine the outcome of surgical treatment of stress urinary incontinence in women?

AIM

The study aimed to determine whether pelvic floor muscle (PFM) function before surgery may correlate with the success of surgical interventions for treating stress urinary incontinence (SUI). Our hypothesis was that addressing identified variables in preoperative rehabilitation could potentially improve surgical outcomes.

METHODS

This prospective observational study was conducted at a single center and enrolled women qualified to mid-urethral tape insertion for SUI between 2020 and 2022. Digital palpation and manometry (Peritron™ 9300 V) were used to evaluate PFM function. The following parameters were acquired: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), the area under the curve during a 10-second MVC, moreover the ability to perform correct PFM contraction, reflexive PFM contraction during cough and relaxation were assessed. All measurements were performed before the surgical treatment and during follow-up assessments at 1, 3, and 6 months postoperatively. The primary endpoint of the study was defined as objective cure, characterized by a negative cough stress test (CST), along with a subjective assessment based on the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7).

RESULTS

The study involved 57 eligible female participants, all of whom completed the 6-month follow-up. Objective cure was observed in 75.44% of cases, while subjective cure was reported in 33%. There was no association between PFM parameters and surgical outcomes.

CONCLUSION

The success of surgical treatment of SUI 6 months postsurgery is not related to preoperative pelvic floor muscle function.

Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

The objective of this study was to identify the potential characteristics of pelvic floor muscles (PFM) in the preoperative assessment that could be associated with post-surgical prolapse severity. We hypothesized that the same variables, if identified, could be addressed in preoperative rehabilitation to improve surgical results.

METHODS

This was a single-center prospective observational study that included women who underwent surgical pelvic organ prolapse repair between 2020-2022. Genital prolapse was evaluated according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All the participants underwent a PFM assessment, including a vaginal digital assessment and manometry (Peritron™ 9300 V) before surgery and at 1-, 3-, and 6-month follow-ups. Several PFM variables were recorded: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), area under the curve during a 10-second MVC, ability to correctly contract the PFMs, and reflexive activation during cough and relaxation. The primary endpoint of the analysis was objective surgical success defined as POP-Q 0 or 1 at the 6-month follow-up. Additionally, a change in pelvic floor muscle function was recorded during postoperative visits.

RESULTS

A total of 106 females were included in the study. Fifty-one were lost during the 6-month follow-up, which is a major limitation of the study. None of the examined parameters evaluating PFM were associated with surgical success. No statistically significant difference was found in MVC and PFM endurance before and after surgery. Post-surgery, a significant change was observed in the vaginal resting pressure and the ability to correct PFM activation and relaxation.

CONCLUSIONS

Preoperative PFM function is not associated with surgical success 6 months after surgery.

Biophysical Modeling of the Ionizing Radiation Influence on Cells Using the Stochastic (Monte Carlo) and Deterministic (Analytical) Approaches

This review article describes our simplified biophysical model for the response of a group of cells to ionizing radiation. The model, which is a product of 10 years of studies, acts as (a) a comprehensive stochastic approach based on the Monte Carlo simulation with a probability tree and (b) the thereof derived detailed deterministic models describing the selected biophysical and radiobiological phenomena in an analytical manner. Specifically, the presented model describes effects such as the risk of neoplastic transformation of cells relative to the absorbed radiation dose, the dynamics of tumor development, the priming dose effect (also called the Raper–Yonezawa effect) based on the introduced adaptive response approach, and the bystander effect. The model is also modifiable depending on users’ potential needs.

Analysis of Indoor Radon Data Using Bayesian, Random Binning, and Maximum Entropy Methods

Three statistical methods: Bayesian, randomized data binning and Maximum Entropy Method (MEM) are described and applied in the analysis of US radon data taken from the US registry. Two confounding factors-elevation of inhabited dwellings, and UVB (ultra-violet B) radiation exposure-were considered to be most correlated with the frequency of lung cancer occurrence. MEM was found to be particularly useful in extracting meaningful results from epidemiology data containing such confounding factors. In model testing, MEM proved to be more effective than the least-squares method (even via Bayesian analysis) or multi-parameter analysis, routinely applied in epidemiology. Our analysis of the available residential radon epidemiology data consistently demonstrates that the relative number of lung cancers decreases with increasing radon concentrations up to about 200 Bq/m³, also decreasing with increasing altitude at which inhabitants live. Correlation between UVB intensity and lung cancer has also been demonstrated.

[Correlation between oncologically suspicious cytologic smears and colposcopic images of the uterine cervix and results of histopathologic examination taken from material provided by the Gynecology Department of the Pruszkow Municipal Hospital from 1995 to 1997]

The objective of the paper was an evaluation of relationship between oncologically suspicious cytologic smear and colposcopic images, and the results of histopathological examination of samples collected from the vaginal portion of uterine cervix and from cervical canal scrapings. The material consisted of 60 patients with cytologic group 3 and 13 patients with group 4 and 5 according to Papanicolaou, who had been selected during a two-year preventive examination period. Cytologic group 3 patients (group 1) were subjected to cytological assessment and colposcopic examination again in order to determine further diagnostic indications. Cytologic group 4 and 5 women (group 2) were collected samples from the vaginal portion of uterine cervix under colposcopic supervision, without waiting for the result of cytologic re-assessment. All these patients were also collected samples from the vaginal portion of uterine cervix. In patients of cytologic group 3 the cytologic and colposcopic examination results were found to be compatible with histopathologic examination results in 53.3% cases. In patients of cytologic group 4 or 5 this factor was established at 92.3%.

[Diagnostic methods for finding causes of infertility, results of HSG examination and laparoscopy in infertile women examined at the gynecologic ward of the city hospital]

The paper presents diagnostic methods employed at the Gynaecological Ward of the City Hospital in Pruszków and the results of HSG and laparoscopy examination, with special attention being drawn to the usefulness of these methods in finding out the causes of infertility. 51 patients with primary and second infertility were examined. HSG and laparoscopy make it possible to diagnose correctly the cause of infertility. They also enable adequate and early classification of patients for further diagnosis and treatment at highly specialized centres dealing with the problems of infertility.

[Problems with pregnancy, delivery and puerperium in teenage girls hospitalized in a city hospital]

At the paper the problems of girls hospitalized at the Gynaecological and Obstetrician ward of the hospital situated on the border of city agglomeration were described. The data regards as pregnancy, delivery and puerperium and they were collected in last two years.